In an effort to not re-invent the wheel, I refer you to Home Delivery Incontinent Supplies co., Inc.

The Assisting and Supervision Stage of Incontinence Care

The Taking Charge Stage of Incontinence Care

The In Charge Stage of Incontinence Care

In an effort to not re-invent the wheel.  I am going to refer you to ...

Home Delivery Incontinent Supplies Co., Inc.  (HDIS)

...not just a catalogue but a resource tool on adult incontinence products. 

  This company will give you a catalogue complete with pictures, descriptions, a list of the brand names, and how to order them.  Their deliveries are in plain packaging, they are extremely helpful through their hot line, and they are a nation wide company.  I believe they also accept discount coupons for product brand names.  They carry all the brands.  They will send you a sample pack of a variety of products upon request for you to try out and a full catalogue which will allow you to look at and examine the products at your leisure. 

  Their 800 number is:  1800 269-4663    Their Web Page:  is:  www.hdis.com

The products fall into these categories:

I will be referring to these various products throughout this section of the web page and I will be breaking the tasks and techniques into the Three Stages of Care because there are different needs and different techniques for the different stages of this illness.

The Assisting and Supervision Stage of Incontinence Care

Until the 'accidents' become more than very infrequent happenings, you will be relying on reminding them, hovering to help with fastenings of their clothing, helping them find the restroom in public places and generally taking a somewhat benign approach to the increasing hygiene problems.

Towards the end of this stage this will begin to change.  The 'accident's will happen more often, the race to the bathroom will get more frantic, you won't be able to trust them completely on their own in public rest rooms because of the increasing problems with managing their clothing, and the constant reminders won't work.  

They aren't wiping themselves properly after a bowel movement.  

They will be wetting themselves .

They may have an occasional bowel movement in their undergarments.  

In the section on 'Dressing for Incontinence Care,' I advised of the need to get men out of boxer shorts and women out of the flimsy panties and into a more substantial cotton brief-like pant as soon as possible.  Now it is essential if it hasn't already been accomplished.

It is also time to buy that first bag of incontinence products.   

The questions are:  Which product?  Where do I start?  How do I start?

Your person will still be able to understand a great deal of what is going on, they will probably deny the need to use these products so don't ask for permission to use them, and you can anticipate a major blow up at the mere suggestion that they need them.

Keep this in mind and minimize the taboo aspect of what incontinence products symbolize.  They are simply a device, a tool, a product, that eliminates the need to go through hell every time your person needs to use the bathroom.  It takes the stress off the family member and it gives the caregiver control over what is only going to be a worsening situation until they are fully accustomed to wearing these.  You need to understand that they are not going to be able to relearn how to be independent in terms of their personal hygiene any more than a small child can.  Your attitude towards the use of these products is more than 90% of the battle.  So get a grip.  Your fears associated with this step in care is far worse than what reality will be.

Basic Tips about using incontinence products:

• Treat the pad as part of the dressing drill.  

•  Use a beltless pad that can be affixed to the underpant as the first product.

• Insert it in the underpants before your dress them. They may not even notice it's there.

• Don't feel you have to go into lengthily explanations of what you are doing and stay away from words like Diaper or product names such as Depends or Attends to qualify what your are doing.  Keep it simple.

• Tell them the truth if they ask.  Tell them it's too crazy racing to the bathroom 40 times a day and this pad will take the stress off Them.  Pads are just a back up in case they can't get to the bathroom on time.  Add that you love them and it will be easier on you and less embarrassing on them.  You support, love, and encourage them and don't dwell on it ad nauseum.  If your female person protests mention it in relationship to a menstrual pad.  If your male person protests, minimize emphasis on the pad and talk about jock straps or trusses as something marginally familiar to them.  They may focus on the marginally familiar more, and less on the incontinence product.  

• You might be surprised at how little they respond to this change in care.  It all depends on your attitude and manner.  Everyone who takes care of someone with this disease makes this transition so you aren't the only one going through this.

• With practice you can accomplish inserting a pad and removing and replacing a pad in a few minutes.  A routine is a routine.

• Work from behind them.  It helps with privacy issues and as their confusion increases they will have less and less awareness of what you are doing.

• If they do have a bowel movement the beltless pad will at least hold the majority of it in one place, another reason to get them into substantial underwear.

Beltless Pads:

There are several different types of beltless pads on the market, some of them designed specifically for males and females and some that are genderless. Products range from those that look very much like women’s menstrual pads to rather substantial pads that measure 14 inches or more in length.

Some of the brand names to look for are:  Reassure, Serenity Poise, Surety, Attends, and Depends.  Don't ignore the generic brand names sold in chain drug stores and department stores.  They work just as well and are less costly.

They are called guards, pads, shields, and beltless pads. Most of them have gathers on the sides to help contain liquid flow and the absorbent material is the same as used in baby diapers, a form of absorbent gel or fiber. Shields don’t have gathers but they do have channels designed into the pad to help move liquid flow along the pad quickly to aid in absorption. All of these products come with adhesive strips.

I used all of them in varying ways. 

A Note To Consider:

Women are used to wearing menstrual pads and may actually have less reaction to a little more bulk in their underpants than men.  Begin with a pad that is similar to a menstrual pad such as those offered by Poise, Serenity, or Reassure to name a few. 

Men have used cups, jock straps and other various  devices during their lifetime and wearing such items along with underwear is not totally out of their realm of experience.  Men need something a little more substantial because their equipment is less contained in one place than is that of women. I used both guards and shields for my husband as well as other forms of beltless pads. The guard has a natural contour to the body, it has a gel inside that absorbs liquid very quickly, and I placed it in his underpant in the spot where it would catch the most flow. (Similarly to how we folded cloth diapers differently for boys and girls back in the days before disposables. The principal is the same.)

To facilitate ease in moving the pad in and out of the underpant just tear off part of the adhesive tape.  I tore an inch or two of the tape off in the front and back of the pad and it stayed in place well enough to meet the needs.  If the underpants are snug enough you may not need to stick it in place at all.  The less adhesive to deal with the faster and easier it is to remove the used pad and slip in the new one.  Use your common sense, and do what works for you.

There are two ways to insert that first beltless pad while helping to dress the individual:

1. Take the pad of choice, secure it to the inside of their underpants with its adhesive strip. Treat the entire package as one item of clothing and then assist them getting it on.

2. Slip the pad in the underpants as you help pull the underpants up.  Do this while working behind them.

Changing a used beltless pad for a fresh one is the same for men and women.

• Stand behind them and undo clothing from behind.

• Arrange clothing, undo trousers or clip up skirt.

• Have the clean pad within reach.

• Pull the back of the underpants away from the body, slip used pad out of underwear and discard out of their reach and visual field. (You don’t want them to be able to reach for it.)

• Slip in clean pad and adjust for position.

• Pull up underwear, rearrange clothing

• Deal with the used pad after your person is re-arranged.

Belted Pads:

Belted pads usually have gathers on the sides to help contain liquid flow and elastic belts which fit around the waist.  They come in medium and large sizes, the difference being in the length of the elastic strips that come with the pads.  Some elastic belts come with buttons and some with Velcro, (similar to baby products now on the market).  

The medium size may be too large for a small boned woman or man. I moved one set of buttons on several pairs of elastic bands, and using double strand button hole thread and a large needle the whole process only took a few minutes of television viewing time. The elastic bands will take months of wear if they are hand laundered and air dried. Do not put them in the drier, the elastic will disintegrate over time.

Some of the brand names to look for are:  Reassure, Surety, Attends, and Depends. 
The generic products offered by chain drug stores and department stores.   These work just as well as the more costly brand names.  

Dressing after bath.

• Attach belts to the front of the pad and place inside the underpants

• Pull on the underpants, reach around from behind your person and fix the buttons/Velcro of the elastic strips one by one in the back of the pad.

• Continue dressing.

Changing the used belted pad while the family member is dressed..

• Work from behind your person.

• Insert the elastic strips in a clean pad, buttoning in back only and set within easy reach. If also using an inset pad secure it in place at this time.

• Approach, undo clothing and drop underwear from behind.

• Undo front buttons of the belted pad, remove used pad from behind and discard out of sight and reach of family member.

• Button elastic strips in back of pad, slip in clean pad, pull the front up into position, reach around and button elastic strips in front.  (It is easier to move the strips around the side of the person and button in front that to try and to sling them between the legs if they're attached to the front to begin with.

• Rearrange clothing and then deal with used pad.

Solution to heavy urine flow  - or if you are not going to be near a toilet for an extended amount of time: 

Use both the belted and the beltless pads together as one unit.   

Place a guard or shield inside the belted pad.  In this case I often used one of the smaller feminine products so that the overflow would be caught by the larger belted pad.  There are also benefits for doing this on a regular bases.

• I only had to change the inset thus saving on the use of and costs of the more expensive belted products.  The belted product held the smaller pad in place without having to use the adhesive strip at all and with the strip covered it was easier to slip it in and out of the other pad.

• The belted product took care of any over flow the beltless pad might have and the elastic waist strips helped hold the whole package in close to the body, which made wearing them more comfortable. Surprisingly the added bulk never seemed to bother my husband.

Changing the inset pad in a belted product involves the same process as that listed for the beltless pads.

• Approach them and undo clothing from behind.

• Pull the back of the underpant and belted pad away from the body, reach in and pull the used pad out and discard out of reach and visual field of your person.

•  Slip in clean pad.

• Pull belted pad and underwear up and rearrange rest of clothing

• Deal with the used pad after your person is re-arranged.

Wear all these products with underwear.  This is why I recommend substantial cotton brief-life items.  They hold the whole package together and keep air from the wet pad.  Body heat will keep it warm and less uncomfortable to the wearer until you can get them to a bathroom to change it.  If the underpants droop, air hits the wet pad and it becomes cold and clammy to the wearer.  

Reusable Underpants with liners:

These products mimic normal underwear.  These are underpants designed to hold a disposable liner and in some cases, for those who wish to minimize use of disposable items, washable/reusable liners.  The disposable liners are in line with the cost of other disposables but there is the problem of finding the specific liners for your specific product in a pinch.  Not all stores carry all products.  They are available in Medical Supply Stores, Drug Stores and through HDIS.

I never got into these.  An incontinence product in the guise of a regular underpant seemed unnecessary to me.  Tom made the adjustment to regular products without any problems, his regular underwear held them in place, so this product was never a real consideration for me.  I also think the purchase of these products hold more value to women and men who are dealing with other kinds of incontinence problems, who have their cognitive function, and lives that are active in ways different from those with Alzheimer's.  

Of the caregivers I've met who used these products with their AD family members, most discarded them early into the process, and opting for them had more to do with their own reluctance to accept the incontinence needs than their family member's.  In the end convenience of purchase and use of other disposables won out.  It was simply easier to use the standard products.

However, If the use of these products makes the transition easier for the caregiver and offers them the comfort zone they need to work through this period, then go for it.   Whatever works!  One caregiver used them exclusively for day time "When mother was more aware of her appearance," and switched to a more substantial pad for over night. This like anything else is a personal preference.  

Briefs:  A description of this product is listed in the next section in the Taking Charge Stage of Incontinence Care.

Briefs are not recommended in this phase of care.  The drawback in using this product as a primary one at this time is that it is bulky under clothes and unwieldy to get on and off a still active person.  Between the tabs, the wrapping, the clothing, the time element, it is just too much stuff to deal with.  For the most part your person will only be dealing with urine incontinence during this stage of care and they are still able to use the facilities normally to a large extent. The brief, slows the whole process down. and there is nothing familiar about it to the family member that will enable them to use the bathroom unassisted when they can.

However, on long trips or over night if your person has had even one ‘accident’ in bed, this product is a life saver and I do recommend that you have at least one bag of these on hand.  Eventually you will need it.

Some of the Changes you can Expect towards the end of this stage of incontinence care.

• You may have to help wipe them after a bowel movement, unless you are comfortable letting them mess their underpants.

• They will have trouble using toilet paper.  You may find the entire role unrolled and on the floor on in the toilet or shards of it stuck to them.

As gross that this sounds, what I did was wet a thin terry wash cloth with warm water and poured  lotion on it.  As Tom stood up from the toilet I made a quick swipe of his behind with the cloth and discarded it in a pail with soapy water I kept by the sink.  Because the cloth was warm to his body he was barely aware of what I was doing and because there was so much activity with helping him to arrange his clothing he was also distracted from what I was doing.  I rinsed and washed the cloth out after he left the room.   Mothers have dealt with the fall out of their children's bodily waste and hygiene for thousands of years.  This too can be done. 

• Men will miss the toilet and pee all over the floor.

Frankly speaking I got tired of watching Tom miss the toilet.  One day I stood by the door watching the fumblings knowing what was going to happen and decided there had to be a better way.  I quietly moved behind him, reached around and guided his hand and penis towards the center of the toilet bowl while I uttered... 'Ready - Aim - Fire.'   He laughed so hard we almost missed the toilet anyway.  Believe me, he was just as concerned about missing the toilet as I was.  

Now I know a daughter isn't going to feel able to make this leap across the 'private space' line as easily as a wife can, but it is an option to think about.  One does just guide the hand.   

• Going into the rest rooms

This problem will overlap at the end of the early stage and throughout the mid stages of this disease.  

What do you do in public when their needs are so obvious?  

You accompany them and you do for them as you would for a child and you do it with authority, kindness and confidence.  

Please check out the articles entitled:  "I Could Never"   and "Been There Tried it, didn't Work"  These articles deal with some of the obstacles we throw in the way of doing what has to be done during the early stage of this disease. 

In talking with other caregivers: 

Men found it more comfortable to take their wives/mothers into the men's room

Women found it more comfortable to take their husband/fathers into the women's room.

• During this stage it is mostly about managing clothing although towards the end you may be dealing with pads as well.

• Learn to carry an emergency kit with you, one that includes 'Handy Wipes,' and extra pads, lotions and extra underwear.

• Use the handicapped stalls.

• If traveling, look for stops off the main highways such as gas stations that have single occupancy toilets.  This way you have more privacy than you do on major rest stops with multi-stall units and a sink within reach.

* I don't know of a owner who wouldn't rather have someone help a family member with dementia in the rest room than leave them to mess themselves, the floor, or the toilet seat.

As I will state over and over in this site, caregiving is mostly attitude!