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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.

She has stress urinary incontinence. Movement causes the bladder to squeeze and due to her age, leaks. I would think she is not a great surgical candidate due to her age. There are meds to help but remember….an empty bladder doesn’t leak! Toilet her more frequently for starters. She may additionally have a decreased sense of urgency due to her age. Again, offer her to void even if she’
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
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Reply to Amichee
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Imho, your choices would be: Physician visit to urologist, medication for OAB, thicker feminine pads, thicker adult diapers and bedside commode.
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Reply to Llamalover47
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Yes there is medication that can assist with muscular control - in the UK we use Oxybutynin (Ditropan XL, Oxytrol)
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.
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Reply to TaylorUK
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I have the same problem and went to a women's MD. There is a small surgical procedure to lift the dropped bladder, but the MD said I wasn't far enough to warrant it. So I wear a pessary in my vagina that keeps the bladder propped so I don't have continual leakage. Ask your MD for a referral to a specialist. And yes, there is a prescription for what they call "Overactive Bladder." It helps, too.
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Flowerpots Jul 26, 2021
Can you tell me the name of that medication?
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I have had 2 doctors recommend ways to help this. One is a botox shot recommended by her urogynecologist. Another is InterStim therapy where a device is implanted. You might want to ask about these two.
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Reply to Hatethis
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Is she on diuretics? Just got off and what a difference!
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Reply to Doylie
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Is catheterization an option for her? Some posters have mentions there are risks with the use of a catheter, but can these risks be managed?

Many paralyzed people are on internal permanent cathers for years and years.
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Reply to RedVanAnnie
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Catheritization = infections. Not a long-term strategy at all.

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!
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Reply to rhsolucky
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My 84 year old Mother is the same. It’s simply lack of being able to control her bladder. I’ve gotten to where I take a thick bath towel and hold it between her legs to control the excessive mess. This works for me. I don’t know what else to do. Due to Moms deteriorating health she’s on comfort care. Drs are reluctant to do anything under general anesthesia.
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Reply to Apeter
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Check with her Dr.
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.
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Reply to bevthegreat
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A thickening bladder wall can impair effective expulsion and retention creating a 'lose - lose' situation. Constant urination suggests there is no control remaining - exertion being the pressure from other organs in lieu of bladder function. However, an infection could yield similar results so it could be worth further investigation.
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
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Reply to Kantankorus
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My wife with dementia, who seems to be unaware of anything and cannot communicate, has taught me some things.
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.
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Reply to EllerySir
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therealjanedoe Jul 12, 2021
I read your response and wanted to tell you how much I admire you for your thoughtful answer and your care of your wife. I'm my mom's caregiver and my dad, her husband or 60+ years does not help in any way. God bless you.
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There is medications that may help you will have to call the doctor, you have make sure the patient can take it. Good luck
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Reply to Mchllc1
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Beatty might be on to something. When I changed my Husbands position he would more fully empty his bladder. (And often times it was enough to create a bit of a “puddle”)
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.
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Reply to Grandma1954
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Her bladder may not be fully emptying when voiding. When she stands, the angle allows the remainder to empty itself.

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).
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Reply to Beatty
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Maybe you could hold a trimmed baby diaper cupped against her until you pull up her Depends. There is a web site that shows has many options to use baby diapers as booster pads.

https://www.adisc.org/forum/threads/baby-diapers-as-booster.110570/

https://continenceconnection.typepad.com/my_weblog/2007/07/stuffers-tutori.html
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Reply to GAinPA
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Stop all caffeinated and sugary drinks
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Reply to XenaJada
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Talk to her doctor about a referral to a urologist. There are medications to help "strengthen" her urinary sphincter muscle. but she may have other problems as well,
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Reply to Taarna
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Try lining her Depends with a Poise pad. When you stand her up wait a few moments before you undress her. That might help.
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Reply to BurntCaregiver
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Willie, funny

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.
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Reply to JoAnn29
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AndreaE Jul 12, 2021
Soda, Tea, Coffee, pickles, tomatoes, spicy foods, energy drinks (which i know shes probably not drinking) and sugar substitutes all stimulate the bladder according to my urologist. I just learned this last week.
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This sounds like she has stress incontinence. Tab style incontinence wear might be helpful here, so that you can get her out of them easily. There are some that hold more volume than the Depends--you might have to let her stand and drain completely into what she has on, then replace it. I know that some folks add a pad to the depends for extra absorption, but it sounds like the tab type would make things easier.
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!)
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Reply to ElizabethY
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The strain of getting up and down puts pressure on the bladder, I've noticed this and I'm only in my 60's 🙄. I think it would be best to get her to the bathroom on a schedule BEFORE she needs to go (and before her shower), and when there is an accident to allow a moment for the urine to soak in to the pull up before attempting to change. If the product you are using doesn't hold the urine then a different absorbency or brand might make a difference.
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NeedHelpWithMom Jul 8, 2021
I am in my sixties too. CW. I completely agree with you about going before the shower. Oh my gosh, anytime I hear water running I have to run to the bathroom! This happens constantly when I am cooking. I wash my hands and I have to go, 😆 hahaha, (part of getting older) then, I wash vegetables, and I have to go again! My hands are so dry from all of my hand washing after using the bathroom and before cooking. I admit that I am very OCD about clean hands.
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I don't know if Kegel exercises would help at this point, but it's worth a try.

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.
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Reply to GardenArtist
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Apeter Jul 11, 2021
Kegals at 98?
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Mom tried a medication for the condition that you are describing. Let me say that it took months for us to notice a very slight improvement.

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.
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JuliaH Jul 11, 2021
Love your response. I've heard Ensure isn't the bees knees as far as a nutritional value. Just like margarine it's a chemical or two short of consuming plastic. The sugar! Yes, nasty. Mom likes a soda once in a while but her choice is Mt. Dew, 12 teaspoons of sugar per can. I'm trying to keep her homecare from letting her buy any soda.
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Not if she has lost the ability to "hold" it. She may need to be catherized at this age. There are meds for that feeling of urgency.
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