Continence: Dry Nights = Happy Nights!

By Andrea Lord

Managing continence at home is easier if you use the right bedding.

Changing a wet bed in the middle of the night can almost be the last straw. Fortunately, there are many bedding products to help you manage continence problems, tummy bugs, sweat, spilt drinks, and other catastrophes.

The best option is an absorbent bed pad and a waterproof mattress protector. Additional options are waterproof pillow and duvet protectors and some form of floor protection, as spills can spread a long way.

Absorbent bed pads or sheets can be placed on top of the bottom sheet and positioned under the waist and thighs. They can also be used as a back-up in case of unexpected spills.

The heavier the incontinence, the more fluid capacity or absorbency you want in a bed pad.

Bed pads may be washable and therefore reusable, or disposable. If solely using the absorbent bed pad, the user needs to sleep in direct skin contact with the top ‘feel-dry’ surface of the pad, and should ideally be naked below the waist.

For any ‘upward wetting’, common when males lie on their back, an absorbent bed pad can be tucked in over the person.

Some bed pads have flaps or wings at the sides which can be tucked under the mattress to help keep them in place. These are especially recommended for restless sleepers.

Products without tuck-in flaps may have a high friction for skin. Those with a nonslip backing will help the pads stay in place.

Washable or disposable?

Reusable or washable bed pads are useful for people with urinary incontinence, but are not generally recommended for people with faecal incontinence because of staining. Sprays and ointments may also cause stains and interfere with the absorbency of the product.

There are many different washable, reusable bed pads on the market. The main points to note relate to the bed pad construction. Absorbent bed pads generally have a ‘stay dry’ top surface and thick, absorbent under layers. The bed pads may have a waterproof backing or require a separate waterproof draw sheet or mackintosh. The ‘skin side’ of a bed pad should be smooth enough to minimise friction and allow the sleeper to move freely without experiencing any skin injury that could develop into a pressure ulcer. The top surface is usually made from fabrics such as polyester and polyurethane which feel dry to touch.

Manufacturers using cotton or poly/cotton facings generally claim good, dry comfort. As fluid passes through the top layer it moves to the middle absorbent ‘soaker layer’ or inner core, and is held there, away from the skin. Good products should distribute the moisture evenly over the entire pad to avoid saturation in just one spot, preventing irritation and promoting odour control.

The absorption capacity of the inner core is often detailed in a product’s description. Absorbent cores are usually made from rayon and/or polyester. There is no evidence that one material is superior to the other.

The third layer in a bed pad is a waterproof backing, which may be an integral part of the pad or come as a separate item. A variety of plastic backing materials are in use; generally, softer, more compliant materials are better at keeping the bed pad in place, but they are not so durable.

Some companies have a ‘domestic’ version of their product with a softer plastic, and a ‘hospital’ version with a more durable backing to withstand the fiercer conditions of bulk commercial laundering.

Pads without a waterproof backing dry more easily, and some people find using a bed pad with a separate waterproof backing easier to manage. Typical backing materials for leakage protection are vinyl, rubber and polyurethane.

Normally, the top and absorbent layers are quilted together to prevent uncomfortable creases and to reduce rubbing, which can form uncomfortable balls of fibres between the two layers.

If you choose reusable pads, look for finished or bound edges that will hold up better through machine washings … but beware of hard stitching which can potentially damage skin. Also look for products containing no PVC, and certification for testing of harmful substances, as many chemicals are used in the textile manufacturing process.

Bed pads are available in several sizes, often determined by the size of the bed needing protection; generally they are similar in width to a single bed (about 85cm x 115cm). Larger sizes will cover a bigger sleeping area and offer ultimate wetness protection. The tradeoff is that bigger products can be more expensive, take longer to dry, and are heavier to handle during washing. Prices range from $20 to $40+ depending on size.

Draw sheets

Draw sheets are cotton, half-size sheets used in conjunction with waterproof (usually plastic) undersheets or mackintoshes. The draw sheet and mackintosh combination only absorbs a small amount of urine and does not provide any odour control. This approach is only useful when protection is needed for a small area. If used, the mackintosh is placed across the bed, on top of the bottom sheet, to lie under the person’s hips. The draw sheet is then placed on top of the mackintosh.

Disposables

Disposable bed pads are also known as ‘blueys’, JPs, underpads, and Inco sheets, and are ideal for temporary bed protection such as during clinical procedures (e.g. enemas) or when using a urinal. They can also be used as a back-up in case a pad or other body-worn product leaks. Disposable bed pads are usually simple rectangles of different sizes to be used on the bed. They vary greatly in their quality, thickness and absorbency.

Some are sealed on all four sides, others on only two. Some are ‘quilted’, which may assist urine distribution. Larger disposable pads may have wings to tuck into the bed. Discreet disposal of disposables can be a challenge.

The possibility of using a mix of disposable and washable products should be considered.

If you are going away from home, it is best to use disposable products, as access to washing facilities maybe difficult.

Disposable pads are usually sold in bulk and range from $36 to $99 for 100. The price variation is due to the degree of absorbency provided by the pads.

Useful bedding things!

• To protect mattresses, pillows, blankets, duvets and sleeping bags there are washable protectors or covers, available in a range of sizes, styles and fabrics. These help to minimise leaks and stains, reduce laundry, and save on replacing worn bedding. Ideally they should be made of an air-permeable waterproof backing, maximising comfort and minimising the risk of allergies and skin irritations. It is important to remember that these products are waterproof but not absorbent.
•  Mattress covers can be made to measure. Some work like a fitted sheet, others completely envelope the mattress like a duvet cover. Purchasing two mattress covers for the bed means you have one ready to use while washing the other. Prices range from $30 to $40 up to $100+ for the largest size, suitable for bigger beds.
• For profuse sweating or drool, a waterproof pillow protector placed between the pillow and pillowcase is good option. Using a duvet or quilt protector is also a sensible management option to protect blankets or duvets from spills or leaks. You can also buy waterproof pillows and duvets. Prices for pillow protection range from $12 to $25+ and the duvet protection prices start from $50 to $60.
• A washable absorbent mat placed beside the bed can also be useful. The non-splash surface absorbs fluid, protecting carpets from stains and odours. The mats are designed to sit firm and flat on the floor to help prevent trips and allow frames and walkers to travel over safely. They are easy to wash by hand or in a top-loading washing machine, and dry quickly on the clothesline. Prices range from $40 to $50+.

There may be funding available for these items through the Disability Allowance and Work and Income, ACC and (depending where you live) your District Health Board. Talk to your local continence advisory service to about available funding for your situation, or seek advice from the national Continence Helpline, (0800) 650 659.

When accidents happen

• Cleansing of skin soiled with urine or faeces should occur immediately if possible, or promptly after episodes of incontinence.
• It is useful to have an emergency ‘accident kit’ close to the bed, or nearby. This bag or kit may contain disposable gloves, toilet paper, nappy wipes, a bowl for washing, soap or skin cleanser, skin barrier products, replacement bed linen, spare night clothes and/or pads, a container (in case the person needs to pass urine during the linen change), towels to wash and dry, plenty of plastic bags (for soiled items), antibacterial and odour remover spray, and hand sanitiser gel.
• Be sure you have everything you need before you begin. Gather your supplies next to you on a stand or table so they are within easy reach.
• Using disposable gloves, use toilet paper or tissues to collect any faecal matter; place in plastic bags to be flushed down the toilet later. Change gloves as often as you need to; place soiled ones in the ‘rubbish bag’.
• Larger sized disposable wipes or nappy wipes allow for quick, easy clean-ups and might be a better choice when using wipes for faecal incontinence. These wipes can be purchased at pharmacies.
• Once the bulk of the soiling has been removed, the person can shift onto a clean towel whilst soiled linen is placed into a plastic bag for laundering later.
• If it is not possible to use the bath or shower, wash the person using a bowl of warm soap and water, ‘bed bath’ cleansing wipes, and/or skin cleansers. Nappy wipes or cleanser may be less time-consuming than soap and water. Look for nappy or moist toilet tissues that are alcohol free, unscented, or fragrance free, as these can irritate sensitive skin.
• Wash the genital area gently, wiping from the front to the back. After cleansing, gently dry the area with a towel or (for fragile skin) a hair dryer on a low setting to maintain skin integrity.
• After cleansing the skin, products such as moisturisers or barriers can be applied to the areas that come in contact with urine and/or faeces. Some cleansers or wipes also incorporate moisturisers. A product that is pH balanced and made without dyes or perfumes that can irritate is recommended.
• Once the person is clean and dry, change into clean night clothes, pads etc. Wash your hands and replace the bed linen and bed pad.
• Wash soiled clothes or bedding immediately, or you can soak them overnight in Napisan in an airtight container until you have time to wash them. Faecal material must be removed before washing.
• Clean any areas which may have been soiled using detergent and water. Always wash your hands thoroughly with soap and water or alcohol based hand sanitisers after handling soiled materials.

Laundering reusable products

A good quality reusable product should be machine washable and safe to tumble dry, so access to good washing and drying facilities is vital. To prolong the life of these products, care must be taken to ensure that they are washed according to the manufacturer’s instructions.

Contingency plans for washing and drying machine breakdown should be made from the start. Usually everyday laundry powder is fine to use on most products, but do not use bleach or fabric softener on absorbent products. Fabric softener coats the fibres and they become less absorbent. Using a warm setting on both washing machine and drier (settings that are too hot could melt the waterproof layer) is also recommended.

Soiled items should be washed separately from other household clothing and linens using warm/hot water for hygiene reasons. Any faecal material must be removed before washing. If any traces of faecal material, odours or stains remain, presoak in Napisan or similar before popping items into the washing machine. Washing of outer as well as under clothing is recommended to reduce odour caused by absorption of gas by clothing.

It is a good idea to wear disposable gloves, and always follow good hand hygiene precautions by washing hands thoroughly after handling any soiled materials. The use of alcohol-based hand sanitisers is very useful. Good cleaning practices using detergent and water is sufficient to clean other areas which may have been soiled.

Across New Zealand there are a limited range of laundry services which will collect and return linens. There are also services which hire bed linen to people who are unable to launder in their own homes. Charges may apply. To find out if there is a service near you, contact your local DHB-based community district nursing service or companies such as My Laundry Bag (available in parts of the North Island).

Laundry turnaround times and frequency of incontinence will determine the number of reusable bed pads needed. If there is incontinence most nights, a purchase of two to three bed pads will allow for washing and drying time so a spare is always available. Washable pads cost from $40 to $150 each depending on size and quality.

For a list of pad suppliers, visit the website of the NZ Continence Association, www.continence.org.nz, or phone the free national Continence Helpline, (0800) 650 659.