Question

"I have a 90-year-old mother and wonder if she has a urinary tract infection. She seems to be using the bathroom a lot lately and it is terribly hard to get a straight answer from her if you ask her questions about her bathroom habits. 

You see, Mom is actually a very private person. In her world, one does not discuss bodily functions at all. If I ask her why she uses the bathroom so often, she just glares at me and changes the subject. This makes it very hard to determine if I should make a doctor appointment for her. I’m the one who takes her to all her appointments, so I feel responsible for this.

I suspect she has a urinary tract infection because I’ve heard those are so common in the elderly. I really have no idea and wonder what I should be looking for and what to do about the situation. A little advice here would be helpful."

Answer

You are correct that urinary tract infections are more common in the elderly, and they often can have more negative consequences. It’s not uncommon for someone your mother’s age to be hospitalized with a urinary tract infection, commonly called a UTI.

First, let’s talk a little bit about UTIs and why they’re a problem for the elderly. As humans age, most bodily functions are less efficient. Our muscles aren’t as strong and bladder emptying may be less complete. Retention of urine in the bladder leaves a breeding opportunity for bacteria. Add to that less agile hands that may not be wiping properly after a bowel movement and introducing bacteria to a very short urethra (opening to the bladder), for a woman. For men, the issue related to incomplete emptying of the bladder is often due to the prostate. Therefore, both men and women her age are at risk.

Some older folks drink less fluids because trips to the bathroom require more movement than they’re comfortable with due to mobility issues. They may also be on medication that causes frequent bladder emptying to prevent fluid retention. That’s a very common phenomenon and could explain your mother’s frequent bathroom trips.

So the first thing to explore is your mother’s medications. Are there any new ones? Do any of her medications cause frequent urination as a side effect? Is she having bowel issues such as diarrhea or constipation?

Using the bathroom frequently to urinate is a good thing for your mother, especially if she drinks a lot of fluid. Emptying the bladder is a good idea as it keeps bacteria moving away.

Another thing to know is that bladder infections in the elderly can present differently than in the adult population. You might see incontinence, confusion that was not present before, falls, low blood pressure, rapid heart rate, or sleepiness. These symptoms are not always present but are not uncommon when someone has a UTI.

I do believe that a change in toileting as you described should be explored, and it will not be easy with your mother. I recommend that in a private setting with just you and her, you insist that she not change the subject and have a conversation with you about it. Tell your mother that you’re concerned and that she is at risk of hospitalization. When she changes the subject, just go right back to it. You might have to do that several times, though I do recommend that you persist. We all need a loving family member to advocate for us and sometimes we can be our own worst enemy.

I wish you success at resolution with your mother.