Self Catherization: Issues and Problems

Get one of those disposable plastic cups. If it's an 8 ounce cups and you fill 1.5 cups then you just cathed 12 ounces (354 ml). I used to put the Pyrex beaker on the lip of the toilet bowl but not sure if a plastic cup will stay in place. Maybe some stickum or double sided tape to hold it. Not sure of the rest of the stall setup but I carried folded paper towels with me that I would put on surfaces and just laid my supplies on them. Maybe a piece of cardboard over the toilet and paper towels on top for a work area? Personally, I rarely had to cath outside of home due both to my work and bladder schedule. Nocturia has a little silver lining as most of my voids were between 4PM and 10AM. You will work it out and it will get easier with practice.

Jim

Hi Wilbur,

As an entertainer, I have to make do with many different situations. When I'm out, I time my voids, using my watch, then  multiplying time voiding by my voiding/sec rate.  It gives me a rough volume count.

SpeediCaths have a little stick-on tab, which I use to afix it to a stickable surface, after opening the top end.  When no surface presents itself, I open and tuck it under my arm!  It's the "KISS" principle!  (Keep It Simple, Silly!)  

And then, may I offer the Cartoonman Simplified Approach to JimJames' Award-Winning-and-World-Famous-Dive-Bomb Technique?  

Clean tip o' Peter with individual alcohol swab (CVS, Rite-Aid, etc).  DON'T TOUCH CLEANED AREA!  Open package, remove SpeediCath, insert per JimJames' instructions.  Do NOT rpt. NOT touch any of the wet part of the catheter!  Did I forget washing hands?  No, I didn't!  It's not necessary to wash the hands, if they do not have the chance to contaminate your insides.  

I offer this approach because it doesn't endanger you (if you do it properly), and reduces time needed to pee, thus giving you a more normal life...

CMan:

Maybe you can draw an "Air Man" patch for those who use the technique If worn, would be a great conversation starter

Jim

PS If you commericalize it, I want royalties!

Or how about a rock band?  Jimmy James and the Dive Bombers!  

Haha! Actually managed one back in the Woodstock days! Love the name btw!

Jimmy

Hi Keith,

Yes, this thread is active, just long!

Your bladder was holding 590ml this morning. I would therefore increase your cath frequency so most of the time it's holding 400ml or less. That way your bladder will not stretch, your kidneys will be protected, and you might even be able to rehab your bladder some so that down the line you will cath less, or possibly even stop like in my case.

I think you will like the Speedicath's with a little bit of practice. If the 12 starts bending on you, try FR14, it's easier to work with, especially when you're new to CIC. Are you going to try the Coude tip? You should and then compare.

As to the Speedicath's being slippery, see if you can find in this thread my "no touch" technique, sometimes called the "Dive Bomb" With it, you never touch the catheter proper, just the plastic funnel. So no issue with it being slippery, it just works for you with less trauma to the urethra.  Total cath time from entering the urethra until the bladder starts to drain is 5-10 seconds although definitely take your time in the beginning. 

Follow your gut. If you CIC is working and you don't want to risk the side effects of GL, then don't. Procedures less invasive than GL are starting to come out now, and in the meanwhile CIC will protect both your bladder and kidneys. 

No idea about your split stream experiment. If you had a cystoscopy, your urologist should have told you if you have an enlarged median lobe.

Jim

 

Jim, What do you do if you get UTI? I know the symtoms,fever ,temp 100 at least, foul smelling urine. If this ocuurs at 1 am, what do you do? Go to the ER. This is what concerns me , and has a downfall to CIC. My Uro office says to go to the lab  do a urinaylsis ,at 1 am ,this is not an easy thing to do ,at almost 88 years old ,there must be a better way of dealing with this?

Thanks Jim,

frank,

I suppose if the symptons were very bad you could go to the ER, but that's never happened to me. Usually it can wait till morning. That said, talk to your doctor about your concerns. He might write you an rx for some broad spectrum antibiotics you can keep at home for such a situation. I've done that on my own a few times over the years, but in general it's best to wait for the urine culture to come back.

Jim

Yeah; thats kind of the fly in the ointment with doing CIC isn't it?  About three months ago before I started cathing I went through two rounds of antibiotics to get rid of a UTI.  Dr. said I had prostatitis which I guess is what they generally call a uti in males; it usually centers in the prostate.  I would not want to have to take 2 weeks of Cipro every year.  I don't do well on antibiotics, at least this last time I didn't.  Of course my GP hadn't arrived at the conclusion yet that I was retaining large amounts of urine so that was making me feel bad I'm sure.  I couldn't feel it.  I understand that voiding helps avoid UTIs but I'm surprised you sort of dismiss this like its nothing.  Maybe I'm misunderstanding.  I'm sure its better than not voiding with CIC but not so sure it would be better, at least for me, to try the G.L.  

Hi Keith,

Not sure why you think I'm being dismissive of UTIs? The advice I gave Frank is pretty standard which is to wait for the culture to come back if at all possible. The other thing is that the treatment criteria is different with CIC. Normally, a urologist will treat any bacteria found in the urine. With CIC, only symptomatic bacteria is treated as asymptomatic bacteria (colonization) is fairly normal and doesn't require treatment. I've been both colonized and non colonized, and other than the clarity of my urine, I can't say I felt any different.

 I've averaged probably a little less than one UTI a year doing CIC, and a fellow who just joined the forum has been doing CIC for three years without one UTI! The fact is that many people have fewer UTIs with CIC than when they are retaining. 

As to Cipro, haven't taken that in over three years. I try and stay away from the quinilones if at all possible because of the side effect profile. So I take something like Nitrofurantoin depending on the culture.

Jim

Oh Ok so you're saying that you were getting asymptomatic UTIs on average once a year back when you were cathing regularly.  Thats a relief.  I thought you were saying you had to go through a round of antibiotics with that frequency.  I so much appreciate your advocacy.  

 

No. I treated with antibiotics three or four times in three years. For about half of the rest of the time I was colonized (asymptomatic bacteria). The first two UTIs were in the very beginning and I think could have been prevented with a day or two of prophalactive antibiotics like I need before any urethral procedure such as cystoscopy or urodynamics.

That doesn't mean you will get three UTI's in three years. It could be more but likely much less. Like I said, a fellow who just joined the forum has been doing CIC for three years with zero UTIs. Also keep in mind just because you have a prostate reduction surgery doesn't necessarily mean you will stop getting UTIs.

My advice would be don't make a decision on surgery or CIC based on hypothetical UTIs. See how it goes, you may not get one. But if you do, remember to only treat the symptomatic ones with antibiotics. Cloudy urine, a little blood in the urine, and even a positive culture for bacteria do not necessarily equate with "symptomatic". But if you do have to treat with antibiotics, consider a Cipro alternative first. Something not in the  Quinilone family.

Jim

Keith, let me add to that a little. 

On reflection, probably only 2 of the UTIs I had needed to be treated with antibiotics, and both as I said happened early on in the process when my body hadn't adjusted to the catheter.

The other 1 or 2 times were technically asymptomatic bacteria (colonization) that I electively treated. I only did so because both times I thought I wouldn't be doing CIC any more and therefore decided to clear the system. If I knew I would be going back to CIC, I probably would not have treated either of those two times. 

Jim

Yes, I think I understand now. 

No I haven't had the cystoscope.  Just recently saw the Uro for the first time.  They had me try to natural void and I could get out nothing.  Then cathed and they did a urine sample, he did the swollen prostate test with the glove, and that was it.  He scheduled a pre-op appointment and a week later the surgery.  My self-cathing didn't begin to get easier for me until about that time; I don't think he knows I'm able to do that so I'm going to keep the pre-op appointment and see what he has now for my options; but I'm pretty sure the watch and wait one is going to be my choice.  Thank you for the hope by informing us that there are some new treatments coming out.  

 

Keith,

CIC seems to be going very well for you. At less than a week you're having a far easier time than most people, including myself. It only gets easier, until after a few months it can be as easy as brushing your teeth, just takes less time! 

If CIC doesn't work out, you can always stop and have your GL, or one of the newer procedures with less chance of retrograde orgasm. On the other hand, if GL doesn't work out, the side effects may not be reversible. 

Good luck whatever your choice, just make sure it's your choice and not your doctors. After all, it's your prostate, your health, and your sex life.

Jim

Hi Keith,

Your story sounds just like mine except mine was 1 year ago, and the uro suggested TURP (at least GL is better than TURP). I have been doing CICs (no surgeries) since with no UTIs ever, and I am not even that clean like Jim. If you use Jim's method there should not be UTIs. Now I can wait, pick and chose since with CICs, my symptoms are reather mild. The best option out there seems to be FLA now.

Hank

Thanks JJ and Hank:  I've been cathing now for about a month.  First time was an urgent care nurse had to do it because I couldn't even provide a sample.  That was about 5 weeks ago, so medicare is providing me with different caths try.  Yes, I get it that this mainly buys me time.  That's kind of why I searched for information cause I felt so much better I thought hmmm, I wonder if I could just get along like this for awhile.  I just finished hep c treatment with DAA drugs; took my last one Wednesday so I didn't really want to go right into surgery for this.  I'd like to just stabalize for awhile and try to get back to normal.  The hep c treatment with the new drugs was pretty easy in my case.  What was making me feel lousy I think was the urinary retention.  

It was kind of a quandry for me because the first coupld of weeks of treatment my instructions from the gastrointerologist was to drink about half my body weight in fluids.  I was trying to do that not knowing about my retention.  I was having overflow incontinence which was why I ended up seeking help for this.  

 

" .. to drink about half my body weight in fluids... "

Hmmm. This statement is not very clear here. Are you referring to weight in pounds and fluid in ounces ? Even that, for an overweight person, it can mean too much fluid. I think the general rule is 2 liters of total fluid (including from foods) per day. For us folks with retention, we may want to go with a little less, perhaps 1.5 liters, unless you are prone to kidney stones and/or gout.

Hank

180 pound man, 90 ounces

Before I did CICs and before I even knew that I had retention, with a doctor suggestion, once I drank more than 2 liters a day for a few days. The results was a disaster: high blood pressure, rapid heartbeats, and kidney function plummeted. Hank

Keith,

Once the treatment drugs clear, you should be able to go back to a more normal 48-64 oz of fluid a day. Of course check with your doc. 

I think I mentioned it before, but it's important if you are going to do CIC, to do it correctly. That would mean doing a void log for a few days, writing down the time and amount of each void. You should also do it again, after you cut down on the fluids, or whenever your fluid intake changes significantly. This information will give you a blue print how to move forward in terms of frequency, timing, etc. 

Jim

@no UTIs ever, and I am not even that clean like Jim.

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Huh, so I wash my hands after eating potato chips And speaking of chips, here's a guy in Australia who has been eating nothing but potatoes for a year. Looking into it

Jim

Ah hah, some one also wrote a book about 'potato diet' in which you can cure all ails eating nothing but potatoes. But of course, you already know about this. I suspect you may even be the author. Hank

Actually the potato diet isn't all that crazy. One of the models for the original Pritikin diet was the New Guinea native diet which consisted mainly of multiple varieties of sweet potatoes and I believe a week long pig fest every three years, which was their version of taking Vitamin B12 pills. No heart disease. 

Yesterday, I made potato and onion whole wheat chapati. Haven't made chapati since my introduction to Pritkin back in the 70's.  

.. 180 pound man, 90 ounces ...

For someone at 320 pounds, he would have to take in 160 oz or over 5 liters a day. What else can he do other than looking for a bathroom all day ? Hank

He could go on the all potato diet and lose weight. The Aussie lost over 100 pounds in one year. But seriously, hopefully that just was a guideline for average weights, and only when taking the treatment drugs. That said, I can see how so much fluid could push a compromised bladder over the line. 

Hi Jim,

Joking aside, can you explain the concept of double voiding (without referring to potato chips, sardines, sushi, or Japanese beer) ?

My latest natural void: 100cc (first void) + 60cc (double void 2 minutes later) + 40cc (triple void 2 min later) + 0cc (quad void attempt failed 2 min later). Between voids, I tapped lightly on my lower stomache. Did this happen to you during your way to recovery ? Is it OK to do it to lower PVR until next cath ?

Hank

Hank,

It's fine. I did it on my way to recovery and still do it occasionally. The tapping stimulates the detrussors. But in general, better tapping, than a real push which in theory could cause some urine to reflux backwards. 

While I used double, triple voids, tapping, etc when doing CIC, I did it even more in the "off" periods of my "on/off" strategy. There, I was going off the catheter for days at a time, so I needed some xtra help that the tapping and multiple voids gave. I also changed voiding postures when in a pinch, and found that leaning slightly back on a chair would help me void when my usual standing position didn't. 

It's still unclear to me if these periodic "off" days or weeks actually helped my recovery or not, but my theory is they did by stressing the detrussors and sending them some kind of message that I expected them to do their job! Then, when it became too much of a PITA I would go back to CIC, often agressively to rest them. 

If you do try this, it's important that you do "reality checks" from time to time, either with the catheter, or by analyzing fluid intake and void logs, so that you won't over stretch your bladder during the "off" periods. 

Jim

Thanks Jim,

I am only cathing 2X at night right now so I have plenty of practice of normal voiding during the day, but not quite ready to try "on/off" method yet, until I have more consistent night time volume. I still don't quite understand how the double voiding works. Perhaps my bladder muscle is so weak, it can work only for a short period of time. Resting in between somehow enable it to work again.

Hank

The interesting thing with the "on/off" strategy was that the "off" periods were more stressful than the "on" periods, because by that time CIC had become so easy and sort of  like an extenstion (no pun intended) of my urinary system -- so double, triple, tapping, etc, just seemed so slow and low tech!

Of course I'm glad I have been able to be off CIC for the last five months, but should my symptons return, and I went back to CIC, don't think it would really matter all that much. 

Jim

 

It could be weak detrussors, but in the case of obstruction, it could just be the xtra load to push through the obstruction requires a couple of attempts with rest inbetween. Or a combination.

As I mentioned, the "off" part can be a little PITA with lifestyle, etc, and I still can't say for sure how much it helped. In the beginning, it wasn't really part of a strategy, it was just "OK, let's see if I can get off the catheter starting now!" So, the first time I had to go back, I looked at it as a failure, but after repeating a few times I looked at it as more of a process. Still a little unsure why I've been able to be off the catheter for so long now. Has to be the chips?

Jim

CIC has been hassle free for me so I do not mind doing it at all, for peace of mind. I am just curious to see if I can repeat your performance of beating it. Hank

That was sort of it for me too at the end. I didn't mind doing CIC at all. The only difference now is that I'm no longer colonized. During CIC, about half the time my urine was slightly cloudy, and showed positive leucocytes, nitrites and blood on the dipstick, all of which I've been told is normal with CIC.  Now everything is clear but I can't say I feel any different. 

Anyway, try and "beat it' if you can, but if you can't, really no big deal.

Jim

I also got off the doxazosin (alpha blocker) to put more stress on the bladder. I hope the bladder muscle will adapt to strengthen itself. So far, just a little less NV, a little more PVR, and a lot less RE. Hank

I went on and off Daily Cialis a few times. It helped a little, but at that time not enough to get me off CIC, so I discontinued it. If you haven't tried it yet, it should work similar to doxazosin but without the RE and a little boost with erections. 

Jim

I had to look up on "chapati". It sounded so exotic. It turns out to be India tortilla. Hank .

I have some Cialis samples but have not tried them yet. Afraid that I'll be hooked since they are so expensive. Hank

Yeah, sorry; take one's body weight, divide it in half and drink that many fl. oz.  Not half my body weight.  Jeez.  It was about 70 fl. oz I figured was good.  But the first couple of weeks of the 12 week treatment for the hep c I didn't know I was retaining all that fluid.  I should have taken care if the urinary problem first but I was able to get the zepatier through my insurance and I jumped at the chance.  But drinkng the extra water per doctors instructions did not help my bladder any.