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One of my clients is incontinent. She wears a disposable incontinence diaper with a pad inside, which gets changed in the morning when she wakes up, early afternoon after nap, and at night when she goes to bed.


Recently it has not been providing enough of a barrier, and her pants and wheelchair have been wet when we go to transfer her. We thought it was due to leakage, but tried changing the diaper to a smaller size has not helped at all. Our only idea now is to use TWO disposable liners, but just imagining it seems pretty awkward and bulky, for them to overlap in the middle. Has anyone encountered this or a similar situation, or can anyone offer some advice? Thanks 😊

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Is the pad that is being used designed to be used in this manner? Some pads have a "leakproof" barrier on the back this would not allow the incontinence brief (not sure if a pull up or tab type is being used {and I hate the term "diaper" for an adult}) to fully absorb the urine.
And on another point a brief should be checked and probably changed every 2 hours not just 3 times a day.
This is not just for preventing leaks but it is a way to clean and check the skin, gets the person to change positions so they are not sitting in the same spot, the same way for hours at a time.
And I hope BOTH the pad and the incontinence brief is being changed not just the pad. If not the brief can absorb a bit of fluid and not look or feel wet at the time but over the course of the day that brief will not be able to absorb any excess.
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My mother has no bladder control at all and constantly soaks her disposable underwear and pad. She now swears by Tena overnight super absorb and I believe the Tena pads. She has a washable pad on her bed and disposable chux pads everywhere else including on the carpet under the beside commode. We have gone through probably every brand known to man trying to find a good fit for her. Can you reduce her liquids? Ask her doctor first.
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dp
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We don't really have any idea of the nature of the OP's employment but I'm going to offer a scenario that is not unheard of here-
Client lives with a caregiver who can't manage changes and transfers on their own (or god forbid even lives on their own) so home care is assigned to stop by to assist. This may be as little as twice or three times a day. The time allotted may be as little as 15 minutes, although morning and evening are more apt to be 30 minutes. Because caregivers are dashing between clients and life happens they are often late and/or pressed for time. But it's so much better to allow people to age in place, right?
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She needs to be changed much more frequently. Do you work for an agency or are you a contractor? The skin, with such infrequent changes, will certainly breakdown, causing ulcers.. If someone were to report this to APS you would be investigated and very likely charged with elder abuse. You have put this poor woman in danger of developing ulcers that could become infected and septic, with a possibility of causing her death.

How did she find you or you find her?
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I'm surprised that your client's care plan allows this way of dealing with her continence care. It's a practice called "double padding" which is usually an absolute no-no - ineffective in supporting continence, risky for both basic comfort and skin integrity, forbidden in all the guidelines I've seen recently.

Is your client able to transfer to a commode?
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ABRI FORM 4 IS A GREAT NIGHT TIME DIAPER.

You do not want the skin to break down. If she gets bed sores on her bottom side, it is a bit of a bugger to heal it. Only takes a few days to get a pressure sore, and a whole lot longer to get rid of it.

Use Calmoseptin cream as well. A & D Ointment.

The abri forms are tabs, not pull ups. Not sure which ones you are using, but the tabs might give you a better fit to help keep the wet from leaking out.
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Momsonlychild Nov 7, 2020
Where do you purchase them?
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We turn and change my mother every three hours during the night.
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This is a problem for my mother also. Temporarily, after a hospital stay, she has a catheter, but before that, she soaked through or around even the highest absorbent pullups and we changed her bedding everyday. Her catheter shows between 1400 - 1600 ml urine overnite, between 8pm to 7am. Yet, not very much during the day. Not sure what we are going to do after the catheter comes out. The best pull ups so far have been the NorthShore's GoSupreme high absorbancy.
Sorry this isn't much help, but we are having the same problem. I don't want to wake her in the middle of the night either.
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Change more often. If not she will most likely begin to suffer from skin breakdown from the urine. Hi
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Using a liner is something that has been discussed on the forum many times and unless you are using a "booster pad" which is specially designed for this it WILL NOT WORK because the liner has a backing which blocks the urine from reaching the pull up/brief, the excess urine will take the easiest route which will be over the sides and down the legs. Aside from changing her more often you could either buy booster pads (available from on line suppliers), slash the backing of the regular pad to allow the excess to pass through (a p*i*t*a* but doable) or try a more absorbent brief or pull up - if you have tried all the most commonly available at your drug store then consider on line suppliers and look for Abena, Attends, Prevail or Tranquility.
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Joycake Nov 1, 2020
Thank you so much for your informative answer. This was exactly the info I was looking for!
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She obviously needs to be changed more often, not more liners in her diaper. How would you like to sit in your pee soaked pants and chair for hours? It's really not rocket science, but common sense.
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Change her more frequently.
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