Self Catherization: Issues and Problems

Hi Yoshiro,

When I used external lube I liked Surgilube. It comes in a tube or in individual packets. I found the individual packets easier to carry with me plus in theory they are more sterile. 

After a few months of CIC I switched to what is called a hydrophillic catheter. Hydrophillic catheters have their own slippery coating and therefore do not need external lube. I suggest you try a hydrophillic as many men find it makes the CIC experience both faster and easier. My favorite is Coloplast Speedicath FR 14 with the Coude tip. The Coude tip is for oversized prostates and also can be helpful with strictures. You might want to try and compare it to the catheter you are using. 

What catheter are you using right now and what FR size?

I also suggest you do a simple void log for at least a few days. This will help determine whether the 3x/day your uro suggested is the optimum frequency or not. Just write down the time of each natural void and the volume in ml. Do the same with the CIC voids. I use a 600ml (2 cup) plastic measuring cup that I got at the grocery store. They have larger ones as well. 

Basically, you don't want to be carrying around more than 400ml of urine in your bladder at any one time. So, for example, if you have a natural void of 100ml and right after that you have a CIC void of 500ml, then you know that you were carrying around 600ml of urine in your bladder. That much urine will keep your bladder stretched. The remedy in this case, would then be to increase your CIC frequency so that the total volumes stay 400ml or below. 

Jim

Hi Jim,  thanks for the prompt reply.  I've heard of the hydrophilic but have not considered it yet. I will sure look into it later. Since I'm doing it three times a day I am currently reusing it by washing it and soaking it in Betadine as suggested by my Urologist. I am using 18 FR.  I will talk to my Uro about the coude tip.  Since we are on this, what did you use to clean yourself before cathing. I presently clean with betadine. Thanks Yoshi

Sorry I missed about the void log. I keep cathing volume for my information.  I cath 0600, 2:00 pm and 10:00 pm. The 0600 is usually up to 400 but the daytime ones are usually around 200 so it's not bad. I worry about the morning but my Uro doesn't seem worried so I'll talk to him again. I'm cathing three time a day to help keep my uretha open as I'm being dilated. 

Hi Yoshiro,

Betadine is good, both for washing and cleaning the meatus. Hydrohilic's are single use only, so if you're paying for the catheters yourself, the costs can add up. Coude (bent) tips are sometimes used with strictures, but your urologist may not want you to use them but can't hurt to ask. Are the catheters you're using red rubber, or something else?

Jim

Is the 400ml at 0600 your catherized volume or the total of your natural void plus your catherized volume?  If it's the total, I wouldn't be concerned.

Jim

Thanks, the volume is cathrized, because I just get up and do it. I don't natural void and than cath. When I know I didn't natural void maybe an hour before I cath the volume is like 500 so maybe I natural void upwards of 150 to 200 at a time. Also the color of the cather is red. 

Hi,yoshiro, I have a question? Why do you cath when you can do a natural void? I  cannot do a natural void so i must cath 6 x a day,somtimes 5 times.

I have seen 4 urologists,they do not know why i cannot do a natural void.Its a bladder dysfunction ,or enlarged prostate. What is the problem you are having? 

frank,

That's OK then, but every once in awhile try cathing right after your natural void and write down both volumes and report back. Sound like you have what is called a red rubber catheter. I started with those and they are easy to clean and reuse. The hydrophillics, as I mentioned are single use only. Are you located in the U.S.? The cath companies here are pretty good with free samples so you can try out dfferent catheters.

Jim

Frank,

Yoshiro is cathing because he has strictures. CIC helps keep the urethra open. His reason for CIC is different from yours and mine.

Jim

I had the TURP in February and after things settled my Uro said I now have a stricture which is blocking my urine flow.  To help resolve it my Uro has been dilating me at weekly intervals to hopefully keep the stricture open. As a maintenance he wants me to self cath three times a day. Sometimes I cannot natural void too between cathing so I'm very disappointed. My Uro cannot figure out why I can't natural void at times. When I cannot natural void I go thru this phrase of spasms and just a little ooozes out and it progressively oozes more and it opens up and free flows until the next cycle maybe after next cath or next day. It is not consistent 

 I am very disappointed  but I look forward for better days. Your Uro can't figure you out too. huh. 

Did the spasms, leaking, etc, happen after the TURP or did you have it before? Sometimes urge incontinence is a side effect of TURP. If that's the case, you have to get tested to find out what is causing it in order to figure out treatment options. If your urologist isn't given you any direction, seek out another opinion, with a uroloigst preferably attached to a large teaching hospital.  

It also sounds like your bladder may be underactive at the same time, meaning you have both an overactive and underactive bladder. This sometimes goes together.

How often are you doing CIC, and what kind of volumes are you getting? 

Jim

Hi Jim,

What makes you think that zd has an underactive bladder, which I think I have all the symptoms. Hank

Hank,

Because he said "no natural void". He also has symptons of overactive bladder (OAB). They often happen at the same time. 

Jim

Thanks Jim. Good diagnosis ! I can still void naturally but with high chronic retention, I also fit under UAB (without OAB though). So would you also classify yourself as having UAB, at least when you started CIC many, many years ago ?

Hank

After the TURP. Before I didn't experience any leaking. Pain, yes,

it would come and go before. I do 6 CIC in 24 hours, volumes 200 - 400

What kind of tests do you have in mind? My uro is mainly concerned with

my cancer. Yet I hate Lupron shots and never continue for more than

6 months at a time. No difference in urinating Lupron or not.

What kind of treatment have you heard of? Thanks Zdz

Hank,

Absolutely. Three years ago my bladder was very underactive with signficant retention and compromised detrussor strength to the degree that near the end I couldn't void without literally pushing the urine out with the palm of my hand, and even then, with significant retention. The first time I cathed at the doctor's office 1.5 Liters came out after a 450ml void. So I was holding close to 2L!  Today, I feel the urge around 400ml and empty down to anywhere between 150ml and zero, depending on the time of day.

Jim

ZD,

There are different kinds of incontinence such as stress incontinence, urge incontinence, overflow incontinence, etc. So, the first step is for you and your urologist to identiy which kind you have and look at treatment options relevant to that type of incontinence. It could be behaviorial, lifestyle, Kegels, medications, surgery, or some combiantion.

Jim

Jim, would you recommend double void and triple void, just before a cath ? Is it a good opportunity to exercise the bladder or just a waste of time ? Thanks. Hank

For discussions sake, let'e  define double and triple voiding as a second or third void within 30 minutes of a first void. 

I sometimes double, or even triple void, but I'm no longer doing CIC. If you're doing CIC, I really don't see the reason to do so on a regular basis because you will be emptying it completly with the catheter. It is desirable to void at least once prior to CIC because it will clean out the urethra and therefore potentially result in less UTIs, and of course it will exercise your detrussors naturally.

That said, from time to time, double or triple voiding before CIC does have infomational value as to how low you can get your residual naturally. For example, if you find that by the second or third void, you're below 100, then you could probably use a double/triple void strategy either to lower your cath frequency or to stop CIC altogether.

Jim

Thanks Jim, it is well explained and it answered my question perfectly. Hank

This points out at least one deficiency of both the ultrasound bladder scan at your urologists office as well as the more advanced bladder/kidney ultrasound at the radiologists. 

So, for example, your uro has you void and then finds out via portable bladder scanner that your holding (PVR) 300 ml.  "Wow", he says, you have significant retention so I want you to try Flomax or maybe Flomax and Proscar. And then if that doesn't work, the next thing you're having a TURP. 

On the other hand, if he just had you wait around for twenty or thirty minutes (unfortunately he's on his next patient now ) and let you void once or twice more, he might find that you can empty down to 50ml. That could save you surgery!  Same thing with the bladder/ultrasound study at the radiologists. Also keep in mind both these tests tend to produce elevated PVRs because of artificial fluid loading prior.

Jim

Very good trick for lowering PVR at the uro office. I have been DVing and TVing within 5 minutes of first void. I may try 30 minutes now. Hank

On the subject of UnderActive Bladder: I suddenly realize that UAB is very common and most of the people on this (and other CIC) thread have UAB. However, it is also undercoveraged. So perhaps you can do us a favor and open a new discussion on UAB as a spin-off to CICs. Of course you can also argue that most of the people on this thread like potato chips and elect to spin off to another discussion. Hank

PVR can also vary by time of day, as you probably know from CIC. So again, the urologist (or radiologist) is only getting your PVR at one point in time. So, if you're not doing CIC, or don't have a home bladder scanner, a good idea is to schedule your appointments at the uro's at different times of the day to get a broader picture.

Jim

Not sure if waiting 30 minutes is technically double voiding. My case is a little different because I have a large bladder diverticulum. So let's say I void 300ml and empty my bladder at 9am. My diverticulum still might be holding 200ml. But once the bladder empties the diverticulum will empty into my bladder producing another urge to urinate. So my second or third void might be a combination of remaining bladder residual, urine previously from my diverticum, plus any new urine produced by the urethra.

Jim

Last sentence, should in part read, of course, "produced by the kidneys".

I guess we don't have a dedicated thread although we talk about UAB a lot in terms of "flaccid/stretched bladder" in terms of BPH/LUTS, PVR, etc. and how it impacts on surgical outcomes, etc. So a good idea.

Jim

Jim , How often do you urinate? I'm trying to figure out what i get the urge to uriniate after 2 hours or less some times. Do you have this problem?

frank,

Frank,

My voids now are natural and your voids are all with the catheter, so it's hard to compare. 

No rush, but when you're up to it, why don't you do a void log one day and post it here.  Just write down the time of the void and the amount in ml. That will help me figure out a little better what is going on.

Jim 

Jim

Jim ,That sounds good ,i will do that.

frank

Frank, my situation is identicak to yours. I can only urinate via CIC and I often feel urges almost immediately after CIC. At the beginning 4 hours apart was ok, now I have problems sticking to that schedule.

My question to you is: do you also feel pain in this region? My penis often looks bruised and feels very tender. I have problems when sitted for awhile.

I had TURP a few months ago, didn't help, on the contrary. The problem is my bladder. Let's compare our miseries 😊 Zdzislaw

ZD,

Have you tried to cath right after you feel the urge to see how much, if any urine comes out? How long does the urge last if you don't do anything? If it's truly empty it may be bladder spasms part of overactive bladder syndrome. Also, how many times a day are you self cathing and how much is coming out each time?

Jim

Hi zd,

Did you try alpha blockers like Cialis, doxazosin, etc. ? Hank

Yes, I did. Helped a little for a rather short period of time (2 years max).

You may want to try 2 things that helped me:

1. During CIC, after the flow already starts, try to push using your bladder muscle so the flow becomes stronger. This will strengthen the muscles, hopefully.

2. Try the alpha blocker again. I notice that it becomes more effective after I stops it for a while. It may fall into Jimjames theory of "on/off". It is worth to try, maybe it will also reduce the false urges.

Hank

Hank,

Yes, I used Daily CIalis but could have used an alpha blocker like Tamsulosin, during some of the "off" catheter periods, however false urges were not a very big issue for me. 

Jim

Hi Zid, Wow ,sorry to hear you had Turp and now they tell you  it's your bladder. Why didn't they run some tests before Turp> The first Uro i went to did cystoscopy ,next thing he said was i have to have Turp.He never did a Urodynamics test. I refused the surgery. I'm doing CIC,thanks to Jim.Now after so many months he tells me i have 3 choices, live with a foley catheter {the bag} Do CIC,or have the surgery Turp ,he says most men have Turp and they can normal void no gaurantee. Well i'm seeing another Uro,maybe he has a better answer.As far as pain.,after i CIC,i don't get pain in my penis,i get a slight testicle disconfort. I do CIC 6 times a day,

I found magic 3 with sure grip catheter works best for me. It is easier now then it was when i first started.How many times a day do you cath?

Did  your URO tell you before surgery that you would be able to Normal Void?

let me know Zid.

frank 

Yes, I have tried, nothing comes out.

If I don't do anything, the urge just remains, only somehow weaker, never gone.

What can be done for these spasms???

The volumes are variable 200-400. Lately nothing comes out at night 

with the external catheter. No idea why. Zdz

Thank you, Hank, I will.

Frank, I haven't heard of a Uro honest enought to say he DOESN'T KNOW what the issue of TURP will be. He didn't garantee me anything either, but he totally neglected any bladder exams. No cystoscopy, no urodynamics before TURP. In fact my operation started with Green Light and ended with TURP because he decides GL didn't work well enough.

I CIC 6 times a day, sometimes 7. That's a lot. Cannot understand bruises, pain etc, because I do it well, with good catheters (Coloplast Flex 12 or Speedicath compact). 

After my TURP I went through several stages (don't understand that either):

1st stage  Natural Void very very often, but easy (May-June 2016)

2nd stage Natural Void plus incontinence (July- August 2016)

3rd stage Natural Void difficult except with external catheter at night (September-December 2016)

4th stage NV impossible, started CIC (December 2016)

but no urges, calm after CIC for 4 hours.

5th stage NV impossible, CIC every 3-4 hours, urges appeared (since May 2017).

The pain is always there , milder/stronger.

How about you/? Best ZDZ

 

Hi ZD,

This is a little beyond my pay grade, but that said, looking at the numbers here and your recent post to Frank regarding the stages since your TURP  

It was a little unclear, but I'm assuming you never had the GL, just a TURP? Well, assuming that, it sounds like initially the TURP worked to some degree and then stopped working. 

My advice is to get fully reevaluated by another urologist, someone not affiliated with your current uro, or his hospital. You want someone unlike your urologist who will run tests first (like urodynamics) and operate later if appropriate.

So maybe the solution is another surgery, or maybe just treatment for both your underactive and overactive bladder. But again, the first step should really be to run some tests and find out more what is going on. I would think in addition to urodynamics, preferably video urodynamics, some imaging and cystoscopy would be in order as well.

You mentioned "pain and brusing", is that from the catheters? What size catheter are you using? Is it a Coude tip or a straight tip? Do you have any visible or microscopic blood in your urine per urinalysis? Have you had a recent urine culture to check for UTIs? About how long does it take you from when you insert the catheter into the urethra until the urine starts to flow? Are you having difficulty passing the prostate and/or through the bladder sphincter? You could try going down a FR size and see if that helps. Also, some here have had luck adding extra lube to the hydrophillic. 

Jim

Just wanted to add -- and again urodynamics, cystoscopy, etc, will tell more -- that it seems your bladder had enough integrity/elasticity right after the TURP to void properly, which suggests that another procedure, TURP or something else, might work. How large is your prostate? If it's very large, HOLEP is recommended over TURP and could be why the TURP failed. Anyway, I'd stay hopeful because if your bladder worked last year after the TURP, I see no reason it shoudn't be able to work again once the obstruction is fixed, assuming that is what is going on.

Jim

Hi, Jim,

I've been healing up nicely from my recent hernia surgery, and a couple of weeks ago started doing some fast walking and strenuous hiking to start to get back in good physical shape. (Haven't been able to do any strenuous exercise for the past 18 month due to my BPH retention and procedures). I'm hoping to start running again soon.

While I'm out doing the strenuous walking/hiking, I get sudden urges to urinate about a mile into it. Most times I can hold it until I finish--sometimes not. My TVs jump to 400 ml or more, and my urine is cloudy for a time or two. It seems that the exercise stimulates urine production. Is this common? It never happened before.

Before they removed my bladder stones in February, I frequently had cloudy urine. Since the stone removal that stopped. I'm not sure why my urine would be cloudy after exercising. I do have 1 kidney stone, but to my knowledge that hasn't been a problem.

Do you think this is just a phase of my healing that will clear up as I continue to exercise?

Stebrunner

Hi zid, Wow,I would do as Jim says,get some tests.I now have an appointment with my  4 th URO. I had tests done,i cannot do a NV, I have to CIC

I'm around the same as you 6 or sometimes 7 x a day. The last Uro said he doesn't know why i have retention, i asked him what would you do if you were me?He said CIC.They won't tell you, you will get out of retention after surgery,probably to avoid being sued.As far as the pain your having,why not try a magic 3 sure grip hydrophlic.That what i do and it's works better for me FR 12

Hope you get an answer

frank

Hi Stebrunner,

Glad to hear that you're doing well from your recent hernia surgery and now starting to exercise.

I don't know that exercise stimulates urine production, but then again, the kidneys seem to have a will of their own! Have you upped your fluid intake before or during exercise? Changed diet or sodium intake? Have you tried to cath right before you exercise, if not, that might help. 

Cloudy urine (usually leucocytes) is pretty common when you CIC, so it could be that. But if it's just after exercising, maybe inflammation from the prostate. A urinalysis might be a good idea and a culture if something shows up, but I wouldn't jump into antibiotics given what you've said so far. And then there is that kidney stone, maybe have the doc take a look.

Jim

Jim

>keep in mind both these tests tend to produce elevated PVRs because of artificial fluid loading prior.<<

Exactly.  When they did the ultrasound on my bladder they had me drink several ounces of water an hour before hand.  I was already retaining a lot (unknown to me) even though I could feel it if I'd push on my stomach or my cat would come sit on me.  So yeah; with what they had me drink I appeared to be holding about 1800 ml.  

 

1800 ml is a pretty large amount.  When my self cath volume is over 500 I felt very uncomfortable. 

...When my self cath volume is over 500 I felt very uncomfortable....

means your bladder is not overstretched. Hank

Hi, Frank! I have tried many different catheters, doesn't change much. Sure, I will get second and third opinion, but right now I am far from any good doctors, so this will have to wait till September...

Hi Jim, should the collecting beaker be between your legs, during the reclining position ? Just to be sure. It seems to be so obvious to me until I suddenly remember that you are into Yoga. BTW, I am OK, just curious. Hank

Hank,

I suppose the beaker can be anywhere within "reach", but between the legs works for me. A towel underneath just in case. 

Jim

Hi Zid, I get the same problem you do, i get the urge to pee sometimes 1 or 2 hours after i CIC. I don't know why and the Uro doesn't either. Usually  I'm good for 3 to 4 hours ,and sometimes 5 hours, i guess i got lucky one night as i slept 6 hours without CIC. I'm getting another cystoscopy {new URO} He was talking about a pace maker in the bladder.The last Uro said no to that. Why are there so many different opinions? Wish i knew. My last Uro said 6X a day is maxium for CIC.

I sometimes have to go over that limit or i couldn't make it.

frank,

 

They have different opinions probably because they don't know what the hell is going on... Keep me posted! For a while I do nothing because I am on holidays in Poland, far from any good doctor. I also do CIC sometimes 7 times a day.... ZD

Hi, Jim,

You are right! My kidneys have a mind of their own! LOL! At your suggestion, I started cathing right before going out to exercise. The first time I did this, I didn't have the urge to pee during exercise. Now for the past 3 times, the urge to pee starts coming on about 30 minutes into my walk or run, and the intensity of the urge builds until I'm done exercising.

Yesterday, I cathed right before my walk/run, and my TV was 280 ml. I barely made it home to pee (decided to get home so I could measure), and my NV was 275 (a new record for me) and TV was 600. I cathed 5 hrs later and had a TV of 225. The other times this has happened, it's been much the same; however, my TVs have been closer to 500.

I'm hoping this is a phase my body is going through as I get back to exercising. Before my urinary retention and BPH, I never had the urge to pee until after I was done with my workout. BTW, my diet and sodium intake have remained the same. I might start tracking my fluid intake, however, as I might not be drinking enough. If I drink the recommended amount, I feel like a walking waterbed! I try to drink enough to keep my urine light colored--not too condensed.

Stebrunner

Hi Steb,

Not sure why that's happening but why don't you just build in a bathroom stop about 30 minutes into your exercise routine, or whenever you feel the urge. A NV may be all you need to get rid of the urge and keep your volumes down. If that doesn't work adequately, you could substitute a "cath stop". 

Alternatively, if you don't have any blood pressure issues, maybe try something salty (saltines, pretzle sticks, chips) an hour or so before exercise. It could be related to sodium balance/retention issues.

How much fluid are you drinking? I would think six, 8 ounce glasses of fluid should be a minimum if you're exercising. More if you sweat a lot. 

Jim

HI Zd, Do you get testicle discomfort after you CIC?I do your right ,they really don't know all the answers/

frank,

Right now general discomfort, all the time!

Hi Zid, Today i had a cystoscopy,the 2nd time. DR said i have a very enlarged prostate ,also a median lobe.Uro Lift will not work. I have to have turp or Gl .No guarntess this will stop me from doing CIC. He also said i have a diverticulm.I think i will continue with CIC.

frank,