Random peeing in hallway

riajean

My spouse who’s in memory care for one month has begun to arbitrarily pee in corners of the building.  He’s on an every hour bathroom schedule but is still finding a corner in the hallway to pee.  He will do this by his bed too.  I’ve asked that there be a light on at night so he can find his way but don’t understand this new and very disturbing habit.  Now they want me to bring him to a urologist and I’m terrified he’ll want me to take him home afterwards or I won’t be able to get him out of the car.  There will be a scene and I’ll be sobbing, shaking and upset with grief. 

I thought MC would handle Dr appointments?   Guess not.  This is so upsetting.  Anyone have experience with this ??

Ed1937

Riajean, I'm pretty sure they want him to see an urologist is to check for a UTI or another condition that causes this. It is certainly worth seeing that type of doctor, but if you have a long wait time before you can get an appointment, a PCP can run a urine test to check for UTI. If you have it done, ask for a culture with it.

harshedbuzz

Riajean-

I would expect any MCF to be able to collect a urine sample for their in-house PCP. I would also expect them to be fairly experienced around the issue of residents peeing in novel places- it's a pretty common dementia behavior. Perhaps they've run through their usual strategies and are not getting results and want to make sure there isn't a major issue.

We took my dad out for his twice-yearly ADT shot. He was relatively new to the MCF and we were terrified of him wanting to go home or refusing to get into the car to return to MC. We hired medical transport which sent a van. Staff at the MCF had dad use a wheelchair that day and it went really well except for the additional cost which was around $130. We met dad at the doctor's office. 

HB

Jo C.

Hello riajean; this is a challenge requiring some easy first step detecting rather than deciding to seek a urology appointment out of the gate; that is a little out there as a first response to the problem issue.  (As it is, it takes forever and a day to be able to get a urology appt. for most.)  Staff concern re the voiding around the environment is understandable and of course that needs to be dealt with.

First thing that should be done would be to get a urine sample for a culture and sensitivity to determine whether there is a UTI or not. If there is a UTI, treatment may solve the issue.

Second concern may be just HOW the facility staff is addressing this in a person with dementia and also how they are dealing with his, "hourly bathroom schedule."  Hourly is a lot - try using that schedule for yourself to see how fast one hour can happen.  Wonder if he is confused and not processing the demands of and with performance of, "the schedule."

Hourly schedule it is in place at this time . . . . BUT . . . . just HOW is staff addressing this?  What sort of staff interaction is taking place?  Are they irritated or demanding with him?  Do they push at him?  Does he feel that he is being scolded?  Is staff demanding he perform a void if is unable to and he feels guilty or put upon for not being able to do what is wanted and perhaps confused by it all?   If he cannot void each hour and if he feels he is being punished or he is doing something wrong, this may be why he persists hiding in corners, etc. to void when he finally needs to do so.  He may well not be able process the finer elements of voiding in appropriate places, as well as not understanding the staff insistence he void each hour.   I would really want to know how this is handled down to the nitty gritty details.  If he is being rushed by busy staff or scolded or if there are instructions given in a harsh way, that may be a problem issue.  Is this even a doable approach?

As for a urologist; just what do they expect?  A UA with C&S can be done where he is presently - that is a first step.   What else do they think may be an issue?  Perhaps a prostate issue?  But that is usually a problem of not being able to void due to enlarged prostate.  I personally, from what is written, feel that the person wanting this appointment may not be on spot and is looking for something easy to change the behavior without putting sufficient time and effort into problem solving planning.  They need to assign the same person to help your husband to the bathroom - they need to keep their voices soft and kind; they need not to push, push, push demanding he void if he does not need to do so.   Can all of us perform a void each and every hour on the hour and with someone with us encouraging or making demands?  For a person with dementia this must be much more difficult.  If husband continues to void in corners despite the hourly schedule, then a different approach will need to be developed.

If you are not working or can take a day or two from work, it may be enlightening to spend those days at the facility - let staff continue their schedule without your input, but watch how they are approaching things and what their interactions are like as well as observing your husband's behavior.  Ask the supervising RN just what and how their approach is and is this the same with all staff on all shifts?  See if you pick up any clues as to why this is happening.

My gut feeling is, and I may be wrong,  that this may be an issue of staff not having developed an effective approach for a patient with dementia who would not have the ability to process what is being demanded re a behavioral issue.  If behavior cannot be changed, then a different approach may need to be taken to deal with the outcomes of such persistent behavior.

If all else fails, there is the option of incontinence briefs such as pull-ups, and if he began to take off the briefs, the Buck and Buck catalog (adaptive clothing) has some very nice menswear that looks like normal clothing but actually closes down the back so the patient cannot get out of their clothing or access their incontinence supplies.   Just a little idea for a "just in case."

There is no value in projecting oneself to be "sobbing, shaking and upset with grief."  You need not put that out there even though some fearful concern is understandable.   If there was a significant health issue requiring a Uro appt., that may be different, but this seems to be only for a patient who has been voiding in corners and wanting to change behaviors.  Another option may be to have your husband seen in office appt,. or even in the ER setting and have a Urologist agree to see him there (not easy to arrange, but can be done).  The facility staff can have your husband transferred by a non-emergency medical transport to the ER and back to the facility .  This is usually done by ambulance companies and the costs are much less for non-emergency transport service.  This way, he would be transported round trip by ambulance staff and you would not have to deal with getting him in and out of the car, etc., but you could still be at the ER so you can communicate with the physicians.

Let us know how it is going, we will certainly be thinking of you and hoping it all goes better than it is at this time.

J.

riajean

Dear J,

The MC set up a Dr appointment with my husband and she requested bloodwork.  Visiting him we noticed his feet and ankles were swollen and that’s never happened.  The results were negative for UTI and normal otherwise.   She said to keep an eye on the edema. The director said they had no issues at this time and my husband was well liked due to his easygoing personality. 

Checking in the random peeing wasn’t going away and they upped the bathroom schedule.  The next call to me was another in house Dr check and an appointment was requested with a urologist.   

My husband was obsessed with the bathroom at home too.  To me it seemed he went due to being bored.  He died gave an enlarged prostate- always has- and a higher PSA so I’m not sure what an appointment will accomplish.   I’ll call today to speak to the head nurse and ask your questions which are helpful. 

As for me I shake before each visit because I’m highly sensitive to my husband’s feelings and mine as well.  This whole 7 year, intense ALZ caretaking experience has affected me deeply.  This  experience has turned me into a fragile, teary person and I feel sometimes like I’m going crazy.  I agree this is a behavior issue maybe one seeking control of some sort. 

Thank you all for your comments.  

DrinaJGB

My DH spent 4 months in hospitals--one in ICU on life support. Each day there seemed to be a new problem---his blood pressure too low--medication changed, now it's too high; new super-bug infection in the urinary tract; new wound on his behind MRSA; new psudomonas pneumonia---day after day and month after month. It was a harrowing experience and the world seemed surreal.

One day I was in ICU and  was told that he had yet acquired another major infection. The doctor left and a new nurse was in the room. I was so exhausted and started crying about his condition.

  The nurse wheeled around, pointed her finger at me and said-

 "No!--YOU are the strong one!!! YOU are the one who can help your husband survive this horrible thing, and you cannot fold up and crater now! He needs you to be strong because he is not! There is no time for tears now!"

That statement changed my life. I truly believe it is why my DH survived a rare brain disease that is practically unsurvivable. He has lived longer than any doctor ever predicted.

  It has not been easy. But we are still here, and I truly believe that the nurse who set me straight is a large reason why we are.

You are the strong one.