Self Catherization: Issues and Problems

Hi Jim, I cannot void,i have retention. The 550 ml happened last nite.it's usaully around 250 ml to 350 ml. I don't know why it was 550 2 times last night. It wasn't more liquids than normal.I gte a kidney pain when i have to self cath  around 5 hours. Do you think i should try to hold off longer?

Thanks for this info JIm,

Frank,

As long as your usual cath volume is 250-350 ml I wouldn't worry about it. Sometimes we produce more urine than at other times, and there are so many variables involved it an be hard to pinpoint what is causing larger voids one day than another.

I didn't understand what you are saying about kidney pain and "hold off longer". Can you explain again, thanks.

Jim

Hi JIm,I don't know if this is the right thing to do? Sometimes after i cath i get a kidney pain, I get the urge to pee after i cath around 3 or 4 hours. I try to avoid this urge and hold off for 6 hours ? Do you do this also?.

My new URO said after GL it's rare to get incontinet ,but possible. Do you know on this forun someone who had this procedure,and did get incontinence?

Thanks Jim,

If you get the urge to pee in 3 or 4 hours, why don't you cath then. I see no reason to hold off for 6 hours. Just keep a log of the time you cath and how much urine comes out. 

The pain you feel in your kidneys could be something muscular but it also could be stones of a UTI. Best to discuss with your doctor.

I think someone here just posted they were incontinent from GL, or maybe it was TURP. The truth is that this sometimes happens but not very often. 

Jim

Hi Jim,

I've been doing CIC 4 times  a day nnow without much difficulty until a couple of days ago. Then in the late afternoon when I was very tense i could not get the catheter beyond the start of the prostate - it was like hitting a brick wall. So I pulled it out and tried again a few hours later. I had more success but there was a lot of burning and blood. I'm using Speedicath 14 coudes.

So I waited 18 hours before trying again last night before bed. In the interim my NVs were ok with no pain or blood.

Last night instead of first doing an NV and then CIC which is my usual course of action I thought I would first try the CIC to see if the pressure of needing to void might dilate the whole region and allow greater ease of insertion. There was a lot of pressure to pee but I resisted it as I the catheter went in.

Sure enough it went in very easily the whole way without any problem. I took out 500ml.

Then I went to bed and awoke in real discomfort to pee at 6 am this morning. Again I resisted the urge to do a NV first and the catheter went in really easily all the way with no resistance. But I was shocked to see 800 ml come out!

So I was wondering what you think about not doing NVs first just before doing CIC? I measure my NVs in between and they are between 100 and 200ml. Do you think I weaken the bladder muscles by not using them first for the NV before the CIC?

Thanks.

Neil

 

In theory a full bladder would make the internal (bladder) sphincter easier to penetrate but not sure why that would make it easier to navigate around the prostate. I would think the opposite if any. So, maybe coincidence or maybe that is just the way it is. 

I see no harm in doing CIC without a NV now and then. Maybe just do it when you think you might have large volumes like first thing in the morning. I don't even see any harm doing CIC without NVs for several days in a row to give things a rest. However, on a regular basis, I would still try and do at least a couple of NVs a day if you can. 

The other thing that could be causing issues is prostatitis (inflammation). I had a problem this morning myself, and seriously considered CIC for the first time in 4 months. Ended up walking it off and out came 50ml, then a few minutes later around 100 and then another 100. By then the pressure was relieved and I was OK. Looking back, it might have been some exercise I did yesterday that inflamed the prostate. So hard to tell what causes what but I do think that prostatitis, even mild, can have a significant effect on voiding especially if your system is already compromised.

Jim

Thanks Jim.

I do about 12 NVs each day that are in between my 4 CICs. Thay usually range between 100 and 250ml.

So I am just referring to the NVs immediately before I do CIC so I can get a good estimate of my PVR. It as amazing to me how easily the catheter went in. There was just no resistance at all - it was wonderful to behold!

Tomorrow I drive to Detroit to get a scrotal ultrasound and talk to the VIR there about a Gat Goren procedure or a microsurgical varicocelectomy. My wife said I should rent a 20 year blond to take in with me so I can claim I want the treatment for children and get it covered by insurance!

Neil

Exactly

Hopefully, between the lube, time and trying some of the things suggested to you, the bleeding will get better and your sphincter will heal. 

But if it doesn't and things get worse, then you might consider at some point giving your sphicter a complete rest for at least a few weeks with either a Foley or preferably with a suprapubic catheter, the latter which totally totally bypasses the urethra by going through the abdomen. It probably would be preceded by a cystostopy to get a better look at what the problem actually is. The alternative is to stop self cathing for awhile but given what you said and your PVRs it sounds like you need to keep emptying your bladder on a regular basis to avoid UTIs and/or reflux into the kidneys.

Jim 

We're all a bit different, but I was startled to read that you are cathing out 600cc at 4am!  Maybe a basic question, but have you tried stopping liquid intakes a few hours before beddy-bye time?  

Hi Cartoonman and Neil,

I am assuming that the 600ml you cathed was all there was in your bladder. In other words no natural void before?

If so, it's consistent with some of the middle of the night volumes I had the first six months of self cathing. And the timing of drinking fluids had nothing to do with it, it was just a shift of voiding from day to night time which happens to a lot of us as we get older.

While not ideal, if it's just that one cath of 600ml a day, probably no harm is being done. The alternative would be to try harder with more of the nocturia strategies or set the alarm clock at let's say 2am and cath. Not sure I would recommend that.

That said, with time, when the bladder regains more tone, you will probably just wake up by yourself at 2am with the urge to urinate. That is what happens to me from time to time. Call it the natural alarm clock

Jim

Neil,

I am curious. Do you have the same resistance during your 4am cath with very full bladder (600 ml) as you do with your day time caths when you're only holding around 200 ml?

Jim

And I'm curious, as to how many times per day you cath?  I'm at 5 or 6 times a day, and about 300-450cc.  Are you cathing when the urge hits, or just for the heck of it?  :-)

 

I often have a total of 600ml cath and NV at 4:00am. My total void is 3000ml+ per day..

Niel I was thinking of your contining problems and these are my thoughts feel free to disregard them..

You and I have kinda been on the same time line as you noted on the other thread. I unlike Jim, cannot really offer any constructive advice other than as you say hang in there.

One thing I have noticed when hitting the bladder wall, is that I'll stand there for awhile and nothing happens but if I start taking a  deep breathe from the bottomup, as it were, prety soon one of those breathes just sucks the cathether into the bladder.

I don't give advice as everybody is so different, I dont know anything, but Jim knows everything   

I would however, observe that you seem to be the kind of guy who is used to saying let's this done and it gets done...

Unfortunatly, it dosent seem that the anotomy works that way. Telling it to relax has the opposite effect.  The thing I noticed from the early days of  my attempts at CIC is that I'd give up trying to enter the bladder far to soon out of fear of damaging the plunbing, but at the same time I felt/feel  just shove the sucker in and get it over with which seems to be the wrong approach ....

I'm still a newbie at this but I've noticed a progression, from maybe being able to do it half the time, to being confident it will eventually go in, to a new plateu for me in that I can relax and take very deep breaths and it just naturally gets sucked it up with a few of those breaths..

I know it's tough to get the Doc's attention but you need to keep them informed, I have told my PCP I'm sorry to be such a pain but I send her voiding logs ect every couple of days if necessary... don't always take her advice but she is always informed.. 

Great advice JW with the breathing. And the opposite, of course, is the tendency people have to unconsciously hold their breath which just tightens everything up.

Also glad that you have progressed from having it work sometimes to the confidence that it will always work to making it work easier with the breathing.

The confidence part I believe played a role in getting you to the next level. And don't be surprised if somewhere down the road it all becomes automatic and slips right in. For probably a year or more, twisting at the sphincter for me was what deep breathing appears to be for you. But these days, it just seems to automatically happen with surprising ease. The body may be a slow learner but eventually the body does seem get with the program!

Jim

Hi Jim - the resistance is much less when I have a very full bladder - I tell my bladder the cavalry is coming to help and just hold on a few more seconds.

Jim - just wanted to suggest that in your opening for this new thread that you provide a link back to the old one for new people coming to this one who may wnat to read all the good stuff ont he old one.

Hi cartoonman - I do NVs during the day of about 150ml every hour. I cath when I awake with 300 to 400ml and then I cath before bed with about 200ml. Then I am awakened in the middle of the night with 600ml.

At one point before this bleeding I was cathing 4 times a day to try and rehab my bladder. Most of those I did not feel the need to cath. I would NV 200ml first and then cath 200ml with those. But now I am trying not to cath at all and let my injury heal.

Last night I was up all night. I NV every hour just like during the day with about 150ml each time so it seemed to just continue my day schedule. I did not lie down at all.

I've also been taking IP6 to try and eliminate my lesion if it is PCa before my biopsy which has yet to be rescheduled. I read last night a big warning that it can cause bleeding and reduce clotting. So maybe this has caused my slow response to heal the injury from Friday to my sphincter. So many things to worry about with interactions and side effects - fix one problem and cause 2 more.

Neil

Thanks jwrhn - your comments are very very much appreciated. I cannot talk to my uro anymore - he just says if I am having rpoblems with CIC then it is time to operate -I have 2 uros and they same the same thing. They could not care less about me. I live in central Mihigan about a 4 hour drive from Detroit so it is hard to attend clinics - especially this time of year.

I was really getting good at CIC for about 10 days - no bleeding. But then I got impatient on Friday at 6 pm to see the news and pushed in too hard.

So do you sometimes pull the catheter out and try again later after waiting for the sphincter to open? I sometimes want to do that but then feel I am wasting the catheter.

I will try your deep breathing idea - it makes sense. I do like my catheter and do not want to try others. It was working great and now with the added lubricant really helps gets past the prostate.

Please share more experiences - we are all we have together to help us.

Neil

Hi Neil,

I thought your resistance would be less because an empty (or near empty bladder) can make the sphincter clamp down hard.

So here's the thought. At least for a few weeks to give your sphincter some healing time -- why don't you either just skip the natural voids altogether, or just do a very short natural void to clean out the urethra, then stop the void, and then self cath.

Hopefully the cath will now slide past the internal sphincter easier now as it will not be as tight as when the bladder is emptier.

Yes, good idea about putting a link to the older thread. 

Jim

Hi Jim-thanks I will try it. I will try to hold in for 4 hours which should equate to 500ml plus the PVR of 200 and then let her rip. Good idea - will try tonight and let you know.

Neil

Yeah, with 700mml in the bladder, you might just find a sign on the "door" which says "Open, just come on in"   

Jim

Except, except...  I'm just a little concerned, when I read about you collecting 700cc before you empty out.  Over-stretching, maybe?  I write this as one whose bladder was SUPER-overextended, when I wound up in the Emergency Section two+ years ago.  THey drained off 2,500cc of pee--- and my bladder has never recovered.  

I now am listening to "the urge," which comes earlier than it did once (not until 600cc or so!), and I cath 250-450, with a max of 550cc and usual of 300cc.  But I'm don't it while litening to my body's signals, which have improved in their clarity, even as I have gotten better at listening...

 

Cartoon and Neil,

700ml wasn't my idea but no harm for one cath to see what happens. I've held in more during the first few months of cathing from time to time.  

If 700ml works to ease entry through the sphincter (by increasing bladder pressure) then Neil can go back to his regular cath schedule and either temporarily just cath without naturally voiding or just voiding enough to clear out the urethra, hold it in, then cath the rest. Either of those two scenarios should give him sigificantly more bladder pressure than he has now where he's cathing with less only 200ml in his bladder. 

You could argue that Neil should start with a lower volume test so if Neil is reading this, it's up to you whether you want to wait till you're maxed out at 700ml to give the concept a full bore test or do it now at a lower volume. 

Jim

Yeah, one or a couple of times are not likely to cause problems, agreed.  Although my bladder hurts just thinking about it!  :-)   And either I never get a completely uncooperative sphincter, or I just don't take NO for an answer!  :-D

 

Cartoonman,

Are you saying you now get the urge to pee when your bladder is holding 600ml? Wasn't clear on that. If not, when do you get the urge and what is your typical natural void and cath volume?

As to your exerience two years ago when they drained 2,500ml of pee from you. I had similar 3 years ago when they drained close to 2000 ml from me. I don't think it was that one event with either of us that stretched out bladder but rather it was the fact that our bladder had been stretched for many years that got us to that point. 

Jim

 

Yes, I agree re years worth of stretching that pee bag out, that rendered mine permanently stretched out.  

As for the other item:  I used to not get any urges/signals until there was 600 or so ccs in the bladder.  On the advise of my Uro-doc, I stopped the 5X per day cathing, and had the urges come at that time, at which point I'd pee out 50 to 150cc, and then cath before bed, and drain off anywhere from 600 to 800cc, occasionally as much as 1000cc.   

I chose to return to listening to my body's signals, rather than doing "every two hours," or what-have-you.  Urge to pee varies, from 3-5 hour intervals (usual) to only 2 hours.  Whenever the urge comes, I listen---and attend to it! The output varies, from 200cc–450cc, usually, with extremes of 150cc–550cc.

You said: Urge to pee varies, from 3-5 hour intervals (usual) to only 2 hours.  Whenever the urge comes, I listen---and attend to it! The output varies, from 200cc–450cc, usually, with extremes of 150cc–550cc.

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

Do you cath each time you void? If so, then you must be cathing around 4x/day given an average of 4 hours between voids? How much of your output is a natural void versus catherized void?

Jim

Hi Jim and cartoonman,

I will try all these ideas and report back - I like to experiment with something new.

Also maybe I should compress or push on my bladder when waiting for the sphincter to open the way we sometimes do for NVs?

Take care

Neil

I do almost no natural voiding at all!  A trickle here n there is all.  When I was cathing only 2 or 3 X per day, on the advice of my uro-doc (who was worried about too many cathings leading to irritation of the lining or UTIs),   I would pee "off the top," maybe 100cc or so, then cath a good 500-800cc and sometimes more(!).  But my stretched-out bladder is so stretched out, it doesn't mind holding extra, and the sphincter releases (I suppose), but the small (38g) but stubborn prostate once again has that urethra closed up tight.  

I now cath 5 or 6 times a day, first time before or after morning coffee (depending on what my body tells me, and if I was up to cath during the night).  Then late morning or lunch time, then late afternoon, dinner time and then right before bed.  Of late, with more frequent cathing, I also am up for one cathing a night, and that's 300cc or so.  But I still often sleep through the night.  Nice, that!

[ I was pretty happy with the Urolift in December of last year, but the effects were not long-lasting.  My uro-doc out in Salt Lake said he was willing to install  a second set of implants, but had strong doubts about that helping, long term.  He said if I were open to Turping, he would do a Turp.  As I am not, I'm biding my time at this point.  Trying a second Urolift (My guy has only done 3 of those, in the hundreds of Urolifts he's performed.) might do something, but if it didn't, I'd be out $1,000 (my share), plus have to worry about having all the implants removed before any other treatment could be done...]

Better try one thing at a time. First just cath without doing a natural void beforehand. The concept is to cath with a fuller bladder as opposed to cathing after you empty the bladder out partially with a natural void. The fuller bladder hopefully will loosen the internal sphincter.

If essential your entire void is via CIC, then ideally you don't want more than 400ml in your bladder at any one time or it will keep stretched out. Sounds like the 5 or 6 times a day is accomplishing that although I would think that 6 is better than 5 as it gives the bladder more rest. Your uro's concerns about frequency of cathing is unfounded according the the literature. In fact the literature clearly states that frequent self cathing is the best preventative against UTI's because bacteria thrives in retained urine. So think of every time you cath as an "oil change" and the more oil change you do, the better the engine runs!

FWIW my bladder was very happy holding 600-1000ml of fluid with little or no sensation. This continued for the first year into the second. I now get the initial urge to urinate when the bladder is holding around 300-350ml. 

As to the internal sphincter, a lot of us don't have the problem Neil has. I'm not cathing too much now, but when I do to check my PVR periodically, for example, I have no problem going by the sphincter even when my bladder is only holding 20ml ! But back in the day, I did notice that the sphicter was easier to pierce with more volume in the bladder and harder to pierce with less volume. 

Jim

 

ok but will apply pressure on bladder if doo doesn't open!

Sure. But try and stay positive. The sphincter doesn't react well to low expectations

Stupid question maybe. But which hand are you going to apply pressure with on your abdomen at the time you hit the sphincter? At that time, one hand should be holding your penis straight and the the other hand should be applying pressure on the sphincter? Do you have three hand maybe or have you found a helper?

Jim

Great to keep a sense of humor in our situations, Jim; way to go!  :-)

Yes, Jim, I considered his advice, was slow to process, but eventually came to the same conclusion you have.  Keeping that stew in there too long kinda reminds me of the days I was a VW Beetle and Bus mechanic, before the art business started paying the bills.  There were people who came in with the old Beetles with 36 and 40 and 50hp engines (No filters!  Only a screen in the sump to catch the big chuncks!)... yeah, some nasty sludge in those sumps, OMG!  

So yeah, I'm with you about frequency.  I managed to get the full number of catheters delivered even while cathing only 2X per day, so I have plenty in reserve at the moment...  :-)

 

Hi Jim - another rough night - I feel like I am in training for combat in case I get caught behind enemy lines.

I went to bed early with a pretty good fever and then finally had to cath at 3 am. I tried not to NV but the pressure was so great I gave in and had a 250ml NV. Then I cathed. The prostate is no longer an obstacle thanks to the lube but again I waited for 5 minutes to get past the sphincter.

I wondered if there was bleeding at that point so I pulled out the catheter and there was no blood.

I used a new catheter and went back in and again waited and waited.... with gentle pressure. I tried deep breathing to suck it in and then I applied pressure with my left hand on the outside. Since there was only about 4 inches left on the catheter I could hold the whole thing out with my right hand.

Anyway nothing worked so I just maintained pressure and tried not to fall asleep. Finally I could feel it slip. There was the usual blood with some smaller clots and then it turned yellow ok. But at the end it again turned red and when I took out the catheter it was filled with reddish pee. The cath volume was 300ml.

I guess I will just have to be patient and train my sphincter over time to open on queue when the catheter knocks. I wonder if going to a 12FR might work better now that I can get past the prostate ok?

Thanks Jim.

Neil

Hi Neil,

Before moving on to trying a 12, I would stick with the plan and try to cath without a NV void first. You do not have to wait to the point where you can't hold it in any longer which seemed to be the problem at 3am. Try and do it this way the next time you cath and let's see if the external sphincter is any more relaxed.  After that, you can try a 12 and see if that is any better. One thing at a time.

Fever could mean UTI. I would contact your urologist. 

Jim

 

Good God!  Sounds awful, Neal!  Just a question:  are you using a straight tip or the coude (curved) tip?

Hi Cartoon,

He's using a coude tip, but it's already been suggested to him to try a straight, as well as experiment with different manufacturer's and sizes, including the very soft red rubber. I believe he's looking into getting some samples.

The problem now is not the prostate but a very tight internal sphincter. What he's working on now is trying to decrease sphincter pressure by cathing with a greater bladder pressure. Sounds like he waited too long last night and just couldn't hold it. 

Jim

Ah, thanks for the details!  Is it possible that the coude is NOT right for his condition?  I received a box by sender's mistake once, and used them unwittingly, but not painlessly!      I'm wodnering whether a straight FR14 would work better...   The blood in the catheter has me wondering whether he is tearing up his insides with the coude!!

And personal prejudice here:  I can't imagine the red rubber (Think: CLOWN NOSES!) type working at all!  :-)  

Cartoon,

Anything is possible and that's why it's important to experiment. I know you had good results with a straight, but with me, the few times I used a straight I got stuck real hard in the prostate, OUCH!  I started with a red rubber and switched to the Speedicath and never looked back. That said, the red rubber is much softer than the Speedicath, so if it can get around his prostate and into the bladder it's certainly worth a try, at least until he heals up some. From what Neal related, the bleeding started after a too agressive attempt going through the internal sphincter.

The idea behind cathing with a fuller bladder (as opposed to doing a natural void first and then cathing) is that the internal sphincter loosens as the bladder fills up. Or inversely, it clamps down as urine is expelled. So in theory it should be easier to penetrate with a full bladder. I'm not suggesting this long term, but if it works then cathing with a full bladder for several weeks may give his sphincter some time to heal. 

As an example, I have almost zero resistance at the internal sphincter. Stop there for maybe quarter of a second before pushing through. However, sometimes when I'm very near the end of the process. The part where I'm slowly backing the catheter out to drain out from the very bottom of the bladder. Sometimes I will back it out too far and it pops out of the sphincter. If I try to push the catheter in at that point it's impossible. Tight as a clam because the nerves have sent a signal to the sphincter saying "I'm empty, close the door"!

Jim 

Ah, details, details!  :-)   And yes, different experiences for different plumbing.  I still remember so well, the pain of using that WHOLE BOX of coude tips, when they weren't right for me.  Ah, the adventures of a Newbie!  :-)

And I see re the full-bladder-cathing idea.  I have had the effect at times, of waiting too long (E.g., stuck in traffic, with no catheters for a roadside draining session), and my insides saying, basically, FU, man!  We ain't opening up for NOTHING and NOBODY!  Although even at those tines, I just hang back, breathe, and gently push forward, and it goes on in.  And yeah, ditto with those SpeediCaths.  Sort of like my wife.  How?  When I found her, it all worked so well, I didn't need to look any further...  :-D

 Thanks Jim and cartoonman - I will follow your sggestions. My uro is useless - he says if I have a fever and blood to put in a Foley. It is weird that my UTI strips show zero nitrites, even with a 101. I tried toCIC  now but my hands were shaking and couldn't do it. I have lots ofdifferent catheters and will follow  a systematic plan..  Maybe the straight will work ok with the lube? I'll get there thaks guys.

Hi jwrhn, Your total urine volume of 3000ml+ is a bit high, IMHO. Why are you taking in so much liquid ? Too much liquid intake can make retention worse and make you have to cath more often. My daily intake is around 1500 - 2000ml. My cath volume is definite lower when I do 1500ml.

Hank

Hi Neil,

I use them both: coude (tiemann) and straight (nelaton). Coude is good for the urethra curve and the first resistance at the prostate. Straight is better at the bladder sphincter (the door). So it depends on how much resistance you have at the first point. If it's a lot, then you have no choice but using the coude. If it's not much, as in my case, you should use the straight. Also, the straight is much cheaper.

Also, the smaller the size, the easier it will get through the door. I even go down to size 10 straight and it will go through within 1, 2 seconds vs 10, 15 seconds for size 12. The problem with size 10 is that it tends to bend and you would have to touch the hose to guide it in. You can still employ Jim's patented and trademarked kamikaze method at the beginning, but be ready with clean fingers to guide it in as needed. As long as you try to touch only the far end of the hose (near the tunnel), I think UTI risk is very low. I have not had any in my 3 months of CIC. I use both, mainly straight, size 10 for the speed and ease and size 12 for plumbing clearing. Sometimes I even go to size 14 for more plumbing maintenance.

Hank

It's always been like that. I also have gout and found many years ago that keeping a high fluid intake reduces the number of flares. Also my providers think I may have a very mild case of diabeties insipitis (as if I don't have enough wrong with me) and they want me to drink enough to prevent dehydration. Today for example from midnight to noon (12 hrs) my total void was 1625ml with 480ml of that RVP...

Hi JW,

Having had a high void outputs like yourself, I also thought I had Diabieties Insipidus (DI), but my doctor told me that unlike regular diabetes, DI a fairly rare condition, and he therefore didn't even think it was worth testing for. That didn't stop me, lol, so I did a simplified version of the DI diagnostic "fluid deprivation test" at home. I passed so I guess my doc was correct.

While 300ml output was pretty common the first year I cathed I think it's probably much closer to 2000ml now, although I haven't done a log in some time. Not sure why that has changed.

Jim

Hi Neil,

Sorry for your discomfort. Yes, a systematic plan is the best approach because trying too many things at once can get too stressful plus hard to tell which of the things is most effective. From what you've told me this would be the order I would suggest but it's really up to how you feel. 

1. Since you've already said that your sphincter is looser with a full bladder, I would try that approach first. In other words cath before you do a natural void as opposed to cathing after the void.

2. If that doesn't work then maybe try a Speedicath 14 non-coude with lots of external lube. 

3. If #2 does't work, try a Speedicath 12, first coude, then non-coude with lots of lube.

4. Try a red rubber FR14 with lots of lube.

5. Try a muscle relaxant such as Tamsulosin, 5mg Daily Viagra or Valium.

(you could actually start with this first if you want)

6. If everything fails and you're discomfort grows, consider a month or so "urethral vacation" with a suprapubic catheter until the sphincter heals up.

Technique wise try deep and easy breathing. You could also experiment with some pelvic contractions at the bladder door, as if you were trying to urinate.

Jim

 

Thanks Jim - my fever is 103F but can't get to ER due to storms here. I had Macobid and started it tonight. I will try number 1 tinight, Thanks guys. Neil

Feel better. I'd see a doc about that fever as soon as you can. If you can't get there at least give them a call.

Jim

Hi jw,

Cherry tablets and basil seem to help me with gout control. Re too much liquid intake, when I tried to increase my intake above 2000ml (2500ml) for few days in May, my blood pressure shot up and my kidney functions went south. At that time I was not cathing, did not know about CIC and did not even know that I had retention.

Hank

I believe you are making a good decision here. My French uro told me today

he isn't going into another TURP and adviced CIC, I am positively surprised.

I have got free samples of Speedicaths, want to start tomorrow, a little scared, but I almost cannot pee any more.

Condom catheters relieve me at night, but I produce 2l of urine at night!!!

My uro mesures the rest of pee in my bladder after my pseudo-peeing

as 350.

Neil,  I think that's a good idea.  The more you do CIC, perhaps the sphincter muscle, will eventually get used to that foreign object, and let it in. What I do, is once I finish draining the bladder, and before I pull the cather out, while it is still in the bladder, I twist it back and forth, for 50 times.  My thinking is that, this way, I get the body used to the catheter, and that I kind of roter-rooter the entrance to the prostate and bladder. I time myself, almost everytime that I CIC, and my best time is 10 seconds, and sometimes, I feel little a little drag, and so it might be 16 seconds instead of 10 seconds.  I use a FR14 Coloplast.  Good luck with your cathing.

Thanks Jim. I've been on Macrobid for 2 days and have a 14 day supply. Yesterday my fever peaked at 104F. During the night I sweated like crazy but did sleep for 5 hours which is record. My wife said I peed through my skin instead. My PCP is useless. She would not call in a C&S to the local lab this past Mon but insisted on seeing me first to run up her charges. But with all the roads closed now for 3 days she has gone off to Florida for 2 weeks!! I cann ot stand these doctors.

Anyway, I tried your idea 2 nights ago where I held in my NV. When I had trouble getting past the sphincter I then tried your idea to just tense the pelvic muscles to pee - well I peed alright - all around the catheter on the floor! But I still did not get in. When I pulled out the cath I was surprised to see small amounts of coagulated blood on the tip.

I was wondering if I should try rotating the tip slowly while applying gentle pressure. It seems if I come in high at the sphincter then the curve of the tip will apply pressure even higher and away from the center of the door. We need a "smart" coude tip then straightens out when it gets to the bladder.

Thanks.

Neil

Hi Neil,

If not your uro or PCP, don't you have a doc-in-the-box place nearby where you could leave a urine sample? Might be worthwhile to rule out a UTI. 

So are you saying the sphincter resistance was the same with a full bladder? Worth a try anyway.

Thinking it over, the idea of tensing the pelvic muscles to help "open the door" should not be tried on a full bladder, as  you found out That said, you might try it after a natural void. 

Before things became real easy, I used the "twist" at the door method to enter the bladder. While holding steady pressure, I twisted the catheter back and forth several times fairly quickly but the rotation was very slight in either direction. Concept really just to loosen things up. 

Not sure if a non-coude will help open the door or not, but one way to find out...

Jim

Thanks Jim - we don't have a doc-in-the -box in our podunck little town in the UP. Even though I have intense irritation I still don't think I have a UTI but I'll never know now. I hope the Macrobid helps - I had it from my cystoscopy in the summer just in case but never used it.

I can't say for sure about the resistance since I am so weak right now from the fever that I can't hold the pressure for too long. It is too bad I had that incident last Friday as I was doing so well. But I'll get back to it with time - just a minor set back. Honestly - anything that keeps me away from the doctors is much preferred.

Take care

Neil

Have you tried to cath sitting or lying down yet? It's possible a different position might help. I would try the muscle relaxers after that and then the non-coude tip.

Jim

...and with all respect due the couce tip and womever prescribed it, it either works very well, or terribly, depending on one's inner plumbing; if you have a straight tip handy, maybe worth trying that before and additional gymnastics.  :-D   Just a thought...

 

Speaking of "gymnastics", when I had an issue with a bladder diverticulum (now sorta resolved) I was going to try head stands to see if that would empty it into the bladder. Unfortunately, too old now for the inverted stuff! That said, "sitting" and "lying down" shouldn't be too much of an issue and in fact sitting is how the SCI community pretty much always does it. I believe he ordered some non-coude samples so there's that. Experimentation (within reason) is the key.

Jim

Neil,  I think that may be a good idea, rotating the catheter, much like trying to screw something in. Not rotating in a circular motion, but rotating side to side. Instead of trying to just add pressure, a little pressure and twisting side to side may do the trick.  Like you are trying to wiggle in to the bladder. It may take a while, but my guess is that the more times, you can enter the bladder, the easier it will get. Like anything else, practice makes perfect.  Another  suggestion, once you get into the bladder, and it empties out the urine, before you pull the catheter out, why not twist the catheter, back and forth, to make the tissue in that area used to the catheter, also it will act much lilke a roter-rooter. By twisting back and forth, you will make the hole more relaxed. After I empty my bladder, and befoe I pull the catheter out, I twist it side to side, for 50 times, then slowly pull the catheter out.  I almost let the catheter move on its own, as it is exiting the body, I go that slow.

Jim, I'm still trying to adjust to the idea of headstands and cathing (I'm not sure the physics of that would work...), and I hope I will NOT be remembering that image when next I do a head stand, either here or in my class next week!      Oooooommmmmmmmm....

 

When I was sent (by error!) that box of coude tipped SpeediCaths, back when I was a cathing-newbie, I used the gentle twist method to get those suckers in with the least amount of pain.  Listening to your body's responses is key...

OK. Here is the image you don't want to get into your head --

First, not cathing while doing a head stand although that might give me some bragging rights. So, my diverticulum is like a pouch off to the side of the bladder. The "inlet/outlet", so to speak, appears slightly downward per an ultrasound I looked at. So when my kidneys empty, most of the urine goes into the bladder but the diverticulum also fills. When I naturally, urinate -- or cath -- the fluid in the diverticulum does not necessarily come out since the opening, as stated, is slightly downward. The idea with the headstand was to empty the diverticulum into the bladder just before cathing so everything would empty. 

FWIW it didn't work, but the good news is that not only has my self cathing helped my bladder it has also apparently shrunk the diverticulum. It used to hold up to 300ml and now, when my bladder is empty it holds less than 30ml which is acceptable.

Jim

Hi, I have the sane problem urine retention. I cannot void without CIC.

My recent URO said URo LIft will not work if you have urine retention?

You say you had uro lift? Was this a thru statement? He also said if he did a

GL i could get incontinet.Just curious ,did your URO say something like this? 

​  Thanks,cartoonman

Yes, I had the Urolift a year ago, but it worked only for several months... And Yeah, if you have a stretched-out bladder (I do), the Urolift will alow you to partially void.  Even when I could pee well, post-Urolift, I still would cath occasionally, to fully empty out.  But my bladder is severely stretched, and can hold 800-1,000cc!  I am currently doing the famous  JimJames bladder retraining, to hopefully shrink it down, but that's another story...

There are possible nasty biproducts and colateral damage possibilites with every treatment available; the best we can do is find the best professional, and hope that s/he does the best job!

Cartoon,

Speaking of JJ Bladder retraining ...I know I have spoken a lot about the fact that my biggest jump progress-wise came after a period of fairly agressive cathing, 6x/day (even more) even when I didn't necessarily have to.

But also keep in mind that there were periods prior to that where I went in the other direction, ie I tried to go as long as possible without cathing, even once over a month. Thinking it over, perhaps the periods where I literally sometimes forced the issue (when I was hardly cathing) were just as important as the times when I got very agressive.

In workout terms -- think heavy days versus rest days, or in cath terms heavy weeks (trying not to cath and get it out as best I could) versus rest weeks (letting the cath do all the work. 

The rest weeks speak for themselves, I just cathed whenever I felt the urge and didn't even bother with natural urination unless it came out really easy. But during the "heavy" period, I tried every trick in the book to keep from cathing. Sometimes I used "tapping" (tapping the lower abdomen to stimulate urination) or even pushing (crede manuever). I also found that if I couldn't urinate standing up, I often had success sitting down reclined a little backward. Don't have a reclining toilet but I do have a nice easy chair and a bucket!

Hopefully this helps some.

As an update, I haven't felt the need to cath going on over two months. The only caths during that period were to check PVRs. And PVRs were fine, mostly between 100 and 20ml. Don't know if this will continue, and I might just be a big beer night away from AUR, but knock-on-wood things right now are just fine.

Jim

To be more detailed as to my current condition, my bladder has been emptying properly without self cathing for probably over six months now. The caveat is that during this time, maybe once a week I would have an episode of AUR which would resolve itself right after I cathed. But for thee past few months no AUR episodes. Curious if a good beer night will break my streak but not that curious

Jim

Thanks guys - I did try sitting down but that didn't help. Maybe try one of those inversion boards you get strapped to!

The thing is I was doing so well with these. But there were 2 things that cjanged last Friday night. One was I opened a new box of the same catheters - but that shouldn't have made a difference should it? The other  is that last Friday I also started using more lubrication. This really helps getting past my huge prostate - I hardly notice it now whereas before I screamed from the burning pain.

My fever is down tonight - just 100F - I still don't think it was a UTI.

Thanks guys

Neil

I also wanted to ask about using the straight tip Speedicath 14s. I know the coudes are for large prostates and mine is the king of large (180gm - previously 280). I can apply lots of lubricant and be very careful but will I not be risking an injury to my prostate? It seems I stuck between a huge rock and a hard entrance!

I had one of my old catheters from the previosu box That i sed in my bottle experiment. I just put it side by side with the new one and there is a slight difference of 5mm in length of the curved portion and a couple of mms in thickness, again of the curved portion. They both have the same flexibility. Neil

Take a good look at the catheters inside the box and check the wrapping to make sure the ones inside are identical to the ones you were using. Maybe time to try a muscle relaxant like tamsulosin, daily 5mg viagra or something else your doc might prescribe. It's too bad you don't have someone local to work with you. I think an experienced cath nurse might be able to help.

Jim 

I'm not sure about the "cath nurse" thing, Jim.  The one who "taught" me--- well, she was tough!  She went at it like she was trying to pop something inside of me, that didn't need popping.  JAB! JAB! JAB!   I finally said to her,"NOW I remember where we met!  It was several lifetimes ago, and you were working for the Spanish Inquisition!"  I thought it was funnier than she did, for some reason...

Instead of the congratulatory bottle of porter I was gonna offer, I think instead you should have a celebratory "hit" of THIS, man!  :-D

Hi JIm,Iwas reading about cialis. I have been taken dutasteride for 7 months i still have retention,cannot pee without CIC.Now i'm reading this pill can cause prostate cancer. YOu suggested quiting this pill and taken Cialis.Have you read this pill can cause prostate cancer?My Uro says i should keep taken these pills dutasteride and flomax if i'm going to have GL surgery. I should quit if i decide to keep doing CIC.What is your opinion on my situation?I can't figure this out??

thanks JIm

Frank,

Two different kinds of medications. Dutasteride in theory will shrink the prostate. Flomax and Daily Cialis relax the muscles so that you can urinate better. 

I'm guessing your doc thinks shrinking your prostate is a good idea before surgery. Not sure why he wants you to continue with flomax since it's obviously not working as you cannot void without a catheter.

You might try switching from Flomax to 5mg Daily Cialis and see if that works better. If not, I'd drop both of them unless your doctor gives you a compelling reason. No real comment on Dutasteride other than folks here report negative sexual side effects.

Jim

Hi Frank - I've been on Avodart for 5 years now (dutasteride). Prior to that I was on Proscar for 5 years (finasteride). These drugs will shrink your prostate for a while and they will destroy your libido and overall energy. But these 5-alpha reductase inhibitors due not cause cancer. In fact they help to shut down certain signaling pathways that lead to cancer caused by conversion of Free T to DHT. The problems reported are that since they lower your PSA for a few years they give a false sense of security if cancer is growing there and would otherwise show an increase in PSA due to cancer and not BPH. Your ok for short term use. Neil

Frank - I forgot to mention that even if Avodart shrinks your prostate and lowers your PSA by half which it did for me after 6 months for about 2 years it may not solve your retention problems for several reasons: your prostate is still very large (like mine); you have a urethral stricture; you have bladder neck obstructions like stones or a large median lobe; your bladder is too atonic (flaccid) to support natural voids. It is so tough for all of us - jimjames is our beacon in the night to save us. Neil

Neil,  When I did my second turp, the uro, removed the median lobe. He told me that I have a clear channel from the prostate, which was blocked before the surgery. I am guessing that the muscles by the prostate, needs to relax more when I urinate. Also, a more toned bladder would be of help.

Hi Neil, You are right! These drugs leave me tired most of the day. I did some research on dutasteride it did say it could cause cancer,i'm glad to hear what you say. Do tou still take this drug and flomax?My URo said if i'm going thave the Gl procedure then i should keep taken this drug,If i decide to CIC then i could stop taken them, He also said i would have to take these drugs for 3 to 6 months after surgery. I still havent decided which way to go. 

Hi Jim, Is Cialis used  to shrink the prostate,or is it used to relax the bladder ,like flomax ?

thanks Jim,

5mg Daily Cialis relaxes the muscles like flomax. 

Hi JIm, I need your advice?1am this morning i did cic 600 ml came out 

2:45 am this time 50 ml was  blood. 530 am 200 ml, blood after taken out catheter the tip was ticker blood.I had emotional stress,do you think that could have been the reason? I know i read on this forum you and many others have had this problem.What did you do when this happend?

Looking forward to your response.

Thanks very much JIm,

frank

How do you know 50ml was blood when it's generally mixed with urine? Was it bright red? Pink? The color of ice tea (brownish)?

Some blood from time to time isn't that unusual, but the blood in urine continues, consult your urologist. It could be a UTI, prostatitis, or something may have gotten bruised. 

Jim

Hi Jim, (I may be in the wrong place)

My semi-erection at midnight was about 4 inches (500ml CV) and at 4 am was maybe 2 inches (400ml CV). I guess straightening the urethra helps.

I have a friend who lives on the Canadian side of the lake and he said he would request some samples. I will keep you informed.

I have a scheduled visit with the continence nurse set for Monday on the sphincter passage problems and bleeding. Tomorrow is my physio class.

One thing to mention about sticking catheters in the urethra. The hydrophilic coatings can sometimes rub off exposing the underlying plastic in places depending on the passage history of the catheter through the urethra. This argues in favor of adding some water soluble gel lubricant to the hydrophilic catheter as it provides 2 water layers of lubrication instead of one and should protect from bare spots. I would suggest to gusy having this problem that they try adding some Surgilube or equivalent to the top of the catheter container when they open it. It is interesting to see the gel blow open when a drop of water hits it. It then spreads its water over the hydrophilic coating and adheres to it in a nice uniform water layer. Neil

 

Hi Jim,thanks again.Iwent to see a URO, I told him about my blood in urine.He said he wanted to flush out the bladder,see if their were clots,as this could cause blood in the urine. He did this and put me back on a foley catheter.I used a 20 catheter to drain urine ,then kept the catheter in and flushed out the bladder,he took a urinalysis .said  it takes 48 hours to tell if iI have infection?I don't get this. I have cipro antibiotics,i called uro office asked if i could start taken this pill.Nurse says you have to get a urinalysis,then you can start,if the antibiotic is the wrong ,you stop taken that and we give the right one. He also said the blood could be from doing CIC. One good thing is, my urine in the bag is clear now.Jim what do you take for pain in the urethra.I asked the URO, he said he has to wait to see results of urinalysisDo you agree with this JIm,i alwyas respect your opinion. Should i find another URO?

Thanks always JIM,

 

Hi Neil,

If it turns out that being semi erect solves your internal sphincter issue, then it could be more complex than just a straightened out urethra. But in any event, going on this strategy, you might be better off switching from uroxatral (alfuzosin) to 5mg Daily Cialis. The latter increases blood flow and often leaves one with a natural semi-erect penis, especially when waking up at night. Alternatively, a subscription to Playboy might do the trick

As to the external lube, I think the issue here is how long the cath process takes. Under most scenarios, one or two minutes max, I think the Hydrophillic coating is superior, and if not (I never combined the two lubes) certainly quite adequate. However, from what you say, and from what I've read, the external lube does last longer, making it a choice for those with longer cath times.

Jim

Not being on the ground, don't have any insight on the on the Foley and flushing procedure. Maybe overkill, maybe not. How long will you be on the Foley? 

If this comes up again, ask him if you can flush the bladder out yourself through the catheter you use for CIC and a syringe with sterile saline. I've done this a number of times and it's not big deal.  Yes, best practice is to wait until urine culture results come back before prescribing a particular antibiotic. Therefore I think the 48 hour wait time. 

As to finding another uro, if you feel your present uro isn't that expert or supportive with CIC issues (most aren't btw), then start looking if convenient. If you're near a big city teaching hospital that might be a good place to start. Also, try to find a uro who has a lot of SCI (spinal chord injury) patients. The SCI community uses CIC as their go to method of urination and therefore anyone working with that community should have more knowledge in CIC than someone who doesn't.

Jim

have to respectfully agree with you regarding that volume - 1.5L or so seems about right in my book also.

i had an IDC for over 2.5 years due to having a bad uro who give me all the negative numbers without any tests to substantiat the  poor prognosis he had given me. - i had extended bladder due to bhp.

i eventually got a turp &  NV'd the next day after they removed the IDC.

i'm stiil catheter free almost 1.5 years later but still have some anxiety  issues as i still can't believe my luck.

all the best.

Hi Jim I am new on here.my bladder is stretched and told to catch 4 times day. I now have no triggers to NVR. I had a TUIP. Any hope to retrain my bladder and stop this c IC. Before surgery I was holding 1000-1200 ml. The thought of catching rest of my life is terrifying. Thanks Bryan

Hi Byan,

I felt the same way three years ago. Really hard to put into words how messed up I felt both physically and mentally. "Terrifying" is as good a word as any to describe the basket of emotions I felt riding home from the doctors with my first batch of catheters. 

Unlike most, I had a very hard first 3-4 weeks. Mind aside, my body just didn't like the the catheters. I won't go into detail now, but again, most take to it a lot easier.

It's been three years now and self cathing is about as traumatic and time consuming (actually much less time consuming) than brushing my teeth. It's a non issue in my life. And I think the majority of folks who have self cathed for some time feel the same way. It's amazing how both the mind and body adjust. Timewise, it now takes me about 60 seconds longer than a normal void, and half of that time is opening up the package and doing the prep. 

The bonus for me is that CIC gradually started to heal my bladder. I started at 6x/day with very little natural voids and PVRs between 300-1000cc. But by my second year, my natural voids were bigger, my PVRs smaller, and I didn't have to cath as much. Even skipped days and weeks at times. 

Today, I only have to cath a few times a month and I'm working on things so I won't even have to do that. My normal voids are pretty normal (250-350ml) most of the time and my PVRs are often below 100, sometimes as low as 20ml which is a better result than you can get from surgery -- or so said my last urologist. 

Not saying that you will get the same results because we are all different, but just wanted to make the point that the bladder does have the capacity to heal, regardless of what your urologist may say. My urolgist said my bladder was too stretched out to ever empty properly without surgery and he was wrong. But even if I had to go back to CIC, again, after awhile it's not a big deal. You have to have trust on that, because I know that right now it seems like a really, really awful situation.

As to your situation, it sounds like you aren't able to do any natural voids now. Is that correct? If so, then I suggest you adjust your cath schedule to the volume your bladder is holding. That's the way to decompress the bladder and hopefully get better. 

Your bladder should ideally not be holding more than 400ml at any one time. If you're doing a natural void before you cath, you would add the natural void volume to the CIC volume, and again you don't want to be over 400. If all your volume is CIC, then you go by that. 

So, broad strokes -- if your total bladder volume is over 400 then you will want to increase your cath schedule, and if it's under 100 you will want to decrease your schedule. If you're not doing any natural voids I strongly suggest you start at 6x/day which is standard for the amount of urine most men produce per day.  Also, keep a diary with volumes and times which will make adjustments easier down the road. 

The other suggestion is to find a really good catheter. If insurance is paying, I would use disposables. Use them once and throw them away. If cost is a factor, there are catheters you can use over and over again. 

The catheter a lot of folks here have found success with is the Speedicath Hydrophillic. I would get some samples in two sizes -- FR12 and FR14. You probably want to start with FR14 (the larger size) and after you get the hang of things, try dropping down to FR12. You also should probably start with the Coude model unless the TUIP took care of the obstruction. Coude tip catheters are designed to go around enlarged prostates without sticking into them. 

Lots of tips in this thread but a bit hard to navigate so please feel free to ask questions. 

I also want to add that my understanding is that TUIP doesn't always produce great results as not that much tissue has been removed. That means that another procedure might produce better results, however a lot depends on how stretched your bladder is. But even if you do decide on another procedure in the future, the time you spend self cathing will potentially help future outcomes by restoring elasticity and detrussor strength to your bladder. 

Jim

i dont know why you would cath if your residual is consistently below 100 ml. some people seem to believe that humans void their bladder completely with every urination. That only happens if you cath. At the least you might empty to 25 ml from what I've been told or read. I had a TURP procedure for Urinary Retention before which I had anywhere from 400-550ml pvr. (I barely urinated unless I had 600ml plus in my bladder. After the procedure I was anywhere from 50 ml -115 ml and my doctor told me I could stop cathing (although I occasionally cath to measure pvr). I see so many posts by people who seem to prefer intermittent cathing over TURP or similar procedures. I cant understand it. My TURP (bipolar technique) was utterly painless and I peed blood-free with in a few days and was allowed to return to golf in two weeks. Everyone's different, but I struggled mightily from mental health issues when in a single day I was catheterized in a Uro office and then taught how to self-catheterize. Perhaps someday I will need to cath again or have another surgery but for now the TURP was more than worth it.

Hi David,

Yes, you would not need to self cath if your residual is constantly below 100. In fact, like you suggest, that is a very good residual even after a successful TURP procedure.

Not exactly sure of your reference, but what I was probably talking about is that at one point I was able to rehab my bladder enough through self catherization to be able to naturally void with a residual under 100ml.

That said, if my bladder volume becomes too much over 400ml, I am unable to void naturally, probably due to my prostate obstruction. At that point I will self cath. The next time I void, I may not need to.

Self cathing isn't for everyone like a TURP isn't for everyone. Reasons vary from person to person why to choose one over the other. In my case, I chose to self cath because I wanted to avoid retro ejaculation plus with practice, I found it very easy to do. At some point if it doesn't meet my needs, I would consider some sort of procedure.

Jim

Hi Jim,

I am new to the whole self-cathing scheme. My PVR is consistently around the 600 ml mark in the morning and just before going to bed. Its been around 3 weeks since I started this regimen. I do around 4 CICs every day. Should I try to do the on/off procedure early on from now or wait till about 6 months to give my bladder a chance to bounce back?

My uro-doc put me on CIC since I was holding around 900 ml on my last visit.

Thanks.

When you say you have a 600ml PVR, are you saying that you cath 600ml after a natural void? If so, about how many ml is in your natural void? If you're not having any natural voids, then we're not talking about PVR, we're talking about catheter volume only.

In any event, the overall idea is to keep your total bladder volume under 400ml. Total bladder volume is the amount you void through the catheter plus any natural void just preceding it.

Keeping your total bladder volume under 400ml will allow the bladder to start contracting after being stretched for all these years and hopefully to regain some muscle tone so that you will be able to have better natural voids with time.

I would work on reducing total bladder volume for some time before trying the on/off method.

Jim

Thanks for your suggestion. My mistake about using the term PVR when I should have said cath volume. I don't pee in a measuring jar. I just weigh myself before and after the CIC to get an estimate. Sometimes, I have a small natural void before the CIC usually in the range of 60-120 ml.

I don't have a good grasp on my PVR since it varies a lot throughout the day. When I wake up, I estimate it to be in 800-900 ml range since I do sometimes get an natural void of around 250ml or so. I then use a catheter and get around 600 ml more.

I will continue to monitor my cath output till I get consistently below 400 ml readings for the CIC output.

At least until you get things sorted out, you want to get a measuring beaker that uses milliliters. You should be able to get a plastic one at the grocery store. It's not just your output but the TOTAL volume your bladder is holding. Total bladder volume will be the sum of what you cath out plus any natural void that preceded it. That total volume should not exceed 400ml. If it does, then you need to cath more often. Better to over cath than under in terms of rehabbing your bladder. The concept is to keep it from stretching and give it a rest. Sounds like your next step might be CIC 6x/day

Jim

I was thinking along the same lines too. I will get a beaker that measures upto 1000 ml.

I too came to the conclusion of CIC 6x per day. Right now I am doing it 4x. I do consume around 2 Litres of fluids that include a couple of cups of decaffeinated green tea. I am wondering if I should slowly bring that down to 1500 ml of fluids per day.

My biggest confusion with all this CIC business is that before I started doing it, I used to naturally void out 2000 to 3000ml per day. Yes, my measured PVR at the doc visits always ranged in 500-600ml range. So I probably have chronic urinary retention issue which could in the long term cause issues with kidney. I just hope that doing all this CIC does not completely make me lose my ability to pee naturally. From your experience, it gives me hope that once my bladder has been rehabilitated, I can stop using catheters someday.

Hi Jim,

Its been almost 10 days since I increased the number of CICs every day. I have gone upto 5 times and on the advice of my Urologist, stopped taking meds (Alfuzosin, Finesteride and Tadalafil). But now, I have observed that I down to zero natural voids. Is that OK? Maybe my prostrate is not relaxed enough for me to urinate even though there is an urge. Just worried if I will lose my ability to natural void if this continues. I am trying to definitely trying to keep my bladder volume to below 400cc as much as possible. But at night, the volume goes up and my first CIC in the morning is usually 600-700 cc.

Due to your urinary obstruction, you were probably only able to urinate when very full (overflow incontinence). Now that you are using the catheter more often, you are not full enough.

It is not unusual to urinate more at night, nocturia. During the day liquids are pulled to your lower extremities by gravity, but at night, when you are laying flat, the liquids are available to be processed by your kidneys.

@TKM, your explanation makes a lot of sense. Thanks!

I got a Urodynamic study done and it showed that my bladder needs to get to around 600ml before I get a sensation to void. Once that happens I usually void out around 200ml and leave the rest i.e. low detrusor contractibility. My urodoc is suggesting that Urolift might help the situation.

Guys, I need your help. I just developed my 3rd UTI is less than 8 weeks since I started self-cathing. I do all the prep work and use the Speedicath Soft FR14 which has a nice grip on the catheter. So my hands do not even touch anything. Some questions -

1. Should I use nitrile gloves when doing the procedure? My urologist told me to just do a good handwash.
2. Should I do an alcohol swab of the urethral opening? My urologist didnt think that was needed. I do wash that area with some ph neutral soap.

I want to continue self-cathing to rehab my bladder. But these frequent UTIs are killing me. Is there some article on how to do self-cath in the safest manner?