Self Catherization: Issues and Problems

Hi Scraggs,

Great piles of sympathy over your plight!  Sounds like it really sucks.  :-(  

Two things that usually cause UTIs are: 1. sloppy prep, 2. severe retention/undrained bladder.  I had frequent UTIs in my first two years, when I "drained" only two  times per day (as per my uro-doc's instructions. At that time, I had 500–800ccs (and occasionally more!) PVR. I switched to JimJame's method last fall, and have usually voided 300-350cc, with little or no natural voiding.  And I haven't had a UTI since November.  

I also have concerns re longterm antibiotic use.  I had a possible (though unconfirmed) UTI in November; I'm pretty sensitive to the body-changes by now.   Wanting to head it off without taking time for a doc visit (I was out of town.), I downed a bottle of kambucha (I'm not a fan!  :-)  , and drank a couple of bottles of real lime juice, and threw some vinegar in for good measure.  No UTI showed up.    This is only offered as something to think about/explore; I'm not saying I'm certain it works this way! 

Hi Scraggs,

You've only been self cathing a month and it's not unusual to have UTI issues in the beginning. The problem here is often not simply contamination but the body adjusting to the trauma of a foreign object. 

I had even a worse time with UTIs the first six weeks. Like yourself, my first UTI wasn't adequately treated and came back. That led to epidimytis (swollen testicle) which is not a lot of fun! 

At that point, like yourself, I thought that this CIC thing wasn't for me. The less invasive procedures weren't around then, so I started researching suprapubic's as well as low dose, long term antibiotics. My urologist at the time talked me out of the long term antibiotics, and said just be patient for now and see how it goes. 

I took his advice and since then I've had only one or two UTIs in the past three years that needed to be treated with antibitotics. 

My suggestion is not to give up on CIC at this point because of early on UTIs. I would also seriously reconsider long term, low dose antibiotics, for all the obvious reasons. I really think your doctor jumped the gun here.

If you're like me, it was the initial trauma of CIC that made your urethra more prone to infections. I think that if you conventionally treat your current UTI (assuming you have one), and then observe good clean CIC protocols (we can go into this more later) your UTIs will hopefully stop reaccuring as your body/urethra gets used to the catheter. 

Jim

 

I would quite happily try anything rather than using antibiotics longer term.

Scarily Jim I am now into week seven, how time flies when you are having fun

Epidimytis sounds nasty to have.

The doctor has today put me on 250mg Cephalexin 4x a day to try clear this one up.

Urologist has said give it 2 months and hopefully my body will get used to things, give it a break and see how it goes, but I really am not happy about the idea, I will see how things go and hopefully get through it without needing to result to long term antibiotics.

Hi Scraggs,

How long on the Cephalexin? What kind of UTI symptons have you been having? Again, I think your doctors are jumping the gun by introducing even the idea of low dose, long term antibiotics so soon. At seven weeks, had full blown epidymitis, but the only person who brought up low dose, long term antibiotics was me, and I was wrong as the uti's did start to disappear as my body got used to things. 

Are your doctors very experienced with CIC patients? Some uro's who are not, tend to overtreat/overreact to UTIs caused by CIC. Either that, or they have sort of given up on it and are looking at a procedure solution. 

I'm not saying CIC is for everyone, but if the only problem you're having is UTIs during the first two months, I wouldn't be overly concerned. Sure, there are lots of good things you can do such as increasing fluid intake, proper CIC technique, cathing more often, drinking "kabucha and vinegar -- not so sure about that one , but I think the best medicine in your case is patience with a dose of positive thinking. The vast majority of folks, here and elsewhere, do tolerate CIC well without frequent UTIs. 

Jim

Speaking of clean technique, as I mentioned before, I would go back to the regular Speedicath hydrophillic coude's and start using the "dive bomb" no-touch technique. Then, once your body gets used to the catheter, you can go more for convenience with something like the FLEX. What kind of wipe are you using for your penis head and meatus? I found good luck with providone iodine swabs (I like the 3 packs and use all three each time). 

Lastly, be prepared in the future for "colonization". That means that it looks like a UTI under the microscope (positive leucocytes and/or nitrites and/or blood) but symptomtically you feel fine. Colonization is not treated when you CIC. This is important. Colonization is pretty normal and I had it most of the time I did CIC. Now that I've been off the catheter for close to five months I no longer have colonization but honestly I can't feel any difference unless I look at the dip stick!

Jim

Hi Jim

I started the Cephalexin today.

Syptoms are cloudy urine, burning when peeing (or trying to pee) constant feeling of wanting to pee and a constant burning in my bladder.

I'm not sure how experienced the uro is with CIC.

I would be OK with carrying on but the constant burning is so painful.

I tried the "dive bomb" method tonight with the lofric which was fine, Speedicath won't send out samples of their coude tip over here to see how I get on with them.

Hi Jim, Do you think having stomach upset,temp 99.6 is part of UTI? 

What symtoms do you look have when you get a UTI?

Thanks,

frank

Frank,

Doesn't sound typical of a uti. Some of the more common symptons are burning when urinating and urgency. They also tend to go with a positive urine culture and sometimes a fever over 101.

Jim

Not sure why it is so important to clean the penis head.  If one hasn't had sex  in the last few hours or put his penis where it doesn't belong  or touched anything but cotton underwear is it that necessary?  Is just body sweat dangerous and can cause infections?  

 

Keith, you bring up a good point. There is both a  "sterile" and "clean" technique . The clean technique (CIC)  was introduced by Dr. Lapides in the 70's. The Lapides technique I was originally taught skips the step of washing both penis head and meatus, and some studies show no difference. 

That said, many people, including myself, use a technique somewhere inbetween clean and sterile. The reason I wipe my penis head and meatus is because these are areas the catheter will likely make contact with (certainly the meatus) on the way into the urethra. Many people take even more precautions (gloves, introducer element, etc) and some just wash their hands and cath with no other prep.

Jim

 

Probably should add that in a hospital or office setting, especially if someone other than the patient is doing the catherization, a sterile technique should be used including gloves, drapes, disinfectants, etc. because of the possiblity of cross contamination. Studies show a lower incidence of UTIs with dedicated catheter teams. 

Jim

Hi Jim, Data Thursday 12:45 am---350 Ml -- 2:40 am--250Ml--5:25 am- 300 ml--10:10 --400 Ml--2 p-m --300 ml--6pm 250ML  9 pm --300 ml-11 pm 300ml

I had to cath 8 times  24 hours. My uro said frequency is a symtom UTi.

He had me do a urinalysis,it was negative.Do you have any idea why i get this urge so often?

Thanks 

frank

Hi Frank,

It looks OK to me. The reason your getting the urge to urinate is that your bladder is relatively full eight times a day. That's normal and actually a good sign because it means that your nerves are still working at least to a certain degree.  Did you show your uroligist the log? I think he would agree. Nothing to do with UTIs based on this. 

Jim

Jim

BTW just because they say "cath up to 6x/day", remember it's just a general number. In the past I cathed 6x/day (sometimes 7) and I had natural voids. In your case, no natural voids so cathing 8x/day is normal. Is the insurance paying for 240 catheters a month? I believe Medicare generally pays for 200 but I'm pretty sure they will pay for more with a doctor's explanation of need. 

Jim

Keith, as casual as I am about CIC, I would NEVER (consciously) not clean the penis head.  It is like inviting a UTI in!  And I AM pretty casual:  I do not usually even wash my hands, as they do not touch the head/area of insertion, nor do they touch the barrel of the catheter.  I use a little alcohol wipe (sterile) to clean the landing site, and then insert.  Ac ouple of the UTIs I had to have treated were caused by late-night insertions after forgetting to swab, or once when I was super-rushed and inserted, then saw the unopened swab pack lying there.  I would never, never, never CIC without that minimum prep!

Thanks for that.  I've definitely been neglecting doing that.    The last time I did a urine sample, about two weeks ago, they said no UTIs; that it looked clear.  Perhaps the two rounds of antibiotics I finished up about 14 weeks ago is still protecting me somewhat.  I haven't been washing my hands either since I don't touch any part of the catheter and drop it in.  Maybe I got lucky so far.  I have some iodine swabs ordered but until then I can use soap and water.

I worry a little bit when I use a non-hydrophillic fr14; when I put the lube on it (I have been using a tube with a flip top cap) that I could transfer bacteria as I touch the catheter with the opening to the lube tube on the catheter to spread it on there.  Sometimes I have used my fingers (after washing my hands) to spread it on the last 6 inches.  Thats probably not too sanitary but if I keep the cap closed on the tube it seems pretty safe. I'm planning on exclusively using the hydrophillic from now on when I settle on the right one.  

Before I switched to hydrophillics, I  bought the lubes in individual packs. In theory, they would be less prone to contamination. I also sometimes did not wash my hands using the the "dive bomb" no touch technique, but it's probably not a bad idea to use at least a hand sanitizer because your non dominant hand does get pretty close to the meatus and one slip in the middle of the night....

That said, it can be guesswork what actually caused a given UTI. I've only had a few but I think in my case trauma (trying a new catheter that didn't work for example) might have been more of a factor than contamination. 

And again, you don't want to be overtreating bacteria in your system. Very important that you and/or your urologist takes a good look at every case and makes an intelligent decision whether it's a true UTI or simply colonization. Under the microscope and at the lab both look the same, however only a true UTI should be treated with antbiotics, not colonization.

Jim

Keith, I'm glad to read that you're changing your evil ways!  Yeah, hydrophylic the ONLY way to go, for all the right reasons.  SpeediCath FR 14 straights for me.  Almost 3 years on them!  Good luck!

Hi Jim, you mentioned that you had epididymitis from CIC earlier. Do you know how it its possible, and how does epididymitis differ from hydrocele ? Hank

I got epididymitis from an uti that wasn't adequately treated with antibiotics. The uti was probably from trauma as I was just starting CIC. Very painful. I believe hydrocele is a swelling where epidymitis might be a cause, but not sure. 

Jim

Thanks for support.  I like the rigidity of the speedicath.  I could use a 14 (I know because I've been using non-hydrophillic ones for awhile now) but I think I could get by more comfortably with fr12.  I assume they're just like the coude ones only without the "blade" on the end.  I've been using the coude 12s but sometimes it feels kind of sharp going in past the bladder opening or right before.  That concerns me a little.  I'd like to try both but whenever I've tried to get samples in the past I've gotten 120 day supply!  I guess I'm talking to the wrong supplier.

I definitely had stomach upset and no appetite.  He said I had prostititus but didn't know the cause.  I know now after these forums that it was because of severe urinary retention.  I didn't start cathing - advised while waiting to see urologist - until about a month later.  Earlier doc gave me Sulfameth for 2 weeks & then Cipro for another 10 days.  It did get rid of the infection but didn't stop my incontinence.  Cathing has done that.

Guess what I got

Yes Epididymitis is pretty painfull.

The good news is I haven't had any more urine infections up to the point I got the epididymitis.

I decided against the long term antibiotics, and discussed it with my doctor who was happy for me to decide how I want to deal with it.

I finaly got Coloplast to send some Tiemann tip samples, which was a major task, they had to speak to my doctor before they would send them out, I really struggled to get them through the Sphincter and into the bladder, on 2 attempts I had to give up after nearly 20 minutes of trying.

I am feeling much more laid back about it now, I have decided to stick with the Lofric Tiemann tip.