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Thread: Bladder Disconfort

  1. #1
    Senior Member mike's Avatar
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    Bladder Disconfort

    I am a C5 quad with a neurogenic bladder. After my injury my urination was pretty normal. Recently I have had trouble starting and have had a feeling of urgency periodically through the day and the problem has interrupted my sleep at night. I have had prostate exams, urodynamics and bladder exams which have all turned up normal. I was advised to take Oxybutin to reduce spasms which it did for a while until the dose wore off. Higher doses of Oxybutin would cause me to need a catheter all the time and I would like to avoid this if I can. Any ideas or suggestions would be appreciated.
    mike

  2. #2
    How many years post injury? How often do you cath? How much volume do you get when you do cath?

    Any chance of urinary tract infection?

    If you are cathing a lot and have low volumes and you have had all the urinary tract exams and everything checks out okay, you may be experiencing what many experience with the neurogenic bladder and that is inexplicable change with time. Frequent cathing is disruptive to your quality of life and sleep. I would suggest that you speak with your urologist about a supra pubic catheter (SPC). You can search this website for many threads on the SPC.

    All the best,
    GJ

  3. #3
    Senior Member mike's Avatar
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    I had my injury 11 years ago. I have had this problem about a year. I have taken Oxybutin once a day at night and when I wake in the morning I might have as much a 400cc. By the end of the day, when I cath a night, I have no more then 100cc as I am able to go on my on reasonable well. I do not have a urinary tract infection. The last time I saw my urologist he had no suggestions. I will mention a supra pubic catheter to him and see what he says. Since I have very little residual when not taking Oxybutin, less then 100ccs, I would almost prefer dealing with the disconfort then working with a supra pubic catheter.
    mike

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    Senior Member lynnifer's Avatar
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    Do your feet/legs swell during the day? I only ask because I wonder if your lower limbs are draining at night when horizontal?

    Apparently as paralytics, a hormone called vasodesmopression doesn't work to slow down urination at night - I *believe* I read that here some years ago.
    Roses are red. Tacos are enjoyable. Don't blame immigrants, because you're unemployable.

    T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

  5. #5
    Mike, I am a little confused. When you say your urodynamics are "normal", what does this mean? If you have a true neurogenic bladder and do not actually have voluntary control over urination, then urodynamics would not be normal. What is your actual voiding pressure (PdetMax) on your urodynamics study?

    I assume that when you say you void that you actually are reflex voiding. Have you been wearing an external, or do you get enough warning that you are going to leak that you can get a urinal in place? Do you tap/trigger or Crede?

    Have you been tested for interstitial cystitis?

    (KLD)

  6. #6
    Senior Member mike's Avatar
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    Bladder disconfort

    Thanks for your response. I have had numerous urodynamics since my injury 11 years ago. The last one being in May of this year. All of them have been normal according to my urologist. I had been able to void during the test. My problem is starting, but by waiting a minute or two, I am able to get started. I have not found it necessary to force to void or use any unnatural means. I can't find my report on the urodynamics, but I will look for it should you need the pressure numbers.

    I have had a weaker stream and a growing problem starting for over a year now, perhaps longer. Also a need to get up four or five time while I am sleeping. After I wake up I sometimes experience soreness before voiding in the sphincter area, but it goes away after I void. My urologist suggested I take one 5mg Vesicare tablet each day to reduce the urgency to go. I have been taking these tablets for about five days before bedtime, and they have helped me sleep better, but I wake up very uncomfortable and sore, needing to void and requiring the catheter to do so. I usually void between 3-4 hundred ccs. Throughout the day my ability to normally void returns and when I cath before bedtime the amount voided is less the 100ccs. I was tested for nterstitial cystitis about two years ago, but if you think it necessary, I will retest. Thanks for your help
    mike

  7. #7
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    IC is painful and lots of urologists don't believe it is a legitimate condition. The bladder is raw or looks raw on the inside if you look at it on a scope (I have LOL)

    Have you tried other drugs?

    Mine is just painful and I have not found a fix (23 years). Reflex voiding has aged my bladder though according to my urologist and all my urodynamics/pressures are okay also. I also leave less than 50cc's when I void. I have never cathed. My bladder is very spastic and has been since my accident.
    T12-L2; Burst fracture L1: Incomplete walking with AFO's and cane since 1989

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  8. #8
    Mike, not to belabor the point, but you cannot have "normal" urodynamics if you have a neurogenic bladder. Normal urodynamics would be found only in someone who has true voluntary control, stability (ie, never any spasms), normal capacity and low pressures, as well as the ability to control the external sphincter voluntarily.

    Many men who void by reflex find that with time the bladder decompensates and no longer can empty effectively (or at all). Voiding with high pressures also often causes bladder trabeculation (thickening) which makes this worse. Have you had a sphincterotomy? Do you have an enlarged prostate (BPH)? Sphincterotomy, in theory, will reduce outlet resistance for the bladder and help with more complete emptying, but not if the bladder has decompensated. If this should occur, then other bladder management methods may be required...either intermittent cath or use of an indwelling catheter. Urodynamics is the best way to determine the condition of your bladder and sphincters as far as their neurologic functioning.

    (KLD)

  9. #9
    Senior Member mike's Avatar
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    Sorry for the confusion. I know that a neurogenic bladder is not a normal bladder. My urologist has me periodically do urodynamics to determine bladder capacity and bladder pressures. His concern is if the pressure increases it could lead to kidney problems. Both the capacity and pressures have checked out okay based on my last test in May. Also the residual has been low, under 100ccs. I void normally, however it is slow starting and with a weak stream and I do have spasms with a need to go frequently. My problem now is that the urgency and disconfort has increased and my urologist has suggested Vasicare to deal with the problem, but this medicine forces me to cath in order to fully empty out. I am just concerned that the condition has worsened and is there another way to deal with the problem beside Vasicare or Oxybutin. Is it common for a neurogenic bladder to worsen over time?
    mike

  10. #10
    Quote Originally Posted by mike View Post
    Is it common for a neurogenic bladder to worsen over time?
    Absolutely!!!

    I am 29 years post injury, C6/7 complete. When I was first injured and for almost 18 years, I wore an external catheter. This worked well, until things began to change and my bladder would not empty as much as it once did. I had residual urine that was too high, and I was in jeopardy of urine reflux and at risk for frequent urinary tract infections.

    I had to begin intermittent catheterization (CIC). That worked well for about 10 years, although I found CIC extremely disruptive to my daily activities and sleep at night. As my bladder began to change it would not hold very much urine before I began to have bladder spasms that would cause me to cath. Even with high doses of Oxybutinin, my bladder was only holding 150 to 250cc of urine between catheterization. I tried bladder Botox. Botox worked the first couple of times it was used and lasted about 6-8 months each time. Then with the 3rd and 4th administration of Botox, I got no significant therapeutic effect. Cathing every 2 hours became a real problem for my daily activities and sleep. I then began using an indwelling foley catheter, but started having frequent urinary tract infections over a year's time.

    I consulted with several urologists. The only thing left for the management of my bladder were invasive bladder procedures. I selected the most simple of options, the supra pubic catheter (SPC). I am very satisfied with the SPC and really only wish I had done it sooner.

    But, as you can see the neurogenic bladder does change over time and alternatives to management of the bladder must be considered.

    All the best,
    GJ

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