Night-time incontinence

[Gormless]

My mum is in her late 70s with a whole host of medical issues including frequent UTIs. She’s ok in the daytime but as soon as she goes to bed she frequently (and I mean 2-3 times per hour) needs the loo. She can’t go to it herself so my poor dad is not getting any sleep at all, helping her up and down literally all night. Friends have talked about thick nocturnal pads for such a situation: any recommendations? I’d be really grateful for any advice.

Would she use a female urinal? Have a google.

What about Tena lady pants?

I'm assuming as she has a host of medical issues, that she is on medication for this? If not, worth trying.

She should be seen by her local continence advisory service to address specifically what is going on - if you google her county plus continence in some areas you can self refer, in others you need a GP referral.

Would she use a commode situated next to the bed?

Or incontinence pants - a bit like pull ups but for adults? You can get disposable and reusable.

www.ageukincontinence.co.uk/advice/introduction/

Hi folks- thank you all for your help on this. She has just started taking a tablet for it (oxybut...?) but no real impact yet. She does have a commode but still needs help to get up and down to that. And she has Tena pads but won’t ‘release’ into them: I can appreciate her wish to not do that but equally the literally endless up and down to the commode is causing all sorts of other issues. Those incontinence pants may be the way ahead, if she can be persuaded to use them.

Tena night pads are very good as are the pants - the night ones are especially for heavier use. Tena also do a pad which is actually on the bed itself under you - they're not on general sale where I live anymore but I think they are elsewhere.

I understand her reluctance to 'use' the pads or bed protector, my issue was fear of leakage and, frankly, embarrassment, eventually the decision was taken from me as my condition worsened, but I do totally understand her reluctance. It's very hard.

She may need to try a different tablet - has the exact cause been established? Sometimes that isn't done and there's an underlying fixable issue sometimes it's put down as 'just age' when there's a treatable cause (I apologise if this has been done - I'm unsure from your replies). The frequent UTIs may be an issue she can get help with as well, though I've found I've had more since using incontience pads - same thing as pads they've begun to be 'scented' and that can cause a lot of irritation.

Becca19962014 Thank you so much for this, and especially your own insights which are especially valuable: I’m grateful for you sharing your own experience. That’s particularly helpful on the scented pads: I’d not thought of that. At present she’ll wear them but tries not to use them; if she ever really has to, she complains of feeling wet which is why I’m wondering what the best pads might be. But there is a big mental battle too: her body is failing but her mind and spirit are still wonderfully alive, which is making this hard for her to accept. We all do our best to make this as un-awful as possible for her but it is tough. That’s also a helpful point about the meds: will give the current one a bit more time to work but keep persisting. She has had numerous UTIs which I think are also closely connected here, and there is now also a psychological element: she is fine all day but now almost expects this discomfort at night so there’s a small element of self-fulfilling prophecy too (though I appreciate the problem is real).

It takes time to find the right pads for you. She needs to start with the lowest ones and move up, it shouldn't take too long to find the ones most suited to her needs. It sounds like those she is using are not the right strength for her needs.

Although I'm not elderly, over the last ten years or so I've dealt with increasing health problems. A few years ago when an elderly relative suddenly found themselves terminally ill the worst part was learning that their body had changed drastically and they'd never be the same again and though my condition isn't terminal the battle inside is the same. It takes a massively long time to cope with it - I still struggle a lot with it. It wasn't something I understood until it happened to me and I think it's something that is drastically under estimated as an issue, for everyone. With respect it's not really something you can help with. She's dealing with a lot of conditions from what you say and incontience is humiliating and it's something you feel you must be able to fix yourself, there's an element of feeling like you're regressing to being a baby again (I know that sounds stupid but it's how it feels). I don't know if that helps you to understand. I know when I began needing them it would take me forever to purchase them and I've noticed people in the pharmacy which is close to the incontienece pads hanging around looking like they're really embarrassed, it's sad to see.

There is also physio exercises that can help. They don't help me because of the nature of one of my conditions but I've heard they can help slow it down.

I get recurrent UTIs for three reasons, one my bladder doesn't fully empty (I'm aware of the irony of being incontient and not being able to fully empty my bladder), two I react to whatever the crap is that's put in pads to stop them smelling (which can and does cause UTI problems because when you're incontient you use them all the time so the chances of a reaction are much much higher than with sanitary pads) thirdly, it's not always possible to change a pad the moment you need to and that can cause problems.

UTIs mean you need the toilet a lot. One thing that could be tried is a daily antibiotic once she is clear of infection to keep a level of antibiotic fighting the infection. The NHS don't like doing this because of resistence, but I've found I need far less full courses (and I need more than just three days recommended) taking one a day. There are things that can help like avoiding acidic drinks - cranberry juice makes mine worse as do those sachets from the chemist, but you can get cranberry tablets which some people have found helpful. There is also a condition called irritable bladder syndrome which can like irritable bowel syndrome be connected to stress.

It sounds like she's really struggling to cope with the changes which is totally normal, I know I'm words on a screen but you can tell her what she's feeling is very normal. It is upsetting when it feels like your body is refusing to behave (it's not logical but then emotions never are).

Sorry for the essay. I hope some is helpful at least!

Becca- it’s all useful. Thank you so much for your time and insights: am genuinely extremely grateful. I know a couple of my mum’s friends are on a daily antibiotic for the same sort of issue and it has really helped them. Mum’s generally fairly pragmatic but is struggling with this a bit, I think because as you say, it almost seems to signify a sort of regression, and the distress is real. She has a good GP though, some very positive and encouraging carers, and Dad and I do all we can too, to at least distract her and make sure she knows she’s loved, whatever changes her body might be going through.

Sometimes as well we decide to drink less fluids in this situation but less fluids are likely to increase the change of infection. More fluids can make your bladder work more efficiently - even though that sounds back to front.

I think a continence advisor assessment would be very helpful. It does sound like, together with the UTIs the issue is that she doesn't empty her bladder fully. Do her host of medical conditions include any neurological conditions?

Getting to the cause of what is happening in her bladder would give her the right treatment. Also an outsider may be able to support her to see the current situation isn't tenable in a way a close family member can't.

I think she knows it isn't tenable and when she's able to mentally understand she'll see that but at the moment she's unable to.

Hope you know what I mean!

Thanks again folks- an advisor would sound useful. Will see what is available where she lives (not UK mainland). And yes: she is a very reluctant drinker of water! She’s had poorly controlled diabetes and a recent mild stroke so it’s all piling up against her I fear. If I could ask a blunt question, if any of you can or feel willing to answer it: if she is basically leaking urine for much of the night (which sounds to be the case if she’s not up constantly at the commode), how many changes of pads would we be talking about in a night to keep her feeling comfortable? I can really only compare this in my own mind to sanitary towels but realise it’s a whole different situation. I suspect too if we can- as Becca helpfully said earlier- convey to her that it’s normal not to be happy about this but equally it is a normal, manageable situation for a lot of people, that might be a useful way forward for her.

It depends really on how much she is leaking and how much, if at all, she's actually drinking before bed. Mine is usually leaking not necessarily full on during the night though that can happen. The tena nights for just leaking can last me all night, if it's not then I may need one or two changes.

Unfortunately it's a trial and error kind of situation.

That is helpful; even just knowing it’s a case of trial and error is comforting as I’m feeling guilty for not somehow just magically knowing these things.

Could a catheter be an option? If the docter would agree. Although am not 100% but am sure you are more prone to infection with one and they would want to be infection free before inserting one.

Has she tried a bedpan fairly simple to use once you get the knack of it.

A catheter may cause a whole lot of other problems at this stage and its unlikely the health trust would consider it necessary.

Its good that your mum can talk to you about it op. Is it that she finds as soon as she feels a trickle she wants to change the pad? I'd imagine I'd feel like that too and it would take a while to understand that a pad is often meant to last for the whole night. [unless it gets totally sodden.]

It's also important to keep a check on mums skin all around those areas so keep any damage to a minimum. It might be worth exploring the use of a barrier cream at night.

The different pads 'hold' different amounts of urine as they have different absorbency rates. If you can trial a few sizes/brands you may find she doesn't need to change at all in the night or even just the once.
She may even be able to get pads on prescription, the local continence team should be able to help, it may be linked to her district nurses if she has any input from them?

Pads on prescription vary hugely. In my trust they're very poor quality (hold hardly nothing) maximum one a day, and the incontience nurse recommends patients purchase Tena instead. That's why I didn't mention prescription pads, though I should have realised others may do better.

Once again, this is all so helpful, especially on the differing quality of different pads. I guess it will be a bit of trial and error there too. And you’re totally right: she wants to change the pad as soon as it’s damp at all, which I can understand but just isn’t practical if it’s constant all night. Re her skin, she has wonderful carers who wash her every morning and I know they are really attentive to any such problems and preventing them. I’d like to think we are nowhere near catheter stage yet: she is absolutely, 100% fine during the daytime. This is a specifically night-time torment for her.