Please help, newbie with pull ups/Depends for mom--I need guidance!

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Mom was just in rehab for two months as she fell (again) and broke a bone. She NEVER had incontinence issues EVER,until she got there and fell while she was there also. This is totally new ground for me. She has being using the pull up Depends 24/7 at the rehab center, but she just came home like 12 minutes ago and I don't know how to do this!! She has mid stage dementia and asking her to remember something never works. She has a little difficulty communicating what hurts and where, so if I were to ask her if the pull up was wet, she may not answer accurately either.

So here's my questions:

1. How can I tell when she's "wet?" When my girls were babies I'd feel the diaper near the crotch and rub the diaper between my thumb and finger to see if it was wet/slippery while the babies were laid down on the bed. This doesn't seem appropriate for my 80 year old mother, but how on earth do I check?!!

2. When am I supposed to "change" her? Once a day?Twice a day? 8 times a day?

3. How do I explain to her why she needs to wear them? her feelings are VERY easily hurt. I need to keep her underpants away from her as I don't want her to change into them and pee all over my bed! Any advice on how to say "Guess what, you have no underpants now mom?"

4. I have an appointment with her doctor tomorrow and I am hoping that this is a temporary issue because of some newly developed medical problem. Also, she had a hysterectomy about 5 years ago. Has anyone had any experience with this potentially being a medical issue?

Thanks so very much. I know this is easy for some of you, but this is so very foreign to me. I want to love mom and at the same time not have my house smelling of pee. When I picked her up, her clothes all stank of urine so I have them in the washer now. Also, I was told that she would take the pull ups off at night (as they were wet) and then hang them on the side of the bed to dry (wearing nothing to bed and peeing all over the bed). OMG, any advice on all of this?



If she has been wearing them in rehab, just put all her regular underwear up, and put these in the drawer instead.... and she should be changed often, it is easy for them to get skin breakdown and UTI's . The Depends will be 'heavier' if that makes sense, is she going to the potty at all with assitance? check then to see if she is wet....
Sometimes you can put larger underwear over the depends to keep her wearing them durning the night... but I would also suggest getting a baby monitor, so you can hear her during the night.... she apparenlty doesn't like being wet and can tell the difference.. so if you hear her, you can change her....
You can also put a plastic mattress cover over the mattress, then the sheets, you can also use water proof pads under her at night.... this may not keep her from getting some of the bedding wet, but it will save the mattress.... hope some of this helps.... but keep her dry if you can.... good luck....
Have you tried putting a poise pad in the depend? It can be removed when it is wet and replaced with another. That's what I use for my mom. But be careful...I have had to fish a few of those out of the toilet before she almost flushed them.
My father used depends and like products. You should be changing them rather frequently or when wet. My father needed to urinate about every hour and a half. You will need to know if she can lift her bottom up in bed to allow you to put another depends on her. Most depends can be ripped on the side seams allowing an easy way to pull them from under her if she is lying in bed.

There are female urinals which might work if you have her up in a chair and don't want to transfer her back to bed for each changing. Using depends or other like products which are more like diapers (have taping on the side) might be easier.

In the bed, you can put waterproof mattress pads, then a bottom sheet and a draw sheet (a twin sheet folded will do) and a bed pad. The disposable bed pads can get too hot for the patient or a washable bed pad which has cotton on the patient side. The draw sheet will help position her in bed if you are doing it alone.

Good luck we have all been there. You will learn how much she can help with transfers in and out of bed. You will figure out how much bladder control she has. It may improve too.

Has she been checked for an urinary tract infection? My mom uses pull ups too, she just recently fell & broke her hip so we are having her go to the bathroom about every two hours during the day & she usually is wet. Make sure you wash her skin & maybe put a barrier cream (U can get this at a drugstore) to help protect her skin. Make sure she is wiping from the front to the back to prevent infection.
My mom was very reluctant to wear the depends all the time but she was peeing all over so she finally gave in & wore them, she calls them diapers (guess they kind of are huh :-)
I also like a lot of Ladee's comments to about putting on a waterproof mattress cover & using pads on the bed.
Also some kind of alarm if you need to help her at night & want to know when she gets up. Older people seem to be up & down all night, they don't sleep as well.
I know all this is very hard, we have a lot of the same issues too, I wish you the best & hope some of this helps you! Marie
When I read your comments, I felt as though I were living them! Broken bone, dementia, falling at the rehab...I too was new at all of this and this group saved me! There are several items you can purchase to keep the mattress in safe--the sheets you can wash. Waterproof pads, AND large square pads that can be placed under the sheet--they are washable and you can wipe down the waterproof cover. With dementia, it seems one night my mum is continent, and the next night she wets. It can be hit and miss, so the pads under the bed are helpful, there also are disposable ones you can purchase at a medical supply store or maybe cheaper online. As for the briefs/depends....I told my mum they were the new "IN" thing---also,remember, out of sight, out of mind--eventually, she will forget about them is she does not see them lying around, sometimes it just takes a few weeks to get into the groove, and believe me, I feel your pain on the "pee" smell. Air freshers in her room, sprays, candles, Windex in the bedside commode if you use one, and spray the sheets with freshener too 3x's a day. My mum has been with me for several months now, and people actually tell me it smells good when they walk in the house. In regards to the "knowing" if she is wet, someone commented the pants are heavier. That is true, and it is okay to do what we did with our children, testing with the finger--it seems like a gross concept and if you not comfortable, lean over and smell--believe me, if she's wet, you will know it!!! I use 2 poise pads and 2 briefs at night so she is not floating on the times we don't get to the toilet in time...also, I have a baby monitor that is set very low--that way, I don't hear the static and every movement, but I do hear when she makes large moves like getting up. "=)
Maybe not relevant, but incontinence is a symptom of a problem with spinal fluid retention in the brain, and it is sometimes precipitated by a fall. The other symptoms are a halting gait, imbalance, and cognition issues. It is called NPH, normal pressure hydrocephalus, and is usually controlled completely with an implanted device, a real lifesaver if this is the case. Ask your doctor when you go, and if he's never heard of it, go to another doctor.!
You got lots of good advice here -the only thing I would add is that the wound care nurse who helped with my husband's skin breakdown from urine recommended Tena brand as being the most absorbent. I used them at night and Depends during the day because they were a bit more expensive.
In addition to NPH, Lewy Body Dementia can also cause problems w incontinence, but a UTI is a likely cause that can be ruled out or in easily enough. Many people have good luck calling them special new undies or as kitten said, the new IN thing- make up whatever u think she will go for ( the dr wants u to wear this kind now, cause they are better for your skin than - insert what ever she has been wearing. Never miss a chance to leverage the ever-respected dr's. Opinion! They don't seem to mind being the bad guy, especially if it means better outcome for patient! All the advice given is very consistent with what I have been seeing on this n other sites in the past, like u, we r just getting started w this after 1st accident. I got duplicate waterproof Terry-top mattress cover, n over that, use a cotton regular mattress pad- makes it more comfortable, n not as "sweat-inducing". Then proceed w the extra bed pads, n Xtra sheets. I dreaded getting to diaper-stage, just wasn't sure I could manage w my mom, butt, ha ha, I'm doing ok! We r trying different types n brands until we see what works best for us, probably a combination of several products together w more protection at night. For super problems w this issue, I have seen several recommendations for "space" briefs or diapers, developed for NASA. I'm sure pricey, but less so than a stinking home. If using, in-room potty, can use plastic trash bags (small size) and or add water to the potty bucket, decreases odor n makes clean up easier. Young mom's rave about diaper genie too. So far I am double-bagging used diapers before placing in trash-no smell, but I empty cans often. Same idea as the d-genie product. Have also read pet pads work =ly well for lower price, not tried yet tho :)!! I already invested in carpet cleaner- happy w power surge scrubbing brushes in my brand n using pet sense enzyme cleaner ( pre-spray 1st), used HE tide added at 1/2 strength to pet product for great results w the cleaner. Good luck finding your easiest path w this dreaded part of CG. Can u come back n let us other newbies kno what works for you!? PS we got a gait belt, rolator walker and training to use both correctly from PT. Fall prevention checklist available on CDC website. We are using monitor, n may add mattress pressure pad alarm or infrared alarm to enable fastest response time. Thoughts or suggestions about these types of products from anyone? kimbee
How to get her to wear the Depends without hurting her feelings:..You might put the underwear away somewhere, tell her they got lost or ruined in the wash, whatever fits your situation, and, until you can find them or buy new ones, these are just "temporary", or just "throw-away" underwear. My mom still uses the toilet somewhat independently, she just was starting to have an occasional accident, and her panties were all old and stained, so threw them out and I thought I would just start her on the depends now rather than later when it will be more difficult communication-wise, and they would already be part of her routine when she becomes more incontinent. Since she is still mostly continent, and she can still tell me if she has an actual accident, I just need to change them once a day. I do it when she goes to the bathroom before bedtime. While she is on the toilet, I take off her pants and the depends and put a new depends and clean pants back on her. I use that time to check her skin and use a Cottonnell wipe to make sure she is clean. Even if your mom doesn't use the toilet for going to the bathroom anymore, during the day you could have her sit on it (you could ask her to do it "just to see if she needs to go to the bathroom") so you can change the depends. This could have the added benefit of maintaining toileting skills for when her continence improves, if it hopefully does.

Someone commented on poise pads being accidentally flushed down the toilet. My mom put something down the toilet that completely clogged it. I had to have a handyman friend fix it. Rather than go through that again, I asked him to set it up so she couldn't flush it anymore, but I still could. He disabled the handle for flushing, and routed a cable from the flushing mechanism out the other side and toward the back of the tank, so I could pull that cable to flush it. Mom just gave up on flushing the toilet herself after a short time, and I just do it for her when she's not looking, and I check it during the day if I smell an odor, and I can see if there is anything unusual in the toilet that shouldn't be flushed down. This is a lot easier than having to go in with mom and be there to monitor what she flushes everytime she uses the bathroom, and less traumatic than having to use a plunger or having it overflow or having to call the plumber, especially if it becomes a regular occurance. (Our other toilet is different and simpler, and for that one, we diabled the handle, and I just have to lift off the lid and pull up on a chain that is hooked on another part and then put the lid back on. There are lots of different kinds of flushing mechanisms, but there is probably a way to bypass the flush handle for each one). (I did a search on the internet, and it seems that frequent toilet clogging is a common problem, even in nursing homes. All of the experts that were asked for solutions for this problem came up with solutions that did not address the problem of inappropriate objects being flushed down the toilet. Most of the solutions they gave were along the lines of preventing the person from being able to use the toilet at all. I guess none of them have been confronted with this particular problem because they aren't caregivers dealing with dementia . This was the best solution we could come up with, and it has worked for me.

I hope this helps!
P.S....When I first started mom on the depends, I used the kinds that have perforations on the sides so you can tear them to put them on and take them off without having to remove the shoes and pants. They also had velcro tabs for attaching and reattaching. I have not found that kind recently where I shop, so currently I use the ones that are more like regular underwear, which are more difficult because sometimes mom refuses to let me take off her shoes and pants to change the underwear because she is sleepy or cold. I'm looking for the other kinds, I hope they still make them!. I think they would also be easier to change if the person is lying down and is not able to lift their bottom off the bed. You could open them up the depends, roll the person onto one hip, and place the depends on the bed and lay the person back down onto them, and pull the front part up between their legs and fasten in the front with the tabs.

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