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Thread: Sudden Change in Bladder

  1. #1

    Sudden Change in Bladder

    Background
    My husband is 2.5 years post C3/4 incomplete (able to walk, limited endurance). Up until 2 or 3 months ago he had the urge to urinate every 1-2 hours. He was voiding on his own, but not completely emptying his bladder. It was horrible, he was tied to the bathroom, constant accidents etc. We found a urologist that specializes in neuro, had a urodynamics study repeated and then we found a combination of meds (Ditropan XL PM and Imipramine BID AM, PM) that allowed him to cath every 4-6 hours, accident free and our life changed. After not venturing out of the house in all this time except for therapy, he had just begun last week to go out. We went to a movie for the first time, and yesterday to the mall.

    Now I am worried. Over the last 3 days he has had a couple of accidents. He seems to be having to cath more frequently, and last night he was up every two hours to cath.

    Now to me this sounds like UTI. But... no fever, no sickness, no bad smell in his urine.

    He did fall around the same time. Other things is he got a blood clot and is back on Coumadin, but that was a few weeks ago. Otherwise no changes. Im worried the meds might be losing effectiveness. I fear returning to that awful schedule and it will certainly crush his attempt to find a new life for himself. He is having a difficult time adjusting, and this is just one setback we didn't need. Anyone have any ideas?

    thanks...

  2. #2
    There are a bunch of issues that could pertain here.

    This could be a urinary tract infection. The resurgence of incontinence is a symptom that deserves attention.

    Bladders do change over time, so this could also be just something that is happening and his bladder regimen may need to be changed.

    As to the night time cathing, able-bodied people have a pulse of a hormone called "anti-diuretic hormone" (also ADH or vasopressin) around bedtime that keeps them from making a lot of urine at night. People with spinal cord injury often lack this pulse and so pee more at night. There is an inhaled form of the hormone that some SCI folks use at bedtime to keep their urine volumes down at night (it's called DDAVP or vasopressin). If he's in a wheelchair, a lot of fluid can pool in the legs during the day and then when you get in bed at night it gets back in the blood stream and goes out through the kidneys. Compression stockings (not TEDS but good knee high compression hose) can sometimes help to prevent some of this edema and lead to more restful nights.

    Your husband could learn how to insert an indwelling catheter for special occasions like movies or for traveling and use a leg bag to collect the urine. He could also use one at night with a larger bag to get a restful sleep.

    There are also surgical treatments. The one I know best is called a bladder augmentation. This takes a piece of bowel and sews it into the bladder, This interrupts the bladders ability to squeeze which reduces incontinece and then a person can continue to cath four times a day. The surgical course is a little uncomfortable but the people I know who have had the procedure are glad that they did it.

    I hope this isn't too much information all at once. But if you keep working with this urologist, you will come up with a solution to this problem.

    RAB

  3. #3
    Quote Originally Posted by kittim
    Background
    My husband is 2.5 years post C3/4 incomplete (able to walk, limited endurance). Up until 2 or 3 months ago he had the urge to urinate every 1-2 hours. He was voiding on his own, but not completely emptying his bladder. It was horrible, he was tied to the bathroom, constant accidents etc. We found a urologist that specializes in neuro, had a urodynamics study repeated and then we found a combination of meds (Ditropan XL PM and Imipramine BID AM, PM) that allowed him to cath every 4-6 hours, accident free and our life changed. After not venturing out of the house in all this time except for therapy, he had just begun last week to go out. We went to a movie for the first time, and yesterday to the mall.

    Now I am worried. Over the last 3 days he has had a couple of accidents. He seems to be having to cath more frequently, and last night he was up every two hours to cath.

    Now to me this sounds like UTI. But... no fever, no sickness, no bad smell in his urine.

    He did fall around the same time. Other things is he got a blood clot and is back on Coumadin, but that was a few weeks ago. Otherwise no changes. Im worried the meds might be losing effectiveness. I fear returning to that awful schedule and it will certainly crush his attempt to find a new life for himself. He is having a difficult time adjusting, and this is just one setback we didn't need. Anyone have any ideas?

    thanks...
    Sounds like a uti. I had a mild one recently with no other symptons other than urgency.

    Up his water intake - even though he will pee more - and a few beers if he drinks. Flush the bladder out.

    Can't he get piece of mind from accidents by temporarily wearing a condom cath and legbag? I hate them but they are better than wetting yourself or worrying about it
    C5/6 incomplete

    "I assume you all have guns and crack....."

  4. #4
    I hope you are right and it is a mild UTI. I will start him on more water. He doesn't drink beer, but we can up his intake of other fluids. His impulse, of course is to drink less. Thanks for your reply. HOw did you know you had a UTI when you didn't have any symptoms? He did have a low grade fever for a couple of days (99.8)

    My husband is a little bit (understatement of the year) stubborn. We use to use the condom cath. Always came off and there were accidents anyway. Now he refuses to use the condom cath and is slow to make changes. He didn't want to cath at all. He is very adament about doing things a certain way, and even if a better way may exist he is unwilling to try. This injury has been very tough on him and he isn't adjusting very well. He is older as SCI's go, 55. 52 when it happened.

  5. #5
    Quote Originally Posted by SCI-Nurse
    There are a bunch of issues that could pertain here. <snip> hope this isn't too much information all at once. But if you keep working with this urologist, you will come up with a solution to this problem.


    RAB
    Thank you for all the info. I am familiar with most of your suggestions as we have been dealing with this for a while, so no info overload. I appreciate your reply.

    I am going to first assume UTI (thanks RR) and try to flush it out. If we don't see improvement, Ill contact the urologist.

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