Question on urinary incontinence.

[dudette10, MSN, RN]

I don't think this is a medical question, but if it is, go ahead and delete/close it. I'm really at a loss as to what to do here.

My MIL lives with us and has dementia. She is becoming incontinent of urine, but only at night. She wears regular underwear during the day, and for the past week I've been putting Depends on her before she goes to bed. I also try to toilet her before she goes to bed to alleviate the issue, but she has a shy bladder, it seems. Here's my problem.

When I got up this morning, I went to check on her, and she didn't have her Depends on. I looked in the bathroom, and the outer part was neatly folded and sitting on the shelf in the bathroom and the blue strip was also neatly folded and sitting on top. She had somehow taken out all of the padding part, but it was nowhere to be found!

When I got home from nursing school, the caregiver said that the bathroom drain is backing up. My MIL must have pulled the pad apart and tried to get it down the drain! Oh, geeeeeez!

We have had past overflow problems from the toilet, the sink, and our sewer drain in the basement due to her throwing stuff into our plumbing system. We also need to have the ceiling in our dining room partially replaced, as it's right below the bathroom. So, you can see the extent of the potential problems with her getting rid of the padding on a nightly basis...

ANYWAY....

I just ordered some adult cloth briefs from the internet, but they won't be here for a another week. ($190 for 5 of them....OMG!!!, but that's another topic all together). I am afraid of putting a Depends on her because of the plumbing issues, but I'm also afraid of her slipping on the bathroom floor if she doesn't make it to the bathroom at night. I discovered her incontinence issue when I went to bed late about a week ago, and I heard her in the bathroom. She was on the toilet, but the floor was VERY slick from urine.

So, what do I do in the meantime? I just need to find a solution until the cloth briefs get here. HELP ME!

[peds_RN]

I would suggest using the Depends until you get the cloth diapers because safety is more important. When it comes to the plumbing issue, maybe you can temporarily "turn the toilet off" to prevent anything from being flushed and then turning it back on when you need it. Just a suggestion :)

[dudette10, MSN, RN]

I would suggest using the Depends until you get the cloth diapers because safety is more important. When it comes to the plumbing issue, maybe you can temporarily "turn the toilet off" to prevent anything from being flushed and then turning it back on when you need it. Just a suggestion :)

EXCELLENT SUGGESTION! Thank you.

And, you're right about safety being a bigger issue which was why I was asking. Your solution is the best of both worlds.

I just went up to the bathroom, and my kids had taken showers tonight. There was the bathmat right in the middle of the floor--it usually hangs on the side of the bathtub. That would be an extra precaution that was sitting right in front of my nose, but I didn't see it.

[SlightlyMental_RN]

Would she use a bedside commode?

[NurseStephRN]

Would she use a bedside commode?

That's exactly what I was going to suggest. Like this she doesn't have to walk far to use the bathroom at nighttime.

[tyvin, BSN, RN]

She could be assessed for OAB and the medication from that decreases night trips to the bathroom.

Also I know of one case similar to this where the person was put in a one piece jumpsuit type pajamas with the zipper being in the back so the pajamas couldn't be taken off. That way she couldn't take her diaper off because she couldn't get her clothes off. I really didn't like it because I thought it frustrated the patient too much but if your MIL is willing it is a good alternative. After awhile the patient got used to the one piece pajamas (she use to tear up the diapers and it was an awful mess). Anyway; Cloth diapers are an extreme hassle IMO.

Good luck

[HamsterRN, ADN, RN]

I agree with the bedside commode suggestion, either in the room or placed over the toilet to avoid the toilet clogging issue. If she insists on using the actual toilet, which is understandable, you could open the back of the toilet and unhook the handle so it won't flush. The absorbent material inside diapers, infant or adult, will quickly clog up the plumbing and it's worth extraordinary measures to avoid getting that stuff in your drain pipes.

[DCtraumarn]

Maybe if you would be able to toilet her once during the night as well. Right at bedtime, once during the night and first things in the AM. I also think the bedside commode and meds may be helpful as well. Any chance she has a UTI?

[rosey2007]

How about a bathroom door alarm(I got one at the dollar store). It might upset her but at least you would get a little time to help her to the bathroom. I also agree with the bedroom commode idea.

[dudette10, MSN, RN]

Thank you for all the suggestions.

Update: turning off the water to the toilet and the sink worked beautifully last night. I did find the Depends in the bathroom this morning, but there was no wetness on the bathmat, and it was evident that she tried to pull the Depends apart again. However, it did NOT go down my drain! YAY! Fishing out the padding wasn't fun (I had to replace the kids' fish tank net today ), but it was less annoyance than calling a plumber to fix our drains?

About your other suggestions...just to answer some of them...

I'm not convinced the bedside commode would work. She is not used to one--has never used one--and I'm pretty sure she'd skip it and head to the bathroom anyway. The bathroom is right next to her room; in fact, one wall of her room is shared with a bathroom wall (to give you an idea how close in proximity they are).

I'm not fond of the jumpsuit type of clothing. First, she's never worn pants in her life, except once, and it was so notable that my husband (her son) remembers the color of them and what she looked like in them when he was about 10 or so! Anyway, she can still toilet herself, and a jumpsuit would prevent that.

As for OAB, she doesn't have the classic symptoms associated with it. She is continent without having to run to the bathroom multiple times during the day. It's only recently at night that this has become an issue.

She is in amazingly good "body health," except for controlled HTN with a single medication and, of course, the Alzheimer's.

Thank you so much for your suggestions and, of course, your support. :)

[kesr]

One idea in additon to turning off the water - flush the toilet one last time with the water off - that should decrease the pool of water in the bowl. Easier fishing!

[Pepper The Cat, BSN, RN]

Aren't there locks that can be put on toilet seats to prevent them from being opened? I believe they are designed to prevent toddlers from opening toilets and falling in, but this might work well for you.