Self Catherization: Issues and Problems
Posted , 44 users are following.
Self catherization (CIC) is a proven and tested method of emptying your bladder completely. And while most people find it an easy and painless procedure, understandably some have problems, especially in the beginning. This thread then deals with problems and issues people may encounter with CIC.
For those not self cathing, or for more general information on the topic, there is an ongoing thread here:
2 likes, 1488 replies
ben_87928 jimjames
Posted
Hello jimjames I don't suppose if you, or anyone else know of an effective muscle relaxant to help relax a tight prostate and/or sphincters and allow the catheter more easily through on his journey into the bladder
Because I think I might benefit from some form of orally taken relaxant, preferably a non-prescription nonaddictive natural supplement type. But to be honest, right now I'll take anything which helps me to relax the prostate, which It seems Is where most of the restriction is.
I've been taking a daily 400 microgram tamsulosin for several weeks now and t he tamsulosin did initially help .
But in the last three days following an enforced three-day stay in hospital for full retention I've also been prescribed finasteride too!
For many many months I've always found first thing in the morning a difficult time, but this morning was a really difficult time. I think it was so because last night after unusually for me sleeping uninterrupted for several hours, was the most difficult I've yet experienced in getting the catheter through the prostate.
I should briefly add on Monday I was discharged from a three-day stay in hospital admitted for full retention. This morning with my hospital supplied Wellspect Nelaton CH 14/4.7 mm, was quite some worrying experience!
Before I as briefly as possible attempt to explain more about this morning. Perhaps worthwhile to point out some information about the different catheters I have.
Following a December 2016 full retention initiated midnight journey into A&E (E/R) my GP supplied me some standard Speedicath Nelaton 28412, which look like CH 12s. These standard Speedicath Nelaton are more flexible than for instance the hospital supplied Wellspect Nelaton CH14 .
I do also have some privately purchased Coloplast speedicath compact CH/MM 12/4.0 18/6.0 catheters too.
So moving on to the brief as I can make it summary of this morning's upon awakening first catheter/s goings-on.
After initially failing with a standard Speedicath Nelaton I did try the Speedicath compact, but again no go, although with the first part of the catheter being several centimetres long, although small in diameter but seemingly quite rigidly firm, I didn't particularly force it in case of causing damage.
I was eventually successful when I reverted back to the third Wellspect. This resulted for the first several seconds a significant amount of flaky broken congealed clots of different sizes accompanying at some pace the significantly red urine. Being a catheter newbie, it caught me offguard. So quite a bloody mess to clear! Luckily it happened here at home in the bathroom.
Being a newbie to CIC, I guess I've steep learning curve to climb!
As to the amount which came out, difficult to be sure , possibly something approaching 400 mL.
Up until recently, on average, I've been measuring around 200 mL. Generally before this weekend's hospitalisation , my normal void amount has being ranging between 100 mL to 300 mL. Only few times however was it that I measured 300 mL.
Since this mornings initial burst, my flow has been at least 50% down on normal.
I was up until about several days ago managing about 250 mL in approximately 1 min. Not great, but a damn sight better than I can make at the moment.
Sorry for the long post, I've diverted a fair bit away from my initial primary reason for posting about the muscle relaxant. But any thoughts about this post are very much welcome.
jimjames ben_87928
Posted
Hi Ben,
Can you tell us a little about your history with BPH and your age? What tests have you had? Any prostate reduction surgery or procedures?
How long have you been self cathing? How many times a day? Do you void naturally before you cath, and if so, about how much? And in the beginning, you should keep a void log so you won't have to guess. Just void into a plastic beaker marked in ml and record.
Jim
ben_87928 jimjames
Posted
Hello jimjames, Welcome again to my tale of prostate woe …
I've not been able to get back and respond sooner as subsequent to my last post seeking info about a muscle relaxant etc ,I've been hospitalised five days due to full retention.
To try and answer your queries Jim. Three or four days before my most recent hospitalisation I'd been doing, with limited success, CIC. Even trying different catheter types/sizes, virtually all resulted in them balking at the prostate and usually coming back extremely bloody.
So with full retention and a significantly swelled stomach, I was in really huge discomfort, with a bladder in spasm. I don't mind admitting I was spooked. Suffice it to say, cutting a long story short, I ended up in hospital for five days before being discharged yesterday.
So Jim to try and attempt to answer your questions of several days ago.
I've had BPH symptoms (frequency urgency) for over four years.
I've had two separate self funded MRI scans, DRE's and three weeks ago I had a cystoscopy. I have had no prostate reduction surgery or procedures.
The cystoscopy results came back negative for cancer. I have not however had biopsy taken.
I'm now taking 400 µL tamsulosin and 5 mg finasteride per 24 hours.
The hospital has now fitted a Coudé tipped Tiemann's. Incidentally yesterday the nurse removed the five-day fitted 9 mm diameter and easily inserted the Tiemann.
Now after nearly a day of being home, so far all is satisfactory with my new scheduled for 12 weeks Coude' tipped Tiemann 5 mm diameter plastic device.
I should add, when I initially hospital in a most distressed state, after four attempts by nurses to insert catheters, I had to further wait for a male urologist to get a 9 mm diameter three-way flexible rubber type catheter through the prostate into the bladder!
Here's a condensed history of my latest stay in hospital with the 9 mm device fitted.
I was on constant Saline drips. Over the five days I must've got through at least 50 L of saline fluid. During my five day stay in hospital, I had four separate flush outs due to blood periodically clotting the three-way 9 mm diameter catheter.
jimjames ben_87928
Posted
Hi Ben,
Sorry for the problems you're having.
What is your plan longer term? Some thoughts...
Are you on a Foley 9mm or 5mm right now? Once they are easily able to insert a 5mm you should be able to self cath wth a 14-16 coude which is around 5mm. That should initially be done under a doctor's or nurses' supervision given your problems.
If CIC doesn't work out, I would consider a suprapubic over a Foley. No tubes in your urethra, less chance of infection. You can get it fitted with a Flip-Flo valve so no bag to carry around.
Longer term, your two options seem some sort of prostate reduction surgery or CIC. But before any prostate reduction procedure or surgery, you want to have testing done, including urodynamics, to make sure that reducing the size of the prostate will help.
Jim
dennis47445 ben_87928
Posted
Ben, so sorry for you condition. I can relate. I had three surgeries so far; a green light the first time, a turp the second and third. This last time, I couldn't void after surgery, so now I am self-cathing, which is such a relief. I hope that you will have all of this behind you some day soon! Good luck.
Dennis
ben_87928 dennis47445
Posted
Hi dennis47445,
Many thanks for your input Dennis. I'm sorry to hear you've been through the mill too.
Pleased to hear though you are now relieved the CIC is working for you.
Yes, if possible, I'm definitely looking to get this situation well and truly behind me.
frank74205 dennis47445
Posted
Hi Dennis,Sorry to hear about your problems ,i do hope your feeling better.Did you have any tests before surgery?Urodynamics tells how your bldder is. I have urine retention,cannot NV . I had a urodynamics test failed.
. They told me i would have 50 or 60 % change of being able to pee ,without doing cic,I have been doing CIC 6 months now,i refused the surgery.After hearing what your going thru,maybe i made the right choice
Idon't know.It sure would be nice to have a NV again.
frank,
dennis47445 frank74205
Posted
No, never had any kind of test, that i know of. Still trying and hoping for a better NV. I did take Hank's advice, and instead of passive cic, I've been tensing up my bladder muscles, when I cic. Pretty interesting, how the stream of urine, becomes stronger, when I tense up.
frank74205 dennis47445
Posted
Hi dennis, I don't know what you mean by tensing up your bladder muscles? I would like to know more about this ,and try myself.I f i could just do a NV any amount,i would be so happy. I have been in copmplete retention for 10 months. Thank God i can do CIC.
thanks dennis
frank,
jimjames frank74205
Posted
Frank,
What I assume Dennis is talking about is that during CIC, you push out gently in the same way that you would when you do a natural void. You will know if you're succeeding in that the urine will flow faster out of the catheter. I did this frequently during the time I had little or no natural voids. You want to do this gently, and it's not necessary to do this every time you cath or even during the complete CIC. But you do want to do it now and then to give your detrussor muscles some exercise. That said, you have mentioned that you try to do a natural void before each CIC, so you're probably exercising them anyway to a degree.
A little off topic, I started a new thread on how to predict the success of a prostate reduction surgery. You might want to show your urologist the studies I cited and see what he thinks. I wouldn't hold my breath that he will go along, but you never know. I think you might be a good candidate for this "trial by stent".
Jim
dennis47445 frank74205
Posted
hank1953 dennis47445
Posted
Hi Dennis, I think you are doing just right. You'll see improvements in no time. Hank
frank74205 jimjames
Posted
Hi Jim,I"m looking for your new thread on how to predict the sucess of prostate reduction surgery,can't find it? Also i didn't know you had no NV?
This makes me think perhaps i could get a NV.I am trying to cut down to 5 times a day CIC. I have to hold off for approx 5 hours.Lately i only get most of the time 200ml or 250 or 300ml. Is this good JIm? when i cic
after flow stops or gets slower,i push out slowly and more flow starts.
thanks
frank,
frank,
jimjames frank74205
Posted
Hi Frank,
Here's a link to the thread (see below). If you like the idea, something to discuss with your doctor.
I don't think my situation regarding "NVs" is similar to yours. I always had some sort of NV, although at one point I basically had to pump the urine out of my bladder. That was when I started CIC.
As long as your cath volumes are below 400ml, you're OK. On the other hand, no reason to make yourself uncomfortable if you feel you have to cath earlier. Are you getting the sensation that you need to urinate or do you just cath? Yes, pushing out slowly and GENTLY during the end of CIC is a good idea.
https://patient.info/forums/discuss/how-to-know-in-advance-if-your-bph-surgery-or-procedure-will-work--583416?page=0&utm_source=forum&utm_campaign=comment-notification&utm_medium=email#2630520
ben_87928 jimjames
Posted
Hi jimjames and perhaps other interested parties.
I'm really grateful for your considered view thoughts and useful information.
Yes, I have a 5 mm Foley installed. The hospital nurse who fitted it said it was a 12 week indwelling catheter.
As I mentioned in an earlier post, my approximately 3 days doing CIC didn't work out too well for me. As sometimes the catheter entered the bladder okay and other times not. I think the difficulty usually occurred when I had maximum or near maximum urge to void. Possibly this gives a clue as to the major part of my voiding system problem.
With regards to suprapubic. Years ago, when seeing my GP about the inconvenience of urgency and frequency, at no point did the GP mention about suprapubic testing. Perhaps this lack of a scientific approach (i.e. expensive approach) can be accounted to the socialised (free NHS) UK medical system.
In hindsight I suppose at the outset I should have educated myself, rather than rely on
others, as to what is available for such a condition and best steps etc to take. Rather than just being reliant and trusting one's own GP to know and/or give one all the necessary information in their 10 min patient slot time!
Incidentally it's a group GP surgery practice with about five different doctors which I'm signed up to, so to get to see a GP fairly quickly it can at times be something of a game of musical chairs…
As regards to my long-term approach. I have a private appointment to see the hospitals senior urologist and I'll be taking a list of questions to attempt to try and find my best way forward.
One or two of the questions involve the delicate subject of the newer prostate size reducing methods. Delicate because I believe the TURP type surgery procedures is the only approach this senior fellow performs. At least that was the case nearly 3 years ago when I last saw this senior urologist.
At least I do have two and three week old mpMRI scan and cystoscopy results to assist with analysis from the various necessary professionals.
I have made some tentative moves in respect to PAE, which for price, is available in the UK.
Also, I was sent a PM from a thoughtful US forum member, who made me aware of the free analysis available from FLA interventional radiologist Doctor Karamanian in the US.
So several days ago I sent the results of my now three week old mpMRI 3T scan through the website for Doctor Karamanian's assessment.
Unfortunately however, although I'm informed by his secretary Samantha the data has been received, I haven't as yet had the benefit of Doctor Karamanian's considered opinion.
Obviously on reading all the various excellent information on this forum, I'm aware of all the other new treatments which are increasingly coming on stream. But in this chiefly UK NHS socialised healthcare system these newer treatments are significantly slower in being implemented.
In regards to the cystoscopy and mpMRI results. They do, as I believe I have already mentioned on the forum, clearly show that my enlarged prostate is pushing into the left-hand bottom side of the bladder, seemingly from MY viewing, reducing the bladder volume by possibly up to a third.
However presently I'm reasonably happy with this indwelling Foley system. Because at least I'm not in near agony with a full bladder and a swelled stomach. Added to which I'm not having to worry about whether I'll be able to urinate. Plus now after a few days being home there is only the occasional small light coloured blood clot to very occasionally tint the urine very light pink.
Speaking of blood. Whilst being in hospital on a saline drip, when viewing the countless numbers of litres of significantly red coloured saline urine, which over a five day period was drained into the 2 L floor bag, my total blood loss amount must have been significant!
Which leads me on to mention the now newly prescribed finasteride medication, along with the tamsulosin medication I've been having for some time , seemingly between them they are taking something of a toll. Because my BP is now averaging around 100 systolic and 70 diastolic. And depending on my physical activity (such that it is now…) my pulse rate is between 77 and 100.. Before being on these medications my BP was typically 120/75 and pulse rate about 63 .
Not surprisingly with these present medication BP figures my balance is occasionally affected along with the feeling of light-headedness. I've also noticed I can now hear my heartbeat fairly significantly pounding inside my head. But I'm not sure if that's due to the finasteride/tamsulosin or the prescribed three times a day Laxido (high sodium content) laxative treatment or something entirely different!
However I suppose my main concern right now is now fitted as I am with the auto Foley, I have minimal to zero muscle bladder etc related activity. And therefore after some weeks of this situation continuing, it will presumably reduce further my chances of a return to something approaching normal voiding!
Well, if you got this far, my apologies for another long post. But I thought whilst I'm at it, it best to bare all and explain in one post as best I can most all of what's currently going on.
Any further thoughts Jim and others, would of course be more than welcome.
With best wishes.
dennis47445 ben_87928
Posted
Ben, good luck! Maybe the turp would be the way to go, at least for now. When I did mine, it didn't hurt after the surgery. My surgeon must be very skilled, because I went back to work around 5 weeks after the surgery. My job, requires me to do a lot of walking and lifting. I hope you are able to function without the foley...it's a pain to wear, I know. I had to wear one for several months. God Bless.
jimjames ben_87928
Posted
Hi Ben,
I'll touch upon a few of your points now and get back later on others.
Sounds like you needed a little more practice and perhaps another catheter for CIC to work. If you want to have another go, I'd suggest starting with Coloplast Speedicath 14F with Coude tip. If that doesn't work, go up a size to 16F. There can be a learning/breaking in curve with CIC but the rewards are great at the other end of the tunnel (forgive the pun)! You will accomplish the same as with the Foley but no tube in the urethra, no bags, etc.
"Suprapubic" is not a test, it's an alternative catheter system to the Foley you have in now. What they do is stick a thin tube through the lower abdomen. You therefore drain through there and not through the urethra. So no tubes in the urethra. Suprapubic studies show more patient comfort than Foley's and less infections/UTI's. So, if CIC doesn't work out, this would be my next recommedation.
The testing I probably suggested was urodynamics. The fact that your prostate is pushing into your bladder and obstructing doesn't necssarily mean the prostate is the entire problem or even the problem at all. Unfortunately, as soon as most doctor's see the obstructive prostate they are ready to operate! Urodynamics checks your bladder elasticity as well and can tell you whether or not a procedure or surgery will be beneficial.
FLA is very new. I would wait a bit till more patient data comes in. So far only three people here have had it. One very good result. But also one person still on a Foley because he can't void. There will be a small trial soon and hopefully more patient data will emerge.
Jim
ben_87928 dennis47445
Posted
Cheers dennis47445,
Your experience is encouraging.
With regards to TURP, at this stage, I've ruled none of the procedure options in or out.
Obviously practicalities will be a major factor though.
Best wishes.