Bladder problems and UTI’s. How do we get her bladder to empty while seated?

I am a pelvic floor PT and do have some suggestions you can try but if they don't work I would definitely ask your PCP for a referral to your local pelvic floor PT or urogyn. What you describe is a common problem. There may be many reasons for her incomplete bladder emptying each with a different technique to try but I am going to give you as many as my retired brain can think of as none of them are dangerous or complicated.

I like the running water trick but be warned that if she is cued to pee with water running her brain may pick this up anytime she hears water running (at the mall, in the kitchen etc) and that could begin a whole new set of problems.

As mentioned earlier make sure her rectum is emptying well and that could be known by the the stool form, (large, hard or small balls, or having to strain is a big clue) and if she is having a BM regularly. As much as you are able try to avoid straining by keeping the stool soft with whatever method works ( OTC fiber, diet, hydration, exercise, stool softeners) and use a squatty potty. If her medications are making her constipated then talk with the doc that prescribed to find ways to soften stool.

Instead of raising on tippy toes try using a squatty potty with elbows on knees, leaning forward and have her breathe in a very relaxed, slow, diaphragmatic pattern. It is fine to try and press on the bladder at this time by placing a balled up hand towel at the top of her pubic bone or using a hand if it will fit. Also tapping or tickling the sacrum (right above her tailbone) either during her peeing or after to see if more can be released while still seated.

Sometimes just rebooting the system by making the attempt to stand up (maybe just lift the buttocks off the seat as high as you can before she begins to dribble) and then sit right back down again if that is possible.

She should not be tightening her buttocks during the peeing process. I am assuming she is well hydrated so her urine is not dark normally. If her bladder is prolapsed (high probability) then the use of a "well fitted" pessary can be very helpful and this can be fitted by a urogyn, gyn or ARNP that knows how to do fit well. Avoid someone that off the bat tells you it does not work well. I would choose one that does them often and likes them. A corrective surgery at this stage of your moms life may not be in her best interest but a well fitted pessary can mimic what a surgery would do. She may need vaginal estrogen at first to prepare the tissue for this but again a good clinician would be able to tell this as well as if she even has a prolapse. They are easy to put it, clean and place back and if you can't be shown then simply have that clinician or a visiting nurse take out every 3-8 weeks (depends on the fitting clinican) to clean and replace.

Another quick solution to keep the floors from getting wet is to purchase these standing female urinal bags that are used for hikers or travelers. You can place the opening right over the vulva before she stands and then hold it there while she stands solving at least that problem.

There are probably more tricks but I can't think of them now. Good luck.

Kris

Cappucino, some folks here swear by a product called D-Manose. I'm sure someone will chime in with the details.

Consider taking your mom to a urologist or genito-urologist. My mom's gynecologist prescribed a hormone cream (rePhresh) which helped with the dryness my mom was experiencing in her vulval area which was causing frequent UTIs. But it sounds like what your mom has might be structural, and hopefully, easily addressed.

Can your mom do Kegel exercises? Sometimes pelvic floor physical therapy addresses this issue; learning to release the Kegel contraction is a way of making sure you've voided everything.

I do have the same problem with my mom, not everyday though, fortunately. She sits for a long while on the toilet but doesn't empty her bladder completely, so when she stands up, she pees down her legs.

What I do to avoid having to clean the floor each time is I put down a small disposable underpad at her feet and help her up, then she can pee down her legs onto the pad. I use a wet wipe/towel to clean her legs. This saves me from having to mop the floor each time she has an accident.

I am curious. Why does your mom not pee standing up while wearing her depend, then go sit on the toilet for cleaning?

My mom has a very similar problem except that she often doesn’t feel the urge to pee so when she stands up to go to the bathroom she pees, usually in the Depends but not always. Her UTI’s have become far more frequent so her PC sent her to a urologist and the first thing they checked was wether or not she was emptying her bladder when she toilets, apparently there is something they can do about that but I can’t tell you what since we didn’t get that far, she empties! Anyway I would request a referral to a urologist and preferably one that deals with elderly patients. Good luck, I know just how much fun the constant clean up is and feel for you.

There are Physical Therapists who can teach a technique to help with bladder problems. I will try to explain the posture but it really needs to be demonstrated.


Mom sits on toilet. Feet go to tippytoes. Mom leans forward and places elbows on knees. This posturee helps the urethra fully open so you can pee easier. The other part of this is take mom to toilet every hour and a half. She sits in this posture whether or not she has to go. It ultimately retrains the bladder.
I don't know if this will be as successful in AlZ/DT patients because of damage to different areas of the brain, but it's worth a try.

UTIs can cause urinary retention.
Constipation can interfere with fully emptying the bladder.
Certain medications interfere with bladder emptying.
She may be having pain when seated on the toilet and not be able to communicate that, so that when she stands up again, she can release urine. Can you coax her to release urine into Depends while in a standing position in front of the toilet? Or run the water in the sink while she is sitting on the toilet, to promote voiding?
The idea of disposable waterproof pads to stand on is a great idea.
A geriatrician (board certified in care of the elderly)would be a good person to perform an assessment of her situation. A geriatrician can probably identify enough of the problem so that a referral to a urologist or gynecologist can be made. Even if there is a waiting list for a geriatrician, it is a good idea to get on the list.
So frustrating for both of you.

If you lean forward while sitting on the toilet, you can put pressure on the bladder. It helps me to void the last of the urine, so means more time until the bladder is full again. See if she can lean forward and push before she stands up?

Before I learned this trick, I went to a specialist physio, who checked that I was doing the Kegal exercise properly by putting a gloved finger into my vagina and waiting for the squeeze. You may be willing to try that. I find that squeezing the buttocks together first, then alternating with the pelvic floor muscles, helps to register which of the ‘invisible’ muscles are being worked.

Please talk to her doctor about her symptoms. She obviously has the "urge" to go but is having difficulties with starting to pee as well as emptying her bowel and bladder. The doctor will most likely make a referral to specialty doctor(s) to evaluate her bowel, bladder, and maybe neurology. If she has had a stroke in the past, a neurologist is probably the best person to talk to first. There are treatments to manage these problems, but it really depends on what the cause of the problem is - nerves in the pelvis, dementia/stroke issues in the brain, or other.

When she is seated kn the toilet, as some others have said, have her lean forward chest towards thighs. This has helped my mom better empty her bladder and enabled her to get off catheter after hospital stay.
Also, never pull up wet Depends. That’s a recipe for uti.
My mom’s utis have been so constant that she has been on a lo-dose preventative. Seems to be working! We are a 3 weeks without one.

I know this sounds weird, but try pushing a closed fist just above her public bone, then having her lean forward.