Incontinence wear in hospital

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I became doubly incontinent suddenly, following an accident in 2013 which left me with a spinal injury at C4/5, paralysis from the chest down and severe spasticity. I spent the first 7 months in a spinal injury hospital here in the UK, where remarkably little was achieved.

Since puberty I had worn a paper towel in my underwear to soak up any dribbles of pee or semen overflows, but really knew nothing about incontinence. The hospital never offered me any kind of incontinence wear. I had a bowel evacuation every morning, and for the first 5 months before a suprapubic catheter was installed, intermittent urethral catheterisation by nurses.

Hospital policy dictated that men's foreskins should be kept forward. I do not know the reason. It came across as another loss of freedom - although not all nurses insisted on it. I remember a regular night nurse who tried to make catheterisation a fun experience. She would flick my foreskin backwards and forwards 'to make the catheter go in more easily' she would say with a slight smile or a wink as she could see the result of her efforts. Leakages and accidents were left to chance. In the first 2 or 3 months I did occasionally leak urine via the normal route, but hospital policy preferred washing sheets to issuing incontinence wear.

For the first 7 weeks I was on 'bed rest' - I was confined to bed and turned from side to side every 3 or 4 hours, day and night. I wore no clothes. Not being a matter of choice, I did not find this a wholly pleasant experience. Some of the nurses were conscious of this. Two of them separately explained that they were nudists and visited a beach not far away - perhaps exaggerated, but it was kind and thoughtful to try and make it seem normal.

After 7 weeks I got up into a wheelchair, gradually up to about 8 hours per day. Although I wore outer clothing, underwear, including that for incontinence, was frowned upon. I guess that was to give easier access for urethral catheterisation at first, but even after a suprapubic catheter was installed hospital practice remained the same.

I got on well with one of the occupational therapists. One day, we had been talking about hospital policy on incontinence and underwear when I was practising writing (my hands are affected by paralysis). I wrote something like 'Does anyone in this hospital wear knickers?' She assured me that she usually did but sometimes enjoyed the fresh air 'commando style' when wearing a uniform with a skirt in summer. Next morning, when she was helping me to shower, I noticed that she was wearing a skirt .... I didn't ask.

Not long before I left, a thoughtful nurse intervened. When dressing me she found my pants and reinstated some kind of normality, as she said at the time, but still no incontinence wear.

Looking back, the lack of incontinence wear in this hospital was a serious fault in nursing practice. Being a specialist spinal injuries hospital, many of the patients would have become incontinent only recently and would be unlikely to know much about how to deal with it. The hospital did not prepare patients for living with it after they were discharged. I thought that their policy towards underwear, or lack of it, was unnecessary and demeaning.

I first began to wear an incontinence pad and fixation pants soon after returning home from hospital. A district nurse noticed I was wearing normal underwear which was not really sufficiently stretchy for her to pull down for bowel evacuation. 'We'll soon fix you up with some pads and knickers' she said. And so she helped me deal with what can lead to embarrassing and distressing situations put me on another step towards normality.

 

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When I first read your post I thought what sort of hospital behaves like that. Then I started to think about my own hospital stays. Each time I have had a Foley catheter connected to a bed side bag, so any sort of underwear would have been impractical. Most of the men on the ward were the same. We all wore hospital gowns or nothing because the hospital was always too hot. I did have leaks bypassing the catheter and like you was told that it is easier to change a sheet than wear pads, no idea why they call them pads. My hospital stays haven't been too bad, but any shyness you might have when you arrive is lost by the time you leave. I remember one morning trying to wash myself using a bowl and cloth next to the bed because I had too many tubes in me to get to the bathroom. I spilled the water everywhere, was very embarrassed, but a very kind nurse simply said to forget about it as she has to deal with a lot worse than a bowl of water. I said that I was embarrassed because I wasn't wearing anything, but she said that she sees so many naked bodies she hadn't taken any notice. So maybe your experience isn't that different to mine, cheers Phil

 

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On one sense, it is helpful to learn that "across the pond" in the UK, they don't seem to know any more than we do - so at least isn't just our broken system in the US. My last hospital experience was pretty bad. While the nurse was unjudgemental and matter-of-fact, she was also extremely unhelpful. Getting information at that hospital was always either "You'll have to ask XXXXXX", or "no, can't do that because of liability." I gave up on the fit of the poor quality diapers. Couldn't get them to tighten the tapes enough, (or hardly at all), couldn't reach to do it myself. To be honest, i could get to the bathroom, with their help, and not all that much help, either, not all that often. But "we can't do that. It's a liability issue." They set up a "bed alarm" so i couldn't just get up on my own without them running in. Hell, only time i saw them move fast. It just made more work for the nurse & housekeeping, work they could have avoided and comfort i didn't get.
We share another thing - our dislike of hospital "wear" policy. I think if there is a next time, I'm just going to ignore their policy and institute my own. Like your PT nurse hinted. Maybe that's what we all need to do. Same for diapers. If we can afford it, bring (or have the spouse bring) our own. Or pads. Clean underwear. Our own bathrobe. They make a big deal about "access" to our bodies. That excuse needs to be examined by us, not just them. Except when in the ICU, mostly we aren't hooked up needing to give "access" any faster. A bathrobe isn't exactly hard to open or get off. It can be washed, by spouse if necessary. Same for loose PJs.
The PT nurse had me walk (albeit with a walker) to the PT gym, so why couldn't i do the same for the few steps to the bathroom? The last of the 3 weeks, was allowed to use walker to lounge - but not the bathroom!
The peasants are revolting! Liberty Equality Fraternity! (Sorry, Brits, for using a French phrase, but they are revolting, just now, too, not just you Brexit vs non-Brexit types!)
A very merry holidays, happy Christmas!

 

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As much as the hospital wants to dictate what you can and can't do, you can often still just do whatever you like.

I've been in the hospital, and when told I couldn't do something because i was hooked up to X machine, after a few requests I flatly told them to unhook me or I would do it myself. When my wife was in the hospital after my son was born, I started unplugging monitors because they were disturbing her sleep, and the nurses pitched a fit because it was Drs orders ... and then the Dr changed the orders.

Be your own advocate.

 

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I was extremely.apprehensive about going to the hospital with continence issues. It has been my experience that most hospitals recognize the dangers of CAUTIs, but they also have their own interpretation of what patient dignity is. My first overnight stay I got a chux and was told to buzz them if I needed fresh pajamas and sheets. After that I advised I wore briefs, and after discovering how bad hospital briefs are I brought my own for future visits.

 

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NoCans, you seem to have the common experience, although most of my nurses were non-judgemental. Like you say, the facility and some of the personnel don't have the same idea of patient dignity. Tjat "buzz us"thing is part of the lack of dignity/privacy. The wait for them to arrive is part of the problem, too. Everyone here (at NAFC) has convinced me my resolve not to put up with the hospital's nonsense is okay. Get a knee replaced and it okay for them to kick you out after two nights. You leave in a wheel chair. Maybe you're now on Home IV. Okay, then I'll bring my own, and I'll just check out or leave when I'm ready (Or sick of them). I can use a wheelchair, and have done the home IV thing, and I'm not afraid of either. It didn't occur to me to bring or send for my brand of incontinence wear, but it does now.
I have wondered it one of the issues is the anesthetic? Does it wipe out the feeling you need when you need to go? Or weaken the muscles? How long to wear off for that? I sure got a lot of effects from it, last time.

 

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If anything, anesthesia will make it harder to empty.

During intake the nurse will usually have a checklist of any issues. Incontinence is one them. They will ask you how you handle it, and just let them know you wear briefs but brought your own and can change yourself. The last time I shared a room it was with a middle agedan who self-cathed, and he continuously demanded they self Cath him instead of doing it himself( he did it when his wife was there with no issues). I think that was the same stay that I had an adverse reaction to a lumbar puncture. I was in my own room by then but had an IV in one arm with a caffeine solution and another IV with anti-naseau. I couldn't change myself and it was horrible.