Is There a Cause to this Incontinence?

[blu]

I didn't know where to post this. I am my Grandma's caregiver, but I don't know yet if she has dementia. She probably does, but she doesn't have a diagnosis yet.

Last year Grandma's doctor recommended physical therapy for balance and strength issues. She was having problems getting off the toilet, chairs, and bed and was having problems pulling up her pullup diaper and pants. Prior to starting PT she was doing ok, if she had dementia it was very mild, barely noticeable.

About two to three weeks into therapy she started acting very strange like she had full on dementia. I took her to the doctor and she was diagnosed with a urinary tract infection. Since the UTI, she will not get up to use the toilet when she needs to urinate. She pees in her pullup diaper. The doctor had nothing to say about this. The urologist mentioned dementia, but that's it. She hasn't been right since this timeframe and I don't understand it.

Did the therapy and UTI severely worsen her dementia (assuming she does have it)? Could something else be going on? Her blood tests are fine, no UTIs. She's on a thyroid pill for an underactive thyroid and she started taking Xarelto (blood thinner) a few months prior to this incident. The blood clots in her legs are part of what led to her needing physical therapy. She takes no other medications.

I can't help but wonder if she would've developed incontinence if she hadn't had physical therapy. I don't think she would've and I don't know what to make of that. What the heck does physical therapy and a UTI have to due with dementia? Am I missing something? Did the physical stress cause mental stress that worsened dementia? Does that mean people with dementia shouldn't have exercise because that doesn't seem right.

I recall one time in 2010 that I had to organize and clean up (without throwing too much away) a horrible mess that a hoarding family member made in two rooms of their house. After one to two months working on it for several hours a day, I felt like I lost a little piece of sanity that I was never going to get back. I've had several stressful situations since then and I now feel like my brain is Swiss cheese (full of holes). I'm not even 40 yet. Is this the kind of thing that could've happened to Grandma with the therapy and UTI?

 

[charlie10]

Hi @blu ......I'm a hands-off carer so I can't speak from experience, but I do know that UTIs.....and any infection...can ramp up dementia, so if a pwd appears to suddenly get worse the advice is always to check for utis etc. They can be difficult to completely get rid of, so it's possible that the first antibiotics didn't completely clear it or it's returned....that's a question for her GP. As for the physio, well my pwd has started a physio rehab programme and we're wondering if he is a little more confused than before......could be from the effort it takes him (he's completely zonked after about 5 minutes) or it could be the change to the rehab unit and different staff.

I'm sure others will be along later with greater knowledge, but wanted to welcome you to the forum

Forgot to say my pwd has very weak muscles all over, and we think that might also have caused his continence problems....not sure if physio will be able to change that as probably neurological damage too

 

[canary]

The physio wouldnt have caused it. I agree with @charlie10 that UTIs can increase dementia symptoms and often progress the dementia.
She was obviously having problems with incontinence before the physio treatment because you mentioned the pull-ups as being part of the reason for the physio. Are you aware that incontinence is one of the symptoms of dementia?

 

[Izzy]

I wondered if you would find this factsheet useful -

https://www.alzheimers.org.uk/get-support/daily-living/toilet-problems-continence

 

[Rosettastone57]

I didn't know where to post this. I am my Grandma's caregiver, but I don't know yet if she has dementia. She probably does, but she doesn't have a diagnosis yet.

Last year Grandma's doctor recommended physical therapy for balance and strength issues. She was having problems getting off the toilet, chairs, and bed and was having problems pulling up her pullup diaper and pants. Prior to starting PT she was doing ok, if she had dementia it was very mild, barely noticeable.

About two to three weeks into therapy she started acting very strange like she had full on dementia. I took her to the doctor and she was diagnosed with a urinary tract infection. Since the UTI, she will not get up to use the toilet when she needs to urinate. She pees in her pullup diaper. The doctor had nothing to say about this. The urologist mentioned dementia, but that's it. She hasn't been right since this timeframe and I don't understand it.

Did the therapy and UTI severely worsen her dementia (assuming she does have it)? Could something else be going on? Her blood tests are fine, no UTIs. She's on a thyroid pill for an underactive thyroid and she started taking Xarelto (blood thinner) a few months prior to this incident. The blood clots in her legs are part of what led to her needing physical therapy. She takes no other medications.

I can't help but wonder if she would've developed incontinence if she hadn't had physical therapy. I don't think she would've and I don't know what to make of that. What the heck does physical therapy and a UTI have to due with dementia? Am I missing something? Did the physical stress cause mental stress that worsened dementia? Does that mean people with dementia shouldn't have exercise because that doesn't seem right.

I recall one time in 2010 that I had to organize and clean up (without throwing too much away) a horrible mess that a hoarding family member made in two rooms of their house. After one to two months working on it for several hours a day, I felt like I lost a little piece of sanity that I was never going to get back. I've had several stressful situations since then and I now feel like my brain is Swiss cheese (full of holes). I'm not even 40 yet. Is this the kind of thing that could've happened to Grandma with the therapy and UTI?

I'm afraid that incontinence can be a symptom of dementia per se whether physio is involved or not. I take it you are in USA? It might be worth trying to get a definitive dementia diagnosis, not sure how it works across the pond.

 

[Sirena]

As others have said, incontinence does occur when the dementia progresses to a certain point. Once you notice it, it is sometimes possible to delay it's onset. My mother is in a care home and a year ago she had a couple of incidents of incontinence, so the carers started taking her to the toilet every two hours. She just doesn't realise she needs to go so has to be prompted and accompanied. So a year later my mother is still continent (although wears a pad at night).

 

[LadyA]

The other thing, that's rarely spoken about, is that quite honestly, urine incontinence is relatively common in older women, even where there's no dementia. The muscles of the pelvic floor can become less"toned", and less supportive of the organs including bladder. My mum is totally urine incontinent, and she doesn't have dementia
She had a "repair" done to the pelvic floor years ago, but seems that's no longer working.
So while dementia and UTI can be responsible, sometimes it's just increasing age.

 

[blu]

Thanks for the replies and advice, it's greatly appreciated.

I can confirm that Grandma did not have a UTI prior to starting physical therapy. It developed about 17 days into it. Before she came to live with me she only needed a diaper at night, but for some unknown reason she started wearing one during the day too (before she came to live with me). She uses a pessary for the pelvic floor issues. As of November she did not have a UTI. She probably does now due to an incident last week. I send her to the bathroom every two hours, but most of the time she's already urinated in her diaper.

I sent an email to her doctor about getting her checked for dementia, I'll probably hear back by Monday afternoon.

So I suspect she had mild dementia prior starting physical therapy. So is it possible that the physical therapy worsened the dementia? If so, why would that be exactly?

I at least want to know what happened even if things can't be treated. This is definitely a learning opportunity that might benefit someone else in the future (Mom, I'm talking about you).

 

[canary]

So I suspect she had mild dementia prior starting physical therapy. So is it possible that the physical therapy worsened the dementia? If so, why would that be exactly?

The physio wouldnt have worsened any dementia - dementia is progressive and worsening with time anyway. I suspect that the incontinence was developing during the period when she was having physio and the physio made no difference.