Self Catherization: Issues and Problems

Hi Hank,

What you describe is standard stricure treatment if you stop short of the bladder sphincter. 

I've also pondered from time to time the actual physical insertion of the catheter and possible widening of my urethra and sphincters played in my rehab as opposed to the decompression of the bladder. I don't have strictures as far as I know so it's just pondering.

My concern would be you might end up instead of a poor man's iTind, with a poor man's bladder neck incision, resulting in possible incontinence and although unlikely, even retro. Remember, there's a reason the sphincter is naturally closed tight and that is so urine won't escape when we don't want it to. 

So, probably OK to do this short of the bladder sphincter although in my case I did quite wel rehab wise just using FR12. But not sure about trying to widen the bladder sphincter itself, I would say do more research and be cautious there.

Jim

Hi Jim - good evening.

My incontinence nurse this week actually suggested i do "urethral dilation" twice a day which consists of inserting the catheter about 10 cm (well short of the bladder ) and then taking it out. I haven't done it as the extra gel lubrication removes all resistance now going in.

As far as getting a good grip, I find that pressing down on the ridge on the green cap of my speedicath  with my right thumb during insertion gives me really good control during the entire insertion process which of course starts off with your dive bomb method and which then goes horizontal half way in and then 45 degrees down while I wait to enter the bladder after which I point straight down. Removal is a breeze with all that extra gel now - I just reverse the process with my thumb over the cap and still on the ridge. That ridge is small but really works for getting  good grip. Take care.

Neil

As long as you're short of the bladder sphincter I don't see a problem as long as the dilation is done gently with progressively larger diameter catheters. I've never done this but have read about injecting the gel into the urethra as opposed to just lubing the catheter. If you google "urojet" for example, you will see the lube available in pre-filled 10ml syringes. However, urojet uses lidocaine, a numbing agent, and my personal opinion is that you don't want to numb the area on a consistent basis because pain can be protective. So, if you could find, or jerry rig something similar, you might try GENTLY injecting surgilube directly into the urethra. For example, when I did sterile irrigation of the urethra I used empty Gly Oxide bottles as a sort of hand pump. With the more viscous gel you might need to go in deeper with a small syringe like the Uroget syringe.

Jim

Hi Jim,

Can you eleborate on how it can lead to bladder neck incision ? Does not incision mean some cutting is involved ? Thanks.

Hank

Thanks Jim - I just squeeze some Surgilube down the top of the catheter holder after I open it part way on the wall. i wait a  minute for the gel to slide down inside the sleeve and coat the catheter. It works so well all the way in and all the way out - as smooth as can be. I checked it under the microscope for compatibility with the hydrophilic coating on the speedicath and the saline and saw that in fact it forms a double water layer along the length of the catheter (since the gel is water soluble) so I get double lubrication. This means that over the 5 minutes or so it takes me to cath the lubrication does not wear off the catheter which helps reduce friction and  makes it so easy. Thanks again for your life-saving help.

Neil

Hank,

A bladder neck incision is a surgical procedure. I was just going with your analogy of iTend. My concern was that if you loosened the bladder sphincter too much there could be the possiblity of incontinence or retro ejaculation. Something at least to run by your doctor as I could be wrong on both parts. However, if you stop short of the bladder sphincter, and just widen the urethra, I don't see any issues other than some trauma if it's not done gently enough.

Jim

That's a very good way to externally lubricate the catheter. but what I noticed when I used external lube was that the lube seemed to sloth off the catheter because of the insertion process itself, ie ended up with a big glob of overflow on the end of my penis. And while I've never tried it, the advantage of injecting the gel into the urethra I imagine is that it will be there waiting. But whatever works, works. 

Jim

Hi Jim - I find that too if I insert the catheter right after applying the extra gel at the top of the one-third open catheter sleeve. But if I wait a minute then the extra gel slides done the sleeve and "melts" into the slaine solution since it is water soluble. Then when I pull out the catheter slowly from the sleeve I get a nice thick uniform lubrication layer that adheres to the hydrophilic coating on the plastic surface of the catheter. It seems to last a long time (over 5 minutes) which was my original problem with just the hydrophilic layer which dried out after a minute or two, My continence nurse says they are made for people for cath quickly like all you guys!

Neil

I forgot to mention that this morning at 6 am I had a NV of 300ml and then started my cath. But when I got in only maybe 10cm I felt the urge to pee again and sure enough the pee came out all around the catheter into the measuring bowl. There was an additional 250 ml though I got no where near the bladder! I took out the catheter and started over with a new one and got into the bladder with some difficulty but surprisingly there was only 50ml of pee in the bladder. There was no blood this time.

I guess I was double voiding through the catheter? Next time I should wait before doing the catheter right away? I had cathed at midnight and took out 250ml right after a NV of 250ml. But at 3 am I awoke with the urge to pee but was so tired I held it in and went back to sleep to 6 am - big mistake! Do you agree with this assessment?

Also 2 days ago I had an ejaculation that was a deep brown in color. Can I assume this was old blood in the prostate from the bleeding episode I had 2 weeks ago? I haven't tried it since from fear - silly I know.

Take care

Neil

When I used the red rubber catheters, On my non-dominant hand, wearing surgical gloves, I would put a big glob of gel between the thumb and forefinger. I would then run the catheter through the glob as I fed it in with my dominant hand. This made sure the entire catheter received gel at least when it starts to go in. But in theory, injecting the gel into the urethra would be the best guarantee that the catheter is lubed all the way in. 

Jim

Hi Jim, I don't know why i get the urge to pee almost every 3 hours.

I don't think it's a good idea to hold of,but if i don't i would be doing 7 caths a day!

Does this sound right. i don't drink that much fluids.I have always had a frequency,even before retention,i don't get this Jim,what do you think it is?

thanks jim

 

Hi Frank,

If it makes you feel better, I don't see any harm cathing 7 times a day versus 6. Just keep a log of your void volumes. 

Jim

Frank, it could be that, unlike so many of us here, you have a bladder that is NOT distended, ergo, it wants to empty sooner than later.  And I second Jim

's suggestion: keep a cath log, or at least pee into a calibrated beaker, dedicated measuring cup, what-have-you, so you know how much you are voiding.  150-300cc is normal; much more or less should be noted!

Hi Jim,Thanks for that reply.Sometimes my cic void is 650 ml,i know you said it should be 400ml or less to rehabilitate the bladder.This amount is not always,mostly under 400 ml. I guess i'm on the right track.I will be doing urodynamics test Jan 25,if all goes well i believe GL will be next.

This retention is getting to me?

Thanks JIm,

Hi, cartoonman, i cannot pee without doing cic. I don't know what causes

a 650 ml or 550ml  at times,not always. I guess the amount of liquids you consume throughout the day matter? I'm not sure about this?

 

Frank, there's an easy formula:  liquids in = liquids out (minus a little for "processing)!  So yes, amount of liquids consumed DO matter!  :-)

That said, my body has its own "mind" at times:  I can NOT drink for a few hours before bed, cath right before bed time, and four hours later awaken, needing to drain 400cc.  Caveat emptor!  :-)  And yes I measure, even during those late-night cath sessions...

Also: if you are cathing out 550-650cc, I would also encourage you to up the frequency, as well as to start "listening to your body" for subtle signs of discomfort "down there," indicating that it's time to drain.  My GOOD Uro-doc was concerned that my 5-6 X per day was too much (He worried about UTIs.), so I cut back to 3 X per day, and wound up with cahting 500-800cc at a time.  I switched back a few months ago to JimJames's World Famous Bladder Rehab Method ("not sold in stores; available only on TV...", started listening for body signals, and am now alerted at as low as 200cc, but usually 300cc for "time to void."

Hi,6 x a day is tops with cathing,however i find it difficult to hold even at 6 x a day. I wish i could do NV,but i can't.How do keep from cathing 6 times a day?

 

Hi, so do I measure even in the wee small hours of the morning. I believe

you should drink at least 5 ,8ox glasses of liquid per day, don't you?

Maybe thats to much ,i don't know?I wish i could find an answer to cath just 4 times a day,that would be great.Do you take cialis?

Hi Frank,

I'm not taking any meds at the moment; I didn't like the side effects of the two I was taking a year ago when I had the Urolift (Avodart and Flomax) and my doc said go ahead and stop taking them.  Cialis has been talked about here recently, and I may try it.  Maybe.  

I don't mind CIC, so it's not an issue for me.  I have, or had, a badly distended bladder, and when I was cahing three times a day, I wound up cathing way too much 800-1000cc sometimes!  For me, rehabbing the bladder is most important, therefore, getting the amount I cath down is what I'm looking for, therefore, it's whatever it takes, which is 5-6 times a day.