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Thread: Mitrofanoff leaking after having a Foley for 6 months

  1. #1

    Mitrofanoff leaking after having a Foley for 6 months

    SCI nurse,
    I have a C5/6 SCI with a neurogenic bladder and I have a Mitrofanoff stoma but I did not have a bladder augmentation surgery.

    I am currently having a problem with my bladder. I was in the hospital last year which included having a feeding tube and a Foley catheter through my Mitrofanoff stoma. After I came home I was still using a feeding tube and because of that I still needed to have a Foley due to all the water that was being flushed through my system, so I had the Foley in my Mitrofanoff stoma for 6 or 7 months.

    I normally use a size 12 French catheter in my stoma, but the Foley was actually a size 14 French. After having it there for so long we noticed there was a change and the stoma looked larger or more open than it previously had. After taking the Foley catheter out I have been having a lot of problems with urine leaking out through my stoma.

    I am not sure if it is possible that my bladder shrunk a little bit during the time with a Foley catheter, but I have been on Detrol since my SCI and they added an Oxytrol patch when I was in the hospital. I was under the impression that these medications help your bladder not shrink, and I have always had very good bladder capacity with up to 500cc's in my bladder during testing.

    Possibly part of the problem is that for some reason I am not producing much urine in the morning and afternoon, and then after we drain my bladder at 5:30 or 6:00 PM I have another 400cc's around 8 o'clock. My body is not used to having 400cc's of urine at that time of the day so I will start spasming, get autonomic dysreflexia, and then urine will leak out of my stoma. The schedule that I've used since rehab 20 years ago is to drain my bladder at around 5:30 PM and then don't drain it again until about 10 or 10:30 PM.

    I am at my wits end here because I cannot figure out how to stop the urine leaking and it is a huge problem. I have not been out of the house much since I was in the hospital and I am scared that I will not be able to be out of the house in the evening without having to worry about my bladder filling up and leaking.

    I have always rationed the amount of fluid that I drink. I have an exact drinking schedule that I have been using since I got paralyzed (with slight changes) and we have not made any changes to it lately. The only difference is that I had the Foley catheter in and I was having a ton of extra water flushed through my system because of the feeding tube.

    I have thought about changing my drink schedule, but on some days it would be hard to move some of my drinks to an earlier time. It seems like as much as I drink in the morning and afternoon, my body is just not producing much urine until later in the day. I have also thought about drinking less water, but I know that that is not usually a good idea. I was wondering if you had any ideas about anything that I could try or any information about anything that you have come across in your experience. I have been paralyzed now for almost 20 years, but I have never had this problem before so I am kind of at a loss as to what to do.

    Thanks for your help. I really appreciate any assistance you can give me. Thank you, Melissa
    Life is a lesson you learn when you're through.

  2. #2
    That is a long time to have a Foley in. How long has it been out? The bladder muscle does contract to a very small size when on a foley and could take quite a while to regain its elasticity. Interesting that you had a Foley through the stoma rather than the urethra. Whenever I had that I had very poor drainage in that the urine did not flow uphill from the bladder (which I have augmented) and resulted in a permanent pool in the bladder. Also, I'm not sure if the Foley even reached into the original bladder proper after going down through the conduit, then the augment, and then finally, at the deepest point, into the original bladder. If you are not all the way down at the bottom, you are just skimming off the top layer, so to speak, possibly leaving a volume which is causing a bladder muscle contraction and leaking.

    I don't know your schedule, but I would start by cathing more frequently and noting the volumes, keeping a log of volume in and volume out. If ample recovery time has occurred you may wish to try Botox.

    I know you may not want to hear this, but to go through the operation for the mitrofanoff stoma, but without the enlargement through augmentation, is to perhaps have problems in the future, especially given that you are a quad. I am a C6 quad, 30 years post, 15 years post augment/stoma, and I have daily leakage issues.

    You may wish to try oxybutynin (Ditropan) instillation (5 mg/30 mL saline) to see if it dampens things down. If it does, that will provide information that overactivity is the main reason for the leakage.

  3. #3
    I would recommend returning to an urologist to get the stoma opening repaired. Yes it is possible for the size of the bladder to change with an indwelling in place for such a long time. It would be wise to also get an bladder urodynamics to look at the pressures inside your bladder and capacity

    pbr
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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