C.I.C problem, help badly needed

Hi Lawson,

I'm not a fan of using an anaesthetic long term during CIC because by masking pain you could end up injuring yourself more. I think the reason you stopped bleeding has more to do with changing catheters than the anaesthetic. If you're happy with the Lofric, great, but you might consider a Coude type catheter as well. Coloplast has a new one -- the FLEX coude -- that has the sheath you like, but some of us here use the Speedicath Coude which is very slippery. No sheath, but it's stiff enough to insert by holding it only by the plastic funnel so you never have to touch the catheter itself.

Jim

You seem to have much difficulty with CIC. Maybe it's not for you. Did you try anything else ? Meds ? Procedures ? Hank

Hi James

What other injuries might I cause myself if I use a local anaesthetic long term?  I believe I t was the rough holes in the Hollister catheter scraping past my prostate that caused my bleeding and now that I've found a catheter with smooth holes it is much less painful.  

I have tried using the Origo LoFric without the local but it is still very uncomfortable pushing and retracting past my prostate and that's 10 years in.  Not painful as such - more like poking a bruise, if you get my meaning and it lasts for a fair while afterwards too.  

Unfortunately I have had a spinal cord injury since 2007 and one of my symptoms is that I twitch and shake quite a lot.  So I couldn't use a catheter just by holding the funnel end as I would never be able to control it enough to get it into my urethra. 

My SCI has left me with an acontractile bladder and when I started self catheterising my measured volume was 1150ml.  I've managed to get it down to just under 500ml by self catheterising 2 - 3 times a day. 

I've not heard of a Coude type catheter before what is it?

Mark

Hello Mr. Lawson,

My concern is that you could cause additional trauma to the urethra using an anaesthetic since you receive less pain feed back. That said, you have to do what works for you, and apparently no harm in ten years. Still, you might experiment with another catheter or two and see if the new catheters are less painful. Two recommendations are the Coloplast Speedicath and the Coloplast Flex Coude.  Size FR12 works for me but some people prefer size FR14 which is less flexible and easier to work with. I would experiment with both sizes. 

The funnel holding method I mention does require dexterity, but alternatively you could just guide the catheter in with a gloved hand if you use the Speedicath. With the Flex Coude model, you have an outer sheath and you just feed it in.

A "coude" catheter has a bent tip and is designed for difficult catheterizations such as a large prostate or strictures. If you don't have a large prostate or strictures then probably not necessary. You could ask your doctor. The Speedicath Flex Coude btw is not a real coude catheter so you could try it even if you don't have an enlarged prostate. 

It's great that you have gotten your volume down from 1150ml to under 500ml! Do you have any natural voids at all or just voids by catheter?

What I try to do is keep my total bladder volumes below 400ml if at all possible, although 500ml isn't that bad. Total volume would be the volume of the urine I cath plus the volume of any natural void just before I cath. The total volume therefore is what the bladder is holding at any one time. The reason you want to keep it low is so that the bladder does not stretch from too much fluid. When the bladder is not stretched, it has a better chance to heal and rehabilitate. So if bladder volumes get too high, best to cath more often if possible and convenent. 

Jim

 

Hi Hank

Yes I tried Tamsulosin for a while as that helped the bladder to open when I tried to start peeing, which it did successfully.  Unfortunately, there are several side effects listed which included sexual dysfunction and incontinence and I got both of those.  It made my already sexually dysfunctional genitals worse and included night time and urge incontinence which I hadn't done since I was a child. 

I tried treating the dysfunction with bigger Viagra doses and the night time incontinence with a sheath and urine collection bag.  It all became too much when I started to get a rash because of the sheath, as I am allergic to various forms of latex, and that was with using a barrier spray before the sheath too!!  Also, trying to be amorous with my wife became impossible not least because of the Tamsulosin but also because I had to spend 20mins a night just putting that lot on after getting ready for bed.   The urge incontinence was fairly bad too because my SCI has left me weak, slow and not very dexterous  on my left side so I failed to get to the loo quite a lot. 

I can go to the loo on my own but I never completely void my bladder leaving about 180ml behind to stagnate.  That's why self catheterising seems like the right choice for me. 

I have never been offered any procedure to help and don't know what's available but to be honest I've had so many ops now (including an Orchidectomy after suspected Testicular Cancer and 5 more down there to correct a hematoma that would not resolve itself), I'd be very wary about going down that route again..!!! 

Mark

Hi Mark,

The procedures I was referring to are for prostate enlargement. Since tamsulosin caused incontinence for you, most of the procedures are out because they would be doing the same thing. 

How much can you void without cathing ? 

Residual of 180ml is not bad. Did you notice that it varies at different time of the day ? Do you have any other symptoms of BPH ?

I myself used to cath 4 times a day. I started out with 500 - 600ml PVR. It went down slowly. Later on I noticed a pattern of my PVR, it is higher at night when I am lying down , lower during the day when I am up and about. Now, a year later, I only cath once before bedtime, when it is about 200ml, to flush out the bladder, to protect my kidney. The rest of the day, it is usually around 100ml, so I thought that it is not worth it to cath, risking injury to my urethra, even though my cathing is normally uneventful, not painful like yours.

Hank

Hi Hank

I don't void at all if you're talking about spontaneously, I push out as much as I can but never get that last 180ml or so out. 

Also I don't have any symptoms of enlarged prostate so please forgive me if I'm in the wrong forum, I was looking for somewhere to talk about painful self catheterising, as I have a Spinal Cord Injury which means I need to use intermittent self catheterisation. 

After I was injured during surgery in 2007 for a Posterior Cervical Discectomy (to remove a disc from my cervical spine that was pressing on my spinal cord),  I woke up completely paralysed down the left side of my body.  Over the next three weeks while in hospital, I discovered I couldn't feel temperature or pain on the right side of my body.  I was told I have Brown-Sequard Syndrome, but they discharged me without saying anything at all about how I would need to urinate from now on.  So I got used to pushing the urine out once or twice a day and this carried on for 2 years.  By the time I was referred to a Urologist my bladder was holding well over 1 liter and was measured in a Urodynamics lab at 1150ml.  That was with them filling my bladder up in measured stages and asking me if I "felt the need to pee" yet?  Even at 1150ml I still didn't get the urge to go, not even a little bit but they thought they'd better stop at that amount as they didn't want to damage my bladder by going any further. 

By now it was 2009 and I was told I need to start self catheterisation up to 4 times per day.  Which I did religiously for 6 years putting up with the pain and  interruptions due to UTI's along the way. 

As I said in a previous post I managed to get my PVR down to 180ml and my Urologist still says that is still too high!!  He says that a healthy bladder empties complely every time the person urinates and that the urge to urinate usually happens at around 500ml. So my bladder starts at a massive disadvantage being more than half full each time I finish urinating without the catheter.   He reckons for that reason alone I should still be self catheterising 4 times a day and not just morning and bedtime as I do now. 

The problem is that it is such a hassle!!  I have an iPhone so I used to set alarms to go off at set times during the day when I had to go to the loo.  But it was a real pain to remember to carry catheters if I was going out and disposal bags and wipes too.  Now of course I'd need to take the Insillagel with me as well.  I'd need to carry a man bag to keep it all in. 

I have biannual Ultrasound scans on my kidneys and urinary tract to make sure there is no scarring or anything else out of place.  So long as they keep coming back clear then I'm happy. 

Mark

Are you saying your residual is 180 after a natural void? If that's the case, your urologist is technically correct, but on the other hand, if you're total bladder volume (catheterized void plus natural void just preceding it) isn't too much over 400ml, then I wouldn't be overly concerned unless you're getting a lot of UTIs from stale urine and your biannual kidney/bladder ultrasound show no damage. 

Jim

Jim and the other guys. This is a strange guestion for you guys. I am going to say this without being crud. Im laying in this hospital bed and lets say im riseing to the occasion its very weird im not thinking about anything it just came up. How do you dealing with this the nurses make there rounds. I have 2 blankets covering me. Never had this happen before. Thanks guys. Ken

Hi Ken, 

I've never had a Foley, in or out of the hospital, so you're on your own 

here, but my guess is that they've seen it all  

Jim

Yes they have.  Guess im getting better.  Thanks Jim.   Ken

Mark, you are at the right place. However, it is strange that your residual stays the same at 180ml. Mine varies throughout the day, even day to day.

I think you are OK even if you cath once a day, considering the problems you have. Like Jim said, just make sure to check your kidneys once in awhile. Take care. Hank

Ken, Foley will do that to you. And yes, it also means you are getting better. Hank

Thank you. Ken