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My 91 year old mother, who has early to moderate dementia and lives in AL, is incontinent. She leaks a lot. She goes into the bathroom at least twice a day for 30 minutes because she is washing out her underwear and changing clothes. She absolutely REFUSES to wear a pullup or even a sanitary pad. We've tried explaining she smells and it's unhealthy. Sometimes she denies she leaks but when we call her on that, she just gets quiet. She's always been someone who worries about what others will think and so you'd think she wouldn't want to smell. But that isn't the case. She refuses to acknowledge she has this issue. The AL staff has suggested we take all her underwear away and replace it with pullups. We know she will pull a nutty if we do this so we've resisted. Suggestions? Thanks!

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Irene, you have the professional advice from the AL to remove her panties and replace them with pull ups. You will get the same advice here.

Don't worry if she "pulls a nutty", she will have to deal with it.
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gdaughter Dec 2019
Yeah, I've heard the same idea. Then you can deal with the problem of not ever changing undies regardless of regular or disposable!
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Better a nutty then a smelly.

The AL has given you sound advice for dealing with this. Please listen to them.
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Yep, you’ve been told by trained personnel to take her underwear away. What she is doing is unhealthy and unsanitary.
What she does in reaction to the staff request is between her and staff.
Stop resisting and give it a shot. Do NOT give an audience to her anticipated outburst.
By refusing to acknowledge this inappropriate behavior she is drawing negative attention to herself and causing others to be uncomfortable and unduly concerned.
Be sure that you as her caregivers are not assuming some embarrassment for her behavior. If you are complying with staff requests you can’t be expected to do more than you’re doing.
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Agree...listen to the staff, they have done this all before. Clearly your strategy isn’t working or you would not be here asking for suggestions. Recognize that you are going to have to do some things that makes your mother nutty and angry..but it is for her best interest and well being... Good luck...
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HI, Irene.
My Mom wears a very absorbent pad, most of the time. But when she was in a PT rehab facility they used pull ups for her and she was fine with it. Modern pull ups can look like panties.
My mom is 91 and also wants to use the toilet.
Good luck.
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Irene23 Dec 2019
Thanks, Chickie1. We've tried different ones but she is all skin and bones and everything is huge and bulky. Any suggestions?
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I’ve no experience in nursing etc however just a civilian opinion - go with what they suggested - take ALL her underwear away and replace with pull ups.
she’ll have no choice then, you have to do what needs to be done and what is best for her as she cannot decide what is best for herself.
who cares if she goes nuts - let her carry on as you do with a child, eventually they tire themselves out and accept that their tantrums don’t change anything.
Again you have to do what’s best for her as she cannot make those decisions for herself
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If the smallest adult size is too large,look for larger children pull-ups. Measure her waist and upper thighs.
Remove her normal underwear. To leave it is cruel. It’s confusing. Out of habit she will choose the familiar. Don’t discuss it anymore. Just put the pull ups in her drawer and walk away. This will be over before 2020 gets here.
Gently mentioning here that you are having a problem with this. It will be okay. Mom can’t help it but she will adjust.
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I tried to introduce pull-ups gradually, but my sister was still using her underwear, sometimes over, sometimes under her pull-up. One day I simply removed her underwear altogether. Another point to note is there are many types to try. Some are definitely more comfortable than others; try them all as well as sizing up one for comfort. Best of luck!
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HI, Irene. Are the absorbent pads too large and bulky or the pull ups. They both come in different sizes. The previous suggestion of children's pull up, was a possible solution.
I do admire your Mom's desire to use the toilet, like my Mom it's a sign of independence.
Older adults can't control a lot of things in their life, so they try to control what they can.
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We had to take my dad’s underwear away and then since he had no choice he wore the pull-ups. Don’t project how she will react. She will adjust.
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What about panty liners?
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Bless you all! My mum refused to wear any protection at all and peed all over the place. You must love her so much. She does know this is happening. Washing her undies herself in the bathroom shows that. She’s a proud lady but an adult does not like to be told, particularly one of her generation. We younger tend to be more accepting of our conditions. She’ll be full of shame and remorse and certainly doesn’t mean to give you trouble. She still sees herself as the parent too, setting an example while she can’t keep it up. Oh bless her and you for having so much patience. You must be at the end of your tether. I was. It drove me bonkers and used all my energy.

First I had to remember that it was her who was experiencing this loss of control not me. We were pretty enmeshed so I had to separate us out to keep my sanity and to remain compassionate towards her.

I had no choice but to put plastic on all the places she sat or lay down and wash the covers I put in top once or even twice a day. It was a real chore, but the only way I could keep the place and her from smelling. Tips:
put down plastic sheeting where she goes. Disguise it with something easy to wash and dry.
I gave mum a bath or a good wash every day. Get a really lovely carer if that’s too much for you, or mum won’t let you. Make sure good but light barrier cream especially PH balanced is used a least once a day. It will stop mum getting sores.

Try just panty liners at first.
work your way up. Didn’t work for my mum, she just took them off and threw them down the loo blocking it, but it’s worth a try.
If you can bear it, amd situation permits, go away and leave her in a nursing home for two weeks. They will get her used to wearing them. Just let her know she needs a holiday and get her somewhere nice. Tell them not to try it for a couple of days if they can. She doesn’t need the shock. It’s only short term. Remember it’s to do you both good so that you can continue to look after her. Your not selfish at all. This is clear. Arrange it well in advance. Take her for lunch at the best place you can find and afford, as an introduction. Get her in the garden there, with the best view so she gets familiar with it. Don’t do it alone. Try and treat it as a day out with family or best friends even bring little presents or a simple game, so the focus is on you being together. You don’t want her feeling abandoned. Take your mind favourite snack or cookies. Don’t allow the staff to bring things that are too unfamiliar. Everyone needs a holiday.
Thats how I got my mum to wear pants in the end. We were forced to do that though, and the opportunity came when she broke her ankle throwing bread crumbs out to the birds.
The suggestions here about taking underwear away seem doable. Make sure you get support to stop you feeling guilty. It won’t help either of you.
Your mum is very advanced in years. Something may change that gets her wearing those pants things.
I wouldn’t want to wear the best ones, they are soooo heavy. She’s obviously a delicate girl. Maybe there’s something out there that is more discreet and pretty.
remember your not alone. But you are a wonderful person for doing this. Not every person loves their parent so much.
I hope something helps. This is a great site for tips. I can only tell you my experience (which was gruelling). Don’t feel guilty yourself, don’t apologise for the situation to anyone if you can help it.
Lastly, it’s impossible to teach someone like our mums something new. Don’t expect to. None of it’s your fault. Keep yourself well.
Love and strength. Naomi
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Salisbury Dec 2019
Right, makes sense. so much more work for you but that is what this chapter of life is, right?

Good luck!
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Follow the staff's advice. Perhaps over time she will forget they are pull ups. Take away the choice and that which is familiar. My mother has NO clothing in her room, not even underwear or bed clothes. I bring her fresh underwear in the bathroom at the time I shower her, and her outfit including shoes to her bedroom when her shower is done. This is how I eliminated conflict about what she wants to wear. Now she is always properly dressed.
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Salisbury Dec 2019
Great idea, Janice! Nice one!
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One idea would be to cover everything in plastic. I had to get a special cover for my husband's mattress. But you could put plastic in her chair with a folded towel on top--to absorb and be washable.

Good luck!
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My husband was incontinent and refused to wear depends. He ended up with a UTI and while getting dressed I told him he had to wear them and I told him I was in charge of his health. I discussed his incontinence in front of him with his Male doctor and he strongly talked to my husband about the smell and not wanting others to know that he wets himself. He has been wearing them every since that day.
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There are some great washable incontinence underwear and pads (with wings) available. Perhaps she hates the feel of paper and plastic against her nether regions (rightfully so).
https://www.womansworld.com/posts/best-washable-incontinence-pads-156282

Put padding and old towels in the chairs she uses.
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My mother was acting the same way..........until she had to pee while we were riding the elevator one day going back up to her apartment in the ALF. She urinated right there in the elevator, fully, and had a total meltdown. That's when she started wearing pull up Depends.

Remove her underwear and replace them with Depends. In the long run, you are doing her a favor since it's a necessity.
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I have had this with my Dad. I try not to draw attention and replaced his briefs with a different kind.
There are some really nice colors of Depends as well as other brands.
You might get several types and ask her to try them.
Replacing the regular underwear with Depends is important because of hygiene. When it’s done, she might be upset for a while...it is worth a try.
Best wishes and prayers.
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May I ask how old your Mom is? Well, I have a very good friends that has this problem at the age of only 60. She chooses the beautiful new panty style that have flowers on them, have colors, etc. If she won't do this, maybe she could line her panties with pads rather than the full panty. I think the idea of wearing diapers SUCKS! It takes away a person's self-esteem. Let MOM know that she doesn't have to feel bad about this incontience; not her fault, and very common; however, she can still looks and dress pretty with Pretty Incontience Panties (can order online, too, for confidentiality). If she refuses these too options, I would take away ALL those panties she is peeing in, tell her they make her smell, and she needs to wear the new ones (don't called them diapers)
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I have another idea if you are willing to tell your Mom a little white lie. Tell her you are struggling with a little leaking, too, and THEN tell her you are choosing to wear these pretty flowered incontinence panties over peeing on yourself, in public, and smelling bad. Then you can quit wearing them once she is wearing them all the time. You can just tell her later that you went to the dr, and realized you had a UTI; you took antibiotics and this corrected your incontinence.
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I am sure you have this suggestion from others but...
Remove her underwear and provide the pull ups.
If she asks tell her that all her other underwear is in the laundry and the machines are broken and it will be a while before her other underwear comes back.
This way she will not have an option unless she goes "commando" and I am guessing she would not do that.
With dementia you will not be able to convince her that she "smells", "it is unhealthy" that is not a concept that she will understand.
The staff should also be encouraging her to go to the bathroom at least every 2 hours. And by encouraging her I mean walking her to the bathroom and "suggesting" that she should use the toilet.
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There are pull ups with medium or moderate absorbency. Available online not in stores. The padding is much thinner and they were a better fit for my mom.
Also made the adjustment to “new undies” easier. Still had to remove all the old to get her to try them though.
I too imagined a huge fight but it was only a couple hours of bad mood and the silent treatment.
Being in a facility when the switch is made helps too. The staff will encourage/reinforce a positive attitude.
Good luck!
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It is a learning curve taking care of our adult loved ones, God Bless you in this journey. This is a common issue with elderly, I went thru this with my mom one thing that worked was telling her I was wearing the same thing & thank goodness I wasn't in it alone & we could help each other out. I also had to "take" to the potty in protest & loving tell her she sat in something awful & I knew she didn't see it but I would help her get changed. I used this story for lots of things she would forget I just used the same white lie earlier. Being a care giver is so hard there is a LOT of stress listen to advice from others but do what works for you. My mother had dementia, she passed Nov. 21st this year. I miss her so much but I am thankful she is no longer in her body that caused her so much pain, falls, UTI'S, she needed to be showered & changed. I know in her mind she hated all that I tried to be with her as much as possible at least 6 days a week. I know I gave her love & comfort I was her voice when she needed one! The staff at the facility knew I was very involved in mother's care, it makes a difference all the way around. God Bless & take care of yourself.
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thepianist Dec 2019
"The staff at the facility knew I was very involved in mother's care, it makes a difference all the way around." This is SO important and it's great that you're there for your mom. I know there are two schools of thought on 'lying' to those with dementia but sometimes these little loving fibs can reduce distress so much. Bless you.
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I always called them throw away pants and she didn't mind. I only used them when we went out and I wasn't sure how soon we would be back.
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What about letting her wear the underwear over the pull up.
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We took all of mom's panties away and replaced them with incontinent underwear (cotton, look like regular panties but have an absorbent, built in pad). We slowly replaced them with Dependz/Always (Always are less bulky and seem to fit her better), and after a few days it became the norm, with no issues. We also use pee pads/chucks on the seat of her chair, and top that with a folded towel. Amazon also sells absorbant, leak proof, washable chair (and bed) pads, which work wonderfully. Fir her bed, I bought several mattress and pee pads, and make the bed with several layers of bedding (layering mattress pad, fitted sheet, pee pad, and flat sheet 2-3 times) so that if she wets the bed all I have to do is remove one layer of bedding and put her back to bed.
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Give HDIS a call, they probably know which disposables look most realistic like underwear and might be the most acceptable. They often have samples to send out to try.
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GmasGirlJass Dec 2019
What is HDIS?
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The AL staff has given you good advice. Beyond the odor, urinary tract infections are a bear to deal with.
"Pulling a nutty" is a fact of life with declining seniors and it is incredibly hard to take. I know implementing it is hard, but what worked for me and my mother, who went through the phase you are describing, was to take the regular underwear away as it comes up for washing.
I take care of my Mom so it was easy, and the garbage can got real full real fast. She had no choice. You may have to enlist staff at the AL facility to help. It has been almost a year, and panties still occasionally appear. Not sure where they come from as I have emptied the drawers, but. . .
As others have said there are a wide variety of incontinence options. In Mom's case, she likes the Depends. They leak at night, but are OK during the day. I have bed pads and just rinse with vinegar and then wash them and whatever else she has soiled.
Good luck, and be sure YOUR doctor knows the stress you are under.
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One year into this journey......take away the underwear!!!!
Replace all with “pull-ups”.
Be prepared for well-intentioned folks
to bring gifts of mini-pads in warehouse
size packaging. (Take them as well).
I also learned about the Plan B bag.....
ALWAYS carry an extra set of clothes, shirt, pants, bra, wipes, socks, shoes,
a large sealable trash bag to handle soiled stuff, Depends, antibacterial wipes for you and a diaper rash cream to prevent rashes....when it starts to happen often you will be grateful for each and every item you have in your GO BAG.
Need More? Add that layer of protection to your car seat.
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katgrab Dec 2019
Yes! The Bag! Sooooo important! One bad, poopy accident, out in public, and you will be forever grateful to have that Bag!
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* (Get and) call it disposable underwear - which it is. It doesn't need to be called pull-ups. Get the disp underwear that looks like real underwear. Is all over in drug stores (here in Northern California). I get mine for clients at RITE AID. Costco has a lot of this too.

* Also, at night, get a pad insert for the disposal underwear to absorb more. The pads are for leakage, they are NOT sanitary napkins. They are POISE or something in pink wrapping.

* ALWAYS ALWAYS have the large 'bed pads' to put on a chair and cut or get something to fit car seat if you drive with anyone with incontinence in your car.
I use on the bed, in this order:
1. Mattress protector (can be costly although saves the mattress).
2. paper disposable sheets (2) next to each other.
2a. Sheets (bottom fitted);
3. Washable pads - come in various sizes. Two smaller ones are better than one very large one - easier to wash. Have extras for when some are getting washed.
4. Paper pads on top of those.
5. Top sheet if you use two sheets.
The key is to avoid washing as much as possible and saving the mattress.
The washable bed protectors are a gift from God.
5. Be sure to put protector on a chair or anywhere s/he may sit during the days.
* Have plenty of disposal gloves on hand.
* A waste paper basket or can with a top is good or, for my client, she manages fine with a large garbage bag and remembers to close it. I have to empty it when I arrive - this works out okay. Depends on the level of cognitive functioning/ability.
* Always keep a can or two of Lysol or something like that to kill germs.
* Is helpful to have a flowery air scent too - depending on the situation at hand.
* Between forgetting and embarrassment and denial, we do what we can. Tough love is essential. (Set boundaries.)
* I hired a caregiver (or wanted to). He met with my friend (86) of 16 years for 15 seconds and said "can I talk with you outside?" He said he couldn't take the job due to the stench of urine. At times, I have to leave my friend too due to the smell. He is embarrassed, gets over it, says it has more to do with depression than incontinence. Its both. He is in denial.
* If you allow her to wear her real underwear over the disposal ones, she might not do that on her own - it a good idea though if she can wear it as needed. My sense is that she'll toss the disposal and just wear the real ones. Gena.
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