Expert: Mary Gordon - 7/23/2010

Question
Dear Mary, Thanks for helping. And, here I am again.
My mother has been incontinent for nearly a year now. While we use an adult diaper during her walks-we do not use anything at home. We do however take the to the bathroom once every hour in the daytime. If there are accidents we just deal with it-so that she can forego the discomfort of a diaper. Earlier in the nights we used to wake her up every two hours and take her to the bathroom-this was a perfect solution till about 4 months ago. Now she wets her bet every hour in the night or even once in 45 mins. We are not sure if waking her up every hour is good for her. Secondly I've seen senior citizens in old age homes who are regular diaper users with severe skin rashes and other problems--something I want to avoid for my mother-her is very fragile and dry. I have no clue what is best for her. Is it okay to be in a diaper the whole night?  will she develop skin rashes or other problems?  Most doctors and others working with senior citizens tell us we will have to work out a way that is best for ourselves.Please help. Thanks very much in advance.

Answer
Hi Nimi, absolutely it is possible to be in adult diapers and avoid rashes. Why you tend to see seniors in institutional facilities with rashes is really a product of neglect - they are not being changed often enough, and barrier creams applied. It is no different than with a baby - other than when there is a yeast infection, the majority of diaper rashes are basically skin irritation from sitting with moisure from acidic urine moisture near the skin for too long.  

I'm the mother of three, and when my babies finally started sleeping longer periods in the night such as a five or six hour stretch, I wouldn't wake them up to change them if they were just wet.

My personal bias is that during the day, you can use whatever product works best - there are gel inserts, for example that go into underwear with a "pocket" to hold the insert in the crotch. There are adult "pull ups" that are like underwear - these can be handy in that they are just a back up for an accident. If you are taking her to the bathroom successfully during the day, they can just be pulled down. There are a range of actual "diapers", from cotton, to disposable.

One downfall of cloth diapers is that you must use a plastic pant cover to prevent leaking. These can increase the temperature within the diaper area and transform it into a breeding ground for germs. This is one reason that many people choose to use disposable diaper to prevent adult diaper rash.

At night, I would suggest one of the modern disposables with gel that are designed specifically for night use. They are designed to hold a LOT of moisture, and to wick all moisture away from the skin, unlike the older types of cotton diaper. They also fit better than the cotton kind. You may have seen modern baby diapers - they have come a long way even from the 12 years it's been since my youngest was in diapers, and light years from my own childhood 54 years ago. The daytime pads and inserts can shift in the night, allowing leakage, but the diapers will stay put if they are the right fit. Also, at night, you will not care about bulk - but during the day, you will want a more discrete product that is not visible under clothing.

Fit is important, as you do not want chafing to occur - it should fit snuggly and comfortably without being too tight, and there should be no irritating folds (i.e. if it is wadding up into folds, it may be too big).

You might have to try a few products to find what works best for you. However, I really do think it's time to take steps in that direction. It is disruptive to everyone to have to try to get her up every few hours. She needs her sleep, and so do you!

You also need to get a good barrier cream containing zinc oxide or silicone, just like you would for a baby, to keep moisure from her skin. There are a range on the market - again, it comes down to personal preference. I like the ones that are easy to apply spread - but some people swear by the very thick pasty ones. These creams often have anti-bacterial agents in them and usually clear up mild to moderate cases of diaper rashes very quickly. If a rash doesn't clear up easily, it may be yeast related (they are nasty and fast moving rashes) which might require a trip to the doctor for some medicated cream. I only had this happen once with one of my children, but I have very vivid memories of it - one day there was a red spot the size of a dime and by the next day, his entire groin looked like someone had taken a scrubby pad to it. It spread like wild fire, but it was an infection from yeast (caught from a caregiver who did not wash her hands properly) and not from infrequent diaper changes.

t is also a wise idea to let the diaper area completely dry after a diaper has been soaked. You can additionally clean the area with a soft cloth and a very mild soap. Having a good hygiene regime is the best ways to prevent adult diaper rash.

Here is a site that offers every kind of product going. http://www.idiaper.com/For-Women_c_36.html
I am not advocating buying anything from them, but you can browse the site and at least get an idea of what kinds of products are available for purchase. They also have a nurse on line who can answer questions about problems and the products. Once you have an idea of what product you might prefer or like to try, you can shop online or locally for the best price.

There are absolutely dozens of on line stores (i.e. http://www.adultdiapers.org/whdi.html and there are many sites that offer product reviews
http://www.consumersearch.com/adult-diapers

Hope this helps. I'd have a good look at the products available, and give some a try. I really don't think rash is inevitable. My own mother in law became completely incontinent about 2 years before her death (both urine and fecies) after a fall. There was never a serious problem at all - she did get some minor rashes a few times (warm weather didn't help!) but they were quickly and easily cleared up and she was not made uncomfortable at all.

Mary Gordon
Toronto