Dealing with nighttime urination

UnusedScreenName

My 92-year-old dad has been living with me for 2 years now, and has gone from being mostly independent with IADLs and doing his own laundry, to regular urge and functional urinary incontinence (now wearing Depends day and night) and most days needing step-by-step assistance with getting dressed and undressed, getting under the covers to go bed, showering, and pretty much any multi-step activity. 

He has kept a urinal bottle by the bedside for a number of years (he has an enlarged prostate), since before he came to live with me, but he doesn't always remember to use it.  About 6-8 months ago I removed the trash can from his room when I realized the reason his room stank so badly was because he would pee into the trash can at night and it would go unnoticed until it became rank.  He sometimes pees into his dirty clothes hamper, which is not a big deal, actually, because I'm doing his laundry nearly every day now and of course, the clothes in the hamper are nice and absorbent.  He has a large washable bed pad in case of accidents, which are invariably associated with getting up to pee in the middle of the night (he's not spontaneous draining while in bed), and occasional fecal smears, and I'm trying to prevent his newest practice of folding the pad up or turning it over (waterproof side up) from becoming a habit.

I occasionally find, when getting him up in the morning, and less often when helping him get into bed when he has started the process himself, that his Depend underwear is on his thighs instead of around his waist.  Obviously, it's not protecting anything that way.  I think what is happening is he is lowering his underwear to pee at night (in his room), and then not pulling it up again.

I had thought we were doing a pretty good job of keeping the floor dry, but I've started noticing dribbles in his room again, and then last night at 3am when I was up in the living room, I heard the distinctive sound of pee hitting the ceramic tile floor.  Dad was standing half way across his (small) room headed towards the door, with undergarment down and aiming hand in position, emitting a good, strong stream right onto the floor; the urinal bottle was in its usual place next to the bed, empty, and when I handed it to him he couldn't figure out how to use it.

I'm at something of a loss how to deal with this.  His behavior is too erratic for me to simply work around it with any kind of a system that I can think of.  Any suggestions?  I'm thinking about putting down an absorbent mat on the floor, but then that poses a trip hazard, and of course I'll have to clean that, too.  Any device that he has to wear stands the risk of being removed, and various devices I see advertized aren't any easier to use than his dirty clothes hamper and anyway he would have to remember to use them.  He can't even remember to simply keep his underwear up and pee into it if he can't make it to the bathroom.

Ideas welcome.

Rebeccah

NizhoniGrrl

This is a really tough one! He may be getting to the point where he really can't be left alone. It might be time to start exploring in-home support or placement someplace he can have more supervision. You're definitely reaching the point where it may not be feasible to care for him alone at home (or fair to your quality of life either).

UnusedScreenName

Of course, today he remembers none of the events of last night and clearly doesn't really believe me.  I didn't push it, but I just spent a couple of hours moving furniture out of the room and displacing other furniture so I could mop the whole floor.  Ugh.  Thank goodness for ceramic flooring and a bathtub faucet to rinse the mop out in.

Maybe I can find a motion detector alarm that I can turn on at night and off in the morning, so that I know when he puts his feet over the side of the bed.  In September we flew across the country to visit my brother's family for a week, and after due consideration, rather than staying in my sister-in-law's huge, unfamiliar house on the second floor, we stayed in a 2-bedded handicapped-accessible hotel room.  Dad got the bed near the bathroom, and whenever he got up, it woke me up so I could direct him in the right direction.  No accidents, there (and this was pre-Depends, although I did bring a bed pad).

Rebeccah

harshedbuzz

Rebeccah-

A couple ideas come to mind.

1. Better overnight undergarments. Depends are often fine during the day, but many people prefer something more substantial for overnights. A lot of folks swear by this outfit-

Adult Diapers & Incontinence Products | NorthShore Care Supply

2. A motion detection mat that would alert your smartphone that he's on the move. This might give you a chance to actively toilet him and avoid cleanups. It might also interfere with your sleep if he's up a lot.

3. Putting him in a onesie style pajama which he would prevent access to his undergarments/undressing.

Sleepsuits - Sleepwear - Men's Adaptive Adaptive Clothing for Seniors, Disabled & Elderly Care (buckandbuck.com)

Back-Zip Jumpsuits - Jumpsuits - Men's Adaptive Adaptive Clothing for Seniors, Disabled & Elderly Care (buckandbuck.com)


4. Maybe he would be more likely to hit a chairside commode than a handheld urinal. 

HB

Paris20

I buy the most absorbant pull-on underwear and place the most absorbant pad inside it. The underwear is pin-striped so I tell my husband it’s Yankee underwear (his favorite team). Then, I put two absorbant pads on top of the bedsheet. I also have a mattress protector. All those layers do the trick. Even those two pads remain dry most nights.

DrinaJGB

If this is fairly new behavior perhaps having him checked for a UTI would be prudent.

UnusedScreenName

Thanks for the suggestions.  I will keep the jumpsuit/onesie pyjama  idea in mind for later, as I had never heard of them.  For now, I'm checking up on him at different times to see if I can see what is triggering him pulling down his underwear.  I discovered something interesting this morning -- when he is peeing at the toilet in the wee hours, he (at least sometimes) pees out through the leg in the underwear rather than lowering the waist.  That may explain the occasional drip on his trousers during the day, if he's opening his fly and not pulling everything down.  I've discussed with him to sit down to pee, but he doesn't want to.

I had thought about a chair-style bedside commode, but if his performance at the toilet is any indication, I don't think it will help.  I think the inability to use the urinal bottle was specific to the situation, where he was half-awake, confused, already mid-stream, and distressed by my reaction.

I thought about better absorbent undergarments, too, but he's not filling them since I went to twice-daily changing them whether he thought they needed it or not.  He's only had one episode of undergarment leakage, and that was before I went to twice-daily changes.

Wetting the bed isn't a problem at present - my current strategy of 1) waterproof mattress cover; 2) large washable absorbent bed pad, draped over the edge of the bed on the side he gets out on; and 3) Depends Fix Flex at night seems to have that well under control.  Most times, when I have to change the bed pad it's for small fecal smears, not urine, but he occasionally has coordination issues with the urinal bottle that end up with the bed pad wet.  Neither of those occurrences is an every-day thing -- most nights he is able to either get to the bathroom or use the urinal bottle, or both.

I remembered that I have an old baby monitor, so I set that up in his room on Wednesday.  That's what got me up early enough today to catch him heading for the bathroom in time to notice about peeing through the leg hole.  I think I'm going to try that for a while.

Thanks again for the suggestions

Rebeccah

UnusedScreenName

Just wanted to give an update...

Dad's incontinence has been getting worse, and at night he was regularly removing his underwear and then dribbling all the way to the bathroom the next time he had to pee.  He went from sometimes forgetting to use the bedside urinal to rarely even trying, and always making a mess when he did - so I removed it from the room.

What I've done:

1.  Bed protection includes a fitted sheet-style protective topper, a large (54") absorbent bed pad draped across and over the side of the bed, and a medium size bed pad on top of that.

2.  Floor protection in the bedroom currently includes two non-slip puppy whelping pads (very thin) covering a large area of the floor, with a moderately large, thin, latex-backed polypropylene rug on top, near the bed.  I added the puppy pad below when I found that enough washes of the polypropylene rug had left the latex backing less than completely waterproof.

3.  I put his shoes far away from the bed when he goes to bed, so he doesn't pee on them in the room and doesn't reach for them when he gets up to go to the bathroom.  The slippers that are within reach are machine washable.

4.  I've got absorbent pads on the chairs he uses, now.  I also got a long, narrow pad specifically designed for the sofa.  It's kind of crunchy and doesn't breate my sweat all that well, with a polyurethane waterproof barrier inside of it, but it's reversible and fairly unobtrusive.

5.  Bathroom floor protection includes another polypropylene rug, with a thick, cotton rug on top of it, in front of and overlapping the base of the toilet.

6. I have a baby monitor in his room, with speakers in my computer room and my bedroom.  I can hear when he gets up.

7.  Biokleen Bac-Out stain and odor remover spray in the Lime Essence scent.  I spray every time he uses the toilet or wets the floor (much less often now, see below), and I have occasionally used it on his slippers or a bed pad.  The bathroom doesn't stink any more, even though I can't really clean the toilet well without unscrewing the seat riser.

8.  We've transitioned from pants with a fly, that need a belt or suspenders to hold them up, to elastic waisted shorts.  Thank goodness we live in southern California, where he can wear shorts year around.  Now I don't have to worry about him getting poop on an unwashable belt or suspenders.  He definitely prefers to urinate out the leg of the underwear, and shorts facilitate that.

9.  I'm testing out different absorbent undergarments.  The current favorites are McKessen Extended Wear for daytime and Depend Night Defense for night-time.

10.  I got a pair of Little Keeper Sleepers in size XL, to prevent his removing the underwear at night.  This has been a LIFESAVER.  He cannot get it off.  I got the style with short(ish) legs, so that he can still pee out the bottom when he goes into the bathroom.  I have no trouble getting it on him at night, he understands what it is for and accepts it.  Once or twice a week we have an issue after he has gotten in bed, where he wants desperately to get it off, and will complain bitterly that I'm killing him.  After several weeks of this, I am realizing that when he wants to take it off, it's not (as he originally complained) because the neck is too tight, but because his crotch is irritated.  Twice now, I've suggested that he take a shower right then, he has accepted the suggestion, and he contently goes back in the sleeper again afterwards and goes to sleep.  One other time, it was enough to change his underwear (it was only slightly wet, but it was a snugger fit than some ot the other ones we've been trying), and he took a shower in the morning.

He has now started removing his underwear sometimes during the day, and I've warned him that if it happens again, I'll be looking for daytime clothes that he can't take off.  He appears to understand.  As with the night-time removals, it's because the underwear has become wet and uncomfortable - at least with the nonremovable clothing, he will complain to me and I can deal with the situation appropriately instead of having to search for the wet underwear and hope I discovered it before there was an accident.

11.  After finding urine in the clothes dryer, I put a trio of baby locks on the door to the garage, up high where he can't reach them.  They are the kind with an adjustable length plastic strap and a snapping closure that you stick on with double-sided tape.  I started with just one, but he kept on trying the door until it came apart.  Fortunately, I was able to find all of the pieces (there was a little tiny spring under a piece of furniture) and put it back together, and reinforce it with two more.  He pulled one of the three apart with a second attempted foray, but after my explaining several times why I didn't want him in the garage unsupervised (a VERY exhausting conversation!) he hasn't tested the baby locks any more.

12.  After finding skidmarks on the bowl and a poop smear on the lid of the upstairs toilet, and the next morning finding a small turd on the floor near the toilet, I'm trying out better strategies for locking doors of places I don't want him to go.  He also, it turns out, has been peeing when he is out on the front porch.  DH saw him doing it and told me, but I was on the toilet myself and DH wouldn't stop him.  (GRRR!)  Anyway, I got the GlideLoc top door lock a couple of days ago to test out, and it's fabulous.  I put it on the front security door so that when Dad opens the door at night (which he sometimes does), he can look out (clothed in his sleeper), but he won't be able to wander off.  This lock only requires one screw into the top of the door frame, and can be opened and closed from either side of the door, so I can't accidentally lock out DH or myself.  I'm going to order a couple more of them for the upstairs bathroom and my bedroom, and may replace the baby locks on the door to the garage as well.

13.  It's amazing, the value of explaining to Dad what I am doing to cope with his behaviors, and why -- even though it requires a lot of repetition and patience, and still doesn't always stick.  For a while, he was rolling up or removing the bed pads, but after I explained to him why they were there, and the fact that they are waterproof on the back side to prevent the bed from getting wet, he quit doing that.  He still forgets to lift the seat riser before he pees, but he's finally more than 50% successful at not specifically putting it down either before or after. (If the riser is down when he pees, it gets peed on and the pee runs down the outside and into inaccessible crevices.)  I'm also far more attentive to when he is using the bathroom, and raise the riser myself if he has put it down and already left the room.

 Oh, and it seems the underwear sliding down off his butt at night is a function of how snugly it fits and how much weight of urine it has absorbed.  It slides down sometimes, even with the sleeper on.  The sleeper is helping me to evaluate the effectiveness of the underwears we are trying out, as it's a pretty effective leak detector.

So, hopefully my experiences may help someone else in navigating this minefield.

Rebeccah

May flowers

Rebeccah,

I just wanted to say thanks for sharing your experiences with nighttime urination. My FIL has been taking off his diaper/pjs and he is soaked head to toe every morning. This is with multiple changes at night too. We got a zip back PJ that was so baggy he was able to pull his arms in and undo his diaper. We tried the little keepers sleepers after reading your post and it is much better. He cannot pull his arms out and the zipper up the leg is much easier for changing!

JJ401

 I got a pair of Little Keeper Sleepers in size XL, to prevent his removing the underwear at night.  This has been a LIFESAVER.  He cannot get it off.  I got the style with short(ish) legs

Where did you buy these? If on the net, could you post a link?

May flowers

I hope Rebeccah doesn’t mind me answering, I got them at https://littlekeepersleeper.com/

My FIL is 5’10ish and 125lbs and I ordered a size 16 (kids size) I got the full length onesie. It fits him snug but that’s what we were looking for.

By the way, I thought FIL would fight a onesie but he seems to like it. I wonder if it is having a swaddling effect like it does infants. 

MsWarren66

Question what can you do when the person doesn't want to take off the depends How do you handle that?

beejay637

I'm very new to both this site and my DH's advancing incontinence issues. After several middle of the night bed changes, I now put down a large waterproof pad, a fitted sheet, another pad and another fitted sheet. I don't tuck the top sheet or blanket under the mattress. Now, I simply pull the top sheet and blanket down, strip the wet fitted sheet and pad and get him back in bed. So far, we're not having to do that more than once a nice. I've found the placing the pads under the sheets keep him from even noticing they are there. I'll also use some of the above suggestions to find better overnight underwear.