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Thread: Bladder routine question

  1. #1

    Bladder routine question

    I'm a c6-7 complete quad, 8 years post. I drink about 70 oz (2070 mL) of fluid per day. 36 oz of water, 10 oz of coffee, 24 oz of soda. I wear a binder & ted hose.

    My bladder can only hold 300 mL as max. Often I'll leak even at 250 mL. I cath 8-9 times per 24 hrs, which includes 1 hour after laying down for the night, then 4 hours later. But I still leak every night.

    I also have recurring UTI, probably from high bladder volumes that cause AD and leakage at night. I already cath 8-9 times a day.

    I'm not sure what I should do. Is intermittent cathing just not feasible for me? I'd hate to get an SP and get permanent kidney shrinkage. Should I drink less fluid? Tips?

  2. #2
    Quote Originally Posted by Nowhere Man View Post
    I'm a c6-7 complete quad, 8 years post. I drink about 70 oz (2070 mL) of fluid per day. 36 oz of water, 10 oz of coffee, 24 oz of soda. I wear a binder & ted hose.

    My bladder can only hold 300 mL as max. Often I'll leak even at 250 mL. I cath 8-9 times per 24 hrs, which includes 1 hour after laying down for the night, then 4 hours later. But I still leak every night.

    I also have recurring UTI, probably from high bladder volumes that cause AD and leakage at night. I already cath 8-9 times a day.

    I'm not sure what I should do. Is intermittent cathing just not feasible for me? I'd hate to get an SP and get permanent kidney shrinkage. Should I drink less fluid? Tips?
    When you are on an intermittent catheterization program, you do have to be a little careful what you drink and when you drink. If the soda and coffee are caffeinated, the caffeine can be a mild diuretic and cause you to need to empty your bladder more often. Cut out the soda. Unless it is sugar free, you don't probably need the calories. If it is sugar free, you probably don't need the chemicals.

    Do you take an anticholinergic medication like oxybutynin? These medications can reduce premature bladder spasm and you may be able to hold more urine.

    Have you considered Botox injections. For some, these injections work much like anticholinergics. These injections are done by your urologist. He injects about 200 units by making a number of injections in the bladder wall. The procedure lasts about 6-9 months and needs to be repeated.

    Your kidneys won't shrink from having a supra pubic catheter. However, you bladder most likely will. You probably need to take low dose anticholinergics with a supra pubic catheter.

    Eight to nine caths a day is a lot. When did you last have urodynamics studies? Your urologist will be able to evaluate what type of bladder management is best for you from the results of the studies.

  3. #3
    I also wonder about what bladder meds / anti-cholinergics you are taking, and what your last urodynamic test looked like.

    That is a brutal schedule. You spend half of your day cathing, and have a rough night sleep to be interrupted twice. This is unsustainable, but I think you know that.

    What does your urologist say? What meds have you tried? How are your bladder pressures?

    My Dad caths during the day, and puts a foley in every night so he doesn't have to get up and cath. If he had to cath 8-9 times a day, and he had failed to improve on all of the meds/botox injections, I would probably encourage him to get a foley/suprapubic. But he's 75.

  4. #4
    anticholinergic medication make my shoulder hurt like hell. And I have tried them all. Why doctor tried BOTOX injections. First time worked ok and no leaking. Second time my shoulder hurt me from April this year till just now. Had 3 UTI to. With the UTI and the Botox making me so tired all the time there went my summer. About 3 hours of being up I could not keep my eyes open. Never do that again. Urologist and me need to come up with another plan. UTI really hard for me to take care of myself. Gets worse it seems as I get older. Seems like after all the years they could at least fix this problem first for us all.
    Art

  5. #5
    Quote Originally Posted by gjnl View Post
    Do you take an anticholinergic medication like oxybutynin?
    Dementia is a common side-effect and it's not even listed on the drug warning.

  6. #6
    Try Mirgabetron (Myrbetriz) it is not an anticholinergic.
    I would cut down some on the fluids a bit.
    CWO
    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.

  7. #7
    Quote Originally Posted by Art454 View Post
    anticholinergic medication make my shoulder hurt like hell. And I have tried them all. Why doctor tried BOTOX injections. First time worked ok and no leaking. Second time my shoulder hurt me from April this year till just now. Had 3 UTI to. With the UTI and the Botox making me so tired all the time there went my summer. About 3 hours of being up I could not keep my eyes open. Never do that again. Urologist and me need to come up with another plan. UTI really hard for me to take care of myself. Gets worse it seems as I get older. Seems like after all the years they could at least fix this problem first for us all.
    If I am interpreting your comments correctly, you are under the impression that bladder botox is another type of the drug classification, anticholinergics. Actually the botox injections are a paralytic agent.

    An Anticholinergic agent is a substance that blocks the neurotransmitter acetylcholine in the central and the peripheral nervous system. Anticholinergics inhibit parasympathetic nerve impulses by selectively blocking the binding of the neurotransmitter acetylcholine to its receptor in nerve cells.

    Botox (Botulinum A toxin) is a powerful drug that acts to temporarily paralyze muscles when it is locally injected.
    Maybe something else was going on with your shoulders, but these two drugs don't work the same in the body.

    Drugs like oxybutybin, commonly used for bladder spasms/overactive bladder aren't the only anticholinergic medications we are exposed to. It is amazing the list of drugs that have anticholinergic effects in the body and we are exposed to them in prescription and over the counter medications. Here is a list (not all inclusive) of common drugs that have anticholinergic (AC) activity (https://www.peoplespharmacy.com/2017...ergic-drugs/):

    • Amitriptyline (Elavil) [high AC activity]
    • Atropine [high AC activity]
    • Benztropine (Cogentin) [high AC activity]
    • Chlorpheniramine (Actifed, Allergy & Congestion Relief, Chlor-Trimeton, Codeprex, Efidac-24Chlorpheniramine, etc.) [high AC activity]
    • Chlorpromazine (Thorazine) [high AC activity]
    • Clomipramine (Anafranil) [high AC activity]
    • Clozapine (Clozaril) [high AC activity]
    • Cyclobenzaprine (Amrix, Fexmid, Flexeril) [moderate AC activity]
    • Cyproheptadine (Periactin) [moderate AC activity]
    • Desipramine (Norpramin) [high AC activity]
    • Dexchlorpheniramine (Polaramine) [high AC activity]
    • Dicyclomine (Bentyl) [high AC activity]
    • Diphenhydramine (Advil PM, Aleve PM, Bayer PM, Benadryl, Excedrin PM, Nytol, Simply Sleep, Sominex, Tylenol PM, Unisom, etc.) [high AC activity]
    • Doxepin (Adapin, Silenor, Sinequan) [high AC activity]
    • Fesoterodine (Toviaz) [moderate to high AC activity]
    • Hydroxyzine (Atarax, Vistaril) [high AC activity]
    • Hyoscyamine (Anaspaz, Levbid, Levsin, Levsinex, NuLev) [high AC activity]
    • Imipramine (Tofranil) [high AC activity]
    • Meclizine (Antivert, Bonine) [high AC activity]
    • Mepenzolate (Cantil) [high AC activity]
    • Nortriptyline (Pamelor) [high AC activity]
    • Olanzapine (Zyprexa) [high AC activity]
    • Orphenadrine (Norflex) [high AC activity]
    • Oxybutynin (Ditropan, Oxytrol) [high AC activity]
    • Paroxetine (Brisdelle, Paxil) [low AC activity]
    • Perphenazine (Trilafon) [high AC activity]
    • Prochlorperazine (Compazine) [moderate AC activity]
    • Promethazine (Phenergan) [high AC activity]
    • Protriptyline (Vivactil) [high AC activity]
    • Pseudoephedrine HCl/Triprolidine HCl (Aprodine) [moderate to high AC activity]
    • Scopolamine (Transderm Scop) [high AC activity]
    • Thioridazine (Mellaril) [high AC activity]
    • Tolterodine (Detrol) [high AC activity]
    • Trifluoperazine (Stelazine) [high AC activity]
    • Trimipramine (Surmontil) [high AC activity]


    For additional lists, see:
    https://www.theseniorlist.com/list-of-anticholinergic-drugs/
    http://prescribersletter.therapeutic...3860&dd=271223
    http://www.empr.com/clinical-charts/...rticle/123667/
    http://www.medicaldaily.com/common-o...heimers-319392






  8. #8
    I take Vesicare 10mg a day. I've had urodynamics done within the last year. He just said what I already knew, that I leak at 275-300 mL. He recommended botox but I hear its effects lessen over time.

    The problem is that my urine is produced at night, after laying down.

    I drink 70 oz per day. I guess I could try 60 oz

  9. #9
    Quote Originally Posted by Nowhere Man View Post
    I take Vesicare 10mg a day. I've had urodynamics done within the last year. He just said what I already knew, that I leak at 275-300 mL. He recommended botox but I hear its effects lessen over time.

    The problem is that my urine is produced at night, after laying down.

    I drink 70 oz per day. I guess I could try 60 oz
    And perhaps drink earlier in the day rather than later, before you go to bed.

    When I started to need to cath as frequently as you, my urologist suggested alternative ways to manage my bladder, the least invasive and big surgery was the supra pubic.

  10. #10
    Senior Member pfcs49's Avatar
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    Is the cause for so much fluid uptake dry mouth from bladder meds?

    If so, there are some alternatives to lessen dry mouth.
    69yo male T12 complete since 1995
    NW NJ

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