problem with my bladder

[Steve]

Hi,
Anyone who had that problem before who can help me? I have so much trouble to empty my bladder when I m siting. I perspire a lot when it s time to pee and almost nothing goes out. I m c4 complete and I use external catheter (freedom condom).
I take Cardura (4mg/day) since 2 years to help my bladder problem but it doesn t work much now.
Thanks

Steve

[Max]

Did you check for bladder stones?

I had similar problem with internal catheter, somehow when we
sit up stones tend to block uretra??

[Max]

Do you do regular bladder irrigations?

First with Solution G & then with sodium cloride solution

[Steve]

Hi Max,
I m waiting for x-ray result.
...regular bladder irrigations...never did that, never heard about that. Interesting, I will check with my doctor.
Thx a lot

Steve

[Steve]

Do I have to see a doctor for bladder irrigations or I can do it at home?

[Jeff]

Are you saying that your bladder empties much better while lying down? That is strange, I've never heard of it before.

I wonder if your prostate could be slightly enlarged or maybe Max has a good suggestion about stones in the bladder.

I'd see a urologist right away. If you're not emptying properly that could be a big problem.

~See you at the SCIWire-used-to-be-paralyzed Reunion http://www.stopstart.fsnet.co.uk/smilie/wavey.gif ~

[Max]

think bladder irrigations are for those with permanent/indwelling catheters...
But I may be wrong? SCi-nurse we need you

I think bladder stones could be checked without X-rays, by
usual cystocopy. Urologist goes with small camera inside your uretra & bladder...Usually they get stones out of bladder with help of electricity,
very univasive method. I somehow trust to handle my stones problem more to English hospitals like Royal Victoria, M General & Jewish Genaral hospitals,

It is much worse if stone is in kidney, then they do x-ray...If stone is small they do ultrasound, if big they able to get it with laser & small incision..

I live in Montreal & the best Dr. in my opinion, for stones & bladder cystoscopy is
Dr. La Plant from Montreal General hospital, since he dedicated his life working with sci people...He knows our stone problems like nobody in Quebec.

I advise you to check for stones regularly once in 8-12 month.

Since even small one can block urine way out of kidney--in worse scenario one may loose kidney...

Fortunately because of regular check up Dr La Plant sptted my kidney stones on time....

Hope this helps

[Max]

You can do regular bladder either by yourself or ask your caregiver
at home...It is very uncomplicated

[Steve]

Thanks Max and Jeff,
I ll check with my urologist.
Later for more infos.

[Max]

You are 100%.
Everyone with our "problem" & some without regular sex/ejaculation should
check prostate for enlargement regularly

[crags]

Difficulty voiding when sitting is not unusual as I learned, and personally experienced. Try searching for the post at newmobility.com. The sweating is not a good sign and could indicative that you are hyperreflexic when voiding. You should get a blood pressure cuff and get your normal bp, then as you start to void, try to take it at the point of voiding and then see how long it takes to return to normal. You could be having a real problem requiring intervention.

[alan]

I sweat some when I void (sitting or laying), but the BP doesn't go beyond about 150/100.

[SCI-Nurse]

Steve - The problems you are having are not normal. The symptoms that you describe that occur when you are trying to void while sitting are indicative of AD. There are persons who do become dysreflexic when their bladder becomes full; one of my former patients had symptoms abate as soon as he voided while the other was/is managed with a suprapubic catheter to help overcome the severe AD that occurs with a full bladder.

In addition to the AD that you are experiencing, there is real concern about the increased pressure in your bladder when it is full and you are unable to void, or void only a small amount. Increased bladder pressures will result in reflux or a backup of urine into the ureters; this can, over time, be harmful to the health of your kidneys as well.

I would urge you to find a urologist with SCI expertise for an assessment and evaluation. If you have not had a urological workup done within the past year, it is time for that to be scheduled. You should keep a journal of your symptoms so that you can give a clear description to the physician. It will be important that you have a physical exam, as well, in which your prostate, scrotum and testicles are examined. Many men who are SCI never have a physical examination of their genital organs, because there is not an examining table that lowers to facilitate transfers. CRF

[Steve]

Thanks SCI-nurse,
I ll see my urologist thursday... Is it dangerous to wait til that day?

*one question: What does AD mean?

[TD]

Originally posted by Steve:

Thanks SCI-nurse,
*one question: What does AD mean?

Autonomic Dysreflexia/Hyperreflexia (AD) - This is a condition that affects anyone with a SCI above the T6 level. You should access the Paralyzed Veterans of America (PVA) Website ( www.pva.org (http://www.pva.org) ) for a comprehensive explanation of this condition. In layman's terms, it is a scrambling of the impulses to the brain from the body which can result in several things the most dangerous being a heart attack or stroke. If you go here: http://www.pva.org/NEWPVASITE/publications/cpg_pubs/AutoDys.htm you can learn all about it and even download a printable copy of the guide to take to your doctor.

"And so it begins."

[SCI-Nurse]

Steve - I am glad that you have an appointment within a few days. In the meantime, is your voiding on any particular schedule? Do you use a power chair? Can you assume more of a reclining position when you need to void? I realize this may not be possible but may offer a reasonable alternative until you have your appointment. The other option would be to use an indwelling catheter for these next several days or do intermittent catheterization when you are in your chair.

TD - Thanks for that reference to the Consumer Guidelines re: autonomic dysreflexia (AD) on the PVA site. These are excellent guidelines; if one choses to purchase the hard copy (888-860-7244), it is accompanied by a wallet card. The latter includes the symptoms and directions for immediate management. If the source of AD is not identified and corrected, this can very quickly progress to a serious medical emergency. Since you have a C4 quad, complete injury, it really is important that you are familiar about the condition and have information with you re: this risk factor. Whenever you seek medical care, it is important to take written explanation of AD with you. The majority of health personnel, including ER staffs, are unfamiliar with this condition if they are not knowledgeable about SCI.

Our nervous system is incredibly complex; it is divided into several subsystems. The central nervous system is composed of the brain and spinal cord while the peripheral nervous system includes the nerve pathways that branch out from the central system. The peripheral nervous system includes the autonomic n. system which controls body functions that are not usually affected by conscious thought.

Signals are triggered when there is an irritating/noxious stimulus below the level of the injury. A message travels up the cord until it gets blocked at the point of the injury; this response is accompanied by a constriction of blood vessels, resulting in an elevation of the blood pressure. At the same time, the brain is able to indirectly respond to the signals and activates the part of the n. system that should moderate and control the rising BP. Abdominal vessels are dilated and the heart rate is slowed, but due to the disruption in the spinal nerve tracts and therefore the transmission of signals within the cord, the blood pressure continues to rise. In essence, the nervous system is confused and out of balance. The complex of symptoms results in autonomic dysreflexia and the potential for a situation quickly becoming a medical emergency.

Symptoms that accompany AD, in addition to an elevated BP and slow pulse, include a pounding headache, heavy sweating, goose bumps, flushed or reddened skin, blurry vision or seeing spots, a stuffy nose, anxiety or jitters, tightness in chest. Causes of AD include bladder, bowel, skin problems, ingrown toenail, bunions, broken bone and other irritating problems. The most immediate action, in addition to finding and alleviating the noxious stimulus, is to remain sitting or elevate the head of the bed until the BP stabilizes. CRF

[Steve]

4 more days to wait...
I will empty my bladder with the help of my girlfriend til thursday.
I feel very good when I do that.
I ll keep you informed after the visit.

Thank again

Steve

[This message was edited by Steve on Aug 18, 2002 at 07:56 PM.]

[Steve]

Hi,
I finally found the reason of my bladder problem. It was because of my position on the whelchair. I was seating too straight (almost 85degree).
Now I pee like never before:)
If someone meet that problem, check your position ...

*I hope my english is good enough for you:)

[Steve]

It wasn t the position on my wheelchair http://sci.rutgers.edu/forum/images/smilies/frown.gif(
I still have problem to empty when I m seating. During the night, everything is ok.
My urologist talked about possible sphyncter cut (yeuurrrkkk). He s not really sure of my problem, I don t trust him. I want to know first if I can try something else to help my problem.
If someone can help me, I would apreciate a lot.

Thx
Steve

[SCI-Nurse]

This is not a common problem, but we do see it occasionally. Some men have problems with voiding when sitting due to compression of the urethra by the pubic bone when sitting. This occures after a lot of atrophy in the buttocks primarily (we have never seen it in a man with a "big butt"). One of our urologists describes it as having a "regular straw" urethra rather than a "flex straw" urethra, and when sitting the urethra is compressed. The only way to confirm this is to do a sitting urethrogram using the same exact posture (and ideally the same cushion) as in your wheelchair.

We have found that a combination of a custom cushion that decreases perineal pressure (behind the scrotum on men), as well as use of either transferring to bed and laying down to void, or (esp. for those with higher injuries) a reclining wheelchair (without tilt-in-space, as the hips need to be straightened) can help for some. A sphincterotomy generally does not help this problem. The only other alternative may be a suprapubic indwelling catheter.

(KLD)

[Steve]

Thanks SCI-nurse,

I ll talk about it to my urologist.

I also noticed that when I m sleeping on the back, my bladder doesn t work very well(and I perspire), but on the left or right side, no problem at all. If anyone else had that problem before, don t hesitate to give me your comments.

Thx

Steve