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Thread: Intermittent Cathing but not emptying

  1. #1

    Intermittent Cathing but not emptying

    I am back to CIC after having the foley in for over a year and still having a lot of leakage. Anticholinergics don't seem to be helping (Trospium). I know I have urethral damage from popping two balloons out over the course of that year and a half so there is that. However, something I am noticing after being back to CIC for a couple of months is that while my volumes of collection have increased I don't think I am completely emptying my bladder with each cath. When I insert the catheter I get a strong flow of about 100cc's then the flow stops abruptly. If I press firmly against my bladder and/or tighten my abs while the catheter is still in, I will get a couple more strong spurts flowing out of the catheter. At the end of the cathing, the catheter itself is still full of urine, it's never empty when done cathing. I have no idea how this could occur. Is there a possibility my bladder is flaccid and there are 'pockets' now?? If I gently move the tip of the catheter around while still inserted it seems I am tapping into new pockets of urine or something. I'm frustrated because although I am cathing from 100-150 cc's each cath, sometimes 200 if I'm lucky, I will leak literally minutes afterward. This is how I have surmised that I am not emptying completely. I'm in a tough spot currently as I had to fire my urologist for an extreme lack of care and guidance and I cannot get in to see my new urologist for another month. I know it's going to be an emotional appt as I have to address urethral damage and possible strategies to correct things (which has me terrified). I would just like to get some ideas in my head before seeing the new dr. Any feedback is greatly appreciated.

  2. #2
    It is possible that you may have bladder "pockets" (diverticuli). Either a good quality ultrasound of your bladder, or a cystoscopy would be needed to determine if that is the case.

    Are you holding the catheter securely in place as the urine is draining? If it slips out a little so that the eye is inside the urethra, it cannot drain the bladder fully.

    In addition, it is a good idea to do some Crede and straining at the end of the catheterization before removing the catheter to be sure everything is actually drained. Also put your finger over the end of the catheter, or fold it back to prevent any urine left inside the catheter from draining back into the bladder as you remove the catheter.

    It is likely you will need to have urodynamics done to determine if your bladder has actually significantly decreased in capacity. A year with an indwelling catheter can certainly do that, and the shrinkage may not be reversable. It is also possible that your bladder is having more spasms and higher pressures. If that cannot be corrected with medications, then Botox may need to be considered. Last resort would be a major surgery such as a clamshell bladder augmentation.

    Have you been on other or additional anticholenergic medications?

    (KLD)
    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.

  3. #3
    I am having urodynamics and cysto both done with the new urologist. Yes, I am definitely holding the catheter in place securely. I have been doing crede, which is actually what I meant when I said I was firmly pressing against my bladder. I have used crede in the past but only while urinating seated on the toilet (I typically only cath from chair, never on toilet). When I crede at the end of cathing, that is where I am noticing extra spurts of urine. I have had issues with urine remaining in the catheter for many years and have always pinched it before pulling it out. My last urologist, however, said I should never do that. But when I do it is not to stop the natural drainage but only to avoid it retreating back into my bladder, as you described. Maybe she misunderstood. I have tried Trospium once last year for a month but I was on the foley at the time and my urologist said if I hadn't had results then it wasn't working (we were trying to treat leakage around the foley). A few years ago I tried Ditropan but didn't have success there either. That was years before I ever had a foley though. Botox is on my list of discussion for the new doctor. I've never heard of diverticuli in the bladder but it makes sense. I suffered two bad sepsis UTIs in the past two years and multiple symptomatic UTIs as well, all while having the foley in. Is it possible repeat UTIs of severity can cause the diverticuli?
    Last edited by oncetherwasagirl; 05-28-2018 at 03:24 PM.

  4. #4
    Senior Member lynnifer's Avatar
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    I switched to a foley from crede/valsalva in 2009. It's amazing how fast the bladder shrinks. It will be interesting to see what the bladder exam reveals. Sorry you're going through this. Paralysis + female short urethra = suckage big time.
    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
    Quote Originally Posted by lynnifer View Post
    I switched to a foley from crede/valsalva in 2009. It's amazing how fast the bladder shrinks. It will be interesting to see what the bladder exam reveals. Sorry you're going through this. Paralysis + female short urethra = suckage big time.
    Yes, it does suck! I miss the days when my para life was not more difficult than, "Oh damn, it's raining and I don't want to get my hair wet" while getting out of the car lol. I'm super nervous about what my treatment options will be as I do NOT want another surgery. SupraP is not something I want in my life either. Trying to remain positive and hopeful. Thanks for your sympathies, it means a lot. :-)

  6. #6
    Senior Member lynnifer's Avatar
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    Quote Originally Posted by oncetherwasagirl View Post
    Yes, it does suck! I miss the days when my para life was not more difficult than, "Oh damn, it's raining and I don't want to get my hair wet" while getting out of the car lol.
    You can say that again! I had it so good for so long.
    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

  7. #7
    Quote Originally Posted by lynnifer View Post
    You can say that again! I had it so good for so long.
    Here, here!! My quad girlfriend is always saying "We were 'Push Girls' when being a Push Girl wasn't cool"!

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