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I am new to caregiving and am currently helping an 88 year old woman to begin her day. She has completely lost control of her bladder. A combination of Depends and a Poise pad works fairly well during the day. But her sheets are almost always wet in the morning. And when she gets out of bed, the urine simply gushes. The carpet is wet every day when I get there and the room is beginning to smell. She has a portable potty right by the bed, but simply can't get there in time. What in the world can we do? We have considered rubber pants, but they are so uncomfortable. We have also considered placing some sort of washable runner next to the bed. But she uses a walker, so we can't use anything that she could trip over. The mess isn't even as bad as beginning every day in such a discouraging way. We can't be the only ones struggling with this! What can we do???

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The family needs to consider removing the carpeting now b/c nothing is going to help remove the odor of urine from it once it starts getting absorbed into it. That's the truth. Laminate flooring is the best for elders who are incontinent as it makes clean up a lot easier.

Ideally, your client should be woken up at some point in the night for a Depends change in bed, if necessary, to avoid having such a large volume of urine collect.

You can purchase nighttime Depends which are extra absorbent, and then add an overnight Poise pad specifically designed to absorb extra liquid.
https://www.amazon.com/Poise-Overnight-Incontinence-Ultimate-Absorbency/dp/B01NAX7KC7/ref=sr_1_24?dchild=1&keywords=inserts+for+depends&qid=1631126018&sr=8-24

Buy Extrasorbs chucks and put them underneath the woman when she sleeps, and on the floor, too:
https://www.amazon.com/dp/B07GYZNDY8?ref=nb_sb_ss_w_as-ypp-rep_ypp_rep_k3_1_10&crid=2OMHYSPV03OOL&sprefix=extrasorbs

These pads are huge & hold a gallon of liquid apiece! They work very well for the situation you describe.

The family can contact the doctor as well for advice; there may be medication to prescribe for her. Her liquids should be cut out before bedtime as well.

Good luck!
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Barbarascare Sep 2021
Thank you for your suggestions! My only issue with putting down a hard flooring is the possibility of slipping when it becomes wet? I don't know if they have tried the overnight products! But I will check in the morning!
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You may just need to pull up the carpet and have a washable floor covering put down. The urine gets into the mat and no amount of washing is going to get it out.

You may need to limit her amount of liquid in take at night. Tea, coffee and soda's irritate the bladder so you go more. Taking her to the bathroom every two hours may help.

I have never understood how a pad being used with a Depends works. The pads have a plastic liner that makes it impossible to any extra urine to get to the Depends.
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Barbarascare Sep 2021
Thank you for your input! She really doesn't drink much throughout the day. But she is on a water pill, which doesn't seem to accomplish much except to make her pee all night!
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If she's taking the diuretic at night you might want to switch that to the morning.

Try some different incontinence products for overnight, I found Tena overnights were better for my mom but there are many other higher absorbency products available.

If the carpet has been soaked as the others have pointed out it is probably beyond saving, once urine gets into the underpad and subfloor no amount of cleaning can remove it completely. You could try the enzyme cleaners geared to pets (nature's miracle) and a thorough steam clean before taking the step of tearing it up. Laying an office chair floor protector mat or a piece of vinyl flooring beside the bed can stop small messes - you can tack the vinyl to the floor to keep it from shifting.
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If the problem can't be cured - containment becomes the aim.

* Absorbent half sheet on bed - on top of bottom sheets.
* Absorbent incontinence underwear worn at night. Must fit snugly.
* Bedside commode - if that can be used safely

My area has a continence clinic attached to a hospital, but also a website & phone number for advice. Do you have anything like that in your area?
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I used the PeaPod mats on both the bed and the floors.
Simply gather up the pads and wash in the machine.
They are not cheap but saves throwing money away every day.
House never smelled and still does not.

Prior to the pads, I would use a wet & dry vac to clean and dry the carpet No fun hand shampooing carpet on the knees at 3:am.
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I can tell you what we do for my mom who has had this problem for years, she just doesn’t always feel the urge and often when she does she is too involved in something to get up and use the bathroom! We have a stock of extra large reusable bed pads (Amazon), a waterproof mattress pad that encases the whole mattress just in case, several rubber backed fitted sheets, they aren’t as bad as they used to be with a soft terry cloth like top and several regular fitted sheets. We then place a pad on top of the mattress cover, a rubber sheet on that, another pad then a regular sheet, another pad on that and another rubber sheet, pad, sheet…so there are several layers of bedding ending with a sheet and 2 pads. This way when the top pads get wet we can just pour white vinegar on the wet bedding and pull it all up from the fitted rubber backed sheet (sometimes if it isn’t too bad just the fitted sheet) and there is already a new fresh made bed underneath, add a second bed pad to the one already there and voila! We then (sometimes on the floor and sometimes on the bed) add her wet bed clothes to the pile add more white vinegar and roll it all up like a big egg roll put that in a plastic bin we use for soiled laundry and let it sit in the vinegar at least for an hour and up to several days before laundering it. The vinegar kills the bacteria which also kills the smell but the key is to get it on everything as quickly as possible. I would saturate the rug in white vinegar too and then maybe shampoo it before putting anything on the floor. It sounds like the rug gets wet only in the morning when she first gets up, are you there or is someone in the house who could put a bed pad in the right place? If someone could put it down before she gets out of bed, place her alter on top and then just pull it up after she’s off to the bathroom that might protect the carpet.

The other things we do is limit her fluid intake after 6pm as much as we can and at night she uses a nighttime Depends (she prefers them day and night) with an additional pad that is designed to work inside incontinence underwear and allows the fluid to soak down through to the pull up once it’s full. Mom has recently added rubber pants that go over the Depends, we got them at the medical supply/pharmacy and she loves them but I’m not so sure they are a good thing from a UTI risk perspective…
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BrendaJayi Sep 2021
Have no doubt this works - but what a lot of labor.
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She shouldn't be taking a diuretic past about 4-5 pm. That'll help, but she's going to have to be gotten up at night to go to the bathroom, too.
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This is a problem that a lot of us are dealing with. My mom wears an internal catheter, depends AND a heavy pad always. Yet she somehow seems to be able to leak past all of that.

It's not practical to clean the carpet everyday, and that is what we'd have to do. Plus, at some point, the urine is so strong smelling that it's overtaken the place.

She lives with YB. He did replace the kitchen and hall with laminate wood. When he pulled the carpet up it was black on the sub floor and he had to remediate whatever THAT was before he could lay the floor. Mold? IDK.

Mother WANTS linoleum, and personally, I think she should have what would work best for HER, but YB will not allow linoleum in his home.

Upon reflection (and hindsight being 20/20!) when daddy died we should have gutted the entire apt and replaced the floors with a sturdy non slip linoleum. But, that didn't happen and now she is living with 23 yo carpet that smells beyond toleration---and it's filthy to boot. You just can't keep cleaning and cleaning carpet.

Doesn't matter WHAT is placed under or around mom, she can 'dribble' enough everyday to make things pretty bad. I think she relies too much on that catheter to catch all the urine, and it does, but she only empties it once a day.

She's 91 and in pretty good health. I fully expect her to live 5 more years, easily. YB, however, is in terrible health and we all fear he will die before mother does.
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My first suggestion would be to remove the carpet and replace it with good grade vinyl flooring. If you want to keep carpet for the cushion effect, I would suggest placing mats (with non-skid backing) on top of the vinyl floor.

A second suggestion would be getting a couple of carpet-like mats (material over a rubber backing with a small rubber edge that lies flat to the carpet) and placing one under the bedside commode and her bed. They should lie flat enough to not be a tripping problem and you should be able to place the mat where the edge isn't in the walker path. Hopefully, the mat will absorb the overnight wetness and you can swap the mat out in the morning and wash it/them. You might be able to place a wetness barrier under the mats IF they are heavy enough to stay flat.
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This is something new for females: https://www.purewickathome.com/
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Here are a few suggestions:

1 - Your charge needs to wear the "overnight" Depends and an "overnight" incontinence pad. Get the pad in the largest and thickest size you can find.

2 - Get puppy pads -plastic on one side and thick adsorbent materials on the other side. Place several on the bed from upper back to midthigh and across the width of the bed.

3 - Expect the Depends and Pad to last about 6 hours. Somebody may need to check her depends in the middle of the night and/or encourage her to use the commode.

4 - Cover the floor. My husband has had a mini "workshop" inside our home while in the military. To keep floors intact, we came up with this solution. First place a thick plastic tarp on the floor (in your case the whole room would be a good idea). Then, place interlocking foam panels like the ones for children's play mats. The foam is solid enough to give good footing and has enough traction too. The foam and plastic tarp will keep urine from reaching the carpet.

5 - Clean soiled areas with cleaners for pet accidents. Those usually have enzymes to break down nitrogenous wastes so the smell will go away.
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Incontinence is a major problem for everyone associated. The cleaning is next to impossible. The laundry can be a full time job.

i have found these diapers good up to 12 hours.
Unique Wellness Brief Original Adult Diaper (Tape-on ) with NASA Technology.

Chux will help prevent leaks from wetting sheets. These are pads with a plastic backing. I have found the puppy pads mentioned to be cheaper than pads through any medical. supply. Costco ones are about 15¢ each.

it is not uncommon for any movement to trigger emptying of bladder - such as loosing it before making it to bedside toilet. It may be time to consider round the clock diapers that are changed in bed.

I am not incontinent but wore the above a couple times before I got vaccinated to enable me to stay out of public bathroom. Never had to use them but hey are quite comfortable moving around.

I put high end vinyl in my husband’s room. Carpet would be impossible to keep clean. It is indistinguishable from wood - which we have had.

Good luck to you. .
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I struggled with my dad having C-DIFF I understand believe me. About the only thing I can think of is to take the carpet out so it's easier. Plug ins' are the best to help with the smell
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my2cents Sep 2021
Great idea. You could even cut out a square section of carpet, install a piece of vinyl flooring for that area. Leaves the carpet in the rest of the room for extra cushion in case of a fall! (Get a carpet person to do the install so they frame carpet correctly with metal strips. Will also prevent a fall from tripping on a piece of raw cut carpet)
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My mom had the same problem; she had the highest absorbency Depends and Poise Pads. That's okay during the day but her bed was soaked every morning. Then we learned about NorthShore products here. We have been buying their highest absorbency pullups for nighttime wear and the bed stays dry for up to 16 hours (she sleeps a lot!) They are bulkier and more expensive than Depends but not having to change the linens every day is priceless!

We do also have a couple layers of washable pads on the bed for occasional extra wetness too. I think what make the Northshore exceptionally helpful at night is the bulk and that the legs are a little snugger than Depends. My Dad has chronic diarrhea and he can't really wear them as they are too difficult to pull up.

https://www.northshorecare.com/adult-diapers/adult-pull-ups/northshore-gosupreme-pull-on-underwear/northshore-gosupreme-pull-on-underwear-medium-pack14?gclid=Cj0KCQjw1ouKBhC5ARIsAHXNMI89vGMnt5kuWah34t7pC1yc60XtDlnVtf4O8leyzFCtR8BIWFJfLQUaAgx4EALw_wcB
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Put bedside toilet closer to the bed so all she has to do is sit on edge of bed, stand up, turn around and sit on the pot. Eliminate the walker in the process. I have a huge bed pad that I put on the floor under the toilet. Never a wet floor.

The pad may not be the overnight type. Sam's sells their Members Mark brand of overnight pads - they are wider in the back and absorb quite well. Cheapest deal on the market,too. You can order online and delivered to front door. 4 pks of 30 pads for about $25.00.
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My MIL, exactly the same problem. She stands up and it gushes out. The depends with an extra pad work in daytime, but in the morning when she gets up… even though the commode is 2ft away, it just gushes. I have laminate flooring, which you may want to consider. I also have washable pads that go from her bed to under the commode which has helped tremendously. These pads are 4’x6’, so it’s not likely that she will get tripped up. My MIL also uses a walker but she can walk the 2 steps to get to the commode
The rug will NEVER be urine smell free.
Good luck to you.
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