Self Catherization. An alternative to Turp, Greenlight, HoLEP...?

Hi Neil,

I'll take a measurement next time but i'm guessing the resistance you're getting is at the first resistance point (prostate) and not at the second resistance point (bladder sphincter). I do know that when my urine starts to flow there's only an inch or so of catheter visible between the tip of my penis and the plastic funnel. 

What you can try is that when you get to the first resistance point, instead of forcing it, just put very gentle pressure on it, try and relax the area, and sort of wait for things to open by themselves. The other thing I found worked was to very gently twist the catheter back and forth a few times while gently pushing. The twisting is very subtle, just enough to break friction and again very gentle. If none of these things work you could try either moving down to a size 12 or temporarily moving up to a size 16.

Another thought, but someone recently posted about the benefits of a "sitz bath" which is basically either buying a commode or sitting in a bathtub for a few minutes with very hot water just covering the prostate. I never did this prior to self cathing but it seems reasonable that this may loosen and relax the prostate a bit and make self cathing easier. Wouldn't want to do it every time but if you're having issues don't see how it would hurt.

Jim

Thanks Jim. I think 14s are the best for me. The 12s just collapse like a noodle against the resistance and cause bleeding and 16s are way to big. It is amazing how fast the body (and mind) lose their memory of self-cathing after a few weeks. Now I have all that stinging and burning feeling after trying just like when I first started. I'll just push ahead - s-l-o-w-l-y! Take care. Neil

Hi Neil,

Since Jim is a bit rusty, I will try to answer you. I have been cathing everyday for the last two months.

The last resistance for me which I think is the sphincter occurs when I have about 5 inches left from the 14" Speedicath. After that resistance, urine would come out almost immediately, maybe not more than 1 inch.

Hope this helps.

Hank

Thanks Hank - that does help as we use the same catheter since mine is also 14" Speedicaths. So I guess I was knocking on the door. But it sure stings again and burns for several hours when I pee afterwards. It will probably take a few days until the body gets used to it again.

Take care

Neil

Hi Hank, I strated self cath about 2 weeks ago,and i was thinking about touching the catheter. I don't think this is a good idea,however i use speedi cath  and you do have to bend that catheter to around 6 inches before you insert it . Is this the procedure you do?

Thanks,

Hi Frank,

I use Speedicath 12fr straight. No, I don't have to bend the catheter at all. Sometimes I do touch the hose part of the catheter near the plastic funnel to add a little bit more pressure to it, but I usually try to stay with the last 1 or 2 inches that is not lubricate (maybe wet but not lubricated). Just make sure that your fingers are clean (I use alcohol pads).

I had to touch the catheter more often when I used size 10fr and hardly ever had to when I used size 14fr. If you have to bend, maybe you should try the coude (Tiemann) tip.

Hope this helps. Hank

Hi Hank,I was told not to use alcohal pads.Wash your hand with soap and hot water.,use benzalkonium-chloride antiseptic towelette to wipe penis head.

I can not insert a 16 inch catheter without bending it. Maybe sterile gloves is the answer.

Hi Neil,

I am pretty sure that you were at the door. Just be patient and wait, at the same time applying constant light pressure. If you are using coude tip, you may have to wiggle it lightly to find the entrace. Coude tip helps at the first obstruction but needs a little trick at the last door.

If you experience stinging and burning afterwards, my guess is that you still have open sores in there. If you can afford to wait until the sores are healed, that would be better. At least you are not bleeding like I did when I just started thanks to some inner cuts created by a nurse at my uro office.

What I did was waiting for 2 days and trying again. If it still bled, I'd wait for 2 more days. Probably after 2 weeks, it finally stopped bleeding. But not everyone can afford to wait like that.

Hank

Hi Neil and Hank,

Well, I just got rid of some "rust" and self cathed with a ruler handy As I stated, prostate resistance was felt at 4-5" and "knocking on the door" of the bladder at around 2". And this should hold true whether I'm using a 12F or 14F. 

That doesn't mean these will be your numbers but if you're first feeling resistance at 5" then that is most probably *not* your bladder sphincter. Your bladder sphicter would be the second point of resistance. 

Jim

Hi Frank,

I understand your nurse told you to bend back the catheter prior to inserting, but this is not standard procedure nor in my opinion the best procedure. As detailed earlier in the thread, you can simply insert the catheter holding it only by the plastic funnel. Alternatively, you can touch the catheter and feed it in but in this case I would suggest using non-powdered surgical gloves. 

Jim

Hi Jim and Hank - thanks for the information - it really helps. I will try again tomorrow. I put some Polysporin on the penis tip and that helped with the discomfort. I learned not to let up from self-cathing for any length of time as the body has to adjust again. Also I'm back to getting up at night every 2 hours instead of sleeping 7 hours after cathing.

Take care,

Neil

Hi Jim,

I find it very interesting that we are so different. Either you have a very long urethra 😀 or I have a very short one 😥 . My first resistance is at about 6" , the second (also the last) is at about 5". After the second at about 4", urine starts coming out. I always try to insert it a little deeper, perhaps 1" more for better flow, so it is now at 3". I found absolute resistance at about 2" left, probably due to reaching the other side of the bladder.

Do you happen to be an ex-basketball center like Shaq? 😁

Anyone for a tie-breaker ?

Hank

Hi Frank,

What was the reason not to use alcohol pad? I use them for 2 months without any problem. Some people thought that it may burn when apply to the tip of the penis but it never happens to me, perhaps the pads I use are more diluted.

But if you need to touch the hose part, it is good to wash your hands well then. If your catheter consistently bends, try to go to larger size.

Hank

Hi Jim,

I just googled "man's urethral length" and the result is 20cm or 8 inches, which is more like my size. Yours is closer to the max which is about 11 inches. LOL. No wonder I had so much problem forcing and bending catheters at the 5" mark in the beginning because I read all your posts.😀

Hank

Hi Neil. When I first began learning how to self cath, I used the coude tip speedicaths in 12, 14, and 16. Later my urologists nurse suggested the 12. And the urologist suggested a straight tip. I was having problems with the coude tips, Quite a bit of blood most times and even blood cots for the next few times I voided normally without a catheter.

Since switching to the straight tips, I've had no trouble with blood at all. Of course that may also be because I perfected the technique of inserting them.

Speedicaths are stiff enough not to double back or kink. But supple enough to easily go around corners. I've never heard of pre bending them.

 sit on the bed and hold my penis facing upward. I wipe my penis head with an alcohol wipe along with my finger tips. Holding the catheter by the funnel only, I use a thumb to open the entrance of the urethra. I Insert the cath carefully and after it has gone in an inch or so, I stretch my penis upward at about a 45 degree angle. I then insert the cath further.

When I feel resistance, I stop, wait a moment and then advance the cath very slowly. That is the external sphincter and the prostate itself. After a couple more inches I feel a sensation which tells me to stop again. That is the internal or bladder sphincter. I take a few breaths and keep a very gentle pressure on the catheter. Just a little. Suddenly the catheter starts to move again when the muscle fatigues and relaxes. A half inch or so later the urine starts to flow. I insert about another inch.

Perhaps you should try a straight tip 12 or 14. Either of those works perfectly for me. My problem is occasional attacks of acute urine retention so I might go 2 weeks without needing to cath.

Well said, John. I was about to do it myself for Neil but I am glad you did. You are more eloquent anyway.

Hank

Hello Jim, Hank and Johnclen,

 First just want to thank all of you again for your help. Just to refresh I am using the Speedicath 14 coude tip.

I just had a successful cath! I followed all of your advice combined so that kept my mind off the discomfort.

Now for the results: I reached the internal sphincter at 11 inches. It wasn't too bad to that point as I rocked the tip back a forth gently. There was a real sting when I knocked on the door so I just held a little pressure for a minute. Up tp that point there was no blood coming out or other fluids or bukckling.

Then all of a sudden some blood came out down the tube. My first inclination was to pull out but I just held it and after 10 seconds the clear pee started to come out. At that point I pushed it in one more inch and held it. So I was in a total of 12 inches at that point with two inches left to the green cap.

Surprisingly there wasn' that much pee that came out. Only about 250 ml and I had forgotten to pee beforehand. Pulling the catheter out really stung but I breathed a sigh of relief when it cleared the tip!

Also, last night I took an AZO Urinary Tract Defense with antibacterial protection tablet and that completely eliminated the burning and pain I experienced while peeing yesterday after my failed attempt.

Thanks guys for all yuor help.

Neil

I am glad for you Neil. It can only get easier from now on. Take care.

Hank

I should add one more thing Neil. After the urine stops coming out, pull the catheter out very slowly. The flow usually starts up again. Then stop and wait for it to stop again. It does that two or three times for me before the catheter leaves the bladder. That is the remaining urine at the bottom of the bladder. When the last of it stops, I pull the catheter the rest of the way out slightly faster. 250 ml is common for me unless I've been drinking a few or more beers. I don't feel any stinging at all. Just a slight twinge or strange sensation when I bump the bladder sphincter. Nothing on the way out. Try the straight tip.

Thanks johnclen. How many times a day do you cath? Also how much do you pee on your own before you cath? My Medicare order is for the coude tips but I can a sample of the straight tips just for fun - if you call this fun!

Take care.

I just wanted to ask all of you if self-cathing affected your regular peeing in any way? Did it improve your flow streams by opening up the prostate restriction or did it worsen your flow streams by causing inflammation due to irritation or did it not make any difference?

Thanks

Neil

Hi Hank,

Hank said: "...Yours is closer to the max which is about 11 inches."

----------------------

LOL. I wish.  Seriously, if you look at an anatomical diagram, you will see that the urethral part of the penis is only one part of the catheter's journey. It also has to pass around the prostate which is different person to person. In any event, as mentioned there are generally two points of resistance felt. The first is when you get to the prostate and the second when you go through the bladder sphincter and urine starts to flow. So really no guessing.

Jim 

Hi Neil,

Glad things went OK last night. As to John's suggestion using a straight tip. Be careful. There are exceptions, both John and "Cartoonman" here to name two, but the Coude tip is designed to go around, as opposed to sticking the prostate. Of course it has to be positioned correctly. Just take a look at the bent tip and then a look at a diagram of the urinary track and you will see how the bent tip acts as a safety guide around the prostate. 

I started with Coude's but tried a straight tip about six months ago because I wanted to see if I could use Coloplast's Compact model that only comes in a straight tip. The first couple of times it worked and then "ouch!" it stuck when it got to the prostate. I tried it once again a couple of months ago with the Speedicath straight. Again, it worked a couple of times but on the third time it stuck again. No more straight catheters for me!

Again, it's an individual thing, but if your prostate is enlarged the Coude should be your first choice. If the straight works, great, just be real careful and never force it because unlike the coude, forcing a straight catheter could possibly result in a urethral puncture (false passage) or a big insult to the prostate if it sticks.

Jim

Hi Neil, I need to cath when I find I can't pee a drop. This happens a few times per month. The rest of the time I can pee normally. Sometimes with a fairly strong stream and sometimes with a slow stream that takes a long time to empty my bladder. 

But when I can't go at all, I need to cath. Usually after doing it once, I can return to peeing normally. If not, I might need to cath again. The most I've had to do that is three times for one incident.

Hi John,

I think you mentioned way back that you were going to check your retention with the catheter after normally urinating. If you haven't, you might try it at various times during the day. If you do have retention, you could just continue as you are or consider scheduling some caths in to be more proactive. 

Our situations started out quite different (I had to cath multiple times a day or I couldn't urinate) but we ended up at the same place in that I only cath these days when I lock up which actually hasn't happened for a couple of months now. 

I also find that if I do need to cath that doing it several times seems to work better to "reset" things. I look at it like a tune up.

Jim

Hi Jim

I agree that the coude tip is needed by some people. And that's why I started with them. But from what I've read, a coude has a better chance of doing damage than a straight tip. And that seemed true in my case. I had terrible bleeding with the coude tip and even passed large clots for the next 24 hours a few times. I have no bleeding with the straight tips or just a tiny bit in the end of the catheter when I pull it out.

But then this was during the time I was learning the technique, so it may be that it wasn't the coude tip causing the problem, but my incorrect technique. I keep two coude tip catheters just in case a straight decides not to go through the prostate sometime in the future.

Thanks for your information.

Hi John,

I bled a lot in the beginning as well but it had nothing to do with the coude tip, just my system breaking in from the catheter. My guess is that if you used the Coude now that you would not bleed at all, but since you don't seem to need it then why experiment. 

As to the Coude doing damage, I have read the opposite. A straight tip catheter by its nature can stick (like a spear) and therefore not only can pierce the prostate but is also more likely to create a false passage in the urethra. That's why Coude's are recommended for enlarged prostates and/or urethras with strictures. Of course the proof of the pudding is in the eatin' or in this case the cathing! Whatever works best works best!

Jim

Hi Jim.

I have inserted a catheter after urinating normally. I did this about 5 times under various conditions and times. Each time I found no more than a few drops remaining in the bladder. So I'm satisfied I don't have a problem with retention.

I too have cathed more than once when I lock up. It helps. Usually I can urinate after only doing it once, but it seems better if I do it twice.

John,

That's great. Sounds like that unlike in my case, you have normal bladder elasticity but a large and/or inflamed prostate? Have you had ultrasounds or other tests to determine why you lock up every once in awhile? Certainly no need to cath on a regular basis although a pre-emptive cath or two on beer night might actually be better than waiting to lock up, that is if you can actually determine it with any sort of accuracy in advance.

Jim

Jim, that happened to me.  My first attempt with a straight tip, was at the uro's office.  I was alone in the restroom, and proceeded to self-cath.  Being my first time, I didn't

Dennis,

I think your message got cut off.

Jim

Sorry, got cut off.  As I was saying, I was in the restroom in my uro's office and proceeded to self-cath. I inserted the catheter, and gradually pushed the catheter, down the urethra.  It was hard to penetrate in a few places, and foolishly, I pushed a little too hard, and when I got through with self-cathing, there was blood on the end of the catheter.  My uro, kind of looked surprised at the blood, and told me that I would have to be more careful in the future, so as not to puncture the lining of the urethra.  I have been very careful since.  I go really slowly, and whenever I feel anykind of resistance, I stop, wait, then proceed again.  I've pretty much mastered the insertion, I think and feel very comfortable about self-cathing.  For me it's the best thing that has happened for the last 12 years, that I've had this problem, which is a hard time voiding.

It's normal to have blood on the end of your catheter the first time you do it. In fact it can be normal to have blood the first couple of weeks until the body adjusts. If your doc was surprised I wonder how much experience he has with self catherization. Anyway, I'm glad it's working out for you. Amazing how something so simple can make all the BPH symptons disappear! Did you ever switch to a Coude tip? No need if you're not having issues, but I find it makes things easier. I timed my cath process the other day and it's just under a minute, total, and only 4 seconds from when the catheter starts to go in until the urine starts to flow. While it's always gentle, I can push very fast with the coude tip because it can't really get stuck since it's curved a little at the end. 

Jim

Hi Jim,

I did have an ultrasound and will discuss it with the urologist next month. I'm curious about how large my prostate is. But so far he's offered no explaination as to why I lock up. For a while I thought it was from overwhelming the system with to much liquid in a short time. But then three times it happened on days when I wasn't drinking lots of liquid. And I also discovered water will do the same thing as the beer. So, it's still a little puzzling. I usually only have my beer drinking day once per week, so sometimes I do pre-emptive cath when I feel the urge to go after getting home. It beats standing there with a slow stream even if I am able to void normally.

Thanks JIm - I better stick with the coude. I'll try again in a few hours - the blood yesterday  was concerning but maybe as you say it will dissipate. It is like starting over for me. The AZO really helped with burning while peeing during normal voids after the cathing.

Thanks everyone for a good discussion.

Neil

John,

Drinking a large amount of fluid -- beer or water -- in a short period of time is only one way the bladder can overfill. Even on low water days, it can fill fast if for example you lie down or even if your sodium intake is such that your kidneys start unloading retained fluid. So, while in general, a lot of fluid in a short time is the culprit, not always.

When you lock up, how much urine comes out of the catheter? That will give you the total bladder volume on lock up. Total bladder volume may be a better indicator than fluid intake. You can then compare lock up volume  to normal bladder volumes to see if it is a volume issue. 

I have pretty much narrowed it down to bladder volume which almost always would be over 400ml. That said, there have been exeptions both ways. An occasional lock up below 400 and there have been times when I could urinate naturally with let's say 700ml although it's uncommon that I let it gets to that point. 

I was at first puzzled by the discrepensies but I chalk it up to the multi variables at play such as activity levels, and then of course the big unknown factors But most evidence still points to volume. 

I have discussed this with two urologists and they don't seem to have a clue or even seem to understand why volume would have a role.

To me, it  seems pretty simple. In layman terms, else being the same, the bladder has to work harder to expel a larger volume. It also makes sense that the more the bladder expands the less leverage the detrussor muscles have in contracting although I am not basing this on a knowledge of anatomy but more of a visulization of an expanded balloon.  But then there are the exceptions

One urologist said we might find out if we did video urodynamics. But that would mean the video urodynamics would have to be done at the exact time you locked up. And since you're locked up and unable to urinate, not really sure that would show much either. 

I'm just very happy that it only happens once in a while and I have such an easy and painless solution on hand to take care of it. It's become a non issue in my life. I did my IPSS score yesterday and it was "5". Just hope things hold up

Jim

Maybe the word is not surprised, but concerned. He told me that I probably injured the lining of the urethra.  It hasn't happend since...just that one time. I was alone the first time doing it in the restroom of the uro's office. I think it would have helped if someone was to be there and walk me through it.  I told me uro, that if his other patients would like, I could talk to them about my experience, with self-cathing.  I believe it really helps to talk to someone that is actually self-cathing, because they know how it feels, having the catheter, penetrating the area.  I use a 16 and a 14 coude tip now.  The next time I order catheters, I am going request the 14. I have to go slowly.  I couldn't do it in 4 seconds, no way.  I hope that someday, I would be able to do it in 4 seconds, not that I would, but that it would mean that my urethra, is allowing the catheter, to move through it, and not rejecting a foreign object?  I go really slowly.  If there's a little discomfort, I stop and wait, then proceed again.  It takes maybe 2 minutes from the time of penetration, till it reaches the bladder. AFter the urine stops flowing, I turn the catheter, side to side, and most likely, it will empty out more urine.  It feels great to have an empty bladder!

Neil,

I'm sure things will improve. It's always a good idea to rule out a UTI although when you self cath the line between UTI and Colonization can sometimes be blurred. My own approach is not to treat with antibiotics unless things become very uncomfortable as opposed to just mild symptons. The times I did treat there was a definite burning sensation when I naturally urinated. 

As to Coude or not, I'm not saying don't use a straight catheter, because I do believe in experimentation. But if you do try a straight, just be very careful when you hit resistance points because it doesn't have the safety of that little bend and you could stick something. The few times I used a straight, things were fine when it worked but the few times I felt resistance it was accompanied by a slight sting at which point instead of pushing through I just pulled the catheter out and returned to my coude.

Jim

 

Hi Jim.

I discover the lockup when I have a normal urge to go. I find that I can't. So when I cath, I see the normal volume of around 250 ml. The same as a normal void. Occasionally it will be more, up to 450 ml but not often.

The night I went to the emergency room with the very first attack. I voided 1000 ml through the Foley catheter Physco Nurse Ratchet shoved up me. That was a painful experience all around and led to me learning to self cath as self defense against repeating that terrible night.

I agree that the kidneys can process large amounts of liquid even when the intake is normal or low. I've had that happen. One night I voided 1450 ml between midnight and 7 am. All without my intake that day being more than a couple glasses of water and a cup of coffee all day. And most of that was voided before bed. I needed to cath twice that night and the rest was natural voids. That only happened that one time.

John

Again, totally normal for there to be blood the first time you cath or for that matter the first couple of weeks. I know it from personal experience but I was also told the same from the PA cath person, my doctor, the cath distributor's help line as well as online research. While alway a possiblity, hightly unlikely you injured anything based on what you described. 

I went pretty slow in the beginning as well. It takes time. The body and mind have to adjust. Relaxation plays a big role IMO, but relaxation cannot be forced it has to come. 

As to emptying fully, standard practive is to push it an inch more into the bladder when the urine starts to flow. Then, when the urine stops flowing, back it out very slowly to drain from the bottom of the bladder. This assumes a symetry that we do not all have, so a side to side motion (or back and forth motion) with the pelvis will help some people drain more. Experiment. I've also found that sometimes pointing the plastic funnel toward the ceiling will also drain out a little more, just be sure to turn it back down into the toilet if/when it starts to flow. It does feel great to have a truly empty bladder does it!  

As long as you're trying a 16 and 14, get a few samples of the 12. If the 12 works without bending back, then that is the one you want to use. I use a 12 now but started with 14.

Jim

 

I'll just add to my previous post that I think the reason a lot of docs prescribe too large a catheter is because either their experience (or their research) relates to the older red rubber catheters which are much more flexible thatn the newer hydrophillics. I could never get a FR12 red rubber into my urethra because it is like a wet noodle yet have no problem with the more rigid FR12 hydrophillic Speedicath. 

Jim

That's interesting John. I guess all we can do is try and figure out the circumstances that *tend* to lock us up. Yet to have a doc give me an explanation. Lately, for example, I'm not locking up at all. One part of me says "great", the Sherlock part of me says, "How come?" LOL. I had a couple of beers yesterday (plus two cups of coffee) and kind of figured maybe I'd see a lock up. No go. LOL. Well, maybe I will really push it one day out of curiosity because as you know, once you have the self cathing down, locking up isn't any big deal. One other thought. Does self cathing in some way shape or form widen or stimulate the bladder neck therefore making urination easier? Just rhetorical, I don't think anyone really knows all the answers, esp not doctors who have probably never self cathed (or studied the procedure) in their lives.

Jim

One other question, John. We both use the term "locking up" but I'm wondering exatly what you are experiencing at that point. For me, there is no pain or anything, it' just that there's a feeling deep within that is the opposite of a release. I've come to know it right away even before I start to "push" with the detrussors or so it seems. Likewise, I seem to know right away if it's going to come out. One day, I may just have that video urodynamics done to see what if anything shows up at that moment. It's not high on my list plus the timing of the test would have to be at the same time I'm locking up. I also have a large bladder diverticulum and wonder if that could play a role in that process as well.

Jim

Can you tell me why the12 is the better than the 14?

Yes, my uro wanted me to use a 16, when I told him that I wanted to try a 14.  He told me that he'd been doing this for 21 years, and that the 16 would be better because of its size.  He's a very good surgeon, but I think on this forum, many of you have first-hand experience with catheters, and so the information on this site should not be taken lightly.

Thanks Jim, Does the fact that the AZO totally eliminates all burning when I pee until the next time I cath indicates I do not have a UTI but rather just irritation? I do that self-test pee check before cathing and it shows zero leukocytes and nitrites but after I cath it shows high leukocytes and zero nitrites which should just indicate irritation.

I did my second cath now - it takes 30 minutes from the time I enter the bathroom until I exit and the cathing part takes 15 minutes. I had 225ml from cathing and a 150ml from natural void just before. Again there was a little blood just before the pee came out and then clear.

I wish all of you best. I wish I had answers for everyone butas it is I think too much and get myself in trouble!

Neil

In most cases you want to use the smallest catheter that works because the smaller sizes, being thinner, have less friction, less trauma. Of course, if the 12 doesn't work, and bends to the extent you can't get it around the prostate or into the bladder, then it's too small and you move up to a 14. I found the 14 easier to work with in the very beginning because it is more rigid, but with a little bit of practice I was able to get the 12 to work. Now, the 12 works so easy I don't even know what problem I had with it initially. A lot is just practice and technique so don't give up on the 12 if the first time it feels a little wiggly. 

The exception would be if you have a stricture or narrowing in the urethra and your doctor wants you to use the catheters to widen the urethra. In this case they might want you to use a larger size because the purpose of the catherization is a little different. 

Jim

Hi Jim.

When I experience what the medical people refer to as acute uninary retention, I simply can't void. Maybe a few drops at most. I just feel a normal urge to void but when I stand over the toilet, nothing comes out. There is no pain or discomfort at that point. I just need to go in a completely normal way, and get nothing.

Then I know it's catheter time. Waiting around for the problem to fix itself just results in discomfort so I don't even bother with that. I just drain my bladder with a catheter. The next time I feel the urge, things might be perfectly normal.

My urologist explains it as an enlarged prostate and offers no reason why it happens only sometimes and not at others. To me it's like the prostate swells and shuts down the urethra and then returns to normal. I just get a funny look from the doc when I say that. LOL

Hi Dennis

I read somewhere that if a 12 or 14 won't go in due to an enlarged prostate, the nurse or doctor will use a 16 because it is stiffer and plows through better. Buy my urologist and his nurse both told me smaller is better if it will work, and that it should. So far the 12 works great. I've used 14 and 16 and have had no problem with either of those also.

I was just wondering how you might describe the sensation. For me, no pain either, almost a short circuit kinda feeling. Yeah, the docs don't seem to offer much here but I'm going with total bladder volume as primary with prostate obstruction contributing. Of course the cause and dynamics of your acute retention may be different from mine. You would think the docs would want to investigate more but why investigate when you have a catch-all solution for everything -- OPERATE

Jim

Hi Jim

I have no sensation at all that might tell me I won't be able to void. Nothing except the normal bladder signal that it's time to pee. When I stand over the toilet, it comes as a complete surprise that it's not going to work.

I got pretty lucky with my urologist. He offered laser surgery and then told me that if I'm happy with cathing from time to time, I need not do anything further. He's not a surgery pusher.

Hi Jim -

When the catheter is in about 5 inches I start to get an uncomfortable burning right where the catheter enters the penis opening. So as it goes in further that burning gets painful. It also is there when I take the catheter out.

Today I looked at it carefully and saw that that is where the catheter surface is pretty much dry. The first 5 inches or so of the catheter are well lubricated (I use Speedicath 14 coudes ) but then the lubricant seems to have just disappeared. I shake the container back and forth before opening and I also store the catheters horizontal. Then when I use your diving method I pull the catheter out quickly from its vertical position on the wall and then immediately insert it so no lubricant drips off the end.

Do you have this problem? Any suggestions? On the good side the bleeding has all but stopped.

Thanks

Neil

Hi Neil,

I haven't had the issue you discussed but will take a closer look at how the catheter is lubricated. I have stored my catheters in pretty much every orientation but do hold them vertical just before insertion as that would be the natural orientation. Have you ever tried FR12? If not, why don't you try a few and see if the problem goes away. Lastly, is it possible that you could be feeling a delayed pain reaction on your penis head as opposed to the pain being caused by a difference in lubrication? You could probably test this by inserting the cath four inches into the urethrea, waiting thirty seconds or so, and then withdrawing it. If you still have the pain then it isn't coming from what you think would be the other part of the catheter.

Jim

Jim

HI Jim - the 12s cannot get through my  prostate. I will try your idea here.

Thanks

Neil

Hi, Neil,

Thought I'd quickly share my experience. When I started CIC I was using Speedicath FR14s with the coude tip. My cathing time was so slow--it would take me a long time to get past the prostate sphincter--that the lube seemed to dry on the part of the catheter outside of my penis. That's one reason why I switched to the Lofric Origos. Their lube doesn't dry as quickly.

Now that I CIC much faster, I switch between Origo FR14s and Speedicath FR12s. Sometimes one will get through the prostate area much easier than the other. Not sure why it's that way, but I split my catheter orders between the two.

When I'm inserting a FR14, I frequently feel a scratchy sensation, especially in the urethra near the end of my penis. Not so much with a FR12. Whenever possible I now prefer a FR12 because it's much more comfortable, and I don't have that sensation. Sometimes when I'm not cathing my urethra near the tip of my penis will itch, and I haven't figured out why that happens.

One odd thing that sometimes happens to me with FR12s, though, is that when I'm done draining my bladder, my bladder sphincter seems to clamp shut on the catheter, making withdrawl difficult. It's almost like I feel a door slam shut! If I relax and/or very gently twist the catheter back and forth (not very far), my sphincter relaxes, and then I can pull out the catheter. This doesn't happen to me with the FR14s.

I also shake the catheters before use to make sure the lubricant gets distributed. Glad to hear your bleeding has stopped!

Stebrunner

Hi stebrunner,

Thank you very much for sharing your experience. You described the sensation I get at the tip exactly. How many times a day do you cath? I was just wondering if that sensation gets better with frequent cathing.

I've been doing it twice a day for 10 days now and yesterday was the first day with no blood. I am pretty consistent with a free void of 200ml before cath and then a 250ml cath volume. Maybe if I stepped it up to 4 times a day I could start to reduce my pvr like jim did.

But last night I had my first real emergency and was grateful for this skill. I was too tired to cath before bed at 11 pm and I knew there would be trouble as I felt pressure in my bladder. I then woke up every hour from nightmares in which I tried to negotiate my way out of waking up as I was so tired. Finally at 5 am the pain was so great from the pressure that I stumbled out of bed. I could not pee at all on my own. So I set up the cath and was shocked that I drained out 800ml ! I felt so good afterwards but worried about the damage I did to my bladder. The pressure was so great that the pee came out along the sides of the catheter.

This was a situation which normally would have me end up in ER so I am very grateful to all of you for helping me master this skill. When I cath before bed I usually take out 450 ml total (200+250) and can sleep until 4 am when I can pee enough on my own to make it to morning.

How do you manage your nights? Do you routinely get up in the middle of the night to cath so you can then go bakc to sleep ok?

Thanks again to everyone. I worry about my long flight to Houston next week for my biopsy as once I hold it in for any length of time I go into semi-AUR.

Neil

Hi, Neil,

I cath 5 to 6 times a day, usually 5, and I usually plan CICs 4 hrs apart. My schedule got thrown off this morning as I went on a birding hike with friends and stretched my interval to 6 hrs. Fortunately I didn't drink much water so I got by with it.

The biggest relief from the scratchy sensation came from using FR12s. They allow me to zip in quickly until I hit my big ol' prostate. The smaller catheter requires me to do more finesessing to get past the prostate, and it takes a little longer to drain because of its smaller diameter. Overall, I find it less traumatic to my urethra.

The FR14s are another story. On some CICs it's a breeze from start to finish. On others, it's scratchy from the beginning and gets worse as I proceed. If it's too scratchy, it usually won't pass my prostate. Not sure if this is due to a manufacturing defect in the catheter or if my prostate is inflamed for some reason. Sometimes changing to a new catheter fixes the problem. Sometimes not.

I'm envious of your natural voiding ability! My highest NV has been 175 ml. Usually it ranges between 50 to 130. During the night I usually wake between midnight and 2 a.m., and do a NV. On occasion I wake a second time about 2hrs later and NV. If my fluid intake is too much in the evening, I might start waking up 2 hrs. If I wake a third time, say around 2 or 3 a.m., then I make a decision to CIC or not. If I CIC, I usually get 4 or 5 hrs of uninterrupted sleep. Sometimes when I wake during the night I'm not sure if I have to pee or not. If I feel a certain pain at the end of my penis, I've learned that I definitely need to get up.

During the day I usually naturally void about 2 hrs after a CIC. Again it depends on my fluid intake. Like you, I'm using Jimjames method for rehabbing my bladder. It seems hard to beileve that my urinary problems started a year ago on Dec. 1st. What a journey it's been!

Traveling can be stressful, I find, when CICing. I try to plan my trips so I have time between flights to hit a restroom. I carry catheters in a round cardboard mailing tube along with CIC supplies in a backpack. That way I can CIC if needed. Once I CIC I know I'm good for 4 to 6 hrs depending on my fluid intake. Good luck on your biopsy in Houston!

Stebrunner

Thanks stebrunner - this information helps me to put my own siuation in perspective.

What PVRs do you usually see and has it improved over the past year?

Last night was really bad for me with that 800ml retention. Did you ever experience that type of retention this past year?

This past week I feel feverish with discomfort in my abdomen. Also I natural void every hour - especially today - with only about 100ml.

I'm going to try and apply some sterile lubricant to the catheter once it is in a few inches and see if that helps withthe irritation. I do have some 12s leftover and could try those later on.

So here is my New Year's wish for everyone: May we all enjoy a reduced PVR in 2017!!

Neil

Hi

I have a similar problem. It gets by the first spincter just fine but always a problem at the bladder. I move it in and out and twist it a bit before it goes in.

I have developed a bit of a sore at the tip where it goes in. I think it is because of all the moving around the lubrication on the Speedicath wears off. I dont think they were made to have much resistance espically toward the end...

One other thought re technique. When opening up the urethra with thumb and forefinger pre insertion, there's a natural tendency to squeeze the urethra alittle in the process. This is OK until the catheter tip makes contact. However, once you start pushing the catheter in, it's important to consciously release any compression on the urethra or you will in effect be narrowing the canal.

Jim

Hi Neil,

I would not worry about any damage from one cath of 800ml, 

I've had worse  

Do you have any urinalysis strips? Given the feverish feeling, urgency, and discomfort in your abdomen not a bad idea to do a urinalsysis and check for possible UTI.

As to applying a sterile lubricant to a hydrophillic catheter, I would call up the manufacturer (Coloplast) first and make sure that whatever you apply will not conflict with their hydrophillic coating.

Jim

Hi Jw,

The prostate would be the first point of resistance. The bladder sphicter the second point just before the urine starts to flow.

Jim

Thanks Jim - all important points. I better hold off on the lubricant then. I will follow your other comments when I cath shortly. Thanks. Neil

Good point I had not thought of that.

What I'm saying is that I get by the prostate fine just looking at how much is left on the cather I can see there is always a problem. I fiddle with it push it in and out twist it while I'm moving the penis around trying to figure out the best angle, so I'm thinking I'm  wearing  the lubrication off it at that point and it is causing the sore. Like Niel I new at this Maybe I'm over thinking it as its getting easier. I have been surprised at the RV now that I can do it almost every time its 300ml + ... they first  measured it with the ultrasound at 100 and said get below that I seem to be going in the opposite direction..

If you're getting by the first point of resistance OK (prostate) then I think the bladder sphicter issue will get better with time as you are able to relax more. Some have success by sort of stopping at the sphicter and holding just a little pressure (knocking at the door) and letting the sphicter open up by itself. I only felt the need to do the twist thing from time to time around the prostate. What is your total volume (natural urination volume plus cath volume)? If over 400ml, increase your cath frequency. 

Jim

The total volume is between 350 and 450ml..as I mentioned before the total 24 hour voulme is about 2800ml +- 300 so not sure what to think. 

I think I mentioned before that 2800 is not that unusual a 24 hour volume. I had similar for at least the first six months I was self cathing. Your total volume is OK but if you're cathing less than 6x/day can't hurt to throw in another cath or two. Think of it as giving the bladder a bit of a vacation by taking the load off of it.

Jim

I'm only cathing 2x a day... to tell the truth I'm still abit taken a back that I'm doing it at all. I'm getting used to it I guess.. at least can get the suckers in pretty much every time now.

For me, its going to take some time getting used to the idea that I not only need to be doing this but maybe I need to be doing it more..

Earlier I believe you said you were not voiding naturally before each cath. So when you say your RV (residual volume) is 300ml plus, is that in addition to a natural void or is it instead of natural void. Because if it's instead of a naturl void then it isn't your residual volume but it's actually your total volume.

Jim

I've been trying to void, at least a little, first, Just finished 180 ml natural void and 275 with the catather so 455ml total. That seems to be about "normal" for me every 12 hours.

Hi Jw,

You might want to check the math, but based on the numbers you gave me, you could reduce your trips to the bathroom from 15 to 12 if you cathed 4x/day instead of 2. And you could further reduce your bathroom trips to 9x/day if you cathed 6x/day. 

My unprofessional opinion is that given your 455ml total voids (TV), you should throw in at least one or two more caths a day to get your TVs below 400ml. Beyond that, it's a quality of life issue meaning is it worth cathing more to have to go to the bathroom less? The other thing, at least was true with me, is that the more you cath the more your bladder gets a rest, and the better the chance for you to return to a more normal bladder function.

In my case, I started cathing 6x/day and now only cath maybe once a week.

I realize that you don't like the whole idea of self cathing, but with time and practice many of us find it a non issue in our lives and as routine as brushing our teeth.

Your alternatives are really only are drugs or some type of surgery or procedure, as carrying around close to 300ml PVR will get you into trouble sooner or later. Have you tried Daily 5mg Cialis? It could help some.

Jim 

The thanks for the thoughts I'll carefully consider them. With the Holidays coming and my schedule I won't be able to get a Urology consult at the VA until February so I have some time to experiment.

I'm taking Finesteride as prescribed, so far haven't noticed any side effects, by February it should have started working or not so I'll discuss the Cialis with them then.

With all my health issues, if I can preserve my quality of life for a few years to be able to enjoy my young wife and family I'll take it.... CIC seems like a good way to do that just will take a bit of time to get my head around it..

Again thanks for the thoughtful advice..

I like that wish!  As for your 100ml retention.  I am pretty similar with that amount of void.  If I am at home or else where, if I have the slightest urge, I will go and use the restroom. My flow, is pretty good usually, but the amount that I void, is around 100ml.  When I used the catheter, it's usually around 200 to 350ml.  I used the catheter, usually two times a day.  In the morning and later in the afternoon, usually at around 5:30PM.  I use a fr14 Coloplast.  The last time, I timed myself, it took 27 seconds from the point of insertion to reach the bladder, and initial voiding. I go carefully down the distance of the penis, and if I feel any kind of resistance, I pause, then proceed cautiously.  I guess, my point is, my natural voiding is not that much, usually around 100 to 200ml.

 

Hi jw - just a word of encouragement. We are at the same point in CIC with the same numbers so our prostates must be related! Just persevere - it gets easier and then you feel so much better afterwards. The best parts are being in control and keeping the uros away. Stay with it!

Neil

Hi Jim.

Your idea to relax my grip after the cath starts helped a lot with the burning. I also tried pulling away to the left on the head to open the slit a bit more. I used the index finger on my leeft hand. That seemd to help a lot too, especially when I take it out.

I try using the detrusor muscle during voiding with the catheter and that works just like normal.

My huge prostate is really tough to get through but with breathing relaxation and visualization it eventually works. This time I had a little blood again.

During the day I seem to void 150ml every 2 hours and 150ml more when I cath. The problem is at night where I store it up as I don't want to get up.

Thanks for all your help.

Neil

Hi Neil,

Yes, there should be zero compression on the urethra with your non-dominant hand. This can be achieved even when pulling the penis straight with your non-dominant hand. You just have to be aware of it. As to getting up at night, if you feel the urge to go, whether you're already awake or awakened, then you should go cath. I used to have all my materials ready in the bathroom prior to going to sleep just in case so I wouldn't have to hunt around for things. 

As to the detrussor muscles while cathing, more important if you're not doing any natural voids. Really not that important if you are. Also, with the natural voids, I personally focus more on relaxing the bladder sphicter and area as opposed to pushing out with the detrussors. It's almost a kind of auto suggestion/meditation. I think there's a cultural tendency to rush things in life, and is also true with urination. Try to just relax and let it flow without pushing for the end. I think you will find this will help a little with your natural void volumes.

Jim

Hi Jim - quick question:

After cathing I often have the feeling that I need to pee again. Is that a common feeling to just be ignored?

Thanks

Neil

Hi Neil,

Not unusual to have that feeling in the beginning even if your bladder is empty. I had feelings of real urgency for the first couple of months.

That said, the possibility does exist that it’s not empty for a number of reasons. Fortunately, there’s an easy way to find out. The next time you get that feeling, cath right again and see how much comes out, if anything. That will tell you if your bladder is empty or not.

Jim

I decided to try 4x a day. Did one at 6:30 pm with 100ml void and 180ml from catather 280ml total thinking thats not to bad... Another 6 hours later at 12:30am with 300ml void before and 240ml from catather...wouza thats 540ml total.

It seems feeling that I have to go is not a good indicator of how full the bladder actually is in my case. It felt the same at 6:30 as it did at 12:30 and was still the same after the  total void of  540.... ..wierd.

I'll stick with the every 6 hours for now and monitor the daily output closely, maybe letting the geek in me experiment can get me past my overall dislike of the whole procedure

Everything sounds normal. A lot of variables regarding urine production so numbers like that happened to me all the time. As to bladder fullness being an indicator, a flaccid (stretched) bladder is not a good indicator. Hopefully, as your bladder rehabs it will regain more of its ability to let you know when it's full. Mine has improved significantly in this area.

Experimentation is good. Call it self research Docs mostly don't have the time (and seemingly the desire) to tweak their treatments for individual patients. Things often seem cookie cutter and assembly line. That's when an informed patient can step in and take over with reasonable "experimentation". 

Jim

Hi Jim,

Could you elaborate on the reasons it may not be empty after cathing? Once the pee starts to flow I push the cath in about another inch and when done I pull out slowly to catch any pee at the bottom. Usually before cathing I double void normally - so do you think I need to double void cathing too? I'll try your idea. Thanks. Neil

Neil,

There could be several reasons other than technique which is probably not the issue.

First -- and I'm not sure how much time you're talking about between cathing and then feeling the need to go -- the kidneys can sometimes unload urine pretty fast depending on several factors including fluid intake. I remember one post void residual test at a hospital where my bladder actually had MORE fluid in it after I urinated. The technician said because my kidneys were probably still unloading in the few minutes between which the images were taken.

Another possibility is a bladder diverticulum (pouch) although your doc would probably have told you if you had one. I had a quite large diverticulum that would hold a couple of hundred cc's of urine. So even if I cathed out my bladder completely, urine would remain in the diverticulum. Then, sometimes only a few minutes later, the urine would drain from the diverticulum into my bladder and I would feel the sensation to urinate. And low and behold another 200ml would come out!

Fortunately, after a couple of years of self cathing, my bladder diverticulum has shrunk significantly so that this is no longer a persistent issue.

But going back to your issue, first things first, so test to see if you really have urine in your bladder after cathing and how much urine. It may be that it's empty and you're just having the sensation of urgency which is also normal when you start to cath.

Jim

Hi, Neil,

When I started CIC my natural voids were a couple of drops. And yes, I counted! Over time that grew to 10 drops, and I was elated! That slowly grew to 20 ml. I struggled with CIC in the beginning, especially at both the prostate and bladder sphincter, sometimes taking 60 to 80 minutes and multiple attempts to complete a cathing. I felt like I was living at the toilet! As a result, I would only CIC 3 or 4 times a day, and my cathed voids were quite large.

Then I had my PAE. After the initial swelling following the procedure, my NVs jumped to 30 ml or more. Gradually that grew. Now it's not uncommon for me to have NVs of 100 ml or more. My record is 175 ml.  Now my CV or PVR is typically 200 to 250 ml. My largest NVs and CVs are usually my first ones of the day.

Forgot to mention the other day another trick that helps reduce that burning sensation when I withdraw a catheter. I sometimes pause once or twice midway while pulling the catheter--for some reason this reduces that sensation for me. I used to whip the catheter out in one quick motion.

Also, when i started CIC again after my PAE, I had that urgency to void again right after CICing. I'd try to pee when the urgency came, but nothing came out. I chalked it up to a bladder spasm. As I got back into the swing of CIC, it stopped.

As Jimjames suggested, you might want to call Coloplast and ask about adding lubricant to a hydophillic catheter. It may not work well. As you get more CIC experience, you'll get faster and the lubricant won't dry out. Part of getting faster is learning to read your body. For example, when I'm at the prostate sphincter or the bladder sphincter, I now recogize a sesnation that feels like I'm about to pee--or like the door is opening. When I feel that I know I can push ahead.

Remember when peeing was a mindless activity? Man, I miss those days! LOL!

Stebrunner

Thanks Jim and Steb for taking the time to share all that information. I just did a double cath: the first one had a NV of 150ml and cath vol of 150ml. The second cath had 50ml.

I wonder to if my PAE just opened the urethra enough for a catheter. Now I get a really strong sting and burning sensation when I hit the prostate. Once I get past that point after a few minutes of meditation the rest is ok but I almost pass out at the point. My prostate is long and large (180gm) but no bladder neck obstructions. I hope the biopsy next week does not cause inflammation.

I guess the feeling to go all the time is just irritation. My stream is weaker since I started CIC probably due to irritating the prostate and closing down the channel a bit. But my home test kit just shows slightly high leu but zero nitrites.

Thanks so much for your help. Where else in the world could us newbies learn this!

Neil

Hi Neil,

50ml is not a big deal but you might want to test some more to narrow down possiblities. How much time elapsed between the first and second cath? Did you feel an urge to go between caths this time?

A few possiblities exist. First, urine production between cath's. To rule this out try and do the second cath immediately after the first cath instead of waiting a minute or two.

Second, operator error Make sure it goes in an inch after the urine starts to flow and slowly back it out almost level with the sphicter so at the endyou will be siphoning off from the very botton. Also, when finished, you can change the position of your pelvis -- forward, back, to the sides, etc, so that you can redistribute any potential left over urine. Even squat a little if you can.  Sometimes I am able to get more urine out at the end by pointing the penis head toward the ceiling and then letting it down when the urine starts to flow. Of course, do this after nothing comes out with the penis pointing toward he toilet or you could have a mess!

Third, do you know if you have a bladder diverticulum? If not, ask your doctor as that could be a cause.

But again, not a big deal and I wouldn't get hung up over it unless you are up to it. Also you have a lot on your plate with the biopsy next week. But if/when you do test, I would do number's 1 and 2 independently and not combine them to get better data.

As to the pain when hitting the prostate, PAE shouldn't effect the urethra, just the prostate? Have you tried going up to FR16? Sometimes that can help with large prostates.

Jim

Another thought about the stinging and burning when you hit the prostate. You might want to purchase one of those portable sitz baths that sits over the toilet seat. It might help both with your natural voids as well as the pain you get self cathing. Obviously, another bother, but maybe once a day might give some benefits. 

Jim

Thanks Jim - you guys are the best! When I am in pubic toilets and hear young guys with their great streams I feel like screaming to them to enjoy it while it lasts! We age too quickly.

I was checked for a diverticulum last April and that was ok.

I was going through my sample drawer and found a Speedicath14fr Nelaton catheter. Is that something I could try? I never heard of it.

Thanks so much for your help.

Oh one other thing - I seem to feel feversih a little with stomach pains - is that just my body getting used to CIC? Did you have that at the start? Or maybe it is just anxiety about next week. Neil

I was thinking that it would be nice to have one of those tiny cameras used in cystoscopys attached to the tip of the catheter - then we could watch our progress on a monitor as we proceed and make corrections as necessary!

I would go up a size to FR16 and see if that gets by the prostate easier. If not, you can go back to FR14 and/or try another catheter. But as long as you have someting else in your drawer, no harm trying but don't force things if you hit too much resistance. Hard to say what your symptons mean but a good idea to mention it to your doc so he can run tests if he thinks its necessary.

Jim

They do have portable bladder scanners that could answer some of the retention questions. I was very tempted but the $6,000 price tag made it less tempting.

Jim

That would be something.  Maybe one day that could happy. Would knows  But for now the men that are starting and doing CIC are just going to have to listen to the edvice of the men that have done it for years with with a great out come.  Remember information and knowledge is the key to any treatment.  Take care all  Ken.

Thanks Jim - have you ever heard of Nelaton Speedicaths or used them?

My peeing habits have changed since I started CIC. I used to have a couple of good voids during the day - maybe 300ml with fair pressure. But now I have very frequent small voids with little pressure. I just wonder, given the huge size of my prostate clamping down on the urethra if the catheter irritates it and causes a little inflammation? Even a little inflammation would be enough to affect my natural voids as I am so restricted. If that is the problem then maybe over time as my body adjusts to the catheter the irritation will go away and then I'll see a good improvement in my NV as well. What do you think? Or maybe I just need more lubrication? I did call Coloplast about mixing lubricants yesterday but never heard back. My uro is useless in all this. You guys are my only lifeline!

Thanks Ken too for your thoughts.

Take care

Neil

Hi Neil,

Not familiar wih Nealton but experimenting with different catheters is not a bad idea. Most of the catheter distributors will send you free samples as long as you have an Rx. Still think you should give the Coloplast Speedicath Coude FR16 a shot to see if it passes the prostate more easily.

At this point wouldn't be as concerned about your NV vs TV. The self cathing is protecting your bladder and kidneys and hopefully slowly adding tone to your bladder as well. If there is some prostate inflammation from the catheter hopefully it will lessen over time.

Jim

Thanks Jim - I will call Coloplast on Monday for some coude 16 samples.

I took apart the Nelaton Speedicath and it is just a straight tip version of the one I have been using. I seem to recall that straight tips can be dangerous for large prostates because they can puncture it or maybe the urethra? Is this true? I have about 10 so I could try it but want to ask you first. Thanks.

Neil

Coude's bent tips were designed to go around large prostates as opposed to sticking them. This has been my personal experience and I won't use another non coude again -- one stick, shame on the catheter, two sticks shame on me! That said, at least one fellow here has had success with straights but I don't know the size of his prostate. If you try a straight, don't force it and withdraw if you get any sort of sharp pain. And yes, straights can also puncture the urethra and cause what are called "false passages". But again, with all this in mind, maybe try one straight and perhaps it will b a good match for your prostate. But if you do, I'd use a straight hydrophillic like the Speedicath you are using.

Jim

Thanks Jim - I'll stay with your advice and continue with the coudes. Last night at 11pm I NV 200ml and cathed 400ml. Then at 2 am I awoke with sharp pains and did another cath - I could not NV but I cathed 700ml! Then this morning at 7am I NV 200ml and cathed another 400ml! Very strange as I did not drink anything after 6 pm. Must be the kidneys doing their thing as you say. The 2 am cath was an emergency and the cath went right in in 30sec with no problem at all! I felt like I was peeing around it as it went in and that was lubricating it so it was easy - no burning or pain but this morning there was pain again at the prostate but not as much. Thanks so much - I couldn't do it w/o you guys. Neil

Hi Neil,

700ml from beween 11PM and 2AM, that happens, has happened to me. Really no way to see that coming. 

Normally how much urine do  you produce at night versus during the day?

If night time production is 40 per cent or over than you have nocturia which is pretty common as we get older.

Nocturia has lots of causes and the 700ml didn't have to come from what you drank after 6PM as the body can store fluids in tissue. If the nocturia starts to really be a problem there are things you can try to urinate more during the day than at night.

Some nocturia strategies include daytime napping, elevating the feet when lying down, compression stockings, watching sodium intake, and certain drugs including diuretics. Sleep apnea has also been associated with nocturia. I personally have found that drinking a couple of cups of coffee (a diuretic) in mid to late afternoon increased my urine production prior to bedtime and therefore less production during the night. I realize coffee can be a bladder/prostate irritant to some but most of the time I have not found that to be true.

Jim 

Neil,

So I just did a little test of my own. I urinated naturally around 250ml (didn't measure) then cathed 50ml. Then right away cathed again and only a couple of drops came out. That compared to your 50 mls. So, I'm thinking that either you waited some minutes between caths or perhaps a technique issue. But again, 50ml is not a big deal.

Jim

Hi Neil, I had the same problem you have (too much urine at night). I found out that restricting liquid after 6PM is way too late. Much of the urine also comes from foods we eat. And it takes transit time for the foods to get to your colon where your body removes the water. Transit time depends on your activity and your resting position, so if you are not active, it may take a while. So I restrict liquid intake as well as wet food intake after 12N and it seems to work for me. I tried Jim diuretic method but it did not work for me.

Hank

Hi Hank,

Very good point regarding water containing foods. That is also a reason why people are sometimes surprised that their urine out is more than their fluid intake in, ie they don't count the water content of foods.

So your suggestion of limiting certain foods after 12N is a good one for folks to try if that fits into their lifestyle. 

That said, liquid restriction is only one factor with nocturnia. It can have other causes such as retention due to heart efficiency, age, sodium in take, etc, which also brings up the issue of "transit time and activity".

In fact, many of us, including myself, find that if we take an afternoon nap, that actually increases day time urination, not decreases it as your activity example suggests. It is a similar mechanism to wearing compression stockings or elevating the legs when possible. All of these strategies can help force fluid out of the tissues and into the bladder. 

Hopefully anyone with nocturia will research the topic and try the various strategies and find out what works best for them.

As a silver lining, however, a little nocturnia can sometimes work to one's advantage. For example, when I was self cathing 6x/day, my nocturnia made it possible for me to usually do 4 to 6 of those caths at home, since my bladder tended to fill mostly late afternoon, evening and early morning -- the times I was at home. For that, I was willing to put up with an extra one or two night time trips to the bathroom.

Jim

 

Hi Jim, What you said are absolutely true. What makes it so difficult is there are so many contributors to the problem (nocturia) and some explanations and theories can contradict the others.

What I mean about activity is that after a late meal, let's say at 6PM, if all you do is just sitting around (or worse, laying around on your recliner or sofa) watching TV until bedtime, then your maximum urine production time will probably around 1-2AM. Buy shifting my main meal to 12N, I shifted the maximum production time to about 8-9PM which is more manageable.

About your mid-day nap theory, it works out with the 'lazy kidney' theory, according to my niece who is also a nurse for a kidney specialist. The kidney has tiny blood vessels so tends to have little blood coming to it until other more critical organs get their share first. If you are always active or have blood flow or blood pressure problem, the kidney may just decided to take a break now and then, reducing its functions until more blood is available, which could be a day-time nap, or night-time sleep.

Basically, activity reduces transit of stool time but also reduces kidney production. My guess is that taking day-time nap or rest and shifting main meal earlier would improve nocturia symptoms. They are complimentary. It did for me.

Hank

Hi Hank and Jim,

Do you think that the act of self-cath could stimulate the kidneys to dump more urine into the bladder? I did a self-cath at 6pm ( first one after this morning) and took out 250ml following 150NV. But right away I felt the need to pee again so I did another self-cath maybe 5 minutes after the first one and took out another 100ml. Then over the past 2 hours I peed 4 times with each void about 50ml.

I don't understand all this but I just wonder for a newbie like me if the bladder irritation somehow stimulates a kidney dump? I tried your gyrations and doing the twist once the CIC pee stopped and got a bit more.

I will try these food intake schedule changes - thanks. I do usually have a big dish of youghurt about 9pm for bowels and that has lots of liquids.

Anyway get this: the past few nights when I am awakened to cath, my fever spikes to 100.5. Then right after the cath it drops to 98 which is normal for me. When I told this to the IR who was supposed to do my biopsy next week in Houston he cancelled it right away and said to reshcedule when I am better. I don't mind because I didn't know how I could take the flight from Detroit. But it is test the lesion for cancer so I worry about delaying it.

I am CICing about 4 times now over 24 hours but it is getting much easier. I just don't understand the all the nuances of the physiology. I started taking AZO again since I had to stop it a week before the biopsy. It does seem to alleviate the burning pain at the prostate but now some of the bleeding is back (not much though).

Sure is complicated and I am very grateful for all of you. Thanks.

Neil

Hi Jim,

On the technique issue, once the pee starts to flow usually it is preceded down the tue with aew drops of blood. Then I push the cath in another inch,  where there is just an inch left to the end. I shake and shimy and even use the detrusors a bit. THen when it stops I pull it out an inch and wait some more. So that is my technique.

One thing I wonder is to maybe try and rotate the catheter 360 while in the bladder? Maybe the 2 side slits are not picking it all up? But then I must be careful to align the ridge vertical before exiting. Any other ideas? I am definitely irrritated but it should go away with time.

Thanks again.

Neil

Hi Neil, I would not try to rotate the catheter too much (360 degree is way too much), otherwise you may irritate or even damage the urethra, especially with a coude tip. Also, after the flow stops, pull it out a little bit at a time until the flow stops completely, maybe 5mm (or 1/8 in) at a time, not a whole inch at once quickly since you may leave some urine behind. After taking it out about 1/2 in, I usually push it back in gently for 1/2 in. Sometimes I got a squirt of urine out of that. It means that a normal quick and dirty self cath will leave urine behind. Just like Jim said: 'got to experiment', however, just be gentle about it.

The kidney should not produce so much urine right after a good cath unless you have a serious case if urine-backed-up kidney. In this case, cathing more often will relieve it. Another reason that there is so much urine after a cath is diverticula. Hope this helps.

Hank

Thanks Hank - I'll nix the rotation experiment. I was checked for diverticula and ok there. I'll try your ideas right now. I may be pulling the cath out of the bladder too fast. I guess I have a lot of irritation now - almost seems like overactive bladder though I've never been diagnosed with that. I do have mild hydronephrosis in my left kidney.

Take care

Neil

Neil I don't do CIC but I have to have a coude tip catheter because of a stricture.  My urologist told me to tell the nurses because they do not use them in the hospital that much is when your putting in the catheter to have the tip facing you ( me )  and it should go straight in pass the prostate to the bladder.  If you know what I mean.  Take care and good luck  Ken 

Hi Neil,

I don't think rotating it around would help but not as concerned as Hank re damage since it's inside the bladder and not against the urethra. So try if you want but make sure it's aligned properly when you pull it out. As Hank says, pull it out a little at a time and then stop. I also sometimes pull it out a little and then push it back in a little and out, etc. You can also pull the penis facing the ceiling, put your finger on the outlet hole, and then push it in and out a little sort of creating a suction effect, then see if anything comes out.

But first I think you should double cath as I suggested. Cath once, then cath right again without waiting, and see how much comes out the second time if any. How much time between the two CICs when you got 50ml the second time?

Jim

Neil, per my previous post, before I start experimenting with different techniques, I'd first peform another double cath test with no time between the two caths. Because if you get little or no urine from the second cath, then your technique is fine and nothing needs to be altered. As I mentioned in an earlier post today, I did a double cath test myself earlier today, no time inbetween, and only a few drops came out the second time.

Jim

Hi Neil, mild hydronephrosis could be the reason for your 100ml within 5 minutes of cath-to-cath. It could be due to irregular shape of the bladder (mild diverticula) or irregular cathing position or too fast withdrawing.

Anyway, I think that it is just curious and not that serious. Maybe next time when you do 5 minute cath-to-cath, try to change positions like rolling around a bit to see what happens with your cath volume.

Hank

Hi Hank and Neil,

It is very unlikely that Neil has mild hydronephrosis given his mostly acceptable PVRs. I would also assume that an ultrasound of the kidneys would have picked this up. More likely is it's either that the kidneys unloaded 100ml of urine in the five minute window between caths or just a normal event due to the shape of the bladder and technique which should not be a major concern. Even a small bladder diverticulum would show up on ultrasound and Neil says he doesn't have one. A back to back cath, with no time inbetween would narrow things down.

Jim

 

Hi Jim and Hank - thanks for your advice. My u/s last April did show some fluid on my left kidney. At that time my PVRs were very high (over 500ml according to u/s). That was when my uro wanted to do a robotic prostatectomy on me. It wasn't until July that I started to self-cath a little hoping my PAE in Aug would fix everything. But after waiting until October I declare the PAE a failure but I did cath a few times to keep out of the ER. It has only been a month now that I daily CIC 2 to 3 times a day and my PVRs have come down except at night.

Now that my biopsy has been put off probably until next month I am more relaxed and will do the double caths and report back.

Did you guys ever have fevers when in high retention? Last night again I awoke at 4 am in pain and my temp. was 99.8 before cathing and then dropped right away to 97.8 after I took out 600ml. Strange stuff!

Thanks again.

Neil

Hi Neil + Ken,

I can attest to Ken's comment re nurses and coude tip catheter. My first experience with CIC was at an uro's office. A nurse was supposed to show me how to CIC with a demonstration on me. She tried and tried and poked and twisted yet could not get it through. Instead, I felt a lot of pain and blood was gushing out. It turned out that she used a Speedicath 12fr coude tip and she had the marker facing her instead of facing me. I never did CIC before that but I knew it through reading and watching stuff. So I asked her to use a straight tip catheter and it worked out easily. But the damage was done and I had mild bleeding for the next 2 weeks every time I cathed until it finally healed.

The point here is some nurses do not know how to CIC as they should. Learn how to do it yourself is your best bet.

Hank

Sorry for the pain.  That is why I carry my information with me.  Hospital do have coude catheter but most of the time nurses use straight catheter not coude. I was in the hopital last year and I told the nurse that if I had to be catheter it had to me a coude catheter.  She asked me what was it because she never heard of it.  Go figure.  I tell them what my doctor told me to tell them and it works out better  Take it easy  Ken 

Hi Neil, I never take my temp unless I feel a chill and body ache so I don't know about how it would be affected by cathing. My first thought is UTI but it is just a guess.

Also, stop the large yogurt at 9PM routine to reduce your nocturia. To prevent constipation, try 250mg of Magnesium (Citrate or Hydroxide) with a little water (100ml or less) before bedtime. Magnesium also helps your sleep.

Hank

Thanks Hank - I'll try that.

I had a similar experience witha nurse last July with CIC except that she tried to ram a 16 straight tip into me. I almost fainted at the pain and blood. This was part of my aversion to CIC for several months. Then I tried a 12 straight tip and it just coiled up at my prostate again with a lot of pain and blood. But thanks to Jim and Steb the 14 are just right. I just need to hone my technique and not rush so much. Thanks agin. Take care. Neil

I've been cathing 4 times a day for the past few days the PVR values starting at midnight are like 240, 220, 300, and 130 for a total daily PVR of about 900ml with an average of 225ml.  The NV values are like 300, 210, 150, 150 for a total daily of about 800ml.

So on average the bladder is holding about 425ml before self cathing. I've had values as high as 640ml and as low as 210ml. Thats a lot of  varience so I was looking for a quick reference and I found the following guidelunes that seem fairly standard:

If the post PVR is less than 150 mls,  increase the time interval between catheterizations  by 2 hours,.

If the PVR, is between 150 and 250 mls,  keep the time interval between catheterizations the same.

If the PVR is more than 250 mls, decrease the time interval by 2 hours.

So according to this with an average PVR of 225ml,  I should continue with the 4x daily routine.

But is the fact that the bladder is holding 425ml on average before catheterizing with spikes to 640ml, the more important factor?  Should I try 5x a day...

I suppose I'm overthinking this but I tend to do that

Mild hydronephrosis, if that is what you had, should resolve within weeks, if not days, once retention is dealt with like for example with self cathing. Have you had a follow-up ultrasound on that? I would ask for it if you haven't. You're not going to have fever with 600ml in your bladder and I don't think the numbers you're giving are significant to draw any conclusions from. Remember, you're not retaining 600ml 24/7, your bladder just filled up to 600ml and you emptied it out at 4am. Hopefully, down the road when your bladder regains some more tone, it will signal you a little earlier. Mine does now. But in the beginning, even though I was cathing 6x/day, I still sometime got high volumes (even higher actually) like yours at night. Don't worry about it. Give things time. But get your kidneys scanned to make sure the fluid in your kidneys has resolved.

Jim

Thanks Jim - that is a good idea - I will look into it.

I have nother question. During the day I cath twice now - around noon and then around 6pm. Both times I NV 200ml and then cath about 150ml. This has been consisitent for the past week. So do you think I need to do these caths?

My caths before bed and first thing in the morning are different stories and they must be done.

Thanks

Neil

Hi Neil,

One of the nice things about CIC is that you literally are checking your post void residual (PVR) every time you cath. So cut back to three and see if that works. And if it does by all means cut back to two. And by "if that works" I mean if your total bladder volume (NV plus CV) stays below 400ml each time you cath. That said, I think I had my best progress in terms of bladder rehab when I was cathing the most. I thought of it as a bladder vacation. Another thought is to mix it up. Some days do it 4x/day and sometimes 2 or 3. Even try 5 or 6 one day. See how you feel. See how your NV's are. Just remember to try and not go over the 400ml total volume except when it can't be helped like when you empty before bedtime and wake up 4 hours later with 400 plus in your bladder. Happens. And remember, you are new at this. Progress hopefully will happen but it may not be linear. Try not to stress too much over day to day events.

Jim

Jim

Thanks Jim - you are the best! Neil

HI jim, This is very interesting,i have complete retention,how do i keep from going over the 400Ml ?If the void is low after 5 or 6 hours that means the bladder is inproving,is the right Jim?

Thanks

frank,

Frank,

The basic idea is that you don't want your bladder to be holding more than 400ml of urine at any one time

Example 1: You go to the bathroom and can't do a natural void so you self cath and out comes 600ml which is your bladder volume. If this happens only once, continue on your regular cath schedule but if you are consistently cathing more than 400ml then increase the number of times a day you cath until the cathed volume is 400ml or under.

Example 2: Let's say you naturally urinate 150ml and right after cath 450ml. This also adds up to 600ml so you would again increase the number of times you self cath a day until most of your bladder volumes 400ml or under.

Don't expect day to day progress as bladder improvement can be a slow process. The important thing however is that if you keep your bladder volumes under 400ml you will be protecting your bladder and kidneys which will buy you as much time as you want for an operation or procedure if that is the decision you make. Or, you can just keep self cathing longer term as I chose to do.

Jim

 

Hi Jw,

No, you're not "overthinking" it and it's good that you're on top of things as our doctors aren't always!

I have seen those general guidelines and they are OK but IMO can be improved upon as they don't take into consideration, or at they best predict/estimate natural void volume (NV) and therefore total bladder volume (TBV). If you keep researching eventually you will find some references where TBV is used as a marker over PVR for decison making, although I will admit the wording of the guidelines can be vague and are no doubt copy and pasted from one medical writer to another. Unfortunately, not a field most uro's are all that interested or into!  

For discussion's sake, take someone who has average PVR's of 250 but NV's of 350. Their bladder is carrying around 600ml (TBV) yet the guidelines above say keep the cath intervals the same. My argument is that if you want to give a stretched (flaccid) bladder a chance to decompress and heal that 600 ml is too much to be carrying and therefore I would increase the cath intervals so that TBV was under 400ml most of the time. 

You are right on the border with most of your cath's within the 400ml range and some spikes up and down. Spikes are to be expected. So, in your case you could either keep things as they are or go to 5x/day. You could even experiment with 6x/day and see how that works out. And no reason you can't mix things up a litle with some days 4 and some days 6. 

My biggest progress in bladder rehab was when I went on an agressive 6x/day schedule and kept TBV's probably below 300ml much of the time. But I also eased up some days -- maybe 4x/day -- so that I would have an opportunity to have larger natural voids and work my detrussor muscles more.  But keep in mind by that point cathing for me was virtually painless and only took a minute or so of my time. I was also home a lot so the whole process was a non event. 

After a point, I started weaning off the schedule and would go for days just with natural voids only cathing on occasion to make sure my PVRs were in line. If not, back to the agressive schedule. 

Today, other than a few tests for PVR, I haven't needed to cath for a couple of months. My NVs are generally between 250-300 and occasionally 150 and 400, depending on fluid intake. My PVRs (checked occasionally by CIC) are generally between 20-100. This is without CIC. 

According to my urologist, these numbers are as good, or better than he gets with his TURP patients.

Jim

 

Jim

Thanks for the feedback. Although I can successfully self cath all the time now, there is still resistance for up to a minute and a bit of discomfort at the bladder. I'm thinking that maybe I should wait until entering the bladder becomes (hopefully) easier before experimenting with the frequency...

Although its easier, its definately not natural. I find prospect that I'll likely be doing this for a long time a bummer, I'll get used to it no doubt,  but it reminds me that the other progressive health problems I have are catching up with me..

Thank you again much appreciated..

What you say makes sense. If it's any consolation, I think entering the bladder should become easier with time because unlike an enlarged prostate, I assume your bladder opening is normal. In my case, I used to feel two points of resistance in the beginning (prostate and bladder) and if I remember correctly the bladder opening had more resistance. Today, I still feel a little resistance at the prostate but almost no resistance at the bladder opening which allows me to start urine flowing with my catheter around 5 seconds after it enters the urethral opening.  It's probably a combination of both less physical resistance from many catherizations and less mental resistance as I can say I am completely relaxed during the entire process now which I was not in the beginning. 

If I didn't mention it before, relaxation of the bladder sphicter is very important both during the catherization process and the natural void process. If you have never practiced body relaxation techniques you can read up on the internet at various places including yoga sources. In the beginning I consciously tried to relax the whole area with special concentration on the bladder sphicter but now it's automatic. 

Back in the day I went to a urologist who did and thought about things in the old ways. He shared a theory about retention having to do with the rushed way people people attend to the process. Probably should have listened to him then!!!

But now, with every natural void, I don't hurry, push things or think of the end, but just let the process take care of itself. Of course my detrussor muscles are involved but my focus is not on pushing the urine out but on relaxing the sphincter.

Jim

Hi jwrhn,

One little maneuver which helps me to open the sphincter when I eventually get there through my huge prostate is to just apply and hold gentle pressure on catheter and then cough a few times - it does seem to work.

Good luck - stay with it.

Neil

Hi,Thanks for that info on PVP. MY Daily PVP If i cath 5times a day is from 1200ml to 1600ml. Idon't know why its so much,and if i cath6 times a day it's from 1500 ml to 2000 ml. Somtimes its 500 ml,350, 300, ,400, it varies a lot.I assume it's how much liquids you consume throughout the day?Do you have any idea why this is so large?

thanks

 

Thanks for the tip. The VA said said to to take a deep breath. Geez I've taken enough deep breaths to strike gold..

One thing I have noticed that when hitting that wall backing off a bit and trying again seems to work...reminds me of my younger days and my girl friends )

Hi JIm ,Thanks again for this priceless info.

I don't know why the volume is  larger than average, I've always been kinda thirsty and  drink a lot of water daily they tested for diabeties  and other things but finally just said your a thirsty guy...  I'm not a real big guy only about  6' and run 220-240 I think I need more water than average because I'm a little bigger than average... 

What a great thought jwrhm!! I thought of that now when I cathed and reached the wall and laughed so hard that it slipped right in! Sure brings back great memories - time can be so cruel. Take care. Neil

Jim,

Thanks for sharing your thoughts about relaxing while CICing and voiding. It was a reminder I needed! This past week it's been a struggle to get past my prostate. I usually try coughing or relaxing my breathing, but that hasn't helped much. Sometimes I can get through with the Origo FR14, but sometimes it feels like I'm pushing a shard of glass. Then I change to a Speedicath FR12, and it goes through slowly without pain. The next CIC it might be the opposite.

I think part of my problem is from stress and/or diet. But a larger part is my tendency to rush. I had been timing my CICs as a way of marking progress and found myself always trying to beat my best time. Even when I void naturally I find I'm pushing because I want to get it done and on with my life. Yesterday I started researching ways to relax my pelvic region, and I'll start trying some yoga, too. I stopped timing my CICs, and I stopped pushing when I naturally void. And I remind myself that the most important thing is that I am emptying my bladder.

Thanks again for sharing your vast knowledge!

Stebrunner

 

Stebrunner,

As that doctor once told me, it seems that we are all conditioned from a young age to get it over with quickly. So, it takes time to reverse that conditioning, to take time and relax. And I agree, best to stop trying for a personal best time Shorter times will come by themselves naturally, no need to push it, and the most important thing, yes, is to empty the bladder completely.

Reading up on yoga is good. Many types of postures/exercises for the prostate and pelvic region. But what I think you will really find helpful are the "body scanning" exercises in the savansa pose. I will PM you some links if I find a good one and you can do your own research.

But basically, you lie down on your back either on the floor, blanket or mat , limbs extended, eyes almost closed, darkened room but some light. And then you systematically scan your body starting with the muscles, and then the tissues, and all the organs. As you scan you visualize each particular body part and at the same time give yourself the audio suggestion "relax, relax" while on that body part. In your case, special attention of course when you reach the pelvic area and scan the prostate, urethra, bladder. Whole process takes around 20 minutes.

I used to practice this many years ago  as part of hatha yoga training but have gone back to this particular exercise from time to time. After some time, simply focusing on an area can substitute for the audio suggestions, and later the whole thing becomes almost automatic.

Today, I try and have this focus both when I self cath as well as when I naturally void. 

I think you might also experiment with a sitz bath. I never used one for self cathing but I didn't have your problems getting around the prostate. A sitz bath can be as simple as sitting in a shallow bath tub with hot water just covering your prostate region. You can also buy devices that fit over the toilet. I understand that you're probably spending more time than you want on self cathing anyway, but you might find that one sitz bath a day, or even every other day, might relax your prostate enough to make a difference. I think it's worth the effort to see if it will.

Jim

MY best time so far is 24 seconds, from point of insertion, till I reach the bladder.  I use a FR 14.  I have never tried the FR 12, but I may the next time I order supplies.  I know what you mean by trying to beat your time.  I know I should take my time, and I do, but there is that thought on trying to go a little faster than the last insertion.

Dennis,

I'm under 5 seconds but I never tried to go fast, it just happened naturally over time. I still actually slow up at the prostate (lose a second )but the bladder sphicter just opens for me. But as a point of reference, not always like that. The first few months were a struggle and it probably took me several  minutes with breaks for deep breathing and grimacing  

As you said, better to take your time and the personal best will take care of itself. 

Jim

I'm keeping a record,from when I started doing CIC.  So far, it's been 157 times that I've inserted the catheter, and 105 days since I started doing CIC.  Time, is flying by!  I'm hoping that in a year, I'll be close to where you are in voiding etc.  Mahalo, for all the help, that you've given eveyone on this forum!!!

Hi Jim, I need your help in clarifying on hesitancy isssue here. When the catheter reaches the second (and final) resistance at the bladder, where we routinely describing as 'knocking at the door', what is the anatomical name of this door ? Is it external or internal sphincter ? If it is one, where would the other be at ?

When we 'knock at the door', sometimes it takes few seconds, sometimes longer for the door to open. I have similar delay at the start when I void normally. They call it hesitancy. I just wonder if it is due to the same thing. Was I basically waiting for the door to open, without knocking on it with a catheter ? Thanks.

Hank

Hi JIm, My self cath PVP is 400 ml ,350 ml 250,ml. I get this urge to pee ,and also getting right side kidney pain,i have been cathing 6 x a day,i find it very difficult to go beyond 5 hours. I need your advise ? I do get this kidney pain,do you think it's from self cath??

Thanks,Jim,

Hi Hank,

When you "knock on the door" you are knocking on the internal sphincter which opens up to the bladder. The external sphincter is located at the prostate. 

It's normal for the door not to open right away, especially when you first start to self cath. Later, I found it became much easier and today, while I slow up a bit around the prostate, I push right through the internal sphincter almost as if it wasn't there. No hesitancy at all.

As to hesitancy with a natural void, that could be caused by several things including an enlarged prostate and/or pressure being exerted on the urethra. I think this is different from self cath hesitancy at the "door" because that just involves the internal sphinter. 

Jim

 

Hi Frank,

I forgot, are you naturally urinating right before you cath yourself or are you just cathing? When are you getting the urge to pee? 

Your urologist should be doing urinalysis every visit at this point with periodic kidney function blood tests as well as scheduled bladder and kidney scans. Let him know you have kidney pain so he can investigate. I really can't tell you one way or another where that pain is coming from. Could be from an infection related to self cathing but it also could be something else like a sore muscle. A number of possibilites.

Jim

Jim

Thanks, Jim.

Hank

Hi, Jim,

Thanks again for sharing your tips on relaxation. Last weekend I took a feldenkrais class and looked up youtube videos on ways to relax the pelvic floor. As an artist I sometimes understand things more easily when I can see them, so I looked up some anatomy pictures of the male pelvic floor--then suddenly the savansa pose became more easily as did other relaxation techniques.

Man, have these techniques made a difference! In the past couple of days, my NVs have increased! NVs of 140 ml or 150 ml are more common. And I'm getting through the external sphincter much more easily. I rarely have trouble with the internal sphincter these days. One of these days I'm going to have to time my again CIC just for grins!

Stebrunner 

Hi Stebrunner,

That's great with the yoga! 140 and 150 are really good numbers and it took me awhile to get there with regularity. Don't be surprised if within the year or so you even start seeing 200 and 250's.

I really have to get back to it more myself. Savansa, while it doesn't look like much, is arguably the most important pose. Combined with auto suggestion (yoga style) it can scan, relax, perhaps even heal the body even at the organ level. I learned with the Sivananda yoga systems and they have some very good tutorials on Sivananda, hopefully online. You should check them out.

Beyond, Sivananda, there are other postures for the pelvic floor as well that might help even more with the external sphincter. But be very careful just copying online poses or sometimes even worse, a typically agressive yoga class at the local gym. They often know nothing about yoga and everything about messing with your body!

I use a very abbreviated form of let's call it standing Savansa, both during natural void and the few times I self cath these days. It's just a moment of focus but the basis was the yoga training. 

Feldenkrais is also good, as well as the Alexander Technique, the latter of which I studied for several years. 

I don't know if you have been following Neil's problems with both sphincter's, and now mostly the internal sphincter. I have mentioned relaxtion techniques to him along the way but maybe we should again. I also think in his case some smooth muscle relaxants like tamusolin, cialis, etc, might help at least temporarily.

Jim

No idea why my last two posts were intercepted by the system's filter. There were no links, etc. If they don't get unmoderated soon I will PM you the gist. 

Hi Jim + Stebrunner,

By "savansa", do you mean savasana (corpse pose) ?

Hank

Yes, "corpse pose". But even more important the auto suggestive "body scanning" aspect of it as I was taught by the Sivananda Yoga system. While in the pose you basically scan the entire body starting with the muscles and then to the organs and then to cellular level. As you scan, you visualize each part of the body and give a silent command to "relax, relax". In what we have been describing here, focus might be on the entire pelvic floor region especially the prostate, internal and external sphincters.

Ji

part 2:

As taught, the process takes around 20 minutes, but with practice can be shortened. It can then be transferred from the floor to the toilet either when naturally urinating or during the self cathing process. With natural urination, I focus on both the internal and external sphincter with very slight deep breathng. With self cathing (I'm in and out in 5 seconds) it's just a momentary focus on both sphincters. I would say it's the diametric opposite of how most people, including myself, reacted to the first time a catheter was pushed through the urethra. That would be a state of tension, this is one of relaxation. It can take time and may not be possible right in the beginning.

Jim 

I found if you put a 3 digit number in the post 3 times it gets moderated? Something about this unusual way of sorting things and it thinks you are trying to redrict to another site...

Hi JW,

Yes, that appears to be what the problem was! Thanks for the heads up for future posts. I just checked and my first post has already come out of moderation. The the one still in moderation is just a duplicate. 

Jim

Hi Jim and Steb - could one of you fine gents PM a link to this? I guess listening to old westerns during CIC isn't a good idea.

Last night I did get through finally. I figured there must be a sweet spot on the sphincter entrance that if pushed with gentle but steady pressure will eventually open it. So I started at the 12 o'clock position and waited for 3 minutes. Then I moved to 1 o'clock for 3 minutes. Finally at 3 o'oclock it opened after one minute - whew! It is like the seet spot in a tennis racket.

It went in nice and easy with just a little blood now. I used tons of lubricant. This was at midnight. I did do a NV before for 200ml and the cath was 250ml. Then I was awakened at 2am with the urge again and I did a NV of 150ml. The same at 3 and 4 am. I then slept till 7 and did 3 NVs over 20 minutes for 600ml.

So I think for me an ideal cath schedule should be just before bed and then at 2 am and then when in the early morning. I don't recommend this but it would be nice to have data from an undwelling cath over a week say of my system's hourly pee output - then I could adapt the cathing scheduling to intercept it and maybe sleep again.

Fever is down to 99 now but pretty weak. Have any of you tried Macrobid in the past? Any problems with it? Thanks Neil

Thanks Jim,

I have to try again. Before, every time I tried corpse pose, I became too relaxed and fell asleep, even in class. I guess I never reach the goal that way.

Hank

I'll look for some links but remind me if I forget. Hard to find exactly the right cath schedule but what you say makes sense and hopefully the 2am cath will keep you from getting up at 3 and 4. Getting up once or twice a night isn't so bad, well better than 3 times. Did you try to cough while applying pressure. Some here have mentioned it. 

I've been on Macrobid and prefer it generally to the Quinolones like Cipro which can cause tendonitis. Of course, you really want to culture first because Macrobid isn't indicated for all bacteria. 

BTW the fact that you found the right clock position could be an argument you should try a non-coude. Assuming of course it gets around the prostate without sticking it. I wouldn't worry about any permanent damage as long as you take it easy. If it sticks, take it out and throw it away. 

Jim

That can happen and I acutally used to use the routine before bed time with the intent of falling asleep. However, the goal of the general practice is not to fall asleep but to relax. Are you closing your eyes? They should be open a little or it's very easy to slide off into sleep.

Jim

Thanks Jim,

I'll try it again. Actually, I did try it during this afternoon cathing when "at the door" and I can swear that it did help relax me quite a bit. And I did not fall asleep either.

Hank

Stebrunner, my best time so far is 10 seconds.  I try to beat myself everytime I CIC.  I have self-imposed rules:  speed, but not if it stings, even if it just a little<>)[/b]

Hi Niel

Glad to see you are feeling better. I have been keeping logs of my daily output both NV and PRV and the time of day on an Excel spreadsheet. After I read your post I decided to graph my results. Between midnight and noon my outputs are always over one hundred and fifty and as high as three fifty. From noon to midnight they are always less than 150 sometimes going as low as eighty but mostly between a hundred and one hundred fifty. 

I also noticed the graph of when I first started was much more irregular once I got the hang of cathing it become more reproducable from week to week

I don't know how handy you may be with Excel but it seems to me you could use your own data rather than from an  indwelling catheter to get a fairly good idea of what your body produces naturally..

Hi, Dennis,

Good on you! I've had to stop timing my CICs because they started to make me tense up while cathing. My personal best was 1 1/2 minutes, but it sounds like your passage is more open than mine.

My prostate size was 90 cc before my PAE, and from my last CT scan, it appears Igor (yeah, I named my big ol' prostate) didn't shrink much. However, after PAE CIC got a lot easier for me. I also have a large median lobe. When I CIC I sometimes alternate between LoFric Origo FR 14s and Speedicath FR  12s. Love using the Speedicaths when I can as they let me speed on down to the external sphincter.

Been using some of Jimjames relaxation techiques, and have been seeing my natural voids increase. Last January I totally flunked my urodynamics test, but last night I had a NV of 180 ml. That's a new record for me! Woohoo!

Stebrunner

180! Congrads! You're starting to creep up on me! What are your cath voids like? And do not start timing like Dennis!!!  

Jim

180 Congratulations!  Before you know it you'll be voiding in the 200's.  I hope that some day soon in the near future, I'll be able to empty my bladder completely, without the use of a catheter. It's helpful that we have this forum, so we can compare notes and help each other with experiences and advice.

My CVs are usually between 150 to 225. Sometimes they are higher first cath of the day. I usually CIC 5 times a day, sometimes 6.

Stebrunner

Your numbers are really looking good.  Not to get too far ahead, but another 50ml or so progress in natural voids and your CV could go under 100. 

Jim

Jim

Hi, Jim,

So this was a weird morning. Got up for first CIC of the day and had a NV of 150 ml. Then when I started to open the catheter package, I had another urge and had a NV of 60. Had trouble getting past the external sphincter and had another urge to void so I pulled out the catheter and had another NV of 140! Then I did my CIC and my CV was 300. Like I said my first TV of the day is usually the largest. The numbers drop after the day gets going. Although my NV came in three parts this morning, giving me a total of 350, it's the first time my NV has been greater than my CV of 300.

Stebrunner

That all sounds very positive! I don't double and triple void that much anymore, but frequently did on my road to where I am now. I think it means tone is returning and as the detrussor's get stronger, your NVs will increase even more. That said, 650ml, while understable for first void in the morning, is a lot of fluid. I doubt I could empty it the first time any better than you did! Fortunately, these days I would be awakened at 300-400ml so pushing out larger volumes hasn't been a recent issue.

Jim  

Jim, Thanks for this info,i greatly appreciate it.

Hey, Dennis,

Your wish came true! I hit 200 this morning! I'm very excited. I also timed a CIC a couple of days ago--timed from insertion to pull out--and hit a new record of 1 min 10 secs, beating my previous best by 20 seconds. The new relaxation techniques I've been learning have helped a lot. Your are so right about this forum. It's made all the difference!

Stebrunner

Stebrunner

Hi, Jim,

I hit 200 today! And today I've had 6 addition NVs of 150. A couple of days ago I did time a CIC--from insertion to withdrawl--for a new personal best of 1 min 10 secs. I don't know if this is from keeping on with my CIC, or from my PAE, or from the relaxation techniques. But I suspect it's the latter. In all my reading on BPH, I don't recall a urologist suggesting relaxation as part of a treatment plan. However, it sounds like Neil's nurse practioner realizes it's potential. I know my uro's staff have never mentioned it to me. Wish I had know about it earlier, but I'm glad I'm learning it now.

Stebrunner

Hi Stebrunner,

200 is great! What was your natural void preceding it?

Relaxation is very important but it's the CIC that decompresses the bladder to give it enough tone to recover. 

In Neil's case, the NP didn't suggest relaxation for bladder rehab -- I dobut she or his doctor even believes bladders can be rehabbed through CIC -- but they suggested relaxation it because he has very tight sphincters and was having trouble getting the catheter in.  But in reality, even if there is no resistance to the catheter (as in my case) relaxation techniques still help the bladder to empty more fully, but again the tone must be there first. I use these techniques every time I void, be it catheter or natural and today it's almost always natural voids. 

As to your time -- and I hope people are not competing here -- when I say, 5-10 seconds (and I believe someone else mentioned 15 seconds) we were only talking about the time from entering the urethra until the urine started flowing. As I understand it, your "1 min 10 sec" also includes the cath process which is probably at least 30 seconds? So I'm guessing you're real into the bladder time is around 30 seconds now? That's a lot of progress from what I remembered were sessions over 5 minutes in the beginning.

Jim

 

Hey, Jim,

Thanks again for your encouragement--I know I only made it this far with your help and the help of others on this forum! My previous NV this morning was 150, so the 200 came as quite the surprise.

I did my recent timing to verify that CICs were becoming easier. Yes, my time includes the draining time and withdrawl time. I know it takes about 30 secs on average to get into my bladder. When I started CIC about 9 months ago, I frequently had times of 60 to 80 minutes, which involved the use of several catheters. Sometimes I'd have to stop and rest for 10 minutes and try again. Sometimes I wanted to grab a hammer and pound the catheter through!

It was almost 1 year ago that my BPH journey began with a huge AUR. The uros told me then I'd never naturally void again--and look where I am today!

Stebrunner

Stebrunner,

From over an hour to around 30 seconds, now that is progress! I do hope Neil sees this because as you know he's been struggling like you were back in the beginning. 

Do you remember what your catherized volume was this morning right after you 200NV?

Jim

Hi guys - I see this and I guess you might say I have CIC-envy!

One pattern I notice every day now is that in the mornings and afternoons my NVs are about every one to two hours and in the range of 100 to 200mls. (no cathing for now during the day).

Then in the evening around now I start to feel a lot of tension in the pelvic region and my frequency goes up to every 20 minutes and the volume drops to maybe 50ml.

So by 11 pm I am so tense I cannot get a catheter in w/o great trouble. Tonight I will not cath before bed so when I am awakened at 2am or so I will be relaxed from some sleep and then cath.

Anyway - I am looking forward to my relaxation class - that could be the ticket for all this.

Neil

Jim,

Evidently I drank more water than I realized this morning. My 200 ml NV came about 2 hrs after a CIC. After the 200 NV, I had 2 more NVs of 150 and 140 within an hour. About an hour later I had a NV of 150 and a CV of 250. This afternoon I got busy on some projects so I wasn't drinking as much water, so the # of NVs slowed down as did volumes.

Stebrunner

Overall, the natural void volumes are very encouraging and the PVR are seem acceptable for your cath schedule.

I thought you were cathing after every natural void but apparently you're not which is good as long as your total bladder volumes most of the time stays under the 400ml range. 

So how many times a day are you cathing now? And about how many times a day are you voiding without cathing? 

Jim

Jim,

Typically I cath 5 times a day at about 4 hr intervals. When I have a class or activity, I often throw in a 6th CIC just so I don't go too long between CICs. I always do a NV before CIC. Between CICs, I usually have 2 NVs. Again this depends on my water intake. So on average, I'd say I do 12 or 13 NVs total during the day. Then I usually do 2 during the night-- one at about 12:30 a.m. and the other about 4 a.m. I don't measure every NV or CV, but rather periodically. And I'd say I measure more NVs because I consider those a way to mark my progress.

Stebrunner

Hi stebrunner,I  typically do about the same 5 x a day,also 6 x aday

Ican;t do NV.I'm thinking of getting a proceedure after the first of the year.I would like know if you had retention,and enlarged prostate?This forum is so great to help each other.

Thanks for this info

frank,

Everything you're saying sounds very encouraging. Increasing NV's are certainly a sign of progress. An equally important sign are low CV's. You might want to periodically check CV's when you think you might be at a low point bladder volume wise. For example, after your two NVs of 150 and 140 which occured within an hour. 

Not now, but with some more progress, you might consider temporarily going off the 5 or 6x/day schedule and maybe just cath once or twice a day, measuring the CVs each time. If they are under 400ml, you then can progress to skipping days as I started to do. Even weeks. The idea here is to test and start stressing the system to see how it acts in "normal mode".

I challenged my system at least half a dozen times after the first year for various time intervals off the catheter like this, being careful to measure CVs along the way to keep things honest. The longest time off the catheter back then was probably two months. After each "set" let's call it of challenging the system without cathing, I would then return to cathing fairly agressively (6x/day) to rest the system. Sort of like the concept of hard and easy days when working out. 

The progress wasn't always linear, and some of the off catheter times produced a lot of frequency, but eventually there were some pretty big jumps in progress. 

If you do go this route at some point, just make sure you check CVs periodically to keep things honest. 

Jim

 

Hi Neil, Did you say you took dutusteride and flomax also,and that it did shrink your prostate ,and now you can do a NV? How long did it take for this to happen?I have been taken this medicine for 7 months ,and still cannot do a NV. I'm thinking of a proccedure after the first of the year. Like Jim says CIC does rehabilitate the bladder.

thanks for tis info,

frank

Hi, Frank,

Last December I was in the hospital for acute urinary retention--and they drained 7 litres out of my bladder! That's right 7 litres! I didn't think anything was wrong because right up to that point I was peeing pretty much as normal, except for a slower stream. After my AUR, I couldn't pee a drop. I totally flunked the urodynamics test. My prostate was 90 cc with a large median lobe pressing into my bladder wall.

The urologists all wanted to do surgery on me (I've seen 5 of them.), but when I pressed them on the odds of their surgery allowing me to void naturally again, they all back peddled. My large prostate is half the problem. The other half is poor bladder tone. When I'd ask them how they were going to rehab my bladder tone, they had no clue. Clearing the pipe, so to speak, won't do any good if the pump is bad!

This forum helped me a lot with my research of various treatment options. My options were limited due to my prostate size and the median lobe. Basically I could do HoLEP or PAE. I chose PAE because it was less invasive, and it didn't mess with my sexual function. Also, PAE allows me to have other treatments done. I started CIC about 9 months ago, and struggled to master it. I feared CIC would lower my quality of life, but have since realized it hasn't--thanks to this forum! CIC also allowed me more time to research treatment options. And CIC gives me a chance to rehab my bladder tone.

Hope you find the answers that are right for you.

Stebrunner

 

 Hi Stebrunner, I had a PAE done in July. When I went in, they needed to drain 2 liters out which I thoght was alot, but not compared to you. I also have a large Prostate at 170 cc. Since the procedure by Prostate is down to 90 cc. I still can't naturally void much. Maybe I can void up to 200 ml if I'm full. They say my bladder needs help. I CIC several times a day, and it's not a big deal. I'm used to it. But I'm looking for ideas on how to help my bladder. I know jimjames suggests keeping your volume at 400 ml or less, but that's often not possible with sleep and the amount of liquid I take in. Do you have any suggestions?  Also I'm thinking that the size of my prostate may be due to Prostatitis. I see different natural things I can take and try, but since I have those beads in my arteries, how efective are natural treatments or antibiotics?

Hi stebrunner, Wow! 7 liters,thats 224 oinces,if i'm correct,32 ounce to 1 liter? Wow!! you had the PAE ,how long ago was this done? Even after PAE you still have to do CIC? Wow! I 'm doing CIC,ihad no proceedures as of now. I've been to 4 URO they all recommend turp or GL.At 87 i don't know. i asked about uro lift--he said it won't work with retention?

 Thanks for all that info,and i wish the the very best in getting well

God bless.

frank

There are several reasons for keeping volumes under 400m. First, larger volumes are associated with urine stagnation which breeds bacteria which can mean more UTI's. Second, holding too much urine can cause back pressure to the kidneys which can result in hydronephrosis (water in the kidneys). 

And even if the above reasons are not pertinent in your case, there's bladder rehab, ie regaining bladder tone. This is something that most uro's don't talk about or even recognize, at least not to the extent of regaining normal or near normal voiding as I have done. But this is how I see it and what has worked for me. (On the other hand if your goal is simply maintenance and not trying to regain normal bladder function, then the 400ml may not be as important as long as you're not getting UTIs and your kidney function is tested on a regular basis).

But to regain tone...

If you hold more than 400ml over time the bladder will stretch, or in our cases remain stretched. And a stretched bladder doesn't have the muscle tone to create enough force to empty the bladder completely. The other point is that 300-400ml is the sweet spot where a normal bladder triggers a neural response to the brain telling you it's time to urinate. If you want to eventually get back to normal urination, you want to respect that sweet spot as much as possible.

This is not to say that you have to be under 400ml all the time, but its good to try and keep around or under that number as much as possible. 

Jim

 

Hi, Greg,

I think I remember corresponding with you before. I knew going into PAE that the procedure wasn't as effective on prostates with large median lobes. I went ahead with it because I wanted to stop my prostate's growth and because I wanted to make CIC more comfortable. For more progress than that, I knew I needed to rehab my bladder tone.

Couldn't find much info on rehabbing the bladder. One uro suggested putting a pacemaker device on my bladder, but I didn't think that would help as my bladder signals me when it's time to go. It just needs more "umph" to empty. Have you seen some of Neil's recent posts? He came across some interesting paper on bladder rehabilitation. I need to really dig into to them to see what I can apply. My main program for rehabbing my bladder is the Jimjames technique.

Usually during the night I wake up twice for NVs. If I drink too much water before bedtime, I sometimes CIC about 2 a.m. I know I'm good for about 4 hrs between CICs so that will tide me over until I get up at 6 a.m.. If I think I'll have to CIC mid-sleep, I use Jimjames suggestion of laying all  my CIC gear out so I don't have to search around for it in a groggy state of mind.

I used to get bouts of what I though was prostatitus and found some dietary changes that helped prevent attacks. Mainly I avoid spicy foods, chocolate and alcohol--not much fun I know, but it helped. Are you familar with the prostatitus foundation? They have a web site with some helpful info. I was recently on it when researching bladder stones, and discovered that guys can have prostate stones. Who knew?

I'm not a fan of antibiotics so I avoid those as much as possible. To avoid UTI's I've been taking d-mannose, a supplement made from blueberries and cranberries, and it's been working very well.

Stebrunner

Hi Stebrunner - thanks for the d-mannose suggestion. I got it a few days ago and started taking it yesterday. I got my C&S report back this morning and it was negative but they told me to stay on Macrobid till its finished. The pee test at the nurse's office also showed no nitrites or blood and just mild leukocytes.

Also I have a meeting set up now with the local "continence nurse" for next week so that should be interesting.Guess now I'll have to see about rescheduling my biopsy.

Take care and thanks for all your help.

Neil

Hi, Frank,

My PAE was done at the end of June by Dr. Charles Nutting in Denver, CO. Yes, I'm still doing CIC. As I said before my problem is twofold--obstruction in the urethra and poor bladder tone. I'm working on improving the bladder tone, mainly through CIC. My current uro isn't happy with my doing the PAE, and he's surprised by the progress I've been making with CIC. He'd love to do a TURP on me as that's the surgery he specializes in, but that's not going to happen. I'm 62 yrs old and quality of life is important to me--and I'm sure when I'm your age it will still be important. I'd rather do CIC than deal with possible side effects from their surguries.

Stebrunner

Hi Frank - I was never in full retention but about 13 years ago I started having bad peeing symptoms - all the usual stuff. So my uro then gave me Flomax. The first pill made me faint but did nothing to help my symptoms. So he switched me to uroxatral (alfuzosin) which I am still on. This alpha blocker has been great for me all this time. I have had no side effects from it and it really helps me NV.

As my PSA continued to rise my uro then gave me Proscar (finasteride) to shrink my prostae and lower my PSA. It did work ok for 5 years but had terrible side effects related to sexual effects and low energy overall. I cannot say if it reduced the PV since that was not measured until 6 six years ago at 150gm.

Anyway, my PSA started to rise again and my peeing got worse six years ago so he switched me to Avodart (dutasteride). After six months it did improve my symptoms again and reduced my PSA by 50% (from 11 to 7) but I don't know the impact it had on my PV.

But after a few years I don't think it is working anymore though its adverse side effects sure are. I know 2 guys who tried to got off of it with terrible consequences (their prostates grew massively and they needed them removed). So I worry about getting off of it as I master CIC.

I personally do not recommend taking a 5-alpha reductase inhibitor - ever. That is avoid Proscar and Avodart and find other solutions. I do suggest alfuzosin to you (rather than flomax and other alpha blockers) - it it just a muscle relaxant and works right away.

Good luck to you.

Neil

 

CONGRATULATIONS!!!  What a nice Christmas present.

Frank, In the past 12 years, I've had one Greenlight Therapy, and two TURP's.  My last TURP, I couldn't urinate after the surgery, so I'm doing CIC.  I"m 68 years old.

Stebrunner,  if I had known about CIC, I don't think I would have done the TURP.  In fact, I used to think to myself, that wouldn't it be nice if I could insert a catheter, to drain my bladder...and that was before I had the second turp. I just didn't initiate and kind of inquiry with my uro.  What's the old saying: "you snooze, you lose."