DM and bladder control issues

[Kit24]

My DM is 65 and has been having problems controlling her bladder. It started a couple of years ago where she would have small accidents/ leaks and has now worsened. She’s very embarrassed about it and won’t tell anyone else in the family but me, not even my dad. I’ve urged her to go to the GP and explained that it’s a common issue, especially among women who have had children and are getting older, but she won’t make an appointment.

I’ve bought her discreet Tena pads to wear out but she won’t use them. It’s now at the point where she is wetting herself when she goes out and has to change when she gets home. She is washing herself and her clothes so it’s not a hygiene issue but she won’t speak to anyone who could help. She recently went for a shingles vaccine and over 60s health check up. She told me she’d mention it to the nurse but when I asked, she said she had ‘forgotten’.

I’m worried about her because she told me on the phone she’d had a bad accident and wet herself so badly she had to change her slippers as they had urine on them. Does anyone have any advice or know if something can be done?

Hi Op, i just wanted to flag up that in my MIL case, she developed urge urinary incontinence and it was because she has white matter small vessel disease or cerebral small vessel disease. Where tiny blood vessels in the brain become damaged meaning parts of the brain doesnt get oxygen and dies. This was only discovered after she had a stroke (a lacunar stroke) but the disease was already moderate to severe by that time. Its caused by high blood pressure, has impact on memory and also on mobility. .

Edited to flag that MIL also started off with wordfinding difficulties and now cannot hold a conversation and cannot really talk as it takes too much processing time and energy so she says one or two words. Very brief. No elaboration.

MILs urinary incontinence was likely already happening before the stroke but she hid it. She didnt understand it was all related to it until i talked to her when she wet herself on a walk. She was eventually prescribed tolterodine, another pp mentioned solifenacin. The tolterodine has helped control the incontinence BUT its several years on now, and ive now discovered that people with cognitive impairment really shouldnt be given tolterodine as it has a huge negative impact on cognition. MILs cognition has plummeted.....

So i think it would be good if she or you could relay concerns to the gp. Get her blood pressure checked at least.

@CautiousLurker2
I am not intending to alarm or worry you, but just wanted to share that ive been looking into these drugs recently because of my MIL and was surprised flabbergasted to find out there is increased risk of developing dementia if taken long term...

https://www.ncl.ac.uk/press/articles/archive/2018/04/dementialandmarkstudy/

They interfere with brain neurotransmitters but apparently there are some safer alternatives, mirabegron or trospium.

Please check it out for yourself.

She really does need to speak to her doctor.

If you have a look at the M&S website, they have 'confidence' pants which were originally intended as period pants but can also serve as incontinence pants. They might help?

https://www.marksandspencer.com/3pk-heavy-absorbency-period-knicker-shorts/p/clp60709193?color=BLACKMIX#intid=pid_pg1pip48g4r6c4

And without WLI too in 10 months. I think it’s easy to underestimate the various ‘things’ that affect health if weighing far too much - it’s not just the obvious ones I’ve found - it’s things like hips no longer ache like mad at night, the urinary thing has improved - even my nails have grown nicely ( that’s probably all the salmon and omega 3 supplements) I had a weird kind of goitre came up in my neck too and that went as well and my really horrible post covid neuro issues went away ! Yay !! I think I just generally had a lot of inflammation that losing weight got rid of - the biggie for me was within 3 months of starting my lower legs looked half the size and I could actually feel bones.

Magnesium can help...

Could you also get her to sign up to online pelvic floor work... Hypopressives have helped me a lot.

If she will sit and watch YouTube with you (I don’t think you can leave her with an instruction and walk away), Elaine Miller is the Fanny Physio and ladies continence is one of her things.

She is extremely entertaining as she puts her message across.

@TheSandgroper That’s a good idea. There is a spare room in her house that sometimes we use as a home gym together. Recently she hasn’t been into using it. But if I can get her back into a routine I can play some of these videos and see if she’ll join in.

What about reusable period pants, I know that won't fix the problem but it may help slightly

I recommend those M and S pants especially if worn with a Tena Pad.

Definitely a trip to the doctor. If she’s having cognitive and continence issues it would be worth checking for Normal Pressure Hydrocephalus. The other key symptom for that is balance issues/ shuffling gait.

Thank you - have booked an appointment with my GP to discuss changing meds. Rock and hard place, isn’t it - my biggest fear as I approach retirement is Alzheimer's but the impact of incontinence over the last 20 years (even having has surgery to try and correct it) has been seismic.

I haven’t read the full thread to know whether this has been mentioned by anyone else, but I think this might be a condition that medication can be bought privately online for through an e-consult.. that might feel a bit less daunting as no need to speak to anyone about it abd also not on her nhs record (i think gps are notified and file it but it’s a letter in the appendices not a part of the main record)

Third this!

She might well have some sort of uti as well and that might account for both the memory and the leaking. I'd be worried about cognitive decline too.

I had a really good chat with a pelvic physio about all sorts of things (had gone with a sore tailbone) but she was fab about my other issues too and life is much better if you're not worried about toilets all the time. I'm not that old and haven't had DC, so it can affect anyone really.

Sorry, a bit late to this one, but has she had a blood test? Ask the doctor to check her Vitamin B12 levels. They really affect memory and my mum has to have them every few months. It really shows when she's due for one. Also investigate Botox injections in her bladder. My mum also has those and they really help with urgency and control. Mind you she is in her 90s so a bit older than yours!

@Maybeitllneverhappen Yes she recently had a wellness check which involved blood test. She told me everything came back fine and the nurse had no concerns.

If you haven’t got power of attorney, access to her bank accounts etc, do it now. She needs to have capacity for it to be done legally.. Then you can ring the practice nurse and ask for the rest yourself for your own peace of mind.

Would your Mum not be wearing incontinence pads because she's not sure what to do with them once used?

Could you maybe buy her a discreet small pedal bin that is next to the loo that she can peel off her underwear and put in the bin? We have one in both pur toilets as I use Tena pads.

Mum had dementia and before she went in a care home she was living on her own and I was doing her shopping and buying her tena pads. Unfortunately I never gave a thought to disposing of the used ones although I made sure to emphasise not to flush them down the loo. Then the one day I found the used ones hidden away in her wardrobe off all places, stuffed at the back. So sad.

Maybe buying her some sanitary disposal bags and a couple of small bins?

You can only exercise Health & Welfare LPA once the person has lost capacity and it's a very low bar. You can only talk to a GP & they talk back if you've been given permission. You can raise issues but they can't talk to you.

I don’t think power of attorney is appropriate at this stage. She and my dad have a joint account, although he was getting concerned as she kept falling victim to online / phone scams. We have had to change her debit card twice and luckily it was noticed by one of us before they took any money from the account. I am always talking to her about scams now.

I asked her about why she doesn’t like wearing the pads. She said she doesn’t like the feel of them and finds them uncomfortable. I told her that surely wetting yourself is more uncomfortable and encouraged her to at least try. She seemed positive when I mentioned the M&S underwear.

This, also she probably has a low-grade UTI, which needs sorting before it becomes serious and turns into sepsis.

It sounds as if your mother does have memory problems, and she knows something is wrong (wetting herself) but isn't thinking logically about how to deal with it. Continence pants are a good idea, she is more likely to use those.

If she does have memory problems you need to go to appointments with her or you won't get an accurate picture of what is happening. It is lovely that she obviously trusts and confides in you.

Both of your parents should do a POA asap. If they wait until it's needed they may no longer have the cognitive capacity to actually do it. I'm in my 60s and did mine years ago, it's the same as making your Will, do it ahead of time so it's ready when needed.

There could be now end of reasons for this. She needs to see her GP in the first instance to rule out basic causes such as infection, not randomly self medicate.
Seconding the poster who mentioned the black knicker/pad things all in one - they’re ideal.

She’s 65, not 85! She needs to go to the GP and get this sorted. There are so many things that could be done to help. Frogmarch her to the GP if you have to! She needs to be told to stop being embarrassed and start taking care of herself.

Please look at vaginal oestrogen which I believe all post menopause women should be offered. It's very effective when used consistently. GP can prescribe or it can be bought from a pharmacy without a prescription. It's safe (no contra-indications or age limits). As well as helping with bladder control, vaginal oestrogen also protects against UTIs, strengthens pelvic floor & helps prevent the vaginal atrophy that happens over the years post menopause. Systemic HRT may also help her with future health. 65 is young to be experiencing bladder problems, so the earlier she starts vaginal oestrogen, the better. Might be worth sending her a link to menopause sites or printing out something for her to read.