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  1. #1

    urine management problem

    Hi all,

    please help!

    I am new paraplegic T4 and this is my question. I had an accident 2 months ago and stayed in the hospital a month and still in a nursing home. 3 weeks ago I started intermitenet catheterization every 6 hours and was working good. since yesterday i couldn't hold my urine anymore and it just comes out whenever by itself every hour or so... what do you think is the problem (change)? is it normal? does this means I couldn't self catheterize any longer? what should i do? also my left leg looks swollen? if anyone has simililar experince pls let me know. thank you.
    Last edited by Martha01; 10-05-2012 at 02:01 PM.

  2. #2
    Do you think you could have a urinary tract infection? Any symptoms like cloudy urine, strong odor to the urine, fever, malaise, pain, any blood in the urine? Are you reusing catheters?

    There is also the possibility of bladder stones. Symptoms you might be aware of are blood in your urine, cloudy or abnormally dark-colored urine. The other common symptoms of stones you may not be able to sense are lower abdominal pain, painful urination, frequent urination, especially during the night, difficulty urinating or interruption of urine flow.

    Your may be experiencing bladder spasms that could be controlled to some extent by taking anticholinergic medications like Oxybutynin.

    I don't think the swelling in your leg has any connection to the issues you are having with your bladder and intermittent catheterization. However, the swelling may have something to do with the accident you had weeks ago.

    Can you request an appointment with a urologist to address the bladder problems and another physician to look at the swelling in your legs?

    All the best,
    GJ

  3. #3
    Moderator jody's Avatar
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    I get that with urinary tract infection, but maybe a uti is causing bladder spasms too. It may take a while to figure out what kind of bladder bowel program is going to work for you.

    Its probably uti though.

  4. #4
    Did you not go through an acute inpatient rehabilitation program?? Just to a nursing home? Are you cathing yourself or are the nurses doing it?

    Do you have any signs and symptoms of UTI other than leakage? Cloudy, foul smelling urine? Blood in your urine? Flank pain? Fever/Chills? Severe malaise?

    Have you seen a urologist since your injury? Have you had urodynamics? At your level of injury, it is very likely that your bladder has evolved into a spastic (upper motor neuron) bladder and that this is due to your resolving spinal shock (do you also now have new leg spasticity? Anal sphincter tone you did not have before??). This allows your bladder to be unstable, meaning that it contracts and squeezes out urine whenever it wants to, often at very small volumns.

    First, you should be cathing more often. Every 4 hours is best, and never allowing your bladder to get more than 450 cc. in it at any time. Secondly, you need to have tests to rule out a UTI (culture & sensitivity, C&S) and treat anything found. Third, you need to have urodynamics done (CMG = cystometrogram with a sphincter EMG). Based on that, you most likely need to be taking an anticholenergic medication to allow your bladder to relax and hold more, and to keep your bladder pressures in the safe range (less than 40 cm. H2O). These meds include Ditropan, Detrol, Vesicare, etc.

    As far as your leg, are you still taking medications to prevent DVT (deep vein thrombosis)? These should normally be continued for at least 3 months post injury. Do you have a vena cava (IVC) filter? Is the leg still swollen first thing in the AM when you have had your legs up at night? You need to have a test (Doppler) for deep vein thrombosis (DVT). This is a potentially dangerous complication that is common in people post-SCI, esp. in the first 3 months, but with continuing risks for life. Ask your doctor about this right away.

    Please come back and let us know how things are going. We can help.

    (KLD)

  5. #5
    Moderator jody's Avatar
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    p.s sorry about your accident, and welcome to care cure.

  6. #6
    thank you for fast reply all. Yes, my urine is cloudy, but no other uti symptoms as far as i know. I don't reuse cathether and I'm in somehow sterile environment now. So I don't know what could happen when I go home. I have spasms which i feel it into my stomach and it could also be a problem and the doctor in the facility doesn't know that much about sci. Yes, i could request an appointment to see urologist, but it takes time. Anyway, I have to wait.... thanks again.



  7. #7
    It may take time to get an appointment with the urologist and get set up for a urodynamics study, but the on call physician should be able to order a urinalysis (UA)/Culture and Sensitivity (C&S) of a urine specimen to determine if you have a urinary tract infection and start treatment with the appropriate antibiotic. Urinary tract infections in people with neurogenic bladders need to be treated with a 10 -14 day course of the most effective antibiotics (as determined by the culture and sensitivity lab test). Typically in the able bodied population a 7 day course of antibiotics is prescribed. When the infection has cleared up and you have finished the antibiotics, wait for 3-4 days and repeat the UA and C&S.

    All the best,
    GJ

  8. #8
    Thank you for replying SCI Nurse, and all. To answer your questions:

    I had a fracture on my left wrist and had surgery. That is why i stayed in the nursing home which has a small rehab center to recover. I'll will be gooing to the acute rehab next week. I cathing myself every 6 hrs with little help from the nurses. I think my injury level is t6/t7, sorry, for the wrong information that I typed t4.

    I had couldly urine yesterday and I also felt chill briefly, other than that no other uti symptoms. I have not seen urologist so far, but I talked to the Dr. here and he ordered unrine test (I don't know the specific test).
    Yes, I have leg spasticity recently, specially, when I go to bed after long stay on the wheelchair. Regarding cathing, when i started self cathing I used to have upto 1000cc and sometimes 800/700 cc and it was every 6 hrs. Currently, the volume has decreased to 500/400 range. Do you think the high output caused the contenence or UTI?
    Regarding the DVT the Dr. ordered Levenox(?) till I would be checked (ultrasound) after Colombus Weekend. Do you think that is OK? I'm to all this and am confused. I really thank you for your help. By the way, I have never taken any medicin for DVT after the accident. thanks again.

  9. #9
    Quote Originally Posted by Martha01 View Post
    Regarding cathing, when i started self cathing I used to have upto 1000cc and sometimes 800/700 cc and it was every 6 hrs. Currently, the volume has decreased to 500/400 range. Do you think the high output caused the contenence or UTI?
    Cathing volumes of 700cc, 800cc, 1000cc are way too high. You need to balance your "I" (input) and "O" (output). If you are cathing high volumes of urine (greater than 400-500cc every 4-6 hours) you need to restrict how much liquid you intake between caths.

    A basic concept of intermittent catheterization is to keep the bladder flushed out every 4-6 hours to prevent over distention of the bladder. Retaining large amounts of urine in the bladder can cause reflux of urine back up the ureters into the kidneys depending on bladder pressures (this is why the urodynamics studies are so important). This can cause permanent damage to the kidneys and ureters. Retaining urine in the bladder for longer than the 4-6 hour period can cause the bladder to become an incubator of bacteria that can cause urinary tract infections (UTIs).

    Most people who manage their bladder with intermittent catheterization have bladder spasms that can be controlled with anticholinergic drugs:
    oxybutynin, Enablex, Toviaz, Ditropan, Gelnique, Oxytrol, Vesicare, Detrol, Sanctura. These medicines act to relax the bladder and decrease leakage and urgency of urination from bladder spasms.

    At this website (the National Spinal Cord Injury Association), http://www.spinalcord.org/resource-c...kb.page&id=249, you will find a number of references to publications about intermittent catheterization. Hope you find them helpful.

    All the best,
    GJ

  10. #10
    thank you GJ for the reply. at first, I didn't know i have to limit my input, but now i have some idea and i try to balance my input. the problem is i don't if the damage if already done and what's gonna happen?

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