Self Catherization: Issues and Problems

Is the clip now serving any function? Is there any downside to having it removed? Or would it be easier to just have it pushed back in so it's tighter?

I'm all for doing as little as possible and to leave well enough alone, but I would consider removing the clip if there's no downside. Another possiblity is to try a different shaped coude or a straight cath and see if that doesn't snag. There is also the IQ cath that might work but not readily available in the U.S.A. 

Equally important to PVR is total bladder volume, which would be your PVR plus the normal void that precedes it. Is your total bladder volume consistently under 400ml? If not, the bladder could start stretching and reverse some of your progress over time. 

That said, assuming total bladder volumes are not too bad, 150ml PVR is borderline, and a lot of us, including myself, have carried that amount of urine around for many years. If you do stop CIC, I would either do an occasional cath check, or have my doc bladder scan me on a regular basis at different times of the day. If you have a little (actually more than a little!) money to burn, there are a few portable bladder scanners you can use at home yourself. 

Jim

Hi Jim,

Could it be that the clip gets caught into one of those eyelets (drain holes) of the catheter ?

Hank

Hank,

Assuming that the snag happens when the catheter is just leaving the bladder sphincter, then it could be either the eyelets of the Coude tip. Using a straight catheter would eliminate the latter. Not crazy though about a loose staple in there, however. Could it work completely loose and end up doing some damage?

Jim

Michael,

That's an important point. If you get the urge to urinate too late, then not only will your bladder over-expand, but your detrusors will potentially have a harder time emptying out the additional volume resulting in higher PVRs.  

By keeping total bladder volumes under 400ml through self cathing, you will hopefully regain the bladder tone to get those signals to your brain at total bladder volumes between 300-400ml. That’s what happened to me, and I now get the natural urge to urinate with natural voids mostly 250-350ml and PVRs between 20-100. That said, it took me almost three years to get to this point.

If you’re up to experimenting, one thing you can try is to drink 3-4 cups of coffee during the day. Caffeine is a known bladder stimulant/irritant with the upside that it might stimulate your bladder to give you the signals earlier. Another possibly benefit is that it may stimulate more daytime urination which means less trips to the bathroom at night. 

Jim

I want to second Jim's suggestion, and from experience.  I started my adventure with them draining 2500cc from my bladder in an emergency visit to my first uro-doc. Stretched-out bladder?  You betcha!  When I started CIC (after refusing a TURP) in Sept of 2014, I didn't get any signals until I was hitting 500-600cc, and sometimes no signals at all, and I would cath out 800cc---or more!  Again, no signals from my body.  

Following the World-Famous Jim James Method, I began cathing more than the three times a day by Urolift Doc recommended,  just doing it at regular intervals throughout the day, doing 5 or 6 caths per day, last one before retiring.  After a couple of months, I started getting signals from my bladder, first at around 500cc, and now I get them between 200 and 350cc when I'm awake.  The downside (if there is one) is that my signals now awaken me in the middle of the night, which tells me my "permanently stretched-out" bladder appears to be shrinking.  Although my Urolift doc was concerned my extra cathing would increase my chances of UTIs (It seems to not have.), I figure this counter-intuitive approach for which I have JimJames to thank, has reduced my bladder size in half a year.  I will continue, to see if it actually does return to something like normal...

Hi Cartoon,

Sounds like great progress! Signals to urinate between 200-350cc is normal and therefore an important step in getting the bladder back to business. It's true that not holding urine like a camel can sometimes result in more frequency but as long as your middle of the night NVs are in the normal range (200-350cc) then they're what might be called non-bph nocturia which happens for a number of reasons unrelated to our prostate including age. 

Curious, are you still on a 5-6 day cath schedule? Before you cath, what is your natural void volume? Do you do any voids without cathing first? If so, what are the volumes?

Jim

Hi Jim + Cartoon,

My daytime PVR is about 200ml (nighttime is more, can be a lot more). I usually don't get the urge until my bladder has about 600ml. I am cathing 4x a day and I am happy about it. I do not want to have a rehabilitated bladder like you Jim if it means I will have to look for the bathrooms more often and have to wake up more often. After a cath, I can go on free for hours and I like it. Am I crazy ?

Hank

Hi Hank,

A normal person without any bph issues feels the urge to urinate around 250-400ml. That translates into 6-8 times a day if he doesn't "hold it in". And he won't hold it in if he’s smart. In fact, holding it in when we were younger, and thereby stretching the bladder,  is one of the reasons that many of us got into this situation in the first place! It wasn’t just our growing prostates as the doctors have us believe.

I do understand there are advantages of walking around with higher bladder volumes but it comes at a price to both your bladder and kidneys. Also, if you ever want the possibility of getting off catheters completely, as I have, you can’t do that by keeping your bladder in as stretched state.

Jim

Hi Jim,

I understand. I think it is what happened to me. I used to drink a lot and then fought the urges and held it in. "Mind over matter", they said. Now I cath 4x a day. My kidney should be protected enough, right ? It is just it used to be "I want to be like Jim ! ", now it is no longer so. Sorry Jim.

Hank

Hi Jim, I don't know what i did wrong? I used to cath 5 times aday ,not i get the urge every 3 hours. I can only pee when  i cic. I use a sure grip catheter, is it possible the catheter does not go in all the way> As soon as the flow starts  i empty in the toilet,i did notice the catheter has  approx 6 inches before it's all the way in . i don't know if this matters?Does the output amount matter,as i only do CIC?

Thanks a million JIm, 

frank

You are probably protected but if you're going to carry around more than 400ml of urine I would have periodic ultrasounds and blood tests to make sure that your kidney function is OK. Nothing wrong with cathing 4x/day but how about zero times a day??? You won't get there unless you pay attention to those volumes which probably means cathing a little more so eventually you can cath less

Jim

Frank,

In my opinion the output does matter. If the output is over 400ml, then cath more often. As to technique, the rule of thumb is to push the catheter in about an inch more once the urine starts to flow. Then when it stops flowing, slowly pull back on the catheter so you can drain from the bottom of the bladder. When it stops draining, then pull the catheter out.

Jim

 

Hi Jim,

My daytime TV is usually below 400ml. At night the one time I gets up to cath around 2 - 3 AM, it is higher. How high depending on how late I eat and drink.

I do have periodic blood tests but what good would an ultrasound do for me ? It can tell me that I have retention which I already know.

Hank

Yo add to Jim James' reply:  when I'm home or in the Studio, I cath with calibrated bottles.  It is useful information, to really know how much you are carrying around.  If you only cath when you get the urge, and are cathing out 5 or 600cc, that's not good for the bladder or kidneys.  

Hi Jim,

I am just curious. Can a person with normal bladder force urinate before the urge ? For example, you normally have the urge at 200ml. Can you force yourself to urinate when the bladder only has 50 or 100ml in it ?

Is it difficult to do so ? Thanks.

Hank

Hank, when I was young, I road motorcycles, and hated having to stop to pee or for any other reason.  I road from Ottowa to Vancouver, and probably stopped twice to pee!    Well, not really, but there were many days on that trip (and I went down the Pacific Coast and back to PA while "sitting on it" rather than stopping... and had symptoms that, had I paid attention, might have been taken care of in the long-ago.  

It DOES matter how MUCH you're holding, as JimJames mentions... And the less you are carrying, the fewer problems you're likely to create!

 

I do cath 5-6 X per day, and I'm comfortable with that.  I check for natural pee-ability, but that's rare, and usually less than 50cc.  What I have noticed is that the "ability" to pee before cathing has improved--- it used to happen with a PVR of 500-800cc!  Now I have that little bit of "how things used to work" happening with bladder holding as little as 300 or 350cc!  Progress! 

My NVs really vary!  Anywhere from 200cc to 350cc.  Last night was unusual, with 600cc!  DAMN!     Otherwise, I'm rarely over 400cc...

 

Ultrasound would show if you have hydronephrosis, a swelling of the kidneys caused by refluxed urine. Self cathing usually takes care of the problem by relieving the pressures but not a bad idea to have it done periodically. 

Jim

I am a little confused. You say "...natural pee-ability...less than 50cc", but later you say, "NV...anywhere from 200cc to 350cc..600cc".  How are you defining "natural pee-ability" vs "NV"? 

Jim

 

Hi Jim - I just sent you a lengthy reply to your reply to my earlier post on your original thread , but for some reason it got caught up in moderator net. So I just wanted to mention something new I learned today.

I had a phone conversation today with my IR in Houston about rescheduling my biopsy. I then mentioned to him the problems I have getting through my internal sphincter during CIC and asked if it could be due to my prostate clamping down there.

So amazingly he brought my MRI images up on ths screen and zoomed in on the region of interest. He said that I had a 7cm long curved section of my urethra just before the internal sphincter that was highly compressed by the prostate in that region.

He also told me that he has inserted 100s of catheters over the years and has never heard of the internal sphincter providing resistance. He said it was definitely due to the stricture in that region.

This would also explain why I always advance the catheter about 2 more inches after it starts moving again before the pee flows. I used to think it was because I was  advancing into the bladder somewhat but now I know why I have so much difficulty. He also said the distance between my sphincters was about 12 cm.

So that is great to know! Maybe the IQ cath will help with that problem or more lubrication or maybe a 16FR?

Take care

Neil

Yes, it's possible. The stronger the bladder muscles and the less of an obstruction the easier but I have been able to do it sometimes if motivated and while my bladder works pretty OK now, I wouldn't call my system normal.  Things like running the water in the faucet and relaxing can help. If you have retention, it's actually not a bad thing to do 10-30 minutes after a void. It would then be called double voiding.

Jim

Interesting. There are various ways strictures can be treated so you might want to discuss this with him or your urologist. Perhaps a simple surgery can get rid of the problem. Or, ironically, one treatment is to use progressively bigger catheters so in that sense going up to a 16F or even larger might open things up. That said, you might want to discuss next steps with your doctors as they have the images. You have something "tangible" to fix now and they just love that! You also might ask them if this could be what is causing your bleeding. There are other tests they might want to order such as retrograde urethrogram to get an even better look. 

It's always easier to solve a problem when you find out the cause! So I would view this as good news. Maybe no more fingers up the kazoo then with your Indian PT doc to relax an internal sphincter that may not need relaxing!

Jim

 

My bad, Jim!  Double-tasking often results in TWO tasks done poorly!    

For NV read Nocturnal Voiding!  (Do we even have acronyms for that?).  That would be via catheter...

Point was (I think) that now that I don't allow a buildup of pee, I don't natually void more than a few ccs.  It's almost all done via CIC at this point...

Ok. So what I think what you’re saying is that almost all of your void volume is through the catheter with occasional natural voids (NVs) of less than 50ml? But what has changed is that you are now starting to feel the urge to urinate with lower volumes.That sounds positive and strongly suggests improved bladder tone with more normal nerve function between bladder and brain. 

How large were your natural void volumes when you were carrying around the 500-800cc in your bladder? Are you currently on a smooth muscle relaxant like Flomax or Daily 5mg Cialis? If not, it might be interesting to see if one of them would increase your natural void volume.

Jim

Correct, re what I was trying to say.  Good job of interpreting!     

Natural voids with the large reserve volume were between 50cc and about 200cc.  I was on Avodart and Flomax (or their generics) for a year or so--- and hated the side effects.  Cialis I haven't done.  One drug I don't remember from the Sixties...    I just read up on it (on the Cialis web site) and, gee, the possible side effects sound worse than anything I'm experiencing now!!!    Have you had any experience with the stuff?

Well, I understand that you visual arts types aren't always the most succinct in the written word

The side effects 5mg Daily Cialis aren't that bad and somewhat transient. Just suggesting maybe try it for a few weeks to see what happens with your natural voids.

Meanwhile, you might have gotten into the habit of not focusing much on the NV part and going right to the catheter. Maybe a few minutes of bathroom mediation/relaxation (running water, music and all ) might help. I found yoga body scanning/relaxation techniques helped where I focused on relaxing the bladder sphincter. You should also be pushing out with your detrussors now and then during catherization to simulate the natural void process and thereby keep the detrussors exercised. 

Did the doc ever tell you why the urolift didn't work? Did you decide yet on a second urolift? If the problem was bladder tone the first time, you might have a better result now.

Jim

Well, Jim, let's see...

I hadn't considered the bathroom meditating approach recently, although I did early on (2 years back).  As a yoga practitioner (18 years now), I do get the body scan approach, and will investigate the idea.  All along, I have done the detrussor pushing about a third of the time, sometimes for the exercise, sometimes to check the flow rate (when I'm on the road or otherwise have no access to a calibrated receptacle, I measure flow by time X 10cc to get the rough amount...).

Focusing on the bladder sphincter I just gave the silent commands "relax, relax" as I had been taught to do in the Savasana pose when I studied Sivananda Yoga many years ago. I think it also helps to let the body know what you want it to do. Call it positive thinking, whatever.

For most of my life voiding was often a rushed job with more important things waiting. That's probably one reason so many of us got into this trouble in the first place by either "holding it in" or rushing the process.

The urologists blame it all on the prostate but I think it starts long before our prostate starts to grow with bad voiding habits. A very old school urologist talked to me about this maybe 40 years ago in the context of prostatitis. He didn't mention retention but his belief was that a lot of our urinary problems stem from what he considered incomplete voiding due to habit and culture. Should have taken what he said back then more to heart.

Jim

Holding it in over time weakens the detrusor muscles through hypoxic/reperfusion injury caused by elevated pressures in the bladder. The detrusors lose their elasticity due to collagen fiber formation. Also neurogenic injury occurs in the connective tissue of the bladder wall. And finally the inner epithelial layer of the bladder wall can lose its integrity leading to IC. So all bad things from holding it in as a habit.

In my 30s I use to fly golfers to various resorts in the US. I held it in as normal operating procedure. No doubt I lost bladder function during that time years before my BPH developed. And their is current research showing that BPH may also be caused by holding it in since it results in oxidative stress of the prostate followed by chronic inflammation and auto-immune disease over time. In those days it was a test of our manhood to see how long we could hold it in - how stupid!! Neil

Holy Moly, Neal!  Thanks for the fancy medical/biological terminology, all of which underscores the message:  DON'T FRIGGIN' HOLD IT!  GO AND PEE!   Of course, the cartoonist in me pictures a CHOIR of us Old Farts traveling around to wherever 20-something-year-old guys hang out, to sing parody songs with the important message... Of course, this begs the question: would we have listened and would this generation listen?

Well, it makes sense re talking to our bodies, and the various muscles involved.  

Four years ago I wound up in the hospital with a suspected heart attack.  It turned out not to be one (I've never had one, don't know what they're REALLY like!), but they kept me overnight.  I did the stress test on the tread mill and was rated in the top 4% of guys our age, cardio-health-wise.  I figured out that it was anxiety, and I had had an anxiety attack.

 Embarrassing for someone into yoga, right?  

Instead of going for anti-anxiety meds, I did self-monitoring/body-directing, which worked some.  But recently, anxiety levels went up anyway.  On a hunch, I stopped coffee three days ago.  I was drinking only one 12 oz. mug a day, then switching to one mug of tea, but still...  

And guess what?  Anxiety levels now down near zero!  Who knew?  I may not give up coffee completely (We are coffee lovers here, and even roast our own beans, prepare it with an Aeropress, etc., etc), but I will know the likely effects of drinking the stuff!

I tried yoga classes a while ago to reduce stress. The problem was that by the end of the class I always added 3 or 4 more people to my enemies list!! I jsut focus on following my breathing now to relax -an old Tibetan Buddhist monk taught me this exercise during a 70s protest in Berkely (Haight/Ashbury). It is called Kum Nye relaxation breathing and for some reason it stayed with me all these years.

When at the urinal these days as I count the drops a young guy often takes the stand next to me and shows off with his flow stream. I try to tell them to enjoy their youth and take care of themselves because it is over in an instant. Some listen to me but most think I am an old pervert! I was warned many times in my youth from different old guys in my travels to cherish those years but I never listened and thought I would be young and healthy forever. Maybe it is Nature's way to ensure the youth age along the same path. I wish I had listened then but you know what - I still don't listen! Take care. Neil 

By the time our prostates starting growing our bladders were probably already compromised. There is very contradictory research showing the relationship (or non relationship) between LUTS and BPH (prostate size).

So for argument's sake let's go with the research that shows no relationship. In addition to the study data, my case anecdotally supports this thesis as my LUTS symptons have all but disappeared and yet my bladder size has not changed. The mechanism here is not complicated. A compromised bladder simply doesn't have the muscles to push out urine efficiently when there is some obstruction. A very compromised bladder doesn't have the muscle even without any obstruction. Conversely, a healthy (or rehabilitated bladder in my case) can push through some obstruction and therefore empty properly.

This is not new stuff and yet very little effort has been made research or treatment wise addressing the bladder aspect of the problem. Self cathing, for example, has mostly been relegated as either a "prep" for surgery or as a fail-safe for failed surgeries. 

Th reasons why this is true would make a good study in and of itself but I think we already know some of them are more economic than medical.

Alan 1951 has an interesting and related post on this at the REZUM thread: https://patient.info/forums/discuss/rezum-have-you-had-this-done--499675?page=4#2492225

Jim

 

I think there are 3 main causes of compromised bladder function. One is neurogenic as its primary origin which leads to LUTS irrespective of urethral obstruction. (Neurogenic bladders can also be secondary to PBOO but leave that for now).

A second primary cause of LUTS is reduced blood flow to the bladder wall due to atherosclerosis like hardening of the arteries. This is also independent of PBOO but as well can be secondary to PBOO if it exists.

The third cause of LUTS or a weakening of the bladder function is PBOO due to BPH or urtehral strictures or other obstructions of the bladder neck. If this source of PBOO can be corrected early enough then it may allow the developing LUTS to correct but if it goes on too long then even if the source of the PBOO is removed the LUTS will persist for some time without some effort to rehab the bladder muscles and restore blood flow.

You have shown that by removing your PBOO using CIC, the most atonic of bladders (and hence the worst of LUTS symptoms) can be rehabilitated over time w/o using drugs. You have restored detrusor muscle function, reversed any neurogenic damage and restored blood flow. This should be  a major scientific discovery and lead to major studies but of course it will not because there is no money in it for the drug companies and the uros. That is too badd for the millions of men and women that suffer from this disease and is all the more reason for you to put together a quick Kindle guide for the LUTS sufferer ( or some other format). We have all benefited so greatly from your shared experience but we rare very few in number.

Thanks greatly Jim.

Neil

Neil, The young don't believe they would ever be old 😁. Maybe this is better,

they don't stress...

How come you made enemies by doing yoga? 😊😊😊

Have you already got your IQ catheters?

My uro told me today that my vessel is 100 years old....

Ha,ha...Yes, I know what you mean.  Many years ago, when I was in my late 20's.  I remember standing in line to use the toilet in the mens room at the Kauai Airport.  The guy, that was using the toilet, was taking so long, I kept thinking I know he is not sitting having a bowel movement, so why is he taking so long. I had to go really bad, but at that age, I could hold it.  When the guy was through, doing his business, and immerged from the toilet stall, he had a funny look on his face.  Now, I know why. He probably was suffering from urine retention...had to go but couldn't, so he stood there, like what I do now.  Wisdom, with age.

Hi zdzislaw - sorry for the delay - somehow I missed it. I did get my IQ catheter samples but  will wait to try them until after my biopsy as i don't want to do anything that could start my prostate bleeding again.

I guess my mind wanders too much when I try to meditate and I always seems to end up thinking about people with whom I have disagreements and replaying our arguments! Focusing on my breath just makes me breath faster! I guess I am just Type A all the way!

Take care

Neil

Hi Dennis - that is a funny story - here's another one. A while back I was at a public urinal dribbling away as usual. I heard the guy next to me come in and pee with one-terrific stream. I didn't look up but when I finished he was already washing his hands. I couldn't believe it - he was easily in his 80s! I reflexively blurted out to home "how do you have such a good stream?". He just looked at me like I was some kind of pervert and stormed out of the bathroom!

Hope all is well in yuor island paradise.

Neil

That is one lucky 80 year old!