Self Catherization: Issues and Problems

I'm trying today not to drink much coffee.  I think it might be irritating my bladder.  At least its stimulating my body to produce more urine which, I guess, is ok as long as I can cath.  I did it 6 times yesterday with around 300 - 350 ml each time; more in the late morning and early afternoon after I started drinking coffee.  I've only had about 1 1/2 cups (large mugs; maybe 8 oz or 10) and I can tell a big difference from yesterday.  I also drank water yesterday and with the diuretic coffee it really ran through my system.  Now today I'm kind of dehydrated.  

Agreed, re doctors minimizing the side effects.  I was prescribed the two usual (FLowmax and whatever the other one is...) and they left me feeling "off," not quite normal.  My balance was slightly affected, and because I have an old house with a slate roof that needs attention now and then, this was NOT a good thing@   And they didn't help the main problem, either!  When I had my Urolift (Dec 2015), the doc said I could quit both drugs, which I did.  The Urolift benefits lasted  only a few months (related?  I don't know.), but I was never tempted to return to those drugs, and am comfortable with CIC until something better comes along.  I'm now awaiting results of the iTind studies...

Hi Keith,

Yes, Dr. Bagla asked me, for the 3 months, as I am recovering from my PAE, which he did the end May, to not drink alcohol, and not eat or drink anything containing caffeine, since they irritate the prostate, and increase urination. 😭 Sorry about that.

Neal

Hi Cartoonman,I still have complete retention,and i was wondering if you ever had this? I'm hoping i can get the Uro Lift. You say it didn't work for?Is this because you had complete retention?This one URO told me Uro Lift won't work with retention?I sure can appreciate tour reply.

Thanks very much,

frank

Yes, Frank, complete retention landed me in first urologist's office, Aug 2014.  They drained 2500CC out of me!

Since then I have done lots of CIC, eventually taking on JimJames's method.  I had Urolift done Dec 2015, with the doc in Salt Lake admitting it wasn't a sure thing, but did not link it to the retention issue.  I never did get clear answer as to why mine did not "take."  I'd encourage you to find out why your doc thinks rentetion is linked to Urolift failure!

 

@cartoon: I'd encourage you to find out why your doc thinks rentetion is linked to Urolift failure!

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

Retention suggests flaccid/stretched bladder which correlates with less than optimal results in bph sugeries and procedures, especially the minimally invasive ones such as Urolift. Urodynamic testing will give even more information. 

Jim

Actaully, Jim, I believe he did say that the "flaccid bladder" thing might cause Urolift to not solve all the problems.  But I don't think that's what's causing the retention.  THese days, there are times, rarely, when it takes forever, to relax the prostate (so to speak) enogh for the catheter to slide through.  So I think it's the prostate itself that's closed in.  And why iTind interests me so much!

 

It's often a combination of an obstructing prostate and a flaccid bladder. So, for example, if the bladder is elastic (not flaccid) you could have an obstructing prostate but still not have LUTS. But if the bladder is flaccid, you could have LUTS with the same prostate. Urodynamics helps determine how much of the problem is prostate versus bladder by measuring function. This has been deemed more accurate than looking at prostate size alone or bladder architecture alone such as size and trabeculation. 

There is another novel approach to test surgical outcomes using temporary urethral stents but unfortunately hard to get too much information on this. The idea here is to place a temporary stent in the urethra (15 minute office procedure) that passes through the bladder and is held in place with a Foley type of balloon. The other end, unlike a Foley ends just before the external urethra, so that the urine will only flow if you consciously relax the external sphincter. 

This type of stent was initially designed as a Foley alternative after surgery, but there have been some studies that show it can be used as a diagnostic tool to help determine surgical outcomes. In other words, the stent will mimic the urination process after a prostate reduction surgery. So if you can urinate properly with the stent, then you are more likely to have a good surgical result. However, if you can't urinate properly with the stent, that means the problem is bladder related and a prostate reduction surgery might not work as well. 

If you google "spanner stent" you can find more information on their web site. The problem is finding a doctor who uses the spanner in this way, and also the lack of trial data.

Unfortunate more work is not being done in this area because it seems promising not just for diagnosis but as a surgical alternative to bph, once certain problems such as migration are ironed out. 

Jim

More on using stents for diagnosing and predicting surgical outcomes in this older thread here:

https://patient.info/forums/discuss/how-to-know-in-advance-if-your-bph-surgery-or-procedure-will-work--583416

Plan on updating it with some of the Spanner Stent materials or perhaps doing a new thread. 

In theory, a trial by stent could become the new gold standard, surpassing urodynamics in terms of  diagnosing and predicting surgical outcomes. But again, hard to find a lot of information on this.

Jim 

 

I like the idea of this "diagnostic tent". However, it would be better if there is a "diagnostic catheter" so we can do it ourself. Hank

You would have to make your own with a larger opening at the bladder end, not eyelets but probably an opening equivilant to a FR18 diameter. Then you would have to insert it through the prostatic urethra and right up to the internal sphincter but not through it into the bladder. In theory this should work if you are handy with machine shop But might just be easy to find a doctor who uses the Spanner Stent and do it in his office.

BTW the difference between the "machine shop" diagnostic stent and the Spanner is that the Spanner goes through the internal sphincter, into the bladder and stops short of the external sphincter so that when you relax the external sphincter you void, and when it contracts there is no leakage. 

The "machine shop" version, however, would not go into the bladder but it would pass through the external sphincter. 

One question I have is why the Spanner doesn't allow normal voids with a flaccid bladder while a Foley does. The only difference is that the Foley exists the urethra while the Spanner stops short of the external urethra. However, once the external urethra is voluntarily opened, you would think they would function the same way? 

Jim

typo: substitute "external sphincter" for "external urethra" in last paragraph. 

An "external urethra" presents its own set of issues

Jim

I think I feel the external sphincter more than I do the bladder opening when I insert a catheter.  When I first started this area was definitely sore and I think it bled a little bit; at least I think that is where the blood came from.  Now I don't get blood, even with the coude tip, but its still sore and hard to push though although I always get it through.  Have you heard of this sphincter being enflamed or enlarged or perhaps the prostate is what is pushing on mt urethra in that area.  I declined to have the cytoscopy this coming week due to other obligations.

The first resistance point is usually the prostate which adjoins the external sphincter. The other most common point of resistance is the internal sphincter as you enter the bladder. There was no rush on that cystoscopy.

Jim

Hi My Friend,Thanks for your reply on Uro Lift. It Was my second URO who said Uro Lift will not work with Retention.My 1st Uro wanted to do Turp. I refused it. Are you still in complete retention ,like i am?

Thanks

frank,

Well, Frank, it depends on how you mean "complete!"   I cath 4-5 times a day, draining 300-450cc each time.  If I find myself without catheters (GACK!) or otherwise unable to attend to cathing (usually do to manic driving somewhere, I can void 50-150cc before cathing at which point the PNV amount is 500-600cc.  

Does this clarify?

Btw, my FIRST urodoc wanted to do TURP also, and as new at this as I was, I also refused.  That dic now has gotten "educated," and does Urolift also.  (He didn't do mine.)

Hey Man,Thanks for that that reply. By retention i mean complete retention,no natural voids. I have been Doing CIC almos 1 year,no NV. This is what i mean, are you also in complete urine retention? I have to cath 6 or 7 ximes a day.

Thanks for info.

frank

Apparently not!  If I retain more than ca. 500cc, I can "naturally void" the rest.  Because my goal is to get my bladder to shrink as much as possible, I don't let it get that full (Plus, it's damned uncomfortable if I go past 400cc or so.).

I cath 5X per day, and it works great.  I'm in France at the moment, so I will say, "Bon nuit!"

>Apparently not!  If I retain more than ca. 500cc, I can "naturally void" the rest.  Because my goal is to get my bladder to shrink as much as possible, I don't let it get that full (Plus, it's damned uncomfortable if I go past 400cc or so.).<<

Thats exactly what I'm experiencing.  There's been a couple of times when I had a good natural void (good for me that is: probably 50 - 150 ml) and I was good for about 20 minutes then needed to do it again.  Not much came out; then CIC & I get over 500.  I guess the idea is to learn how to use the clock and also be sensitive to the way your body feels.  In my case, its hard to describe the feeling when bladder is full.  Definitely not like it used to be; much more subtle.

 

Agreed!  The signals are different, more subtle, not a screaming, "GOTTA PEE!" thing.  When I started CIC, I have lost the sense of fullness, and just went by the clock.  Now, after three years of self-training, I know when I  need to go...

Jim, a friend of mine has a catheter in place since 3 weeks, closed  with a plug, which he opens several times per day (no bag!!!). Since I am in a lot

of pain from unknown source (I suspect hemorroids, but also my urethra constantly irritated by CIC (no NV, 6-7 CIC per 24h), do you think this would be a solution for some time, just to give my urethra some rest? Suprapubical catheter for me is a no no, doesn't appeal at all...Anybody here has had a catheter with a plug? Zdzislaw

Frank, isn't your urethra irritated be 7 CIC per day? Mine seems to be. I have no NV either. Zdzislaw

Zdzislaw, I don't know your details, but if you are not using SpeediCaths (or some other hydrophyllic catheters) I would highly recommend trying them out!  

I usually cath 4-5 times a day, and occasionally 6 times.  Been at this for three years now (except for the three months my Urolift worked!), and I've never expereinced irritation for the cathing.

Zid, I use magic 3  sure grip catheter. Never have had the uretha irritated.

These are the best ones i've used.

Try them, it might help .

frank

Hey Cartooman, You say you can NV if you retain more han 500 ml.I thought you had the same problem as i do, no natural void?I guess the Uro Lift did help?

frank

Hey Cartoonman,Well then you can do a natural void{Great} I cannot  Pee

unless i do  CIC.Is there something i can learn from you  how to do a Natural Void?

Thanks my friend

frank,

I wish I could claim to have a trick, but I don't.  I think my stretched-out bladder expands to hold 400 or 500cc, and then the push-back over that allows it to expell any more than that.  But for almost a year, I've mostly kept the amount down to 300-400cc, in an effort to reduce the size of that pee holder.

 

Hi ZD,

Sounds like your friend has a Foley with a plug or Flip/flo valve. Since the tube is probably larger than the catheter you use for CIC, not sure having it in your urethra 24/7 for three weeks will help your irritation, it could actually make it worse. In general, people have less issues -- irritation, UTIs, etc -- with CIC than Foley.

Curious why you're against suprabubic? It sounded appealing to me (verse a Foley) when I was having problems with CIC in the beginning. If you don't like th suprapubic, they can pull it right out. 

The only other thing I can think of is the Spanner temporary stent. You can go to their website and get more information. Supposedly, less irritation and better tolerated than a Foley, but it still rests in your urethra. 

When did the irritation start and where and when do you feel it? When cathing? After? What catheter and size are you using? Have you been checked for UTI? If you're using a hydrophillic, changing size might help and/or adding some external lube. 

Jim

 

Using Coloplast Speedicaths Compact and Flex. Might be a syndrom of sth else, pain in the pelvis region. No UTI.

I use Speedicaths Compact and Flex 12 . Not sure the pain is from cathing. Might be hemorroids??? All this region is painful. No UTI (the strips don't show), but constant urge to pee. Will try to consult, but not very hopeful...

Suprapubic just sounds awful. A hole in my body when I am already in pain?....😢

Cartoon:  Heve you ever used a speedicath FR14 straight NON-hydrophillic. I received a shipment in the beginning a couple of months ago.  I can use them; very fast out flow when I hit the bladder.  But it feels a little traumatic to my urethra at the prostate.  

I know that you use fr14 hydrophilic.  I wonder if those ones go in easier than the non hydro with lube.  I'm torn between the fr12 and the fr 14.  I don't want to be be stuck with a bunch more to have to ship back... but I suppose the only way to know is to try.  Yes, I had two samples but different circumstances made me unsure.

Keith,

Cartoon likes the straight. I like the Coude. That may be because Cartoon has less of an obstruction than I do because Coude's are recommended for obstructive prostates. But the important thing is not what works for Cartoon or myself, but what is the most comfortable for you. If the straight 14 feels more traumatic to your urethra than at the prostate, do not use it. Use what is the most comfortable, your body will tell you.

Same with catheter size. Use whatever size goes in the easiest with less trauma. For me that's FR12 but it might be FR14 for you. That said, I still keep some FR14's on hand just in case I ever have a problem with the 12's and need a little more of a hammer!

You're new at this so definitely try a few different ones and if you can't make up your mind then keep a supply of both. If your distributor is like mine, you can always return/exchange down the road.

Jim

ZD,

I would spend a little time figuring out what is causing the pain before doing anything. If the problem is hemmrohids, changing catheter type isn't going to help. As to suprapubic, it competely avoids the urethra, so if that's where your pain is then it will offer the most relief and healing. On the other hand, if your pain is elsewhere, then as mentioned changing the catheter type will not help.

Jim

I like it smple!   So not having to add steps is what I like.  The hydrophyllics are ready to use, as soon I open the package.  I like that!  

I say STRAIGHT, you say COUDE,

Fr12? But 14s are GOOD!

Straight, Coude, 14s are good,

Let's call the whole thing off!  

(with apologies to George Gerschwin)

Yes, I think so, too. Monday

I will consult . Maybe a colonoscopy...

Hi,My friend Cartoonman,Do you mean you can release {natural Void} if your bladder expands over 500cc ?Not sure what you mean? Sometimes doing CIC i expell 600 ml, but i never get a NV.Would you tell me if you are still having acute urine retention? The I tind your saying is also very intereting.

Thanks

frank,

Yes, Frank, you read my report correctly.  If I don't do my usual voiding per catheter, I wind up stretching out my bladder and hold too much liquid.  My bladder is able to expell the larger amount, down to about 450-500cc, at which point I must CIC.  And yes, I suppose I could just go on that way, but I agree with JimJames' assessment, that a chronichly over-full (more than 300cc) bladder is a great set up for bacteria to bring on a UTI!  

Just add that in addition to bacteria, a chronically stretched bladder will lose tone which could compromise the results of any future BPH/LUTS treatment or surgery. Coversely, decompressing the bladder under 400ml can sometimes bring back tone. In my case, it did that to a significant degree.

Jim

Jim, Most days i cath 6 x a day.The last couple of days have been different i don't why?

Here is my void Wednesday Aug 2,

2:05 AM---300ml--------------Aug 1st---140 Am----550 ml

5:40 am--250 Ml----------------------------5am-----450.ml

10:30 am 250 ml----------------------------810 am-250 ml

530:pm  200ml------------------------------105 pm--150 ml

10:30 Pm 150 ml--------------------------720 pm 200 ml

-------------------------------------------------10 30 pm 10 pm

Do you think i will someday be able to do a NV without surgery?

Thanks 

jim

frank

 

Is that August 2nd (5 times) on the left and August 1st (5 times) on the right? Also 10 and 10:30 are blank. 

It's possible you might get some natural voids without surgery, but not enough to be able to stop self cathing. The question really is how much a surgery will help, as I know you've gotten different opinions on that.  

Jim

Jim,The Uro on this forum Jersey,said Uro Lift will not work with urine retention. Also my 3rd Uro said the same thing. Now I;m seeing a 4th Uro ,see what his opinion is ?

I now have come up with arthritis on my toes which makes walking very difficult,lots of pain.Does any one on this forum have this problem, Xray showed arthritis,take tylenol was the DR reponse,it does'nt help.Also get numbness on bottom of my feet.What could this be?Perhaps a new Dr is the answer?

frank,

JIm, August 1st-was 6 x----August  2nd --5 times

There was no CIC at this time 10 and 1030

thanks 

frank

I see two columns with 5 entries each?

JIm, August 1st----140 am------550 ml

                              5 am------450 ml

                              810 am-------250 ml

                              105 pm------150 ml

                              720 pm------200ml

                              1030 pm    150 ml

I usaully do CIC 6 tims a day,

thanks

jim

 

Did you remember what times you felt a strong urge versus what times you just cathed because you were on a schedule? For example, did you feel a strong urge at 1:05 pm?

Jim I don't seem to get a strong urge ,like i used to.It seem like 5 or 6 hours is ok with me. Usaully after 5 hours i get the urge. Right  now its been 5 hours ,i'm getting an urge i could hold off. I was told not to wait over 6 hours to cic. Does this sound right?

frank,

There is no hard and fast rule about how much time between self cath's. Just try and keep the voids down to 400ml and under most of the time. Looking at your log, you probably could have gotten away with two (instead of four) CICs between 8 and 10:30 PM, especially if you really didn't have a strong urge. If this is a pattern -- low daytime voids and higher at night -- then it's OK to adjust your cath schedule to reflect that. FWIW your void pattern is similar to mine. It's called nocturia polyuria, and it means we void more at night than during the day. Pretty common with us older folks

Jim

Jim

Hi, My friend cartoonman,When you had your Uro Lift 2015, benitfs stopped after a few months. My very much concern is, did you have Urine Retention, no natural voids, before you had the Uro Lift 

thank you very much for your response.

frank

Hi Frank,  From what I remember, retention, no natural voids unless I was holding more than 500 or 600cc, at which times the overflow flowed in a natural way.  For 10 months or so, I've been doing CIC every few hours as moved to so do by inner sensations (not quite like "needing to pee," but I know what it means), and emptying usually 300cc, more or less.

Just out of curiosity this morning I didn't CIC upon rising, had several small pees (of about 25-75cc I estimate) and thought I would stay with this all day. But a couple of events kept me from the john, and by the time I got home, I REALLY needed to pee. When not much came out I CIC'ed, and... drained off about 800cc.   Project FAIL!  :-(

Cartoon -  I'm the same way.  I've had a couple of pretty good natural voids since I've been cathing but I know that if I do... there's at least 400 ml pvr.  BTW- you're saying CC.  How does that compare to mililiters?  Seems a little tricky at this point to keep it under that.  First thing after morning CIC I can go 6 hours or more without feeling like I need to again.   Yesterday I had a little overflow... it surpirsed meI can drink a couple of mugs of coffee and feel OK.  Then, if I drink a glass of water, it really starts going and I have to drain about every 3 hours for awhile.  That tells me I'm probably getting dehydrated from the coffee (or just from not drinking enough fluids) and my body is making up for it.

Cc and ml are the same thing, yes.  And everybody's a little different about CIC.  I void first thing, then again in a couple of hours, then sometimes not for 4 or 5 hours.  And after last CIC before bedtime, I sometimes sleep right through, sometimes am up once during the night.  Last couple of nights after returning from 4 weeks in Europe (I live in EST Zone) I've been up twice per night; glad THAT's not normal for me!!!

Studies suggest coffee is not dehydrating as once believed. That said, there could be other properties of coffee that could alter the way your kidneys produce urine. If you're curious, you could reverse the order using the same volumes-- water in the morning and coffee later -- and see what happens. FWIW I have a similar void pattern. Once I empty in the morning, I can sometimes go well into the afternoon until I need to void again. Part of age related nocturia, I imagine. If you can, try and shedule natural voids every 2-3 hours even if you don't feel the urge and maybe something will come out. 

Jim

JimJames, I was an every-morning-one-mug-of-hand-pressed (Aeropress)-coffe drinker for years.  In January I quit, and switched to one or two mugs of black tea instead.  I was dealing with an anxiety condition, but was curious as to whether giving up the 1500 chemicals in coffee might also affect my BPH condition.  Although the switch had an IMMEDIATE affect by lowering ambient anxiety (my wife noticed the first day), it had no discernable affect on the other matter...

Jim My voids are quite different,i assume it's what you eat or drink.Example--August 5--i had to cic 7 times.

1230 am--500ml 

  4 am--500ml

715  am---250 ml

1050 am  150ml

3 pm    400ml

 7 pm--300 ml

1015 pm  300ml

frankj,

Jim@..Studies suggest coffee is not dehydrating as once believed..

Does this mean you are backing out of the theory "2 cups of coffee in the late afternoon to ease nocturia" ? Hank

I think current thought is that caffeine is mildly diuretic which could account for earlier urination but not necessarily dehydration as Keith suggested. YMMV.

Jim

 

I wouldn't worry if you have to cath seven instead of six times. I did that often myself.

 

I've been doing the deep knee bends (gawd I hated those in high school) sometimes when I feel the urge but nothing coming out.  I'll be darned if that doesn't work.  It helps.

Do you mean just doing squats? How many times?  Am interested because I go through phases where I feel blocked up and have no success in passing urine. I have been doing CIC when this happens but I rather natural void. Thanks. 

I try to NV everytime before I CIC.  I usually do the knee bends when I feel the urge and I am getting ready to CIC but I'm waiting for the flow to start.  It seems to help in that situation.  Still don't get much out typically 20 - 75 ml. but I figure a little is better than nothing.  

Yoshiro,

It doesn't have to be squats. Walking around for a few minutes can accomplish the same thing. The problem seems to be that inactivity can sometimes make natural voids harder, so just getting up and doing something for awhile often helps, especially if the bladder is on the full side.

Jim

 

Hi Jim,You should not have any significant amount of urine in your bladder after CIC ,unless you are doing something wrong or your bladder has a very irregular shape, or perhaps you have a diverticulum. This is what i was told after my bladder ultra sound.If i get the report on the bladder ultra sound then i should see if i have  diverticulum?

Is this this right?

I sure want to find out if i have diverticulum?

thanks Jim

'frank,

That is correct. If you use proper technique, a bladder should empty pretty close to zero with CIC. This is not necessarily true however with a diverticulum, depending on its size and positition, etc. 

There are basically two different types of "bladder scans". One is a real time scan that shows an ultrasound picture and the other is a 3-D digital scan that just gives you the volume in ml. Only the real time scan with an ultrasonic picture will show the diverticulum. From what you've said, it's unclear which type of scan you have had as they are often called the same thing. That said, if your doctor orders a bladder/kidney ultrasound study, they will use the real time scan with ultrasonic picture. 

Jim

Jim, Thanks for this info. I asked the Uro about this bladder/kidney ultrasound,and would the diverticulum show up? His answer was it might.

I emailed him again and asked what test will show if i have a diverticulum?

I'm waiting for an answer.I will let you know,

frank,

Hi Jim, my ultrasound bladder /kidney  study said i have a enlarged prostate at 5.5x 5.3x 5.1cm,74 cc

Does this sound like a very enlarged prostate?

Thanks Jim

frank,