Increased incontinence - any suggestions?

[Wildlife]

Just re-read the title -not sure it's quite right - I'm looking for help to deal with this, not ideas to make it happen! Sorry - getting slightly hysterical here. I'll explain.

Mum (90, AZ. lives with me & OH) has come home from a week in respite 2 weeks ago and is quite a lot more incontinent than when she went in. This has happened before and usually improves once she is home, but not this time. She wears pull-ups (which we get from the Continence Service - 2 pairs a day) and although they were getting increasingly heavy by the morning, her night time ones were coping with an extra liner. Now she has very strong-smelling urine and seems to be going to the toilet a lot more (she does still know when she needs to go, but doesn't get there in time). I've also been greeted by discarded, sodden pants and a puddle of urine on the bedroom or bathroom floor several mornings and consequently a wet bed as she doesn't always find clean pants to put on (or get them on correctly if she does!) Talked to the GP who has asked for a sample to check for a UTI, but she has no other UTI symptoms. It's making the whole house smell as I think she's trodden in puddles of it and then walked on the carpets. Lovely

Does anyone have any suggestions for the cause, or strategies to deal with it please?

 

[Sue J]

Just re-read the title -not sure it's quite right - I'm looking for help to deal with this, not ideas to make it happen! Sorry - getting slightly hysterical here. I'll explain.

Mum (90, AZ. lives with me & OH) has come home from a week in respite 2 weeks ago and is quite a lot more incontinent than when she went in. This has happened before and usually improves once she is home, but not this time. She wears pull-ups (which we get from the Continence Service - 2 pairs a day) and although they were getting increasingly heavy by the morning, her night time ones were coping with an extra liner. Now she has very strong-smelling urine and seems to be going to the toilet a lot more (she does still know when she needs to go, but doesn't get there in time). I've also been greeted by discarded, sodden pants and a puddle of urine on the bedroom or bathroom floor several mornings and consequently a wet bed as she doesn't always find clean pants to put on (or get them on correctly if she does!) Talked to the GP who has asked for a sample to check for a UTI, but she has no other UTI symptoms. It's making the whole house smell as I think she's trodden in puddles of it and then walked on the carpets. Lovely

Does anyone have any suggestions for the cause, or strategies to deal with it please?

Hi Wildlife
The fact that your Mum doesn't have any other UTI symptoms doesn't mean she hasn't got a UTI. The fact that it is very smelly is enough of an indication. Hopefully treatment for the infection once identified will improve the incontinence to a degree. Hope you get the results soon so it doesn't get worse or bring on other symptoms.
Best wishes
Sue

 

[Nebiroth]

Smelly urine and frequency are UTI symptoms. It actually takes a really bad infection to get things like discoloured urine (due to discharge, essentially, pus mixed with urine) and a really bad smell.

In fact lots of people get a UTI which has no symptoms. In most the immune system would just deal with it and they would never know. In people with dementia you would know because of the devastating effect all UTI's (even 'silent' ones) have

The urine test will tell you for sure.

It's also possible that her kidneys are producing more than usual amounts of urine at night. Usually the body produces a hormone during sleep that tells the kidneys to produce less (but more concentrated) urine, so that we aren't woken up every two hours with full bladders. As people age they produce less of this hormone.

There are also lots of health problems that can produce excess urine production at night - having to get up and urinate during th enight is called nocturia.

One of the commonest causes is a prostate problem but you can rule that out right away since women don't have one! On the other hand, problems like weakness of the bladder muscles is more common in women than men.

Lots of these problems can be treated so if it isn't a UTI it's still possible the problem can be dealt with.

In any case, it needs assessment by a doctor, since it is a change in what is normal for your mum and persistent changes that are unexplained should always be referred to a doctor.

 

[cragmaid]

Quick help with the smell on the carpets....Pet shops sell stuff to deal with the smell from animal pee...they can work for human pee too!

 

[Jessbow]

commode in the bedroom be of any use?

 

[Wildlife]

Quick help with the smell on the carpets....Pet shops sell stuff to deal with the smell from animal pee...they can work for human pee too!

Thanks Cragmaid - I've got some sprays but it was undisguisable
so we had to get the steam cleaner out. Just hoping not to have to do it too regularly

 

[Wildlife]

commode in the bedroom be of any use?

I tried that Jessbow - I though it was a good idea but it remains unused

 

[Wildlife]

Smelly urine and frequency are UTI symptoms. It actually takes a really bad infection to get things like discoloured urine (due to discharge, essentially, pus mixed with urine) and a really bad smell.

In fact lots of people get a UTI which has no symptoms. In most the immune system would just deal with it and they would never know. In people with dementia you would know because of the devastating effect all UTI's (even 'silent' ones) have

The urine test will tell you for sure.

It's also possible that her kidneys are producing more than usual amounts of urine at night. Usually the body produces a hormone during sleep that tells the kidneys to produce less (but more concentrated) urine, so that we aren't woken up every two hours with full bladders. As people age they produce less of this hormone.

There are also lots of health problems that can produce excess urine production at night - having to get up and urinate during th enight is called nocturia.

One of the commonest causes is a prostate problem but you can rule that out right away since women don't have one! On the other hand, problems like weakness of the bladder muscles is more common in women than men.

Lots of these problems can be treated so if it isn't a UTI it's still possible the problem can be dealt with.

In any case, it needs assessment by a doctor, since it is a change in what is normal for your mum and persistent changes that are unexplained should always be referred to a doctor.

Thanks for your detailed reply. I was just hoping to avoid antibiotics as she's on Warfarin and they send that all to pot (and upset her tummy too) We'll see what the results are.

 

[susy]

Ask the GP if taking something to change the ph of her urine to make it inhospitable to the bugs that are there would be a good idea instead of the antibiotics. Does she drink lots?she would need to be able to drink lots and be amenable to taking what the GP advises. Good luck xx

 

[Wildlife]

Ask the GP if taking something to change the ph of her urine to make it inhospitable to the bugs that are there would be a good idea instead of the antibiotics. Does she drink lots?she would need to be able to drink lots and be amenable to taking what the GP advises. Good luck xx

Thanks suzy - I hadn't heard of that. She does drink quite well so it could be an option

 

[susy]

Only do it with the guidance if the GP though. I have no idea if it could upset any other of her medications and the pharmacists are very careful about giving these out for the elderly so there must be a reason why. (Why isn't it Monday so we can talk to the GP!!!!) in the mean time keep pushing fluids to keep her urine diluted as much as possible. She may well wee more but it won't be quite as strong hopefully.

 

[Nebiroth]

People often recommend cranberry juice or extract tablets to help prevent UTI's. However, cranberry interacts with warfarin and can interfere with it's action, changing the INR, so you must ask the doctor about this first in your mum's case.

 

[Nebiroth]

Thanks Cragmaid - I've got some sprays but it was undisguisable
so we had to get the steam cleaner out. Just hoping not to have to do it too regularly

You will likely need a combination of both. Fresh urine is generally odourless and sterile (unless you have something like an infection).

Stale urine smells because it breaks down chemically to produce ammonia and nitrous compounds - these are what cause the smell.

Even small amounts of stale urine can cause a smell, so if you get it into carpets or fabric furnishings it will smell as it is very difficult to completely remove it. When it dries it will leave behind crystals that will smell again if they get damp at all.

Steam cleaning helps because it sterlises the areas and helps to dilute the urine and lift it out. The pet sprays you can get contain chemicals that specifically neutralise the compounds in urine that cause the bad smell. So you wil likely have to use a combination.

You can also get something like a Vax or Bissel carpet washer. They are essentially vacuum cleaners that are safe to use with water and have a very wide but thin nozzle that sucks (and therefore drys to just damp) the carpet. They also sell carpet shampoos that are very good at breaking down "organic" stains, espescially the "oxygen" ones.

 

[ali p]

you could try sprinkling bicarbonate of soda over the mattress to soak up odours?

 

[Wildlife]

Thanks everyone for your comments & suggestions. Mum's urine sample (given to the GP on Friday) has come back positive and she's now got a course of anti biotics. However, in the meantime, she has mastered using the commode at night so we have fewer puddles to mop up in the bedroom and her urine is much less smelly!

So now I have a dilemma - I hate giving her unnecessary drugs, particularly antibiotics as they upset her warfarin (so no to cranberry juice i'm afraid) and her stomach (when things are calming down urine-wise) , so do I give her them or not? I'm going to ring the GP again tomorrow, as I only spoke to a receptionist today to get the results, so I still don't know if the infection is a low grade one or worse.

As far as the hall carpet goes - I'm pleased to repot that our Bissell cleaner worked a treat (I know I said steam cleaner, I couldn't remember the name before!)

 

[susy]

I would be surprised is the answer was anything but "she must finish the course" the reason for that is although things seem all better these bugs need to be killed off all together or they will simply grow in number again until she is symptomatic once more. Then she would need yet another course. This is also how bugs can get resistant to anti biotics. Please do get advice from the GP of course but in the mean time, don't stop them.

 

[Wildlife]

Latest update - day 2 of 5 of antibiotics (4x daily) . Mum is finding it very hard to swallow them and tries to spit them out surreptitiously. So I phoned the GP again for advice and was told she only needs to take them for 3 days not 5 but take another sample in if she still has problem after that. I think the problem is more to do now with her not waking up in time to use the loo/commode as she's not so smelly in the urine dept now but still has very wet pull up pants every morning.
Planning to contact the Continence service to see if they have any advice now that she's had the UTI treated.
Thanks again to you all for your ideas & suggestions. xxx

 

[nita]

They can give her antibiotics in liquid form. Three days seems a bit short for a course - they're usually five - seven days.

 

[Oxy]

Glad your mum is improving but gps give antibiotics for a reason. When my caree has had them for only 3days the UTI often comes back. Usually they asked me to take another sample in 3days after completion to ensure infection has disappeared. They also do INR sooner as it increases result. WithAB they have even,though not for UTI,reduced the warfarin.
The stuff that reduces acidity got over counter has too much sodium in if your mum has blood pressure or heart probs, if it's what I think someone was talking about eg cymalon?? Can't remember name for sure.

 

[Vesnina]

In my case, what helped was removing all the carpets and having floors washable
(I use vinegar and ethanol in water),
using protection for mattress, armchairs etc,
and having everything else washable - just cotton linen etc.

In the period mother used to wake up to use toilet during night,
I put handrails - addition to the handrails she already had along some walls - to keep her in the space (corridor, toilet.. ) she was to use at night.
Before, just after sleep, she would believe she was at some other place - forest or so,
so she would make a puddle believing this was the right thing to do.