Self Catherization: Issues and Problems

Neil checked with Coloplast and they said it was OK to use an external lube with them. The one I used is called "Surgilube" and I believe you can get it on Amazon. I like the little packs as they travel well and seem more sterile. 

The twisting thing would only be when the coude tip is all the way in the bladder and not touching any tissue. Twist gently to make sure, and then pull. And yes, coughing or visual relaxation -- two things that seem to work going in, could also work coming out. 

As to cystoscopy, I'll leave that up to you and your urologist but I personally would try the other things first. 

Question -- Before you pull the catheter out, do you put your finger over the hole in the funnel? I do in order to trap the urine in the catheter. However, just thinking that this could cause a suction effect that might be causing your issue. So, maybe try holding off capping the funnel until at least the coude tip clears the bladder sphincter. You might lose a few drops of urine but I don't see any other downside.

Jim

Hi Jim - your last point about taking your finger off the top of the funnel is really important. When I did my simple plastic water bottle experiments I tried an experiemnt where I put a wad of steel wool in the neck of the bottle to represent loose tissue in the trigone region. Sure enough, after emptying when I put my finger over the funnel some strands that got drawn into the eyelet drain holes during the emptying phase got stuck in there and were pulled out with the catheter. After seeing that I changed the way I take out the catheter. I just slowly pull it down vertically into the toilet bowel. I don't even cover the funnel head when the catheter is already in the urethra in case of trapping any tissue strands.

I guess I should have mentioned it then.

Neil

I never cover the funnel head with my finger going in and have only made a mess maybe a couple of times in three years. Like you suggest, the trick to lower the penis as you approach the bladder sphincter so that when the urine starts to flow it will go in the bowl.

Michael's problem is when he's coming out of the sphincter. The idea of not covering the funnel here could prevent any material being sucked into the eyelets but it could also work just by equalizing the pressure and therefore causing less resistance/suction. Since his problem is when the coude tip is inside the bladder, I think it would be OK for him to put his finger back on the funnel top as soon as the coude tip cleared the bladder sphincter. That way, he would still trap 95% of the urine in the catheter.

Jim

I was referring to coming out of the bladder too. Going in I never cover the funnel but I used to cover the funnel once the urine flow stopped as i oulled it out. But having seen little strands pulled into the eyelets during the flow period from my model I no longer cover the funnel at any time - going in or out - just to avoid snagging any tissue.

Neil

Just as an example, because I have a diverticulum, right after I emptied the bladder I would sometimes keep the catheter inside for a minute or two and push the catheter in and out creating a suction effect trying to suck fluid from the diverticulum. The point is you can create a suction effect by covering and releasing your finger over the funnel hole. In your case, you don't want that suction.

Jim

Hi Jim - just want to mention what happened last night for comment.

I did not cath before bedtime at 11:30 because I was so tense and irritated. I got up at 1:30 and just did a small NV. Then at 3:30 I got up with a lot of pain and pressure. So I did a cath.

Now this was funny. I was emi-erect with about 4 inches extension. The catheter went right to the sphincter with no resistance at the prostate in about 10 seconds. That has never happened. But I was worried I would run out of catheter length because of the sem-erect state which did not go down. At the sphincter I only had an inch left before the green cap.

After just a few seconds the catheter entered the bladder nicely with no discomfort. I was right up against the green cap (14FR; coude). Then a fire hose of pee came out. I measured 800ml!! Then I felt great and went back to sleep and slept for 4 hours straight.

Usually when I would cath before bed I would get out maybe 200ml with much discomfort. Do you think the semi-erect state made a difference in the ease of entry? Maybe it straightens out my urethra for easy passage through the prostate?

Every cath is a different experience for me. Thanks Jim. Neil

Hi Neil,

Sure, anything is possible. An erection also means more flood flow in the area. Easy enough to duplicate. Just get yourself semi erect next time and see if it goes in as easy. An equally plausible explanation is the 800ml you were holding. We discussed this before. Larger volumes mean higher bladdder pressures which can transate into a looser bladder sphincter. Here, I would not try and duplicate very much because 800ml is too much for you to hold and keep bladder tone. I suggested before that as a test you try cathing prior to a NV. I think you might have done it once but urine squirted out. Maybe try again at least for testing purposes. 

But going back to the blood flow idea, consider trying Daily 5mg Viagra. It not only increases blood flow but relaxes smooth muscle tissue like your bladder sphincter. You will know within a week of trying it if it works. 

The key is really to try different things until you hit something that works.

Jim

 

Thanks Jim

I wonder if the Kegel exercises I do every day aggravate the pelvic floor muscles by tightening them up? I do notice that when I do those exercises I get a burning in the lower regions. I think I will stop those for now. My physio appointment is set for Friday so I can bring that up.

Also this could explain why my epson salts baths work so well. The magnesium relaxes the pelvic floor muscles since that is the only part submerged in the 3 inches of warm water.

Also, on the bleeding - it seems to follow the same scenario every time. Since my self-inflicted injury 11 days ago, every time I go in, including last night, first thing out is a clot followed by a tablespoon of fresh blood followed by normal urine and then right at the end a teaspoon of blood that filles the catheter. So every time I go in I must be dislodging the clot which then bleeds a little and pools a little blood in the base of the trigone. Over the next little while a new clot forms at the site of injury which then gets dislodged the next time I go in - so the cycle keeps repeating. I guess I can just ignore it now and hope that eventually it will heal over for good.

Take care

Neil

I would stop the kegels and see what happens. They may be tightening your sphincters which is the opposite of what you want to accomplish now. I don't think it's the epsom salts but the hot water that is helping things. "Sitz baths" can do wonders for the whole urinary tract. You might want to try a very hot sitz bath just before self cathing and see if it helps.

As I see it, the problem seems to be a very tight internal sphincter muscle. The two ways of dealing with this are: (1) adjusting cath materials and technique to more easily enter the bladder; (2) relax the bladder (internal) sphincter muscle. Or, of course a combination.

Adjust materials and technique includes: 1. trying a non coude; 2. different brands; 3. external lubricant; 4. twisting, coughing, etc. 4. 

Relaxing the internal sphincter: 1. drugs 2. cathing with a fuller bladder 3. sitz baths. 4. Guided Yoga body scanning. 4. Physio.

You have tried some of the above, but still have a ways to go in solving the puzzle. The more different things you try the faster you will get there. 

Jim

Thanks Jim as always. I forgot to mention that I did try the straight catheter but pulled back when I got a lot of resistance at the prostate. I held light pressure but unlike the coude it did not advance after a few minutes so I pulled out. I am really afraid of puncturing it.

Your ideas are great. I did try a soak in hot water w/o the epson salts a while ago and it offered some relief from the burning and tension but the magnesium salts completely eliminated the discomfort for an hour or so.

I do twisting; coughing; bending; and the external lubricant and they all help.

I will stop the kegels - should have stopped them a long time ago but my uro said the only reason I am not incontinent right now is that my large prostate is acting like a sphincter so if it reduces from the PAE or another procedure then I will need a strong external sphincter. I never believed that and should not have continued with the exercises as it is likely contributing to my problems getting in.

But again - this problem getting in only started after I injured myself 11 days ago. Prior to that it was fairly easy (maybe 2 minutes or so) but no bid deal. So I wonder if the clotting/scabbing/coaulation is adding to the resistance to opening the door.

Thanks again for all your time. My C&S was negative today.

Neil

 

Yes, don't force a straight catheter at all! Worth the try, however. I just read that you are on a muscle relaxant -- flomax or something similar? If so, perhaps up the dose and see if that helps or switch to another smooth muscle relaxant and see if it works better. 

When you say "2 minutes or so" is that the time the entire cath process takes or is that how long you "knock" at the door until it opens? If the latter, definitely something tight there. 

At some point if nothing works you might want the doc to look inside and get a close look at the sphincter.

BTW I just heard about a very interesting catheter called "IQ Cath". They are manf by Manfred Sauer which I think has offices both in Germany and the U.K. You might want to check them out as they are supposedly designed for problematic cath scenarios like yours. I'm looking into them myself as a back up to Speedicath should Coloplast ever change its tip design, or as something I could bend more easily for travel.

Jim 

Jim

IQ Cath - sounds lke a smart cath - I'll into that  - thanks.

Yes - during

  my heyday of CIC ing that lasted 2 weeks it took 2 min to get past the door --  and I thought that was good. I think the Kegels have been causing me problems.

I have been on alpha  blockers for 13 years (uroxatral).

Here is a stupid question: After my epson bath I don't cath right away as I worry ordinary water gets in my urethra and the cath will push it up into the bladder - germs and all.  Is that nuts?

Thanks Jim. Neil

 

To get the maxium benefit, I would cath right after the bath. I don't think you have anything to be concerned about since your urethra will be cleaned by the urine from your NV just prior to cathing. But if you are concerned, I suppose you could fashion a condom of sorts to keep the water out.

BTW I'm not a big fan of Epson baths because they dried out my skin so bad one time that I was literally itching for three months! I also think you can get the same benefit from just soaking in hot water. But in any event, the water should be as hot as you can stand it, and it should at least cover your lap. Stay in it for 15 or 20 minutes, then urinate and then cath right away. Worth the try.

Jim

Thanks. I sent a request for some IQ hydrophilic catheters after watching their video. But with that soft tip  wonder how it would "open the sphincter door?". Seems though that this was what coude tips were designed for but worth a try.

Neil

Neil,

Are you in the U.S.A.? Not sure they ship here but I'm also trying. I had the some concerns about that flexi tip but the YouTube video showed it going right through! For me, I'm just looking for an alternative to Speedicath that doesn't stick my prostate. So far, all the other coude's have done that.

Jim

Hi Jim - yes I'm north of Detroit. I'll let you know if I hear back.

Why don't you try adding a little lube to your speedicath to make it slip past your prostate? It works wonders for me now - I used to have so much trouble with it sticking but just a small dab at the top of the package after you open it and then just wait one minute for it to slide down.

Last night at midnight I did a IC again semi-erect (I don't know why). Anyway the catheter went through like butter and only took a minute at the sphincter. I took out 500ml (NV just before was only 50ml). Also there was no blood for the first time.

Then at 4 am I did another one but this time it took several minutes to get past the door and there was the usual small clots followed by the blood and then clear. Again I took out 500ml with a prior NV of 150ml.

It has been getting more difficult for me to NV but I think it is stress so tomorrow I hope the physio guy can show me some pelvic muscle relaxation exercises.

I also did an experiment to see how the gel lube I add effects the htdrophilic coatings on the cath since they are different principles. I was worried the gel might just mask the speedicath coatings. But in fact they workk together when exposed to water and add a lot more lubrication. So this is likely why I now can get through my prostate like it isn't even there. Give it a try for yourself and see f it hellps with sticking.

Thanks.

Neil

Well, again, a semi erect penis but also a very full bladder. Hard to tell what made it easier. Was the 4am cath with a semi erect penis or not?

My post regarding the IQ cath and speedicath was badly worded. I don't have any problems with the Speedicath Coude at all. I'm into the bladder in around 5 seconds!  What I meant to say that I was looking for a back up catheter that would work as well as the Speedicath. I hate to be so reliant on just one model catheter from one manufacturer. Never know when they change the mold!

My understanding is that we may have to go through a few hoops to get the IQ caths shipped to the U.S.A. but I'm going to give it a try. If you live in Canada or Europe, no problem. It's an FDA approval thing apparently.

Jim

Hi Neil, I'm having the same issues ,i was concerned  if blood clots and blood were a UTI? I am doing cic last  night from 4 caths from 10 pm to 7am--my output was blood.i went to see a URO.he put a foley catheter back in.First i had to use a  20 to drain urine ,then he flushed our my bladder,found blood cloths,took a urinalysis won't get results for 48 hours.

My question is when the urine output has blood does that meanit's a UTI

thanks Neil 

Jimjames, do you know of any side-effects Cialis  or Viagra has?

Great!  an empty bladder, is the best.

I think similar to Tamusolin (Flomax) also some say slightly blurred vision. But with Daily 5mg Cialis, the effective dose in your system is only around 8mg which is far less than the 20mg "weekend" dose many take for sexual performance. I also initially got heartburn from the Cialis, but that went awy completely when I started to take one OTC Prilosec in the morning. The side effect profile on all these drugs can be different for different people. You really just have to try them and see. 

Hi Frank - I am sorry you are having these problems. About 2 weeks ago I rushed my CIC and injured my internal sphincter which bled a lot. Ever since that time, every time I CIC the first thing out is a few blood clots followed by a tablespoon of fresh blood. Then it turns to a normal yellow color except right at the end where it is bloody again for maybe a teaspoon - it fills the catheter.

I think what happens is that every time I go in now I dislodge the scabs or clots that form over the injury and cause it to bleed again. I CIC 2X at night but not during the day to give the injury a chance to heal.

I did call the nurse who first showed me CIC and she said to keep doing it and that it would heal eventually. But then I emailed my uro in Detroit and he said to put in a Foley for 2 weeks! So the nurse works for the uro but gave a different answer.

I will continue doing my CIC at night and hope it clears up. I was doing CIC 4X a day before the injury with no blood.

I don't know if a UTI can cause blood in the urine. Severe iritation and inflammation can cause tissue bleeding for sure. They tested me for a UTI this week because my symptoms were like one but it was ok. I have been on Macrobid for 14 days because I had a high fever which may or may not be related to my injury.

Sometimes I wonder if I have bouts of non-bacterial prostatitis which normally is quiet but can flare up from time to time. That can cause bleeding too as well as BPH over time from chronic inflammation of the prostate.

I wish you all the best.

Neil

Neil,

We talked about Plan "B", ie a Foley or suprapubic to give your internal sphincter a rest. If it works out for Frank, consider it again if your symptons persist, especially since your Detroit doctor also recomends it. Personally, like your nurse I think it will resolve by itself but your body will tell the real story.

PS You might want to email your Detroit doctor and ask what he thinks about a suprapubic vs Foley. Suprapubic is more comfortable but the Foley keeps the urethra open which he may or may not want. 

Jim

Hi Neil,Did you ever have your bladder  flushed out, he said their were scabs and clots,Today thats what the UrO did , and it stopped the bleeding from my bladder.I was put on a foley catheter for 5 days. Severe iritation,what you say makes sense. Did you take antibiotics What would cause chronic inflammation?a UTI.or CIC ?The one thing good about the foley is I don't have to get up at night time to CIC.Did you take antibiotic when you injured your internal sphincter?It's great that we can share all this info on this form.Thanks for your reply.

i hope you start feeling better also Neil

frank

Hi Jim - thanks for your advice as awlays. Last night I awoke at 1 am with much pressure and stumbled to the bathroom to cath. Again semi-erect. I got to the sphincter in about 20 seconds and through in about 30 seconds. Then I took out 700ml again with no blood. I could not NV before that. I sure hope the anti-oxidants I am taking are preventing oxidative stress and bladder wall deterioration with all that pressure.

Then I slept nicely till 6 am and cathed again. This time I did NV of 150ml followed by 450 CV. It took 4 minutes to get through the sphincter with some clots and blood at the edn of the cath rather than at the start. I had maybe 2 inches to brag about.

(did you knwo Playboy no longer carries cheescake pics!)

I think this will resolve (I hope). I will ask the phsyio guy today about relaxation exercises for the sphincter and the pelvic floor and on Monday I will ask the continence nurse about the bleeding and clots. It is getting less. I am making progress. Thanks for your help. Neil

Hi frank - I am glad you are doing better. I will ask the continence nurse on Monday about flushing out my bladder to get rid of the clots. Did you have to stay on the foley for 5 days because of the flushing process?

I did take antibiotics and am still on them. I am taking Macrobid which is good for UTIs and is easier on the stomach and tendons than Cipro. I am on day 11 of 14 days.

BPH itself is chronic inflammation and I have a huge prostate (180gm). But being new to CIC that also causes urethral inflammation from the irritation. Since I started adding some gel lubrication to my speedicath hydrophilic coude catheters that has really reduced my urethral irritation and makes it so easy to get through the prostate to the inetrnal sphincter. Now if I can just find a way to open the sphincter easily I will be home free.

Please keep us up to date on your daily progress. I will look into the bladder flush - thanks for the tip. Good luck and happy holidays. Neil

Similar numbers therefore again hard to differentiate if the reason is a very full bladder or a semi erect penis and therefore same advice in my previous post if you want to figure it out. That said, beyond playing detective, you seem to be carrying around too much urine in your bladder, ie 700ml. Don't know what your cath schedule is but I would increase it. 

BTW I mentioned to Frank in a previous post about self irrigation for the clots, etc. (He was irrigated by his doc and is now on a Foley rest). Since you seem adverse to a cystoscopy, Foley or Suprapubic, you could try self irrigation yourself or at least run it by the nurse. You basically use a syringe barrel filled with 40ml of sterile saline, mate it to the plastic funnel of the catheter, pump it in and cath it out. Repeat until urine is clear.

Jim

Thanks Jim for that idea - I will mention it to the continence nurse - sounds easy to do with a good benefit. I've only been cathing 2X at night and not during the day to give the injury a chance to heal. When I did cath during the day I would get maybe 200ml and my NVs during the day are around 100 to 200ml every hour. The problem during the day is so much tension in my pelvic muscles so I hope I can get some relaxation tips today. I live in a super-stressed environment and all my tension goes to my pelvic region. Take care. Neil

Hi, Neil and Jim,

I watched the video about the IQ catheter, and the bulb tip seems to be the same as Coloplast's olive tip. It doesn't appear that you can get Speedicath with an olive tip; however, you can get their Self-Cath model with a coude/olive. 

My uro's staff gave me some Self-Cath FR 18s with coude/olive tips to use when I first started CIC. They got through well enough, but I found the FR 18s very uncomfortable (too big) and didn't like messing with the lube.

Looking forward to hearing your report on the IQs. They might be the best of both worlds for me.

Stebrunner

A couple of years ago, I had blood in my urine.  It turned out to be a bladder stone. The uro, removed it with a laser, and now no stones. I was worried for awhile, that it could be cancer.