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Thread: How to tell if you have a UTI...no symptoms?

  1. #1

    How to tell if you have a UTI...no symptoms?

    Let me be more specific. T6 complete. I cathed 5 times a day for years while on oxybutinin and botox, but got tired of the side effects and botox stopped being effective. I recently switched to using a leg bag/condom catheter full time and cath twice a day (every 12 hours). When I cath it's for less than 100ml, so most of the urine gets pushed out to the leg bag on its own.

    I just had my yearly wellness exam and was told I have a UTI (after getting cultures back). I didn't have any symptoms that stood out which is the reason for this post. My urine is occasionally cloudy even when I don't have a UTI, so that wasn't a give away. I can't go by more frequent leaking like I could in the past since I'm using a leg bag now. I have severe chronic nerve pain 24/7 so I have no way of knowing if any of it is from a UTI. The only other symptom I've had in the past is the smell of the urine changing with a UTI, but I haven't noticed that this time.

    1. So how do I tell in the future if I need to get checked for a UTI?
    2. Is wearing a leg bag full time and cathing less frequently make me more prone to getting them?
    3. Would cathing more frequently help, or is it creating more opportunities to get an infection?
    4. Does urine staying pooled in the tip of the condom catheter due to the dump in my chair make things worse? If so what's a solution?

    Any advice would be appreciated.

  2. #2
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    Quote Originally Posted by Brad09 View Post
    Let me be more specific. T6 complete. I cathed 5 times a day for years while on oxybutinin and botox, but got tired of the side effects and botox stopped being effective. I recently switched to using a leg bag/condom catheter full time and cath twice a day (every 12 hours). When I cath it's for less than 100ml, so most of the urine gets pushed out to the leg bag on its own.

    I just had my yearly wellness exam and was told I have a UTI (after getting cultures back). I didn't have any symptoms that stood out which is the reason for this post. My urine is occasionally cloudy even when I don't have a UTI, so that wasn't a give away. I can't go by more frequent leaking like I could in the past since I'm using a leg bag now. I have severe chronic nerve pain 24/7 so I have no way of knowing if any of it is from a UTI. The only other symptom I've had in the past is the smell of the urine changing with a UTI, but I haven't noticed that this time.

    1. So how do I tell in the future if I need to get checked for a UTI?
    2. Is wearing a leg bag full time and cathing less frequently make me more prone to getting them?
    3. Would cathing more frequently help, or is it creating more opportunities to get an infection?
    4. Does urine staying pooled in the tip of the condom catheter due to the dump in my chair make things worse? If so what's a solution?

    Any advice would be appreciated.
    My guess is your health care provider is not familiar with the difference between colonization and a urinary tract infection. Your urine test indicated there was bacteria in the urine, but did anyone take a look at the number of CFU or Colony Forming Units which indicates the number of viable bacteria in the urine. For counts up to 10,000 CFU the specimen is considered normal. For counts between 10,000 to 100,000 CFU it is considered indeterminate in the normal population, but in the spinal cord injured population counts in that range may definitely be considered a urinary tract infection if there are symptom, fever, cloudy urine, urine with an odor, urine with blood in it, general malaise (just feeling listless, tired, out of sorts), some may have flank (upper abdomen, back, side) pain, frequent urination) autonomic symptoms of chills, high blood pressure. For counts 100,000 CFU and above, it would be considered a urinary tract infection for any population. Does your urine test indicate the CFU in the specimen?

    Did you only have a urinalysis (UA) or did you have a culture & sensitivity (C&S) test too?

    Have you had a urodynamics study recently to know your residual urine and bladder pressure?

    It is important to remind your health care provider that as some one with a spinal cord injury who manages their bladder with a condom catheter and intermittent catheterization that you will be colonized, but colonization doesn't necessarily equal a urinary tract infection. Your provider should always order a C&S when ever a UA is ordered. The C&S test grows cultures of bacteria and subjects the cultures to antibiotics to test for sensitivity.

    Your provider should also be aware that any infection you have is to be considered a complex urinary tract infection (treated with determined antibiotics for 10-14 days and then follow up UA and C&S a few days after the course of antibiotics has been finished) and may have to be treated when the provider may not treat others of his patients. That said, there should be symptoms, as detailed above, present before starting antibiotic treatment.

    Are you removing the external catheter before intermittent catheterization or are you catching through the external catheter? Are you using a new intermittent catheter every time you cath?
    Last edited by gjnl; 09-19-2018 at 07:04 PM.

  3. #3
    I agree with what gjnl said above.

    Was this physician your primary care physician, or your urologist? You should be seeing, ideally, a neurologic urologist who knows the issues around SCI urinary management, and have a check-up annually with them. If you have not had urodynamics in the last 2 years, you need to have them repeated.

    Cathing more often actually will decrease, not increase your risks for UTI, especially if you have high bladder pressures.

    Condom catheters in and of themselves don't cause UTIs, except if you are voiding with high pressures, or you wear the same condom catheter more than 24 hours. Urine does not leak back up the urethra from the condom in males...the urethra is too long.

    (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.

  4. #4
    Thanks for the responses. I remove the condom catheter to intermittent cath, and always use a new intermittent catheter each time. This was done at my general physicians office and was caught during my yearly wellness exam. Normally I go to my urologist if I think I have a UTI. I just looked at the results of the culture test and it says:

    >=100,000 CFU/ml
    Heavy growth Escherichia coli

    They gave me 7 days worth of cipro. It's been a few years since I have had urodynamics done, so I will get that set up soon. I do use the same condom catheter for 2-3 days since they are still sticky enough to stay on and are expensive out of pocket. I didn't know you weren't supposed to use them more than 24 hours. If I clean my leg bag everyday, why can't the condom catheter be re-used over 24 hours if it's not necessary to replace the tubing or connectors daily?

  5. #5
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    Quote Originally Posted by Brad09 View Post
    Thanks for the responses. I remove the condom catheter to intermittent cath, and always use a new intermittent catheter each time. This was done at my general physicians office and was caught during my yearly wellness exam. Normally I go to my urologist if I think I have a UTI. I just looked at the results of the culture test and it says:

    >=100,000 CFU/ml
    Heavy growth Escherichia coli

    They gave me 7 days worth of cipro. It's been a few years since I have had urodynamics done, so I will get that set up soon. I do use the same condom catheter for 2-3 days since they are still sticky enough to stay on and are expensive out of pocket. I didn't know you weren't supposed to use them more than 24 hours. If I clean my leg bag everyday, why can't the condom catheter be re-used over 24 hours if it's not necessary to replace the tubing or connectors daily?
    It doesn't sound like a culture & sensitivity (C&S) test was done. Automatically prescribing Cipro and only 7 days isn't the way to go for complex urinary tract infections in people with spinal cord injuries. If you have already started taking Cipro, I'd continue the course, but meanwhile, I would contact my urologist, tell him about the infection found during your visit to your primary care physician and request an order for another urinalysis (UA) and C&S to be done 2-3 days after you finish the Cipro course. In this way you will know if the E. coli bacteria is gone or if there are bacteria lingering and if you should take another course of an appropriate antibiotic for a longer course.

  6. #6
    Quote Originally Posted by Brad09 View Post

    I do use the same condom catheter for 2-3 days since they are still sticky enough to stay on and are expensive out of pocket. I didn't know you weren't supposed to use them more than 24 hours. If I clean my leg bag everyday, why can't the condom catheter be re-used over 24 hours if it's not necessary to replace the tubing or connectors daily?
    I'm a little confused. You say you remove the condom catheter and clean your whole penis skin before cathing, then replace the same condom catheter and use the same one for 2-3 days? Or are you cathing with the condom catheter still in place through the condom catheter opening? Neither is recommended.

    Numerous studies show a significant increase in true UTIs in those who leave a condom catheter in place for over 24 hours, and in addition, checking for skin breakdown can be a problem and not caught until it is quite advanced. Odor may also be a problem.

    (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.

  7. #7
    Quote Originally Posted by gjnl View Post
    It doesn't sound like a culture & sensitivity (C&S) test was done. Automatically prescribing Cipro and only 7 days isn't the way to go for complex urinary tract infections in people with spinal cord injuries. If you have already started taking Cipro, I'd continue the course, but meanwhile, I would contact my urologist, tell him about the infection found during your visit to your primary care physician and request an order for another urinalysis (UA) and C&S to be done 2-3 days after you finish the Cipro course. In this way you will know if the E. coli bacteria is gone or if there are bacteria lingering and if you should take another course of an appropriate antibiotic for a longer course.
    Thanks I will have it checked after finishing the antibiotics. I scheduled the urodynamics this morning as well.

    Quote Originally Posted by SCI-Nurse View Post
    I'm a little confused. You say you remove the condom catheter and clean your whole penis skin before cathing, then replace the same condom catheter and use the same one for 2-3 days? Or are you cathing with the condom catheter still in place through the condom catheter opening? Neither is recommended.

    Numerous studies show a significant increase in true UTIs in those who leave a condom catheter in place for over 24 hours, and in addition, checking for skin breakdown can be a problem and not caught until it is quite advanced. Odor may also be a problem.

    (KLD)
    Sorry for the confusion, I take the condom catheter off, intermittent cath, then put the condom catheter back on. I'm only intermittent cathing to keep residual urine from sitting in my bladder 24/7. I'm just using the condom catheter to catch what leaks between intermittent caths and since it's external I didn't think it mattered if it was reused. The condom catheter is essentially the same after I cath as it is before, so I'm not sure why it would need to be changed so soon. I would obviously never re-use an intermittent catheter since it goes into my bladder. I guess that's what I get for assuming, so are you saying I need to use a new condom catheter everytime I take it off?

  8. #8
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    Quote Originally Posted by Brad09 View Post
    Sorry for the confusion, I take the condom catheter off, intermittent cath, then put the condom catheter back on. I'm only intermittent cathing to keep residual urine from sitting in my bladder 24/7. I'm just using the condom catheter to catch what leaks between intermittent caths and since it's external I didn't think it mattered if it was reused. The condom catheter is essentially the same after I cath as it is before, so I'm not sure why it would need to be changed so soon. I would obviously never re-use an intermittent catheter since it goes into my bladder. I guess that's what I get for assuming, so are you saying I need to use a new condom catheter everytime I take it off?
    I understand the concept of removing residual urine in the bladder, but I've always thought that changing the external catheter twice a day to do intermittent catheterization is 1. expensive and 2. a good deal of wear and tear on the skin of the penis. When I wore condom catheters, 100 years ago , when the first self adhesive external catheters became available, it was a struggle keeping the skin healthy and intact, changing every 24 hours (I didn't have residual at that time) let alone thinking of removing and reapplying it every 12 hours, skin prep always used. But, I understand...what are your options if you leak in between even 4-6 hour spaced catheterizations when anticholinergics have unwanted, intolerable side effects and Botox no longer works. Cathing more frequently than ever 4 hours is a pain, leaking is not an option, then you go to a supra pubic like I finally did and don't look back... for me it was an excellent option.

  9. #9
    Question, how did they collect the sample? I hope clean cath sample not from bag
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  10. #10
    Quote Originally Posted by fuentejps View Post
    Question, how did they collect the sample? I hope clean cath sample not from bag
    clean cath

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