Caregiving and night incontinence: how to improve your loved one’s sleep, and your own

Bladder leaks or urinary incontinence can happen for several reasons and there are several types.¹ Let's look at the main types of incontinence your loved one may be experiencing.²

Stress Incontinence (Leakage during movement)

This type of incontinence occurs because their pelvic floor muscles, which support the bladder, are weak.¹ Some causes of a weak pelvic floor may be:¹

• Childbirth
• Pregnancy
• Being overweight
• Menopause

With less bladder support, when extra pressure is put on your loved one’s bladder during daily actions or activities (like sneezing, coughing, or laughing) and it can lead to leaks.¹

Want to learn more about what stress incontinence is? We’ve got a guide about this common condition for you.

Urge Incontinence

This is also known as an overactive bladder. It’s when leaks occur with an intense, sudden urge to pee, and could lead to nighttime incontinence. In fact, 16 percent of adults with urge incontinence, may experience nighttime leaks.³

Urge incontinence could happen because of the following:¹

• Aging
• Menopause
• Bladder infections

Curious about urge incontinence? Read our article about this condition to empower you with the information you need to manage it.

Overflow Incontinence (Incomplete emptying)

Overflow incontinence is when leaks occur when the bladder doesn't fully empty even after using the toilet.1 It can also cause happen at night4 and could happen due to:¹

• Constipation
• Some medications
• Enlarged prostate

Mixed incontinence

This means that your loved one may have more than one type of incontinence, it‘s usually a combination of both stress and urge incontinence, and it’s most common in women.¹

New to caregiving? Learn more about developing a care plan for your elderly parent. 

Your loved ones may be experiencing nighttime incontinence due to several reasons, including:

Neurological conditions

These conditions could affect how their body stores, makes, or passes urine.5 Some neurological conditions that could cause leaks include:⁶

• Alzheimer's disease
• Dementia
• Parkinson's syndrome

• Prostate enlargement (in men)

  This condition can cause blockages in the bladder and urethra (a passage for urine to flow out of the body), leading to leaks.⁷

  Lifestyle factors

  Their lifestyle choices may also influence the likelihood of experiencing nighttime incontinence. Drinking fizzy drinks, caffeine, or alcohol, or being overweight or smoking could also influence their bladder, causing night leaks.⁷

  Medications

  Medicines like the following can affect your loved one’s bladder, leading to leaks:^4,7

  • Antipsychotics and sleeping pills can irritate their bladder⁴
  • Diuretics increase how much urine they make, because of higher fluid intake⁷

  Aging bladder muscles

  As your loved one ages, their bladder capacity decreases,8 reducing how much urine they can store, which, in turn, causes nighttime leaks.⁷

  Diabetes

  Type 1 and Type 2 diabetes can cause the body to produce more urine, especially at night.⁷

  Not sure what could cause bedwetting? Learn more about the causes of adult bedwetting.

Dealing with nighttime leaks for both you and your loved one can be tough. Don't worry, here are some practical ways that could help you manage and treat those unexpected accidents overnight.

Rule Out a Treatable Condition

As we grow older, our bodies change in many ways that can result in needing to empty our bladder more often at night. Our sleep becomes shallower, our kidney function declines, and our bladder grows less elastic.

Still, a treatable ailment can sometimes be at fault. If you suspect this may be the case, consult your family doctor to rule out a urinary tract infection or some other condition that may respond to treatment.

Adapt the Day Routine or the Night Routine

Seemingly obvious measures like avoiding caffeine and excessive fluid intake before bed, and being sure to empty the bowel and bladder, can make a big difference.

If your loved one takes a nap during the day, make sure they don't sleep for so long that it keeps them awake at night. Also, try to keep their sleep cycle consistent and encourage them to go to bed every night at the same time.

Medications like diuretics can also increase thirst and fluid intake. If this is leading to frequent night toileting episodes, ask a doctor about replacing these medications, or administering them earlier in the day.

Encourage Habits That Will Aid in Sleep

Take a look at patterns that may interfere with a good night's rest. Does your family member's daily regimen include enough exercise and fresh air? Are there nagging sources of pain or irritation that may be contributing to insomnia?

If so, it may be time to re-examine the analgesic regime. Evening activities can be worth considering too. Is TV before bed too stimulating? Maybe that late glass of wine could be replaced with gentle stretching, reading, or listening to calm music, to promote a restful frame of mind.

Take Steps to Avoid Missteps

A groggy trip to the bathroom in the dark can easily result in an accident. Installing a chair-style commode next to the bed in the evening can enhance safety and simplify the process.

Alternatively, installing motion sensor lights can help your senior relative see where they're going when heading to the restroom in the wee hours. Be sure to clear the path to the destination and get rid of loose rugs and other hazards.

Create a Sleep-friendly Environment

Remember that your own sleep matters too. Sleep in a separate room from your loved one, if needed. Make it a sanctum that elicits a natural sleep response, free from stimuli that prompt anxiety or stress.

If needed, invest in a baby monitor to keep in close touch during the night. If advanced dementia is present and night wandering is a concern, consider a bed alarm to alert you if they get up and wander off.

Want to spruce up home safety as a caregiver? Learn more on about home safety for the elderly.

Bed Wetting Alarm Systems

Moisture alarms can be a helpful tool when managing or treating night leaks.⁴ You can place them on your loved one's clothing, and when leaks occur, they alert you or wake up your loved one.⁹

Also, over time, as they continue to wake up after leaks, their brain begins to take control of their bladder, resulting in fewer leaks.⁹

Monitoring Fluid Intake

Limiting caffeine, alcohol, and large amounts of water in the evening may help reduce accidents at night.⁴

Still, you need to make sure your loved one stays hydrated throughout the day. A good way to monitor hydration is by checking the color of their urine.¹⁰

Here’s a quick guide:¹⁰

• Clear or white: too much water; try scaling back.
• Light yellow: Ideal; hydration is on track.
• Golden yellow: Still fine, but keep fluids steady.
• Dark yellow: They could be dehydrated; encourage more water.
• Dark orange: Dehydrated, time for more fluids.

Scheduled Nighttime Voiding

This method can help reduce nighttime leaks.⁹ It involves setting alarms for specific times in the night to take your loved one to the toilet.⁹ You could set your alarm for:

• A few hours after they fall asleep
• Around midnight
• A few hours before they usually wake up

For extra protection, have them use incontinence products for the night like bed pads and protective briefs in case a leak happens before the scheduled trip.

Ensure Healthy Bowel Management

Fecal leakages during the night can be frustrating and embarrassing. In elderly people, damage to skin in contact with feces occurs quickly. Emptying the bowel during the day will help minimize the risk of interference during the night.

If diarrhea is the issue, your doctor may prescribe medications to promote more solid stool. On the other hand, constipation may respond to dietary changes such as increased fluid intake and fiber-rich foods. Exercise activities aimed at strengthening the pelvic floor muscles can also help maintain healthy bowel movements.

Take Care of Fragile Skin

The discomfort of a nagging skin condition can have a serious impact on sleep, and may in some cases contribute to an increased need to urinate at night. To help maintain natural skin health, TENA has developed a three-step skin health solution for those living with incontinence.

• Keep it dry using TENA PROskin Overnight Stretch Brief - a fast-absorbing product to reduce moisture on the skin, both day and night.
• Keep it clean with TENA PROskin wipes and cleansing creams.
• Keep it protected by applying barrier cream for protection against irritants.

Dry, clean, and healthy skin is key to keeping your loved one comfortable. Learn more about elderly skin health and hygiene for the elderly.

Provide Comfort, Support, and Protection

You may not be able to control your loved one's night incontinence, but you can make the experience considerably less uncomfortable. Make sure their incontinence product has an absorption capacity that will last through the night, and that it is fitted correctly to avoid skin irritations and leakages onto their nightwear or bed linens.

If leakages outside the product continue to occur, try to figure out the reason. Is the absorption capacity too low? Is it being loosened or picked at during the night? In that case, it may be necessary to pad the bed, or even waterproof the mattress.

Wearing Incontinence Briefs or Pads at Night

At TENA we know that when you’re caring for an elderly person with incontinence, getting a full night’s sleep can be a challenge. That’s why we developed TENA Overnight Briefs with Lie Down Protection — specifically designed to keep fragile skin dry for longer.

Plan Your Worrying

Knowing it's pointless to spend sleepless hours fretting over your relative's care doesn't make it any easier to shut down your anxieties and go to sleep. A trick for switching off can be to set aside a designated time during the day for pondering and planning. Write a to-do list, and put it away until the next day. Knowing you've done this might just make it possible for you to let go and drift off.

Being a caregiver is more than just a physical role. Learn more about dealing with the emotions that come with caregiving.