Incontinence, overnight diaper changing, bedsores, opinions please

I noticed when researching this question that the answer depends on who you ask. Should incontinent sufferers be woke up during the night to have the wet disposable diaper pants changed and be cleaned up? Here is my school of thought but I welcome advice because I'm unsure. I've always been a big proponent of a good night's sleep being the best medicine, so I just hate waking Daddy up. As it is, due to sitting and laying down 24-7 for many months, the pressure point of the tailbone, (pressure points being anywhere there is little 'meat' between skin and bone, like heels, elbows etc,) was getting no blood flow and it caused him to develop a bed sore. I'm sure urine or excrement would make that wound worse and hurt. I'm going in and waking him (as little as possible,) to roll him from one side to the other to keep him off the wound on the tailbone, every couple hours. He's a 6' tall, 200 lb man and I'm a 150 lb 50 year old woman, so it's not easy particularly because in the middle of the night he's less responsive and at times, like when he has any other medical issue going on, he's more confused and has even hallucinated. (Even not having had a bowel movement for a few days does this, including the hallucinations which are NOT frequent thank God because it freaks me out and I want to help him so bad and of course, can't). Anyway, I want to get a better brand of adult diapers and pads and use 2 pads in the diaper for overnight. I mean, when my daughter was a baby I sure didn't wake her to change her diaper. I used ample padded diapers for overnight which wicked the wetness away from her and she never once had diaper rash. I read that in some nursing homes they wake the residents every 2 hours to either walk them to the bathroom or check to see if they need changing. That would be horrible and would totally disrupt any chance for a healthy sleep pattern! I read about someone saying they used towels in the overnight diapers. WHAT ARE YOUR THOUGHTS?? When a sufferer becomes incontinent and also has to spend most their time in bed, (in Daddy's case due to weakness and bodily stiffness,) how often should they be changed during the night if at all and how often do they need to be rolled over? (I'm in the US, are there any particular brands anyone recommends? I want to check out the Teva brand, read some good reviews for overnight pads and diapers.) Due to the PSP Daddy's body is oh so stiff, he can barely move and at times, he can't at all especially his legs. He's even said before he's telling his leg to move and it's not moving. How scary that must be to KNOW and be aware. Ok now I'm in tears, but I really need to figure this out because I'm the only overnight carer for Daddy. (adding tags: pressure ulcers, nappy rash, diaper) Thanks yall. And one other thing, the "pressure ulcer" or bed sore, (a thorn by any other name is still a thorn,) is almost gone in a week which surprised me because it was slightly ulcerated. I suspect we caught it very early and have taken measures immediately to get rid of it, but it's taking a toll on Daddy because it's preventing him from sitting in his lifting recliner in the family room. He's stuck in his bedroom where we his carers check on him frequently but he always seems depresssed when he's stuck in the bedroom full time and I don't blame him for feeling like that but he's so weak it makes him too difficult on individual carers to transfer him from bed to wheelchair to recliner. Ok, I'm really ending this THIS time haha and thanks again!

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  • My only comment is that I want my dads pad changed every 4 hours because he is always soaking wet after 4 hours so my opinion is yes, wake them, my dad goes straight back to sleep after being changed as he is more uncomfortable being wet!

    Ask yourself what you'd prefer to be dry but woken up for a few minutes or lie in a wet pad possibly lie in pooh?!

    That's my very brief take on it

    X

  • Not so with my father. He can't lift his hips off the bed so changing his briefs and disposable bed pad means rolling him from side to side several times. This wakes him up to the point of not being able to sleep. He can lie awake in bed for hours and hours overnight and when this happens, he often begins to hallucinate. He's always had a hard time falling to sleep. However if he's known to be wet, he gets changed but he's not changed on a schedule of waking him in the middle of his sleep, for now anyway. When he's not comfortable it will wake him up and I keep a sound monitor by my side all night to hear him. All he has to do is call my name and I'll be there. (That's a song I think, a young Michael Jackson lol!) Hey thanks for your input!

  • Hi hun talking as a trained carer i would recommend to double pad him. The most absorbant that you can get. The outer ones i used were like pampers that fastened at the front.the inner one was a shaped pad make holes in the inner pad to wick away the urine that way his skin will stay dryer for longer. And a good barrier cream. The less you have to disturb him the better (less pain and stress on all).

    As for turning i only turn Brian once in the night. The carers leave him propped up on his back and when i go to bed i put him on his side and when i get up to spend a penny i use his kylie to flip him onto his other side. And then when i get up in the mornings i flip him on his back.

    But your best course of action would to either get convien catheters (or even a catheter) that way he will stay dry and skin will heal better.

    Hope this helps. Janexx

  • Guess what, we're already doing everything you said except ONE thing which is absolutely BRILLIANT... poking the holes! I LOVE that! AND guess what ELSE! His bed sore is like, miraculously about 90% healed if not more, the nurse who's come over to check on the issue can hardly believe her eyes! Thank you so much for your comments! And oh we're also not doing catheters and I dont know much about them yet except I believe he'd need surgery as since he's 81 and has always had heart issues, we'll avoid surgery as long as possible. Just yesterday I found what sounds to be better, more absorbent and better wicking away from skin briefs and pads that go in the briefs. The briefs have tabs that are repositionible so the pads can be changed without the whole ordeal of waking him enough to move him back and forth a dozen times to change his briefs. His body is so stiffened he can barely move and he's 200 lbs. But I'm going to google the convien catheters to see if that's different than I'm thinking. Thanks again and wishing you a great day and many blessings!

  • Good on you. But there is no operation to fitting a catheter. A tube is inserted in the natural outlet. But if he can wear a convene that is a better option.

    If you google indwelling catheter at the same time as convene you might have a better idea wich will be best for your dad.

    Good luck. Janexx

  • My personal opinion is, if somebody is asleep, then leave them! Unless you need to for some acute medical condition. Also, as his only Carer, you need to sleep for as long as possible as well and getting up at silly o'clock, it's NOT attending to his overall welfare.

    Lots of love

    Heady

  • Thank you Heady! And thank goodness that I'm actually his only caregiver during part of the hours of a day and night. I'm always the only overnight and usually part of the afternoon and evening. I spend more hours with him than anyone else. Lots of love to you too sweetie!!

  • Does your dad have a hospital bed with a ripple mattress which has air changing where the pressure is on his body? This helps avoid sores on pressure points. If he has, he shouldn't need turning very much. Has he tried a convene? When my husband urinates in the night, urine is all collected in a bag so he is never wet, apart from on the rare occasion it has come off. I or his carers always clean him up straight away if he is soiled as tender skin can soon become very sore.

    It's a shame he is in his bedroom all the time. It doesn't sound as if you have a hoist to transfer him from bed to chair. Any chance of getting one?

    My husband lies on a disposable incontinence sheet without any clothes on the bottom half of his body. It's easier to clean him if we don't have to remove pads or pants etc.

    We as carers need sleep but my husband sleeps a lot during the day and isn't really awake if I change him at night. Sometimes I have to change all the sheets and pillow cases as he sweats so much. It's difficult putting him into the recovery position to remove wet sheets and put new ones on but he quickly goes back to sleep again, if he wakes up. I can't leave him without changing him as he is them soaked from his neck to his waist, back and front.

    You will have lots of different views on this. Mine is that I'd never leave C wet if he could feel it on his skin.

    X

  • I think Daddy was sweating tonight and I just finished changing everything but it woke him up and he's miserable right at this moment because he can't get back to sleep yet he's very tired and weak. It's hard to win.

  • And Nanna B, thank you for the thoughtful reply, it helped.

  • And by the way YES he's on a hospital bed! The fluctuating air mattress arrived a couple days ago but even before then, his bed sore was healing VERY fast, thanks be to God! It's all but gone. We use the cream and overnight pads, disposable bed pad on top of a washable thicker absorbent waterproof pad that lays flat which is now on top of a what-cha-ma-call-it thick pad with handles that helps tremendously to roll him from one side to the other. He sleeps in NASA-created overnight briefs, with 2 Tena overnight pads. So, last night in the middle of his sleep, I changed everything damp, not wet, including his shirt, briefs with pads, bed pads, top sheet. It took 30 minutes since the PSP is causing his body to be very stiff and especially in the middle of the night he's SO weak and can help assist me in moving his body NONE. So it takes longer. And when Daddy wakes up, just as he's been all his life, he doesn't get back to sleep and as I just posted to another reply, he hallucinates when he's in the middle of the night and unable to sleep. It's a hard choice and a decision that may fluctuate depending on the condition of his skin of course and if he's uncomfortable enough to wake up. I'm listening to him overnight on a baby monitor and if he whispers my name, I go to help him. Kind of playing it by ear for now. And yes we sure do have the lift thing, the Hoyer but I'm not sure it's a Hoyer per se. It's on 4 wheels, 2 long bars along the floor that expand widthwise to accommodate furniture where Daddy is sitting on a big sling hammock, suspended from a metal bar system at the top which rises and lowers with levers, all very heavy duty, not electric but I can do it by myself so it's like magic! He wasn't wanting to sit out in the family room for much of the day, during the last week while he hurt from the pressure points and bed sore, which is the reason he's been in his bedroom so much, but he did today. He stayed in the family room for most the day today, in the recliner. I think his pressure points get sore when he's been in the rising recliner for very long like he's been doing for the last year. He's had PSP about 10 yrs and he's 81 years old. He's never said a word about giving up or being angry, nothing like that. He's not in the same mind though that he was before psp. It's greatly affected his thinking abilities. The last thing he wrote was in church when the preacher asked everyone in the prayer group to write things they're thankful for. I noticed his handwriting was so tiny I could barely see it, and later read that even that, something so unusual as tiny handwriting, was also a psp symptom. That was about a yr ago and at that time also he could no longer write the numbers in order 1-10 which was shocking for a man who once could do algebra in his head without pen and paper much less calculator. Thanks for reading. This is a difficult journey but there are many happy moments, with Daddy and for him, even still.

  • I agree with Heady and jzygirl if asleep leave change if he is awake and uncomfortable but double pad with most absorbent ones.

    I suggest if he has sores use the medication prescribed but then cover with Vaseline or other petroleum jelly as a waterproof barrier, old fashioned, this worked with my siblings(1950's) and children's (1980's) nappy rash, not the same sore but similar conditions. Remember though to thoroughly clean and reapply on pad change.

    Good luck Tim

  • Thank you Tim!! I appreciate your excellent advice and is pretty much what we've been doing, all except we haven't used the vaseline yet and have only used the expensive barrier cream, with the zinc. I told his wife about using vaseline so we will eventually use that also, as preventive.

  • I use a baby's ointment, a modified Vaseline-type, which smooths on a bit less stickily. It has kept his skin in good shape so far, and acts as a barrier to irritating urine. I also use wipes infused with a cleaning barrier cream on most changes.

  • Thank you, I didn't know they made a wipe infused with a cleaning agent made for cleaning off the barrier cream but I can easily understand the need. If the barrier cream is hard to remove then all the excess wiping could create the very effect using the cream is trying to avoid.

  • Sorry, I wasn't clear. The wipes are both clean the skin and leave a lotion-like barrier cream. 2 in 1, very handy.

  • I use Depends underwear nd guards for my husband. When he goes to bed at night the aide lines the Depends underwear with 4 guards. Husband still gets wet but not as much and only one mattress pad is damp. After trying different brands found Depends best. After having a problem with bed sore we now use imitation sheepskin under him when he sleeps and haven't had anymore bedsores. Luckily with the help of Rytary medication he gets up during the day. Wish you could get him up somehow and out of the bedroom. It would help with his back and depression or at least out of bed and into a chair. Wish I could help you more but will be thinking of you and praying.

  • All great suggestions Ollie, thank you. And we have been getting him up with his early morning caretaker, from about 7:30 a.m. until around noon. By then he's been ready to go back to bed because he's tired very easily. Oh and WOW 4 guards!! The bedtime caregiver was using just 1 overnight guard and a thin brief and it was NOT working. I convinced her to use 2 overnight guards. I'll tell her now that you use 4 and still get some wetness. (The last years of my menstruation I used 3 or 4 for overnight so I GET IT!) Thanks again!

  • I forgot to mention, of course, my husband is washed immediately when awakening in the morning and lotion applied. On a good day when he can walk a little the aide gets him in the shower and then to the living room and TV.

  • With our new carer, who is my best friend's daughter who just got her CNA and loves "old people" she gives him a bed bath every morning but does it with a pan of warm water and not just the spray stuff. There's no longer a way to get him into a real bath which I find sad. He can't walk and sometimes can't even stand, so the house would have to be remodeled and his wife isn't going to do that.

  • Look into the option of a straight catheter. It's weirdly easy if there are no prostate issues, and you can drain his bladder before he goes to sleep and keep him dry longer!

  • I just googled that and it looks uncomfortable for the sufferer and difficult to maneuver for the carer but maybe I'm just scared to do it. In fact I'm breaking into a (rare) cold sweat just thinking about it. I realize you're right it's something that suddenly needs to be considered and faced.

  • I was given a 2-minute demo by the visiting nurse, and it never bothered my guy at all. It's just that his prostate is too enlarged so that obstructed the tube and so we couldn't continue. Wish we could have! It WAS intimidating at first, but not difficult, truly.

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