Night time Incontinence.

[Bowles1882]

Hi, I work with an individual that has very bad night time incontinence, I am not there through the night, however his wife says that his incontinence has got worse as he is thoroughly wetting the bed at night and is completely soaked in the morning, also it doesn't wake him at night ( which is quite rare in my profession) he uses pull ups and has all the continence products needed, however he still wets the bed fully at night. is there anything out there products wise or medication wise that could help.
He cannot have Desmopressin as he has a heart condition.

 

[canary]

Hello @Bowles1882 and welcome to Talking Point.

Im assuming here that this person has maximum absorbency pads/pullups together with a waterproof mattress cover and a couple of kylie sheets on the bed.

Are the pull-ups being positioned properly? What I mean is that if they are just being pulled up it is possible for the penis to be pointing up and then bypassing the pull ups (if you see what I mean).

Another possibility is to use a sheath catheter and a night bag. This can be difficult to attach, though, and often the person with dementia will remove it during the night.

Has someone contacted the continence clinic for advice about this problem?

 

[Bowles1882]

Hi, yes they are using the high absorbency pads and everything else mentioned and i am assuming it is put on correctly, however he does move a lot at night, yes they have contacted the continence clinic for advice but only given the advice you have stated, a sheath could be a possibility however they can cause the penis to be sore and it might irritate his skin.

 

[Weasell]

There is no pull up I know of that is effective as a proper night pad. In extreme circumstances a slip liner can be added. Fluids need to be pushed in the mornings, and gradually reduced as the day progresses.
If he wears the above padding and is still wet, the most likely reason is the penis has been ‘ readjusted by hand ‘ through the night. The answer to this is he wears an adaptive sleep suit. ( like a back to front onesie).

 

[Bowles1882]

There is no pull up I know of that is effective as a proper night pad.
In extreme circumstances a slip liner can be added.
Fluids need to be pushed in the mornings, and gradually reduced as the day progresses.
If he wears the above padding and is still wet, the most likely reason is the penis has been ‘ readjusted by hand ‘ through the night.
The answer to this is he wears an adaptive sleep suit. ( like a back to front onesie).

Hi, Thank you for your feedback, I will mention this to his wife and see what she thinks , however knowing the gentleman in question I do not think he would be comfortable in a back to front onesie, it can be tried and tested but he would not be adapted to that, I have mentioned about giving more drinks in the morning and gradually reducing them throughout the day, I will also suggests an extra slip , but to be honest I think this maybe an on going thing we will have to persevere with.

 

[Violet Jane]

I agree that reducing fluid intake as the day goes on is the way to go. Many people are used to having a milky drink to help them to sleep but this is asking for trouble. It might be wise not to have anything to drink after about 7pm. I would also make a point of taking him to the toilet just before he goes to bed and an hour or so before that.

How much urine does he pass during the day? There is a condition whereby people pass most of their urine at night and very little during the day (Nocturia?). If that’s the case then even high absorbency products are going to struggle. Short of waking him during the night to change him or take him to the toilet I don’t think that there’s much that can be done apart from using as many products as possible to protect the mattress. A hospital bed with a plastic cover would help but that might not be acceptable or available.

 

[sdmhred]

There is no pull up I know of that is effective as a proper night pad. In extreme circumstances a slip liner can be added. Fluids need to be pushed in the mornings, and gradually reduced as the day progresses.
If he wears the above padding and is still wet, the most likely reason is the penis has been ‘ readjusted by hand ‘ through the night. The answer to this is he wears an adaptive sleep suit. ( like a back to front onesie).

@Weasell are the NHS maxi night pads effective? you sound like you know! We’ve been using Tena maxi pull ups which with one change in the night are working well. We’re expecting a delivery of night pads from incontinence team. Never used pads before ……. I don’t want to start having to wash every morning if I can help it!

 

[cobden 28]

Hi, I work with an individual that has very bad night time incontinence, I am not there through the night, however his wife says that his incontinence has got worse as he is thoroughly wetting the bed at night and is completely soaked in the morning, also it doesn't wake him at night ( which is quite rare in my profession) he uses pull ups and has all the continence products needed, however he still wets the bed fully at night. is there anything out there products wise or medication wise that could help.
He cannot have Desmopressin as he has a heart condition.

Before my late stepdad died twenty years ago he used to try to get up in the middle of the night to go to the toilet and being around 6 ft tall to my Mum's 5 ft 3 ins, when he sat down on the bed afterwards it was with such force that Mum woke up and had great difficulty in getting back to sleep again. In the end she changed from a double bed to two single beds but in the same bedroom. If your client is wettig the bed at night maybe changing to two single beds instead would help reduce tha amount of washing his wife has to do; it worked for Mum and stepdad

 

[canary]

There is a condition whereby people pass most of their urine at night and very little during the day (Nocturia?).

Its called nocturnal polyurea. My OH has this so he only passes about 500cc during the day and nearly 2, 000cc at night! Fortunately he has a catheter so it isnt generally a problem, but sometimes there are catheter malfunctions - the leg bag springs a leak, or the night bag becomes detached and when that happens a couple of kylie sheets have saved my bacon (not to mention the mattress!)

@Bowles1882 - I am surprised that a couple of kylie sheets is not sufficient. Can you check that she is putting them the right way round on the bed (white surface underneath) and is not washing them with conditioner or "all in one" detergent?

 

[Bowles1882]

Before my late stepdad died twenty years ago he used to try to get up in the middle of the night to go to the toilet and being around 6 ft tall to my Mum's 5 ft 3 ins, when he sat down on the bed afterwards it was with such force that Mum woke up and had great difficulty in getting back to sleep again. In the end she changed from a double bed to two single beds but in the same bedroom. If your client is wettig the bed at night maybe changing to two single beds instead would help reduce tha amount of washing his wife has to do; it worked for Mum and stepdad

Hi Cobden 28,

They have swapped beds already and sleep in different rooms as she didn't get much sleep, its a difficult situation to be in, I am just looking for a situation in where he won't wake up in the morning soaking a d she has to do all the washing and also he will eventually start ending up with bed sores sooner or later, I don't want to see that happen as they are hard to heal, especially with night time wetting.

 

[Bowles1882]

Its called nocturnal polyurea. My OH has this so he only passes about 500cc during the day and nearly 2, 000cc at night! Fortunately he has a catheter so it isnt generally a problem, but sometimes there are catheter malfunctions - the leg bag springs a leak, or the night bag becomes detached and when that happens a couple of kylie sheets have saved my bacon (not to mention the mattress!)

@Bowles1882 - I am surprised that a couple of kylie sheets is not sufficient. Can you check that she is putting them the right way round on the bed (white surface underneath) and is not washing them with conditioner or "all in one" detergent?

Hi Canary,

So am I surprised that a couple of Kylie sheets don't help, unfortunately I don't know what she uses as detergent but I can ask and advise her not to use the products you mentioned, he is not really at the stage where he needs a catheter at present even though it does sound like it, I need to go back to the drawing board and start again, your advice has been noted.

 

[canary]

he is not really at the stage where he needs a catheter at present even though it does sound like it,

Catheters are not really recommended for people with dementia unless there is no other option. Most people with dementia do not understand what it is for so they try and remove it, which can damage them. My OH has one, not for incontinence, but for urine retention and it is lucky that he does not try and remove it, even though he doesnt really understand why he has it.

BTW, a sheath catheter is different and can sometimes work well for incontinence, although you have already mentioned the problems.

 

[Bowles1882]

Catheters are not really recommended for people with dementia unless there is no other option. Most people with dementia do not understand what it is for so they try and remove it, which can damage them. My OH has one, not for incontinence, but for urine retention and it is lucky that he does not try and remove it, even though he doesnt really understand why he has it.

BTW, a sheath catheter is different and can sometimes work well for incontinence, although you have already mentioned the problems.

Hi,
Your feedback is appreciated, could mention it to his wife and see what she thinks about a sheath, but I do not think she would be happy to apply one, although I could, its whether he would stay still enough all night or not pull it off for irritation, which could then upset him more, sorry if I sound awkward I just want to get everything ok for them both as it is distressing for them both, although he does not realise he wets the bed really.

 

[canary]

Im afraid that there is never a perfect solution to incontinence, especially when dementia is in the mix.
All you can do is the least worst and make things vaguely tolerable.

 

[Bowles1882]

Im afraid that there is never a perfect solution to incontinence, especially when dementia is in the mix.
All you can do is the least worst and make things vaguely tolerable.

Hi,
I will keep persevering and go back to the drawing board to see what, I can come up with, thank you so much for all your feedback....

 

[Weasell]

@Weasell are the NHS maxi night pads effective? you sound like you know! We’ve been using Tena maxi pull ups which with one change in the night are working well. We’re expecting a delivery of night pads from incontinence team. Never used pads before ……. I don’t want to start having to wash every morning if I can help it!

Well it depends!
Different people get given different night pads.
The grey ones are superb.
Wishing you good luck when the delivery arrives!

 

[sdmhred]

Well it depends!
Different people get given different night pads.
The grey ones are superb.
Wishing you good luck when the delivery arrives!

Thanks! We will wait with anticipation as to what arrives. Am reluctant to change what’s working ….but it would be good to save a bit on the old pull ups!!

 

[LyndaR]

I too have started having problems with my husband wetting himself. Mostly overnight.
Occasionally during the day. I’ve tried to regularly ask him if he needs the toilet but he says ‘what’s a toilet’ if I ask if he needs a wee he says ‘what’s a wee’
I have waterproof liners on bed and get him to wear night pants but he often removes them.
He sometimes wanders around in the night and wees in wrong places.
I’ve asked for referral to incontinence clinic but not sure how they will help.
I’m trying to stay patient but it is hard work and difficult.

 

[Sunshine11!]

Mum lives with my father and sister who are now struggling with mum being doubly incontinent. They are reluctant to ask the Carers for additional help and pursue respite. I’m at a loss - again- to know what to do and say to help them

 

[Jerseygirl]

I look after my mother and very similar problems. Since i tried her wearing 2 tena pants together at night this as greatly helped, as when she moves around a lot in bed the one pull up would move down easy. It can occasionally still come through a bit as heavy wetting, and could still come through all the 'special' bedding, but i used thin plastic aprons given to me as PPE under the top sheet and this prevents the leak going any further down the bedding.