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Thread: Incontinet/UTI

  1. #1

    Incontinet/UTI

    I am T-4 and I intermitten cath for the past 30 years. I have been feeling like I have to pee when I get a 200-250cc of urine in my bladder at work. I try not to roll around when I feel this way as it makes me feel like I am going to go. If I don't move around a lot I can hold 400cc but begin to dribble urine. I have been getting no other symptoms of a UTI. Normally I take 1 - 5mg oxybutin tablet a day. The last couple of days I took 4 - 5mg tablets a day to see what this would do. I did not feel like I had to pee when taking the increased dose. Yesterday I dropped back to 1 - 5mg pill in the morning and 1- 5mg pill in the evening. Last night I was incontinent in bed so I took another oxybutunin tablet and made it the rest of the night without being incontinent.

    Not sure if I have a UTI but in the past all my UTI symptoms were back pain, head aches, fever, chills, incontinent so this feels different and than any other UTI have had. I have been on Bactrim 1 tablet a day for the past 30 years. My urologist prescribed that and wanted me to stay on it. Wondering if Bactrim even works anymore or if I have become immune to it after this much time. I have never had a urodynamic test. I have always cleaned my catheters and reused them since my health insurance will not pay for new catheters. I cath 6 times a day.

    I had a physical on 7/5/16. They tested my urine. Wasn't having issues at the time. Bacteria results said 1+. Not sure what that means or any of the results.

    I plan to take up nother urine sample to see if I have a UTI. I am curious to understand the urine test results. Are there certain parts that I should be looking at to help me understand if I have UTI? Will someone who intermitten caths always show up with bacteria in the urine sample? Could something else be causing the incontinence like stones?
    Last edited by Mike_Stan; 07-30-2016 at 09:09 AM.

  2. #2
    mike your urine will always show some bacteria in it as most people who use maths are colonized. so unless you are symptomatic they usually won't treat it. it does sound like you may have something starting and a urine sample will tell you what if anything other then your colonized urine is. i suggest you get in with your urologist and ask him what is going on. you may very well need your oxybutunin increased but he will be able to tell you that more than we can.
    T6 Incomplete due to a Spinal cord infarction July 2009

  3. #3
    After thirty years of intermittent catheterization, you bladder has gone through changes. When was the last time you had a urodynamics study?

    Botox may be an option to help calm the bladder spasms (if, of course you don't have a bladder infection or stones or other issues). See your urologist for a complete workup.

    All the best,
    GJ

  4. #4
    The OP says he has never had urodynamics, which is very concerning since there is no way to know how high your bladder pressures may be now (and no history of what your past pressures were). You should be having these done every 1-2 years; more often if there are problems such as frequent UTIs, AD, or leakage.

    A daily Bactrim is most likely going to result any actual UTIs you get (with the fever, chills, flank pain, etc.) to have bacteria highly resistant to Bactrim. It is absolutely necessary that if you do develop a true UTI that you have a full urine C&S (culture and sensitivity) done to determine which antibiotic is right. Your 1+ results suggest that you only had a UA (urinalysis) during your physical, or worse yet, just a dip-stick check.

    We strongly recommend a full range of annual tests for your urinary tract annually. Many things can change with no symptoms. This includes the following:


    • UA
    • C&S
    • 24 hour urine collection for creatinine clearance (must be combined with a blood test)
    • Ultra sound of your entire urinary tract (to look for stones, strictures, hydronephrosis, kidney size, etc.)
    • Urodynamics with cystometrogram (CMG) and sphincter EMG
    • Prostate exam and PSA for men over 40 years old
    • Other tests as indicated by signs or symptoms, or the results of the tests above.


    It is likely you need to be taking more antichoenergic medication. Dosage should be based on both things like leakage, but also on the results of urodynamics. I would not recommend your trying to adjust it blind on your own. Many people need 30 mg. of Ditropan daily, but there are also other newer drugs on the market.

    I would encourage you to download this clinical practice guideline on urinary management after SCI and insist that your urologist and primary care physician read it and follow these evidence-based guidelines.
    http://www.pva.org/site/apps/ka/ec/p...oductID=883860

    Have you appealed the limit of 6 catheters monthly by your insurance? Medicare allows 180 per month (I suspect you are not on Medicare because you are working??). You would need a supportive urologist to help you file such an appeal.

    It does not sound like your urologist is an expert in neurologic urology; you may want to seek out a new one.

    (KLD)

  5. #5
    I don't think any of the urologists in my town are experts in neurologic urology(of course they all probably think they are since they deal with stroke patients). I would probably have to go 3 hours away for that.

    Appealing with my insurance was a waste of time. They said the manual states it does not cover catheters. Not sure what good health insurance if they don't cover the things you need. Obama said no one could be denied coverage yet once covered they deny you what they will cover. Just another way go get your money.

    Had a colonoscopy in Nov 2016 and they said prostate looked ok then.

    My incontinence seemed to stop for 10 days just by increasing my dosage of oxybutynin. I dropped backed down to regular dose of 1 tablet per day and was ok for about 10 days. Now I am incontinent again and increasing the dose to see if I can it to stop again. If this was a full blown UTI I wouldn't think that increasing my dose of oxybutynin without an antibiotic would stop the incontinence would it? I am thinking if increasing the oxybutynin stops the incontinence again that it must be something other than a UTI. I am scheduled to get an ultrasound to look for stones and to take up a urine sample. Is an ultrasound the the best method to look for stones or is an xray better? Sometimes I think they see some bacteria in the bladder and they think it must be a UTI.

    I may need to schedule the Urodynamics test but will wait to see how these others tests come back first.
    Last edited by Mike_Stan; 08-13-2016 at 10:44 AM.

  6. #6
    I wouldn't think if you had a UTI you would stop it with increasing oxyb. Sounds like something else might be going on. Get things checked out. Not sure if stones are found better with ultra sound or xray. As far as appealing your health insurance they are going to cover only what their plan states that is covered. Appealing won't work.

  7. #7
    You should talk to your urologist about increasing your Ditropan. You can take up to 30 mgs. daily, but you still need to have urodynamics done. Ultrasound is fine for looking for stones as long as your kidneys, ureters, and bladder are included.

    (KLD)

  8. #8
    Has anyone experienced a racing heart when increasing the oxybutynin? I seem to get that feeling.

  9. #9
    This is why you should not be adjusting your meds without consulting you physician. You may need to change the anticholenergic you are using.

    (KLD)

  10. #10
    It said on the bottle I could take up to 3 times daily.

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