Nancy Treaster 

We both wish we knew how to handle incontinence better once it began.

 

Sue Ryan 

We sure do. For Incontinence, we’ve actually created a five-part series because there’s a lot going on with Incontinence.

 

Nancy Treaster

Yes there is and it’s coming.

 

Sue Ryan

In this series, we’re helping you preserve your care receivers dignity and we’re giving you information about what to expect. So you’re prepared mentally, physically, and emotionally for this part of your journey. Once incontinence starts, it’s not going to end for the remainder of your caregiving journey. 

 

The five podcasts of the podcast episodes are episode nine, preparing for incontinence. Episode 10, pre incontinence. And when incontinence first begins, episode 11, is about cleaning our care receiver. Episode 12 is bowel and bedbound incontinence. And this episode 13 is taking care of our care receiver in incontinence overnight.

 

Nancy Treaster

As Sue said, this is the fifth and last episode in our five part series. And in this episode, we’re focused on helping you with incontinence overnight. We are sharing four tips. Sue, are you ready to get started?

 

Sue Ryan

I am between getting to the bathroom in time and finding the toilet, managing incontinence can be a lot of hit or miss and especially overnight. So we’re suggesting ways to minimize the challenges with incontinence overnight, which is going to happen. And there’s kind of a tough balancing place. And we’re really going to be candid about this because while we want to minimize their messes,

 

We also need to get sleep. And so we need to also prioritize ourselves. And Nancy, you’ve got a really good story to share about this.

 

Nancy Treaster 

Well, I guess what I tell people when they ask about this is I feel a little bit about incontinence at least until they’re absolutely completely incontinent. And I’ll talk about this also later. But as they’re still getting up trying to find the bathroom or not staying put, the way I described is you gotta sort of let the chips fall where they may, in my opinion. So, you know,

 

This is the point in time where, well, we’ll talk a little bit about more of that later. Not everyone’s sleeping in the same room with their care receiver. And you do need to know what’s happening or be available and able to glance and see what’s happening. But you don’t need to take care of everything that happens overnight. There are gonna be plenty of accidents. You just need to be ready the next morning to deal with whatever happened during the night.

 

Sue Ryan 

Yeah. And part of that is also going to end up being, know, this is, it’s an inflection point. It’s really, really an important inflection point for whether or not this is something that you have the capacity to do. You’ve had a very, very full day caring for your loved one. And now you know that they’re going to most likely get up at some point in time during the night.

 

They’ve got to be able to get to the bathroom and back safely. You may or may not still be sleeping in the same room with them. Nancy, you brought in cameras. But you’re getting up at night. And so there’s a lot of opportunity for us to be missing sleep, valuable sleep at night. And one of the things that’s really helpful here is to make sure that you reach out to somebody, reach out to us, reach out to your support community.

 

Talk to your family about it. And if you’re a family member of a caregiver, you ask them, how are you getting sleep at night? Are you getting enough rest? So make sure, we get asked a lot by family members of the caregiver and care receiver, how can we help? What can we do? These, especially this is one of the areas where you can really lean in to help.

 

They may be an inflection point for getting help in at night. So you can get sleep. It also could be an inflection point for maybe it’s time that they go to a care community because this is too much for you to be able to do. You’re not getting valuable rest. So is there anything else you’d like to add on with that, Nancy?

 

Nancy Treaster 

Well, I think it by default it can be very stressful because you don’t know what you’re gonna, if you allow yourself to sleep during the night, you don’t know what you’re gonna wake up to. And in the wandering episode, we talk about at night, you should be at this point, minimizing the areas at night that your loved one can go to. They need access to a bedroom and a bathroom. And if it’s an ensuite, you need to be keeping them in the bedroom and the bathroom and if they have access to a bathroom that’s down the hall you want to minimize the number of places they can go except to the bathroom. 

 

In episode four, which was an episode on wandering, we talk about making the bathroom easy to find and in episode 10, which is on incontinence, making the bathroom easy to find. Either way, if you’re not getting up with them in the middle of the night, and they’re still getting up looking for the bathroom, you can’t manage things 24 seven, give yourself some grace, but you’re gonna wake up often to a mess. And that’s stressful.

 

Sue Ryan 

Lots of mess and they didn’t mean to do that. I mean, they don’t want to do it.

 

Nancy Treaster

That’s a very good point. You got to give everybody some grace yourself and them included. There’s nothing valuable about getting mad at them for whatever mess happened during the night. You only take a very difficult situation and an embarrassment and a shame and frustration on their part. You make it worse. We’re really trying here to maintain their dignity every step of the way and getting upset in the first thing in the morning because there’s poop on the floor doesn’t help anybody.

 

It’s stressful for you because you have to clean poop up off the floor. So, you know, that’s unfortunately part of what needs to happen.

 

Sue Ryan

Yeah, first thing in the morning, you’re cleaning poop up off the floor and you probably didn’t get enough sleep that night. So you’re waking up a little bit tired. And this is one of the first things you’re going to be doing. And so, you know, and it’s reasonable that this can be overwhelming.

 

Nancy Treaster

Yes. So be prepared. Now, the good news is most people don’t have a bowel movement at night. So that’s not a very common thing. So anyway, at this point in my situation, my husband and I were not sleeping in the same room. And there’s some reasons for that. In addition to incontinence he was, like a lot of people with dementia, getting restless at night and getting up and walking around a lot at night and you can’t get sleep while that’s happening either. But I did install cameras and I installed cameras where I can see on an app on my phone what’s happening. So I do use those on a regular basis now as well. just if you hear noises and hear things going on, you wouldn’t be able to keep an eye on things if you possibly can without having to get out of your bed. All right, enough about how hard it’s gonna be. So let’s talk about tip one. How do you feel about that?

 

Sue Ryan 

All right, tip one is transitioning to nighttime underwear. And as a restatement, we don’t want to use the word diapers and we don’t want to use the word pull -ups. These are types of underwear, different types of underwear. And in the early stages of incontinence, really the problem is them getting to the toilet fast enough. So what we want them to be doing is at least wearing some washable incontinence underwear in the very beginning. 

 

Hopefully because you’re gonna be sleeping and so a little bit about my background with my husband with this right after he was diagnosed. I brought it up to him and I said, honey, there’s gonna be a day when you’re incontinent and you’re not gonna be able to get to the bathroom on time. And I wanna make sure that while you can still tell me what’s comfortable and not comfortable that we try some of these products out and figure out.

 

when it’s that time, what I can be having you wear that you’re going to be comfortable with. And he was actually OK with that. I mean, it was kind of like it was one of those reality things of, it’s you know, it’s really kind of right here. But you know, like when you’ve got, you know, no ability to have the conversation, here’s what it. So by the time that was about time and you could kind of tell he wasn’t able to really communicate about it. We’d have had a few accidents. So what I started doing over the course of a week.

 

I started replacing his underwear with the depend and I would do it every other day and I would just say, honey, it’s in the laundry. And so I only had one pair of underwear in his paint in his underwear drawer a day and be like, honey, I’m doing the laundry. And it was either the depend or the regular under well, after a week, it was just solid with the depend. And then I filled it all back up with the depend. And that’s pretty good. Now, the challenge I had is he was used to putting on his underwear in the morning.and wearing it for the day and he did not want to put on a clean pair of underwear before he went to bed. He usually took them off when he went to bed. So that was a little bit of an adjustment. So you can start that process earlier. I hadn’t anticipated there was gonna be that much of it so you can start the, cause some of the things we did start early, but anyway, that could be one of the things, but it didn’t take, it was like a week when we adjusted and he was just full into it. So it didn’t take long.

 

Nancy Treaster 

And so I’ve that it’s a very good point because a lot of people don’t wear underwear under their pajamas. So for example, like my mother convinced my dad that he had to wear nighttime underwear. And he, you know, looked at her kind of funny, but he did it. And that was the end of that discussion. And it was a Depend.  But same with my husband, he didn’t wear nighttime underwear. And so we did start with the washable incontinence underwear.

 

But when they’re beginning to be incontinent, they have to have something on to absorb the liquid even when they just can’t get to the bathroom fast enough, including at night. So, you really have to transition them into some kind of nighttime underwear, however you get it done, but it needs to be, they have to wear something underneath their pajamas.

 

Sue Ryan

Yeah, yeah. And you’re also going to be and you’re going to be talking about this. You also have to be protecting the bed.

 

Nancy Treaster 

Right, which actually is tip two. There you go, we ready to talk about tip two? So tip two is to protect the mattress. And that’s because there’s going to be accidents that happen. Some of them happen in the bed, some of them happen on the way to the bathroom, and it’s going to become closer and closer. It’s gonna be less and less on the way to the bathroom and more and more around the bed. So the bed itself needs to be protected and Sue and I both have the same experience where the best waterproof mattress cover that we both found was the allergy proof mattress bags and they say they’re waterproof as well and they are. Most of the rest of the mattress covers that say they’re waterproof, they might be waterproof if you’re two. But they’re not waterproof for a grown adult who might completely go to the bathroom in the bed. And both my father and my husband both, I think sometimes men just think that they’re in the bathroom and so they push their depend aside and they literally go in the bed. you can’t, that’s not, even a regular waterproof mattress covers not absorbing all that.

 

Sue Ryan

No, and they also do that in their sleep. I learned they do that in their sleep. So they’re not awake doing it. They just, they gotta go.

 

Nancy Treaster 

Exactly. Just recently Sue and I heard about a product called Peelaways at peelaways .com and they are waterproof covers that are on that you put on that go onto a fitted mattress sheet and you literally peel away a dirty top. And then you’ve got another layer underneath and I think the ones for a regular size bed had like five layers on them.

 

I can’t wait to try them, honestly. Because it’s not always even just, it’s not every time is it gonna be a complete urine mess. It might just be a little bit of urine. And then the same sometimes with bowel movements. If my husband gets up in the middle of the night and has a bowel movement and gets back in the bed, it’s not a complete disaster, but there’s definitely stool on the sheet. So I can’t wait to try those. That’s gonna be very interesting. Multiple layers.

 

Nancy Treaster

Whatever it is you want multiple layers because you’re going to need to massively protect the mattress. I have two layers of mattress covers and then there’s loose mattress covers that aren’t necessarily fitted that I have even in between the two layers of mattress covers. Some days we take one mattress cover off and wash it, some days it’s the mattress cover and the loose one in between and some days it’s all three of those. Rarely do I have to take the whole mattress bag off but I’ve had to do that once as well, which just got all the way to the side of the mattress bag. So be prepared. There’s a lot of sheets to be done. Sometimes in the morning, it may not be that there’s poop on the floor. It may be like, are you kidding me? I’ve got to take these sheets off and wash them yet again.

 

Sue Ryan

Again, okay now, there are two things associated with that then, Nancy. One of those is, you just recently made me aware of, boy did I wish those had been available before, is the huge pet pad that’s what, 72 by 72?

 

Nancy Treaster

Yeah, 72 by like half four feet, I think. But there’s pet pee pads. And you can get jumbo pet pee pads. And the one I have right now is 72 inches long, which is the length of a king size bed and about half the size of a king size bed. Massive. You can stick one of those in there as well. Much better idea just to have another layer of protection. I keep those next to the bed as well. Because at night, there’s not as much walking around the room and going in the wrong place, but there is some standing up and going next to the bed. We’re down to one spot. And so I keep a jumbo pet pee pad in that one spot as well.

 

Sue Ryan 

And another tip that’s really helpful with that is, especially if you’ve got a king bed, is making it two twin beds. take that for the map. So, you know, do you want to share a little bit about that, Nancy?

 

Nancy Treaster

Yeah, that’s a very good point. All of your bedding needs to be washable, including your comforter, everything needs to be washable. And you need probably two of all of it.. So if you don’t have a washable comforter or bed spread, that needs to go, you need something washable. So everything’s washable. But wouldn’t it be nice to not have to be washing all the sheets for the entire king size bed every time. So you can get two extra long twin top mattresses and then extra long twin sheets. And it’s a little bit of trouble to crawl over them and change them, but you’re not changing the entire bed every single time there’s an accident. And you know, that’s useful.

 

Sue Ryan

It’s a lot less work. So there are a lot of different ways that you can make it easier.

 

Nancy Treaster 

Yes, yes, yes, yes. Okay, I think we’re ready for tip three.

 

Sue Ryan 

All right, tip three, huge, huge tip for us. That is to make the bathroom easy to find because if they do wake up and they do want to go to the bathroom, they’re somewhat disoriented. One of the things that happens with dementia is both their depth perception and their vision change. We don’t know how clear their vision actually is necessarily and even if even if they’re you the eye test shows it’s pretty good what happens with their depth perception is that shadows become very challenging you’ll probably notice this with your loved one is that when they’re around shadows they can’t necessarily tell if that’s a person or something else or something in the way so you want to we call it making it a beacon you want to make it so easy to find the bathroom that that they pretty hard to miss

 

So there are a couple things that you do one is you leave a light on in the bathroom you may leave like we live in Florida and so there’s a there’s the where the bed is then there’s a hallway that has the two little closets with the Folding doors and then there’s the bathroom and so there’s a light that lights up that little hallway So I would leave that on I would leave the lights on into the bathroom to where bathroom, I would took everything away that could be distracting to them. So that there was nothing when he got in there, he wasn’t confused. And he didn’t also grab something that was not appropriate for him to grab. So no glass, there was nothing there. There were no products that were harmful or anything like that. But make it really like have the light going and make it a beacon. So it’s easier for them to be able to get there. A couple other things. We’ve mentioned this in an earlier episode.

 

take the lid off the toilet seat, leave the toilet seat on, take the lid off of the toilet seat. And then, now I was talking about having those, like the folding doors, the pocket doors. I got a door jam, just one of those rubber door jams, and I got a bigger one, and I put it right where the hinge part of the door was, on each side. And so if for any reason he tried to open that, it wouldn’t open. So I did that, and then for the doors, because again, if they’re,

 

Sue Ryan

If they have, if you’ve got the bathroom that’s right there, you want to have the childproof door lock or another way where they can’t get out of the bedroom. You want to make sure that they’re because if you do fall asleep, you don’t want them to be able to get out. So either that or if they have to go down the hallway, make sure that anything that might be in the way or might be tempting to them or might confuse them, you’ve gotten out of the way. So there are pet gates or all different kinds of things you can do to make the path for them as easy as possible to get safely to the bathroom.

 

Nancy Treaster

Yeah, good tip and critical. We talk about it multiple times. So this is a big part of your journey. Now, eventually, moving on to tip four, eventually.

 

Sue Ryan 

you know what Nancy I want to make one other one other point with tip three that I just now thought of I went through a period with my dad where he knew how to get to the bathroom he couldn’t remember how to get back to the bedroom because when you come into the bathroom and it’s an open area there and there’s the shower and there all the other things and then you know so he she he couldn’t remember how to get back to that. And so what we did is we put pad, they’re the little, they’re grip grip pads that you would put like in a shower, something like that. They’re like feet. And so we put those that would mark the way back to the bedroom.

 

Nancy Treaster

Interesting. All right. Good. Good idea. And that’s a good another good example of where you need cameras in the bedroom and in the bathroom because when you hear them get up and go, you don’t necessarily have to get out of the bed and do anything, but you do want to keep see what’s happening because if they’re lost, you know, you probably want to get up and go help them. Now, eventually, they’re going to stop even looking for the bathroom. Part of it, they’re gonna be a period where they just wander around the room. Then you’ll be dealing with that mess. We talk about that in episode 10. And part of it is eventually they’ll be going more and more just directly in the Depend they have on. So with that, you wanna keep them as comfortable as you can overnight.

 

A Depend on its own, even the ones with the nighttime strips in them, I don’t find enough urine for someone to be comfortable. So there’s something called guards. You’ll see those in the grocery store next to the depends, you’ll see guards and guards are really meant for extra absorbency. They’re almost like a sanitary pad, but much thicker. And guards are meant to go in the depends mostly at night.

 

Sue Ryan

for men and women.

 

Nancy Treaster 

Yes, everybody guards are good for everybody. And we were at a point where we’d put two guards in. That was fine for a while. My aunt put four guards on her husband’s Depend. How do we know how you get it? All those guards in there. So one of Sue’s friends would actually cut off the inside of the depend not the other part of it, but the inside and put a whole like a second depend inside there. So that’s an option as well. 

 

Sue Ryan

Yes, that worked great.

 

Nancy Treaster 

That said, there became a point in time, my husband’s still at home, where he’s still uncomfortable. That’s still not enough for him to be comfortable sitting in a wet depend. And so we would wake up in the morning and we’re no longer spending our mornings cleaning up messes from the nighttime before. We’re cleaning up what we would describe as a winter wonderland.

 

because he would pick the inside out of the depend and leave it all over the room because it was uncomfortable.  Yeah, the inside of the depend, which was wet, obviously, because he was uncomfortable and he would just, I mean, he doesn’t know what he’s doing, right? So the question would be when you walked in in the morning, was it a winter wonderland or not? Well, I didn’t really know what to do about that. 

 

Nancy Treaster

I mean, this has been going on for a while, but at one point, one thing I do is I always keep abreast of what’s going on in the care communities that are around me. I want to make sure if the day comes I need a care community, I’m not caught at ground zero trying to figure out where I would, what places I would be interested in. So I tour care communities periodically and a new one had opened up really right down the street. So I went on a tour and when I was on the tour, they talked about how, in the memory care unit, they would change them in the middle of the night. Well, duh, never crossed my mind that we should change him in the middle of the night, honestly. Yes, never crossed my mind. Now, not everybody can do this. Some people have to sleep straight through the night, eight hours, and this is not even an option. But for me, it was a wake up call.

 

Sue Ryan

This is why we’re sharing this in the podcast episode

 

Nancy Treaster 

I’m a light enough sleeper and I sleep for a good four hours and then I wake up pretty refreshed and then I go back to sleep for another four hours. Well, guess what I do now when I wake up in the middle? I go down, I change his depend, I go back to bed, he goes back to bed. The winter wonderland is gone. I know he’s more comfortable and honestly, it’s a pretty easy process for me.

 

So something to keep in mind. Now, when they get up in the morning, they have now been sitting in more urine than you would, a normal person would be sitting in. So the first thing we do when my husband gets up in the morning is he gets a wash down from the waist down because he’s been, you know, he’s been sitting in urine, even if it’s only been for four hours, it’s longer than he would normally have been. So we try to keep him clean in the middle of the night.

 

And then we deal with whatever bedding challenges we have. I will say the longer this goes on, the later stage to which we’re in, the less accidents and bedding challenges we have overall.

 

All right, Sue, any comments?

 

Sue Ryan 

And yeah, I would say one of the things we want to make sure that they’re doing and part of the reason people have said, well, why don’t you just cut back on their water? And it’s so important for us not they really, really, really need to stay hydrated. And, know, it’s it’s for us and for them measuring out that water throughout the day and making sure they get it is great. One of the things you can do, though, is if you can help them get that water earlier throughout the day.

 

and then stop it earlier in the evening, then they’ll have much less need to void throughout the middle of the night. Don’t put back on the amount of water. People will bring that up all the time. like, well, just cut it back. Those are where urinary tract infections come from. dehydration is not a good thing.

 

Nancy Treaster 

But you’re absolutely right. And my father had Parkinson’s and so he had to, and he’d want to get up all night and go to the bathroom. And people with Parkinson’s, obviously it’s a big struggle because they have massive balance issues. And his doctor did suggest that he not drink after 6 p so that it would minimize the amount. But clearly to your point, you got to push a lot of water earlier in the day if you’re going to implement that strategy.  Okay, good addition. Thank you. 

 

All right, well, let’s summarize. 

In this episode, we talked about incontinence overnight and we shared four tips. First is to transition into some kind of nighttime underwear. You really can’t not have underwear on at night and there’s lots of options. Second one was to protect the mattress. Third one was to make it easy to find the bathroom. And the fourth one is try to make your care receiver as comfortable as you can overnight.

 

Now, if you have tips that you think would help people around incontinence overnight, please share them on our Facebook page, our Instagram page. The links to both of those are in our show notes. 

 

And if you would do us a favor, if you like this podcast, please subscribe and rate and review it. We’d really appreciate it. Any products we discussed in this podcast will be also in the show notes as well. 

 

Now, incontinence overnight sounds like a lot. That’s because it is. This is a very difficult situation to manage. It goes through a very messy stage. It does get better, but it does not go away.

 

Sue Ryan

Give yourself a tremendous amount of grace. Check in with yourself. Is this something that you are feeling okay with or do you need to bring in someone to help support you or potentially consider moving your loved one into a care community? And again, family members, reach out, support your loved ones who are in this caregiving process, because there is a lot of the impact that is on them. We’re all on this journey together.

 

Nancy Treaster

Yes, we are.