Self Catherization: Issues and Problems

Sounds all good Neil. Let us know how things work out. I was going to tell you about the finger up the anus relaxation thing but figured you might be freake out It is a standard relaxation/release technique and I believe they sell plastic or rubber aids so that you can do it yourself. 

Hopefully, the relaxation technique will make it easier for you to get through your bladder (internal) sphincter so that CIC will become easier. They may also help with the NVs but don't lose track of the PVR. At the end of the day it's the low PVRs that will get you off, or significantly limit CIC and not the NVs. That will happen when the detrussor muscles regain tone after being decompressed over time with CIC. 

Jim

Neil,  that was very interesting!  Please keep us updated on your progress.  I might start doing squats, to work on that muscle that you were talking about.  Got to get my NV, up there.

While kegels and squats are prescribed for incontinence, some people think they may be counter productive for retention in that they could potentially tighten the muscles. The counter argument is that they tighten and then relax. What you might do first is just use the squats for stretching and relaxation. In other words, holding onto something for support, squat as far as you can to stretch your pelvic muscles. The "holding on" is so that it becomes more of a stretch and less muscle work. Many people around the world are able to sit in a squat position although in our culture most of us unfortunately lose this ability fairly early in life due to invention called the chair. 

Jim

Hi Dennis - just want to ditto what jim wrote here. I found the kegels very counterproductive to all my voids. My external sphincter is in good shape so the last thing I need to do now is tighten my internal one. Also since I stopped the kegels I do not have the burning sensation I had during my NVs.

On the squats, they were very shallow ones - I wouldn't even call them squats but rather just shallow knee bends. The main thing is to try and "pass gas" while you are going down but don't push too hard. I do 10 of them while resting my right hand on the dresser. Neil

Neil,

Same advice to you as Dennis. Doing squats as you describe could potentially tighten things. If you can get to the down position and up again using your hands, great, then it's really as stretch. But if you're using your hamstrings and core during the squats than consider stretching on your back instead for example by bringing your knees up to your chest or other pelvic bends.

Jim

Wanted to throw something else out in regard to your tight internal sphincters. 

I have been doing some recent research regrading my own bouts of AUR. The docs don't have an explanation and the literature is unclear. One thing I notice is that it seems to occur at higher bladder volumes. My working has been that at higher volumes my detrussor's don't have enough strength to open the internal sphincter. But a newer I have is that at higher volumes the sphincters themselves may tighten up so even with the same force my detrussor's can't push through. 

Taking the latter concept over to your problem, I'm wondering if you could get through your bladder sphincter easier at lower bladder volumes? I understand this contradicts what I recommended earlier but so be it, as again the literature is confusing as to the relationship between internal sphincter tightness and bladder volumes. One way to test that would be for to cath relatively soon after a scheduled cath. In other words cath when you have a lower volume but not a completely empty bladder. If the catheter slips in more easily then your solution may be as simple as cathing more frequently. Worth a try.

Jim

Thanks Jim - a lot to digest there so I'll think through it. One thing I notice when I go into AUR is that it follows my holding it in and clamping down for an extended period of time. This could be during a car or plane ride where it isn't convenient to stop or at an event or movie where I don't want to leave or during the night when I don't want to get up. I tdoesn't seem to be related to the fullness state of my bladder but rather the clamping down so when I try to pee I only get out a few drops  at a time if even that.

The same clamping down occurs for me when I am stressed. That's how I internally stress. Unfortunately my Christmas was not in the spirit and was full of stress and clamping down. I am sure this is related to my internal sphincter muscle that closes down like a tight o-ring around the opening. Early on with CIC I was tense over the CIC process itself but now I am over that and look forward to the feeling of an empty bladder. Maybe I need hypnosis to relax!

Anyway I will study your ideas here and try them. I've tried all your ideas and welcome them. I will bring up the questions to the nurse tomorrow you suggest. I am not on blood thinners and I have tried cathing while sitting and even lying down but had the same issues. I prefer standing though.

Thanks

Neil

Just thinking about your ideas here - I wonder if at high bladder volumes we clamp down more on the internal sphincter muscle to "hold it in" - after all that is what is meant by holding it in - we wouldn't be holding it in at low bladder volumes (unless we had OAB). So maybe by tightening and tensing the internal sphincter muscle around the bladder neck oepning at higher bladder volumes we make it that much harder to open it involuntarily and relax it when we wish. It fits like a tight o-ring around the orifice - so maybe part of the problem is that the internal sphincter itself is losing elasticity and the ability to respond fully on demand - like our detrusors losing the tone and elasticity over time. I need to understand the sphincter better - maybe it is part of the detrusor at the base of the trigone (bladder outlet) and is subject to the same deterioration over time. I will study that - thanks Jim. Neil

Hopefully the nurse of one of the ideas might help. If not, it might be time for the doc to take a look through the scope and make sure there is no physical obstacle. Down the road hypnosis is not a bad idea. There's also acupuncture. All reasonable roads should be explored. For another condition, I once paid a couple of hundred dollars to a highly recommended visiting Qigong master from China for a 10 minute healing/cleansing session. Well, my wallet did get cleansed

Jim

 

The internal sphincters are involuntary. What you are describing is more the external sphincters which are voluntary. When we "hold it in", as soon as we relax the external sphincters we urinate. That said, the higher bladder volumes may involuntary tighten the internal sphincter which is your problem. If they weaken one can dribble or develop incontinence. That's not what is happening with you. To test if lower bladder volumes relax your internal sphincter, just cath 30 minutes or so after another cath. 

The one thing I have come to understand from researching is how complicated and interconnected the urinating process is. The fact that most urologists blame almost all LUTs conditions to an enlarged prostate and then present their pet surgery as a solution, is at best lazy cookie cutter medicine and at worst, well you fill in the blank.

Jim

Hi Jim - Just now I had a strong urge to pee so I clamped down on the external sphincter and set up to cath. I did a quick test pee to see if the inner sphincter was open just before I cathed. Sure enough a few mls came out and then I clamped down again hoping the internal sphincter was open. The catheter made it to the internal sphincter in about 30 seconds with the feeling of peeing the whole way though no pee came out. So I was expecting easy passgae through the door but no such luck. Once again I sat outside trying different passwords to get in and finally after 10 minutes it slipped in.

I was surprised that only 250ml came out but happy that there was no blood. I will go back and cath again now as it is 30 minutes. As you say the whole physiology is very complex - I doubt anyone understands it.

Thanks

Neil

Hi Jim - I had a good 2 hour visit from the continence nurse. She was very helpful overall. On my rpoblems getting through the door she said that it is likely caused by the shear size of my prostate side lobes clpaming down on the urethra which is connected to the internal sphincter muscle. She confirmed what you said that most men have no problem getting through to the bladder but she said she has never seen a prostate my size. She did suggest I give the straight catheter a try again and just use tons of lubricant to avoid poking the prostate. So I will do that today. She also suggested the olive tip one which has a bulb at the end - this has been suggested here too. Maybe the IQ Cath will help as well when I get the samples. She did not recommend muscle relaxants but did recommend an overnight in-dwelling one so I can sleep. She said I absolutely must get back to 4X a day and not to worry about bleeding at all.

She also said to try putting up one or the other leg on a footstool while I cath or squatting and peeing in a tupperware dish before I cath as that may loosen up the pelvic floor muscles. So lots of ideas. She will come back next week to assess my progress. She also said I need to drink 2 litres of water a day and that fluids that are part of food do not count. She really emphasized that point.

My last 3 caths have been without any bleeding so that is good.

Thanks and take care.

Neil

Hi Neil,

Sounds good and glad she doesn't think the bleeding should be an impediment. That said, unless things clear up, consider getting scoped and/or some imaging to confirm what she said about the issue being due to the size of your prostate clamping the urethra. That would also tell if you have any damage at the sphincter.

Regarding "an overnight indwelling one" to help you sleep? Is she suggesting a Foley that you put in yourself at night and take out in the morning? Interesting idea if your interrupted sleep is a major problem? Pesonally, I never found getting up at night warranting something like that but I guess I'm used to getting up at night. If you do the Foley thing, ask her about infection risk. I would also make sure she is with you the first time the Foley is inserted to make sure it gets through. 

Jim

Jim

Neil, where have you found IQ Caths?

Some more thoughts. If the problem is not a tight sphincter but an obstructed one (and that really should be confirmed by your doc) then it makes some sense that the relaxation exercises aren't working. Of course, the problem could be both. 

But assuming the obstruction, just be very careful with the straight because you don't want to cause any injuries either at the prostate or at the spincter because you will be using a "spear" now instead of a "nub". The other thought you might run by the nurse is to go up a size with the Coude. That might give you the extra "push" needed to get past the obstructed sphincter.

Jim

They are available pretty much everywhere except in the U.S.A. due to the FDA approval process. If you know someone in Canada...

Hi Jim, Today i saw a new uro. He was on vacation.however his nurse was very good at taken out the foley catheter. I asked about a condom catheter,she said they are no good with retention,i should not use them. I was hoping for another answer , not to get up 2 times a night to CIC>

Whats your opinion on this Jim? She also said because i'm in retention,the amount of urine output means nothing. I don't get this.does this sound right?

Thanks much Jim,

Hi Frank,

Glad they took out the Foley. If you can't naturally void, the condom catheter probably won't work, so your nurse is correct on that one. What "amount of urine output" are we talking about?

Jim

I have a friend who lives in Ontario Canada and he requested some samples from the local supplier and he is sending them on to me.

Hi Jim - my wife agress with you not to try the straight one again. The bleeding has finally stopped and she does not want me to take any chances. My wife also says that even if it takes 5 minutes for me to get through then what is the rush? It is not like I have some place to go!

The home nurse was infact recommending an over night Foley just for the night but I don't see how that would let me sleep better.

I did have a cystoscopy in the summer and there were not any blockages at all leading to the bladder.

I recently read a paper titles "The Urethral Sphincter Muscle in the Male", by Oelrich 1980. It is deep into anatomy and a tough read but it changes how I view the sphincter muscles. i though they were like 2 little o-rings that contracted but in fact it is one big muscle that extends the same length of the urethra as the prostate. Also, the prostate overlies it so with large prostates like mine it may mean that the prostate compresses the sphincter muscle and makes it difficult to open with the catheter. Thsi could explain a lot of my problems and why I am "unique". The nurse said most men cath in a minute or less unless they have an injury but she admitted that none of her patients had prostates as large as mine. So maybe I just have to live with it and be happy that I can CIC at all. She was in her mid 50s and has 30 years at this.

Also I must add that she hates uros even more than we do! She literaaly applauded me for no letting them do any surgical procedures on me and then told tons of horror stories about the carnage they leave behind that the nurses have to deal with. She said it is especially bad for women. So bravo to all of us and a big thanks to you in particular. Neil

Hi Neil,

Sounds like the description of the external sphincter, not the internal sphincter you are having problems with. I also don't see the purpose of a Foley for one night. Since you were scoped and I assume had some imaging, why not check with the doc to see he supports the nurse's analysis of your large prostate pinching the sphincter. She may be right but I've learned that opinions are just that in this business Also prostate size in and of itself does not determine symptons. I'd say try one size up with the Speedicath Coude. Going up a size is standard protocol in difficult catherizations and I can't see anything you have to lose. Scary what the nurse said about uros, even though we sort of know that. Keep her number, sounds like someone you can work with. I still am optimistic you will one day join the "under a minute club".  

Thanks Jim. I took your advice and once again packed away my straight Speedicaths. I cathed twice last night with no blood at all. Now I need to focus on getting to Houston for my biopsy asap. Also I agree about not doing the Foley at night. I manage ok now thanks to all you guys!

My problem really is the internal sphincter. I get through the external with no problem now in 30 sec and just have 3 inches left on the catheter at the internal one. The figures in that paper show the prostate grows aroun the sphincter muscle at the bladder neck too so I will assume that is why I am so unusual with everything else being ok. Anyway that is my working hypothesis of the day until I disprove it! It does make sense though. On Monday I will receive the IQ cath samples and see how that works. Thanks for all your help. Neil

Hi Jim,I stopped measuring the amount of output.The nurse said it doesn't matter when you have retention,This is not PVR. Whats your opinion on this JIm,

Thanks,my friend

frank,

The nurse is wrong. The reason you want to measure output is to make sure your bladder is not holding more than 400ml of urine at any on etime. If it is, then you want to cath more often until it holds less than 400ml. If you allow your bladder to hold more than 400ml it will remain stretched and chances are it will never regain enough elasticity to void normally. Your nurse probably has written you off and doesn't think you will ever be able to void normally. She may be right but I was also written off and guess what, both my doctor and nurse were wrong. 

Jim