Self-cathing (CIC) and Urinary tract-urethral Inflammation

Hi Jim - Do NSAIDs in general interfere with natural voids or is it just Advil? Why is that so? I've been taking a prescription NSAID called Torodal for the past 24 hours which is much stronger than Advil. It has reduced the inflammation and my NVs are up to 100ml but is that working against natural voids? Prednisone is a steroidal anti-inflammatory which really works well for me but too much is a serious problem.

My catheter is the Speedicath 14fr hydrophilic coude. Thanks. Howard

The literature suggests antihistamines and decongestants are bad for bph, but with NSAIDs it's mixed. Some say they are beneficial for their anti-inflammatory effect, and some suggest an increased risk of retention. So I guess it's trial and error, but if you're going to use them then it's important to track what they are doing in terms of retention.

Jim

When I awake in the morning I usually have about 600ml in my bladder and cannot NV right away. But as I go about my activities I can NV about 4 times with each NV about 100ml over the course of an hour without any pushing. So then I am left with my usual 200ml residual.

My question is this: is it better to just CIC right away when I awake or is it better to let the bladder muscles get some exercise by NVing those amounts over the first hour?

Thanks Jim. Howard

Very good question. First, what you describe is normal. Movement/activity can make a NV easier. As to which approach is better -- empty completely with CIC or multiple NVs -- it depends on what you are trying to accomplish.

If your goal is bladder rehabilitation over the long term, I suggest starting with a period of maximum decompression of the bladder which generally means CIC 6x/day. That's what I did. During this period you want your total bladder volume (CIC volume plus any NV preceding it) to be under 400ml. This keeps your bladder from stretching and gives it time to heal and recover from years of abuse.

Later on, you may be able to decrease frequency, and then start "testing" things. I started a thread on this called the "on/off" strategy, however I don't recommend this in the beginning.

As to bladder muscles getting "exercise", I found they were adequately exercised during my natural voids and during period I didn't have a natural void I would "push out" gently during part of the cath process (maybe every other CIC) to simulate the NV process and therefore to stimulate the detrussor muscles.

In my case it took a couple of years before I saw significant results. As mentioned I started self cathing 6x/day with a very stretched and dysfunctional bladder. IPSS score was in the "severe" range. Today I self cath only a few times a week, and my IPSS score is in the "mild" range.

While my results are the most dramatic posted to this discussion group so far, others here have made significant progress with their bladder function through a program of self catherization.

Jim

On re-reading my post, above, I guess I forgot to directly answer your question. As long as you're self cathing, regardless of strategy or goals, in your case I would CIC on awakening as opposed to the process you describe. In fact, if you had to pick only two times to CIC, in general that would be before bed and first thing in the morning. Of course, much better IMO to set your schedule by total bladder volume (keep it under 400ml) which generally translates into 6x/day for someone with no or very little NVs. And btw nothing wrong with keeping total volumes even lower than 400ml, what you want to try and avoid is keeping them higher although sometimes they are bound to creep up a bit, especially the first morning cath.

Jim

Thanks Jim. I guess since I still have some inflammation it would better to CIC first thing in the am. Last night I self-cathed  before bedat 11pm and took out 400ml with an NV 0f 100ml prior to it. Then I was awakened at my usual 2 am in extreme agony and took out 600ml with no NV. Then I slept to 7am and awoke in great discomfort. But instead of a CIC I went about my activities and NVd about 100ml every 30 minutes until 11pm. Then I did CIC and took out 350ml w/o trying a prior NV.

So I think I will follow your advice here at least till the swelling is gone and CIC first thing in the am. I do have lots of NVs during the day again at about 100 to 150ml so still below my normal of 200 to 250ml. I'm doing 4 CICs a day whereas I as doing 2 a day before I got this irritation. Thank goodness I can do CIC - what a blessing relatively speaking and I owe it all to you. Thanks again for being there for us. Howard

Thanks pluff mud! I've tried 3 different lubes but they don't seem to make a difference for me. I do like the Coloplast 14fr coude's as they have just the right flex for me. The 12s are too soft to get through my prostate.

Just curious - are 4 CICs a day sufficient for you with no NV to keep your bladder empty? What are your volumes when you CIC? Thanks. Howard

My bladder got distended. I was only voiding a small amount on a frequent basis and retaining 1.5 liters. I don't measure the volume on a regular basis, but usually void between  400 - 600 ml overnight and 300 - 400 each time during the day. Although I sometimes feel the urge and try, I haven't had a natural void since I started CIC last summer. 

I use a straight tip latex or soft plastic catheter. The latex in 18 fr and the plastic in 16 fr.  Coloplast makes a soft plastic catheter that is more flexible than the standard one. My preferred lube is Dyna Lube.

You might consider increasing your frequency to 6x/day. That would lower your bladder volumes, compressing it more and possibly speed up a rehabilitation process. Four years ago, I was also retaining 1.5L with small, infrequent voids and now my bladder functions fairly normal with CIC only required a few times a week. I started 6x/day and sometimes even more.

Jim

You might be able to solve the bunching problem by guiding the catheter with your CLEAN fingers touching the hose part closer to the penis, as opposed to only touching the funnel. I've been doing this since the start, no UTI whatsoever. Hank