Q. Can treatment for recurring UTIs in the elderly lead to urinary incontinence?

Hello doctor,

My mother is 96 years old. Five years ago, she had many recurring UTIs caused by E.coli with positive cultures on urinalysis with burning urination and incontinence. She does not have them now. Now she has dementia and is on the tablet Mirabegron. However, she has more urinary accidents and large uncontrolled voids. She had a urinalysis, urine culture, and a blood panel test last week. Her electrolytes are under control. Her urinalysis was clear for nitrites, RBCs, and WBCs, and her urine was clear. She might not have taken a midstream sample, though, and no urine microscopy was done. I do not know if the urine culture will come back positive. If it does, I do not wish that the GP readily treats it as it will set her up for true UTIs. Or do they need to treat it as she has more confusion and large incontinence accidents?

Please give your suggestions.

Hello doctor,

Thank you for the response.

Would you still add the tablet Darifenacin if she is already taking 5 to 10 mg of tablet Donepezil? Mirabegron had some benefits a while ago but not as many recently. She has sleep apnea and uses a BIPAP. Her apneas have decreased a bit this past week and so have the number of accidents from four per day to two. But it looks like she voids with no control whatsoever. Her urine culture came back as mixed growth of uncertain significance. She does not have the traditional UTIs of yesteryears. She has dementia of some sort, and it is progressing.

Please help.

Hello doctor,

Thank you for your reply.

She also has heart failure and takes 1.5 mg tablet Burinex daily which drives all this. There are no accidents on the day she does not take any diuretics.

Please help.

Hello doctor,

Thank you for your reply.

Her family doctor declined the tablet Darefenacin citing that he was not familiar with taking it with the tablet Mirabegron. Would this have helped 5, 20, 50, 80 percent, etc., in holding urine? If it was a higher chance, I will ask again. She is only taking 5 mg of the tablet Donepezil instead of 10 mg. It did not hold off dementia and probably contributed to both urine and fecal incidents. She now wears an absorbent at night. I realize she is 96. She has stable CHF at the moment but much faster-advancing dementia than expected. Two weeks ago, she spoke sentences. Now it is yes or no, and I feel sad about it. I shall do my best to keep her at home till she passes. Nursing homes are a mess, and respiratory viruses are just adding more turmoil.

Please give your suggestions.

Hello doctor,

Thank you for your advice.

Can one use the tablet Darifenacin and not tablet Mirabegron? Also, can one get used to a bladder drug and will it lose its effectiveness? Unfortunately, our family doctor has suggested not to use both. I have changed her absorbent five times. I am giving her 0.5 mg tablet Burinex during the day. Yesterday it was 0.5 plus 0.5 and she had only one incident. However, it was tough to manage.

Please share your opinion.