I’m not sure how to even present our situation so I’ll do my best. Our mom has dementia and up until about a month ago she started to have urine accidents. Sometimes we would fine her bed wet or her bed quilt wet and up until recently one of LVN’s at facility found a wet spots near her laundry basket. Mom is still able to walk with her walker and TRY’s to get to the bathroom on her own. But here recently it’s getting harder and harder for her. When she does make it to the restroom she has a very difficult time lifting her pamper and pants up and leaves them half way down her legs causing us to worry about a terrible fall to happen. We are trying to find a solution to try and get her to go on the pamper and a solution to keep her from leaving her pamper and pants half way down her legs. She’s become so weak physically but the dementia just won’t let her mind rest. We appreciate any advice or suggestions you can share. Looking to help
Withholding fluids at night is not a good idea as it can cause dehydration and create other problems.
If she wants to drink, she needs to drink. By the time someone feels thirsty, they are already slightly dehydrated.
Dehydration can cause dizziness and lead to falls. It can also cause irregular heartbeats, as well as adversely effect liver and kidney health.
Once my LO started with urine issues, the other came quickly and she was not able to handle her own toileting at that point. That's about the time she also needed Memory Care. They handled it all and do that by having a toileting schedule for bathroom and/or changing of her Depends. If the person with dementia can't get their depends and clothes up and down, they must be accompanied to the bathroom each time for complete care.
What I have learned thru the last several years is a way of body positioning to prevent that leakage that comes out after I feel finished voiding sitting on the commode. The leak it prevents is that 1-2 tablespoons that comes after you feel empty. After you stand, you then get resoaked a small amount as you pull up your panties.
So there you are, standing with your folded arms moved from your waist to your knees and lifting your bottom high into the air your position change may output some more urine. It feels to me that I have 2 bladders. So great to avoid soiling 2 pair of panties for 1 void!
how:
Sit on the commode and void all you can. The position for this first voiding is sitting with you arms crossed hugging your waist and slightly leaning forward.
After you wipe, you cross your arms over your knees now. Then you stand and lift high your bottom so that the residual amount of urine can be emptied right there after standing you push/strain to get more urine out.
CAUTION Straining to void or pass stool using these tips should never be be attempted alone. Caregivers must be aware that one could easily fall head first when leaning over and straining. It could lead to disaster. If you have hand bars to hold on to is ideal.
The 'pushing/straining/grunting to void or stool is called the val salva maneuver. It is a dangerous movement and can cause the patient to faint and fall!!! Someone or even a second one is needed to protect by CONSTANT HANDS ON, no exceptions. If a doctor is involved it would help to get his order regarding this positioning. Nursing assistants and new home caregivers should all know that this is dangerous and something not to do without guidance and training. Please do not go try it on your own.
best regards
a fellow leaker
The way I deal with it is, 'it's kind of like housebreaking a puppy' - sometimes it's all how you can deal. No, it's not pleasant, especially when diarrhea in included in the mix - but at least he's still alive and with me. That's why God invented Clorox Wipes!
Some incontinence products are very stylish and look like underwear. Maybe those will help.
As mostly a night nurse for 40 years, I try real hard to make the toileting a safe and positive activity.(ex multitask doing your shift skin assessment, applying ointments, vital signs and even give meds when patient is naturally awake). Sometimes a patient is too asleep and just won't awaken for a few hours except by an act of God. I try not to fight mother nature.
Words can wound so. I called them 'briefs' and never ever call them 'diapers' or 'pampers'' to anyone. It is important for visitors not to talk or phone talk with others at the bedside like the patient is not there. Confidentiality is so important as a sign of respect.
If the bed side commode is out of sight in day shift (like placed in the bathroom) I explain that night time is for sleep not for exercise walking as I set the commode right by the bed. I always cover the seat with chuxs. I like to have all we staff empty and sanitize the bucket after each voiding.
I like how commutergirl hid the bedside commode behind the door and had the shoe pockets on the door to keep wipes, ointments, chux and pads(and call bell) available where she can see and reach them. (I collect little hand bells from thrift stores/yard sales and place one in each room so the home care patient can easily call me. Laughingly I tell the patient that this bell is different from a hospital bell because someone actually appears!
It is important to place a bedside commode right next to bed (especially on late evening and night shifts). If patient has a stronger side or sleeps facing one side then that is where the commode should be placed. Just stand and pivot!!!! This can save walking fall risk especially if there is some unrecognized night confusion when a patient first wakes up. Also the oldest old are usually very modest and that needs to be considered.
Some previous posts list cheaper cost places for a bedside commode. Some medical equipment stores will rent this equipment. Try googling it . It is typically made of bent pipe for the bedside commode. Unsightly even covered over.
There is also a elegant faux leather winged chair style available which looks lots better. The chair is lovely and so important for the atmosphere of the room which may be the patient's long time home. The seat lifts off revealing a bucket to catch the urine and stool. In catalogs there are plastic bags to catch urine and stool so the emptying is cleaner.
There is a lot of wisdom in the experiences of the nursing assistants. Be sensitive to their unmet often need for respect. There is so much to learn from the bedside caregiver.For example there is an art to cleaning off the large, liquid stool of a bed bound patient. The aides' way maximizes the patient's comfort.
Be free with your praise. Name names. Let it be known that you will show your appreciation when you prepare your evaluation letter at the end of care. The aides are overworked. They will put you on the top of their list to satisfy because they need the positive feedback.Get a book entitled 'Take this book to the hospital with you' from amazon.com/books. Also openly keep a log of each day's tests or events such as falls, pain treatments, doctor's visits.
Each bucket emptying can be cleaned with swishing cheapest and maybe diluted mouthwash. Fighting urine odor is SO very important. I like to also use the generic lysol spray which is associated with germ killing.
Resources are available if you know where to find them. AgingCare.com is a great community and I frequently share it with other caregivers and families. Best wishes.
One night she had a bad bout of diarrhea and must have laid in it all night without getting up or calling for me (we have a baby monitor in her room).
Ever since then, for some reason, she started wetting the bed at night and not even trying to get up. Doctor ruled out a UTI.
So now she wears the overnight diapers and also daytime ones as she also started having occasional accidents during the day.
What will save you from daily laundry is a waterproof mattress pad and a waterproof disposable pad to put over the bottom sheet. You can find the disposables ones on Amazon. They are actually made for kids who have trouble with bed wetting. I like them because they are large enough and they have large adhesive strips on the back to keep the pad in place.
If she is in a facility, you can talk to the staff and provide these for them.
If you are having a hard time getting her to wear disposables and be comfortable with "accidents" being contained in her underwear I have a couple suggestions, first try the more expensive brands, they are far more comfortable and acceptable than the ones the hospital has and probably the facility she is in supplies (if they supply them) and some have easier rip away sides without attaching like diapers (that type exists too) making some bathroom situations easier including maybe helping with safety since they should rip off before tripping her when she doesn't get them up properly. It may be a slow adjustment since she isn't used to disposable underwear and has memory challenges so in that vane they do make reusable incontinent underwear as well as pads to use in them so one isn't replacing the whole panty each time. They are cotton so look and feel more like sensible underwear rather than disposable and might help ease her into disposables (PIA to keep laundering I imagine & likely something you would have to do) then the more expensive disposables might ease her into the more generic brands. Just an idea. I saw the cotton versions on Amazon which is how I learned about them and I purchase the disposables, my mom is more active still and the better quality brands make a big difference to her, on-line or at Costco in the bulk cases depending on what is offering the best price. I find there are often coupons on the cases, otherwise I have her set up for regular monthly deliveries from Amazon. She also uses the incontinence pads inside the briefs at night which I also buy that way but she is comfortable with that, I think the pads must be harder to get used to.
Back to the redressing after using the toilet, does she wear easy to pull up pants? Might she wear a skirt so she can just lift the skirt and it's never a danger around her ankles/legs? Then with the underwear that will rip off at the sides when pulled hard enough it might be a little safer? Finally while you may have to go over the reasons for it the rest of her life from time to time, it can all be in the presentation. Maybe presenting the idea of wearing a special new undergarment could be related to you or someone else, "Ever since having children I have had these annoying little leaks when I laugh but they seem to be happening more now, I just can't hold my urine the way I used to! I found these great new panties though that absorb my leaks and don't feel wet next to my skin or show it by going through onto my pants. It occurred to me you might like them too. The things they come up with these days!" or "I was reading about incontinence, I had no idea it was such a common problem. Guess that's why they have so many things available to help live with it, just like using makeup for laugh lines!" I'm sure there are better approaches and it's the kind of thing that seems like the kind of thing that's best geared to the individual and perhaps the timing but you get the idea, it's all in the approach which includes tone of voice and demeanor. If it's upbeat and positive as well as somewhat nonchalant it's likely to be better for everyone and perhaps retained longer?
This is such a tough subject and why is it that the accidents seem to get worse and more frequent as their sense of smell goes too? It's the overwhelming scent of urine when you walk in certain rooms that she doesn't seem to smell that's hardest for both me and my brother (bless his soul, he get's the worst of it more). Good luck and I hope I have people who care as much around me when the time comes as you do about your mom.