She wears depends but it runs down her leg as I am pulling them up or down. She has the feeling and wants to use the toilet but understands it is hard. Changing clothes and getting out of the shower is extremely hard. Constant urine when getting up and down.
says she doesn’t have to go. You will also be training the bladder with more frequent voiding! Good luck! God Bless her!’ Amichee Board Certified Urology
But pessary use can also help by supporting the bladder and exercises if she is able to do them.
Urine infections can also be a cause.
Have a word with geriatric Dr and discuss medication and possible physiotherapy.
Many paralyzed people are on internal permanent cathers for years and years.
Agree with the info on "shy bladder". If she could use a bedpan, would there be an issue? One of the problems is "getting comfortable".
Folks realize that there are people in certain areas of the world who toilet train babies. It's a matter of trigger, response, reward. And some people can understand some instructions but nothing complicated.
I'd suggest the following:
- Try a bed pan. Put her in control of using it.
- Try the underwear inserts (basically like sanitary pads).
- Talk to a urologist (with female experience) about any hormonal methods to control urine. If it needs to be applied directly to the area, use the previous suggestion and spread some on there to not have to be too personal about it.
Good luck. Urinating is more important than making a BM, and it's really difficult for some people, even if we have all our marbles. Distracting myself (counting tiles in the bathroom for example) while trying pee often works best!
Maybe she isn't getting to the bathroom soon enough.
The older you get the less time you're able to hold it.
Maybe she doesn't feel the urge til it's too late.
You do at least have this knowledge, so asking your client to sit/stand a few times prior in a manageable environment (shower recess, commode chair) should serve both purposes of relieving her bladder and fitting fresh pads in the preferred order.
Catheterisation is a feasible alternative but not without risk
Holding pee, bashful-bladder, clenching,
My wife started puddling everywhere and then wouldn't go when we set her on the toilet. We put her in diapers.
Then she started overflowing, so we just changed them on schedule.
But often when we stand her from her chair, she would let loose, either in addition to a full diaper, or just a lot of pee. Then she would not finish when we got her to the toilet. Bashful bladder. Some people are very private about personal acts and will clench and pinch off the flow. She was always that way. I am that way, I could never pee in a cup.
She lost all of her memory, doesn't know us or even herself. She auto responded to needs of eating and toileting by expression.
The one thing she is that pee is a very personal thing to her.
We realized that she is not physically incontinent. She simply forgot how to take herself to toilet and was too bashful to express to anyone.
So she would hold it until she couldn't.
Then she hated peeing in a diaper. As would we.
So she would hold it until she couldn't.
We stopped using crotch covers in 2013. Skirts and gowns for privacy.
We toilet her every hour. I am old and I have to pee every hour.
She sits and sleeps on washable bedpads with cotton overlay.
Rarely an accident or UTI in these 8 years.
If you are changing her position prior to the change, maybe about 30 minutes before it might be enough for the bladder to empty a bit more and the pull-up brief time to absorb the extra urine.
Changing every 2 hours, more often if needed is good but changing the position before hand can help. If she is in a recliner put the seat upright in advance, if she is sitting up recline the chair a bit more.
Could be a bladder diverticulum (a pouch in a weak part in the bladder wall) that is holding the urine.
Scans & an Urologist may find the actual reason but at advanced age it may be more about 'containment' than 'cure'. So neat fitting continence underwear & clean ups.
Another option may be a permanent catheter (suprapubic) - if appropriate.
(I wish my relative would get one, would make her life so much easier than constantly rushing to toilets, everyday incontinence & dealing with accidents at home & in public).
https://www.adisc.org/forum/threads/baby-diapers-as-booster.110570/
https://continenceconnection.typepad.com/my_weblog/2007/07/stuffers-tutori.html
As u age your bladder drops. Meaning it becomes hard to void completely. So u need to push more. At 98 she may not be able to do this. Someone said on here that her daughter with MS was told to lean forward when sitting which helps to void better.
As said you may have to put her on the pot more often. Having her sit there for a while. Give her time to void.
If she drinks soda and tea, cut it out. They stimulate the bladder.
Is she on a water pill, maybe it should be stopped or cut back on.
What about starting or stepping up a toileting schedule so that there's less urine volume to handle?
Caution needs to be used for some meds. A lot of docs aren't aware that
''aggravation of symptoms of dementia (e.g., confusion, disorientation, delusion) have been reported after tolterodine/oxybutynin therapy was initiated in patients taking cholinesterase inhibitors for the treatment of dementia''. So meds like Detrol would be a no-go if she was on something like Aricept. (Ask me how I know, LOL!)
I'm wondering also if she gets up too fast? Can she get up on her own, and if so, she could scoot to the edge of the chair, hold onto something and rise slowly? It may not work if the physical stability has been lost through age though.
Another consideration might be to have your client (or agency if you work through one) raise the issue of consulting with one of her doctors about general exercise. If she's like some older folk, can't get up easily and hurls herself, that could be a contributing factor. Strengthening legs, if she's able, could be helpful on an overall basis as well.
As to showering, I would switch to no rinse products. They're not cheap, but they are effective in cleaning. I've used both the no rinse shampoo and no rinse body wash; they were provided to me during a hospital stay, and I still use them occasionally.
I will share with you what her hospice nurse told us. She said that sugar increases urinating. Mom was tiny and never had much of an appetite. She did like Ensure drinks, which are fairly high in sugar. When she cut back on Ensure, there was some improvement. My mom lost any control, like your mom. It is miserable for them.
Mom’s hospice nurse arranged for her to enter a hospice house for the last month of her life. They placed a catheter in her then. She was completely bed bound with end stage Parkinson’s disease.
I feel for you and your mom. It’s a frustrating situation. Wishing you and your family all the best.