Voiding-Question for Nurse, SMOKEY (from his previous reply)

[Susan]

Smokey, your disability history is very similar to my husbands. He was put on med's to paralyze his voiding so then he could self cath throughout the day because of high pressures and UTI's. The medication was giving him dysreflexia so he said ---- it! And went back to his same ol same ol. But, now with this continuous sweating and more UTI's I think he's going to have to make a change after 22 years. Can you tell us your routine, what kind of caths you use, how well the cathing works for you- being a quad C6-7 like my husband, the med's your on to stay dry in between, and any affects from the med's and the over all process. My husband works 8 hours a day. I don't know how well this cathing throughout the day will work out for him. He's just starting up with a new urologist because of being on a HMO now through work. The Doctor has just given him a low dose antibiotic for UTI's maintanence. Although he is still sweating, and the high pressures haven't been addressed yet. I don't think the doctor has dealt with SCI before - which is frustrating because he can't go to his regular doctor's he's had for years when he was on medi/medi.

[SCI-Nurse]

The meds usually used to both reduce bladder pressure and keep a person dry between their caths on CIC include Ditropan, Detrol (both available in regular and extended release versions) and sometimes the addition of a low dose tricyclic antidepressant such as imipramine. If he has not had recent urodyanmics he should have these done ASAP as here is no way to know what his pressures and bladder capacity are without these. It can be difficult to get back on CIC after such a long time of using an external. It make take a while for his bladder to be able to hold much urine without getting AD, so cathing more often may be necessary at first. If this does not improve, then he may need to consider a surgical procedure such as a bladder augmentation.

Most people drink about 2400-3000 cc. daily, mostly in the AM and afternoon, then cut out fluids after dinner to reduce urine output at night. Most people I work with cath 5-6 times daily....usually every 4 hours during the day and are able to go 6 hours at night. I have many clients at this level of injury who work full time and cath at work. With practice is does not take much longer than going to the bathroom when you are AB. I usually recommend the use of a plastic catheter at this level (it gives better control) and cathing in the chair can be learned fairly easily for men (easiest to learn in bed first though). Many people find that this is easist if they either connect a piece of extention tubing to the catheter to drain directly to the toilet, or hook on a leg bag. This makes it easier to cath without risking getting urine on clothing.

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(KLD)

[alan]

I do most of my drinking in the evening (6 - 11), as that's when I have an attendant here to bring me drinks. I usually release 1300 cc or more during the night.

[SCI-Nurse]

Alan, as we had discussed before, you probably need to drink more fluids since you do not do CIC. There are ways to have fluids available to you throughout the day if you need them, even without an attendant.

With CIC, you need to limit your fluids in the evening or you will have to cath in the middle of the night.

(KLD)

[smokey]

Urologist put me on 5mg. of Ditropan XL to reduce bladder spasticity, I could probably use a little more as my bladder still contracts a little when I have to void (400cc.) but not enough to leak urine. I use ordinary red rubber catheters, 14 french from Bard or Dover. I drink about 72 oz. of water each day and catheterize perhaps 3-4 times a day. At night, when I go to bed, I insert a catheter and tape it to my extraordinarily large penis to keep it from pulling out, secure it to my thigh with a Dale catheter strap, and hook it up to a night-bedside drainage bag. At night, I drink as much as I want. Take a dump in the morning, take the catheter out before I shower and I'm good for 5 hours or so then catheterize as needed. I have no side effects from Ditropan. I do need to pick my spots for cathing since I can't just drain a leg bag anywhere anymore-I do need privacy.

[gjnl]

Alan, as we had discussed before, you probably need to drink more fluids since you do not do CIC. There are ways to have fluids available to you throughout the day if you need them, even without an attendant.

With CIC, you need to limit your fluids in the evening or you will have to cath in the middle of the night.

(KLD)

When I was managing my bladder with clean intermittent catheterization, I would restrict fluid intake after dinner, but because of edema in my lower extremities draining at night, I had to cath up to 3 times during a night, which is one of the problems that drove me to the suprapubic catheter.

All the best,
GJ