Incontinence

[OldMarriedMan]

My stepmother refuses to wear diapers. She has stage 6 kidney failure and has trouble controlling her bladder. She has early onset of dementia too and can become very obstinate. On several occasions when out running errands, we ask her to use the bathroom and she says she doesn't have to go, and then when we get back home, we find that she has wet her pants. She can get all the way to the bathroom, but can't hold it long enough to pull down her pants. We also found urine in a wastebasket next to her bed. From her caregiver. "Look what I just found in xxxx's side of the bed, a trash can filled with urine.🤮 She must have decided to empty her urinal out in the trash can instead of the toilet. 🤦‍♀‍" Questions for the community: 1. Should we get a commode to sit next to the bed that she can use in the middle of the night? 2. Should we "persuade" her to start wearing diapers? 3. How to "persuade" a senior to make changes in daily living habits without being too heavy handed? I'm concerned about their quality of life and perceived independence.

[LindaS407666]

The person I am caring for, we got him a bedside commode, which he has used. But now sometimes he can't hold anything in and he tries to get to it if he can. It's right next to the bed! I got him bedpads and old towels to keep under him, and I can change those, if he will turn. He gave up wearing bottoms and uses the urinal. He won't wear the diapers, either. Old folks can be very stubborn, but sometimes I try to understand their side of the story.

[sa4984]

One thing that I would do, is that I would not call them a diaper. A lot of people refer to them as pull-ups but that is still the same as what you call a childs version. I would see if there was a name you could use for them that had a more adult feel to it. I think that part of the problem is psychological and may have to do with it being called a diaper. Try saying pull-up instead and if that doesn't work, see if you can come up with another name.

[l228918d]

@sa4984, you're right. @OldMarriedMan, if you traded places, would you want to wear a diaper?

Consider calling it what it really is: disposable underwear.

The ones these days in the drugstore are designed like underwear. They have colors like underwear. Yeah, you'll never see them in a lingerie catalogue, but they aren't built like babies' diapers or toddlers' pullups either.

Your stepmom already is embarrassed and feeling like a little kid. The bedside commode definitely will help when access is of the essence.

Sometimes a bit of cool breeze is enough to tell the bladder that it's time, right now, especially if she has to be on some sort of "water pill" such as hydrochlorothiazide for high blood pressure. (Do check with her doctor to make certain about side effects of any of her meds. Sometimes substitutions with fewer side effects are available.)

If she's willing, let her pick out the colors and design she wants on the underwear while still making certain that it has the absorbency she needs.

If the bedside commode works without the disposable underwear, even better. If she likes wearing dresses, that, too, will help with getting underwear out of the way faster when getting on the commode or a regular toilet.

But having both the commode and disposable underwear around could allow her to get up and about with more confidence than she's comfortable doing now. Sometimes even exerting the muscles to stand up and get walking cause other important muscles to loosen up.

I hope she sees the advantages. My mom actually went a different direction: Instead, she liked the idea of a pad in her regular underwear because she considered it more like the menstrual pad she hadn't needed for a couple of decades. Most of the time, that got the job done, but it wasn't perfect.

So think about changing the lingo. Give your stepmom a choice, and take care.

[GailL1 · Accepted solution]

@OldMarriedMan 

It isn't easy - remember that they aren't doing it on purpose.

If you ever had any kids remember how difficult it was when potty training began - if your experience was like mine, you check the toddler often and then took them to the potty and kept them changed.  The roles are just reversed here.  In this regards, you aren't training - you are caregiving but the results are the same - keeping them clean to ward off infection and discomfort - skin or urinary tract infection.

Be persistent - don't just ask - your roll and/or the caregiver is to gently persuade and then keep her changed.  Make it a routine.

Sounds like she has little control now.  A bedside toilet might help but in my experience it may not,

especially if there isn't someone there to get her up and to it.  Problems in thinking or communicating may prevent a person from reaching a toilet in time.  She may have constant leakage from her bladder especially if she already has some kidney or bladder problems. 

Personally, if it were me, I would buy the most comfortable and even prettiest diapers (psychological asset, maybe)  - right size ones.  Then change her often - if she can't step into them, buy the kind that connect on the sides.  But somebody else has to take the lead - don't leave it up to her - she may not realize it.. 

Going out, check her, as you would do a toddler, change her before leaving. If you are out for an extended period of time - take some spares and check her periodically.

From my experience, if there isn't some correctible physiological problem, it does not get better.

To find out if there is a correctible problem - check with her doctor.

Good Luck -