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My 82 year old wife has many problems, but I am now focusing on her overactive bladder. I have an appointment next week with a specialist when I am going to ask about Sacral Neuromodulation, which is the implanting of an electrical device that stimulates the nerve that controls the bladder. Has anyone tried this procedure? Has it been successful? What are the downsides? Any advice or suggestions?

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This site has some helpful info about dementia behaviors including incontinence https://www.caregiver.org/resource/caregivers-guide-understanding-dementia-behaviors/

My mom who has dementia, as her dementia has progressed, has seemed to not recognize the need to urinate until she needs to go right away, which results in needing a quick trip to toilet. She wears depends bc she can't get there fast enough or if an aide is helping others right then. Taking her to the toilet on a schedule helps. Don't always ask if she needs to go, she might not realize it. Make it part of a transition, stop in the bathroom before lunch, or a walk, or a TV show.

My mom used pure wick, while in bed only in the hospital,. It was so so. Placement distressed her, and if not placed just right, it didn't work well. A bowel movement in the adult diaper/pull up made a mess, and I worried about uti.

One thing I ask you to consider is to widen your definition of "try" and " not try". As moms disease continues to progress, multi step procedures confuse her. Needing bathroom, finding bathroom, remove pants, underwear, sit down...etc. I find when I need mom to do something or ask her something, I need to break it down simply and do one step at a time, and wait for to do it or to respond. Then next step. It requires tremendous patience.
If you say you need to do this and this and this, ok. She may say OK, but only processed the first thing.
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Old Dog - Your profile says your wife suffers from dementia and a string of other issues, you also characterize yourself as someone who has " Much patience for someone who tries; much impatience for someone who won't try". The problem is people with dementia have a disease that is destroying their brains, very often they can't try. If you are finding it is too much work to care for her then perhaps it's time to consider finding her a nice facility.
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OldDog4321 Oct 3, 2021
I wish there was such a thing as a "nice facility." I have checked out several in my area, some of the best around. They all suffer from understaffing, and I don't see how my wife could ever be happy in any of them. She has a permanent inner ear problem so she can't stand or walk without assistance. I have to do everything for her. She is extremely picky about her food; I don't think they could accommodate her desires, which are very limited (it is hard to get her to eat anything beyond her set meals from which she refuses to deviate, and she refuses to go out to eat). She also eats at odd hours, often in the middle of the night. And she would never go to a dining room; she would want to always eat in her room. Probably the biggest hurdle would be her urinary problem. She is up about every 15-20 minutes all night for me to take her to the bathroom (I have a potty chair set up beside the bed). I would think any facility would either put her in Depends or put a catheter in her. So far I see my only option is to get help to come in our home. I have someone coming every Tuesday for 7 hours, which allows me to do so longer errands. I also am trying to remain active for my own sanity, and I have a couple evening meetings each month, and I have someone come in to stay with her when I go to my meetings. When no one is with her, I can get out for 20-30 minutes to run to the store or take a short walk. (Until recently I was able to walk 5 miles per day without checking on her, but I am down to 20 minutes at a time now.) She is showing some early signs of dementia, and maybe some OCD. She takes her medication at 9:00 am and 9:00 pm, and from about 7:00 pm and on she constantly calls me to ask if it is time for her medicine yet. When I say "constantly," I don't even have time to sit down after walking out of the bedroom until she is calling me again. She gets most of her sleep from about 5:00 am until 6:00 or so when I fix her breakfast, and then until her 9:00 am pills. She will sleep some until lunch time, which is around 11:00 am. I try to do my short errands while she is sleeping in the mornings; sometimes she will sleep for an hour or more then. But the rest of the day she just lays in bed and calls me to take her to the bathroom every 15-20 minutes, sometimes every 2-3 minutes. I have been getting pretty good about quickly getting back to sleep during the night, but I know I am not getting a proper amount of sleep. I can't even get a nap in the afternoons, since she is constantly calling for me. I am new to this forum, and I told myself not to become a complainer, which is not my character. But I decided to let it all hang out with the hope of someone giving me some suggestions that might help. We have been married for 58 years, and I do not want to abandon her at this stage of our lives.
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Elective surgery @ 82 years old? No.

If she has a prolapsed bladder, frequent urinary infections, change her care over to a urologist as a routine. They at least will perform a real urinalysis, and not just a dipstick test.

Ask instead for physical therapy and kagels exercises.
Decrease caffeine and alcohol.

You may be able to manage symptoms of an overactive bladder with simple behavioral strategies, such as dietary changes, timed voiding and bladder-holding techniques using your pelvic floor muscles. Has she tried these?
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OldDog4321 Oct 2, 2021
We have tried all of these. I say "we" because she isn't very interested in putting forth much effort, much to my dismay. I was looking for something that might help her without her doing much work. But it doesn't sound like it is likely to work for her. I'll keep the appointment with the urologist (a new one) to see what he can suggest. I also thought about the Pure Wick external catheter, but Medicare has stopped paying for it, at least for the time being. I may have to pay for it myself. But it might be worth it. Thanks all.
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My mom had one implanted. It was very ineffective, she had it reprogramed several times by the company. many visits to the urologist, battery replacement under sedation once. when another battery was replaced, she had the entire device removed. her sister-in-law had the device and got a severe infection from a battery replacement surgery. I have incontinence from damage from a fall earlier this year. my urologist does not recommend them. They aren't that effective.
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cwillie Oct 2, 2021
Your first hand experience sent me searching online for more information and it seems your experience is not unique, I found this article from JAMA Surgery
https://jamanetwork.com/journals/jamasurgery/fullarticle/2672214

"Conclusions
Sacral neuromodulation is associated with a very high rate of failure, as measured by reinterventions, that occur at alarming rates within 5 years of placement. A device registry is urgently needed in this setting to advise stakeholders and assist future innovations."
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These kids of solutions are meant to treat people who are younger and attempting to live a normal life, I really doubt this is an appropriate option for someone like your wife whose incontinence is the result of dementia.
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