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Thread: Ditropan dosing...can you use it only at night?

  1. #1
    Suspended Andy's Avatar
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    Ditropan dosing...can you use it only at night?

    I am going to get my Dr. to give me a script for Ditropan to try to counteract my haywire kidneys at night somehow. I used to have a bladder capacity of 1100+ without popping off when first injured, now a year or so after SCI and with taking Baclofen it seems that I pop off maybe around 700-800 or so it seems (at least when cathing after a going swimming episode at night). Since I cath every 4 hours at night and sometimes the kidneys still produce more than I can hold sometimes, I am thinking of killing off this reflex so this does not happen. I know these volumes are not good, but there is not much I can do to counteract this short of waking up every two hours just in case this bi-weekly piss fest occurs. I know about moderating fluid intake, but I have always had water retention issues even before SCI, which is causing this problem. Since I only have these problems during the night and dont want cotton mouth/other side effects during the day, is it ok to load up on Ditropan only at night and skip it during the day? Does Ditropan need to be constantly in your system for it to work correctly or can you use it in an "as needed" basis like I am planning?

  2. #2
    You should not be holding more than about 450-500 cc. in your bladder at any time. Volumes of more than this decrease the circulation to the bladder wall and increase your risk of infection. In addition, they can cause high pressures which increases your risk of reflux and hydronephrosis.

    How much are you drinking daily? You should not be drinking more than about 2.5 quarts daily, and most of this should be between 6AM and 2PM, tapering off after this and not drinking anything excepts sips needed to take meds after 6PM. This, and the use of compression hose will reduce your third spacing and dumping of fluid at night. You cannot make more urine that fluid that you take in...it is physiologically impossible on a consistent basis.

    Ditropan and other anticholergics are designed to both decrease dangerous bladder pressures and increase capacity. They are best taken in a way that maintains a consistent level in the blood/bladder. If you have side effects, you should discuss possibly using intravesicular bladder instillations of Ditropan instead of taking it orally.

    Do you have a good neurologic urologist? Have you had recent urodynamics? It is very common for your bladder to change neurologically, esp over the first 2 years after injury, and during that time urodynamics may be needed as often as every 3-6 months to stay on top of these changes.

    (KLD)

  3. #3
    Suspended Andy's Avatar
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    Thanks for the tips. I really dont guzzle too much fluids and normally cath volumes are around 300-400, just sometimes the volumes drop some, water builds up, and I blow a valve when sleeping and I am not aware that the kidneys are working triple time. I know that I would probably be really consistant if I had no salt intake and only drank early in the day, but that is not too realistic in my situation. In the meantime I figure that a little bit more bladder retention ability will help with this problem when it does happen however unsafe it may be.

  4. #4
    KLD - Thank you!

    No wonder I'm having so many problems lately. I've been trying to drink about a gallon + a day for fairly high intensity workouts (and general flushing) but have been experiencing increased bladder spasticity (leakage through urethra with normal sensation) when I'm pushing my chair (hills, speed, etc.) hard or trying to work my abdominals - sit-ups. I can feel the pressure in my bladder (bloated/distended/sometimes sharp)but it just can't seem to drain fast enough through my sp.

    Obviously its probably due to my intake?

    Dummy me.

    Ok, but a couple of questions?

    1. Does bladder sensation improve over time generally?

    2. By taking 2mg of Detrol LA per 24hrs is this enough? Should I adjust/increase my dosage?

  5. #5
    Chris D,

    I'm no doctor but regarding bladder sensation, for me, it improved. For the longest time I was goin every 4 hours, and sometimes it was pointless. Apparently, you start to become more in tune with what your body's telling you, so I'm not sure if it's necessarily increasing sensation. I find that I know when I need to go based on how much pressure I feel. Mind you, when I get a UTI, I'm screwed over big time, cuz there's the constant pressure, and urge to pee.

    "To live is the rarest thing in the world. Most people exist, that is all." - Oscar Wilde

  6. #6
    My statements about fluid limits and bladder volumes applies to those who do intermittent cath. If you have an indwelling catheter, you should drink at least 3 quarts daily; more if you exercise heavily. If you have an indwelling catheter you will have a low bladder capacity over the long run, but if your catheter is not plugged and is properly positioned you should drain freely and not have much urine in there a one time.

    Anticholergic meds are recommended for those using indwelling catheters to prevent leakage, and also reduce bladder shrinkage and the risk of bladder spasms causing reflux of urine to the kidneys.

    (KLD)

    (KLD)

  7. #7
    How many milli litre makes one quarts, SCI nurse?

    ammu

  8. #8
    Senior Member ~Patrick~'s Avatar
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    1 qt = 1.137 litre
    32 ounce = 1 qt
    35.2 ounce = 1000 ml

  9. #9
    Suspended Andy's Avatar
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    Thanks for the conversion Pat, looks like I am under the 2.5 quart limit usually anyway. I knew it was just over 1/2 a gallon KLD described, too lazy to look up what that was in the metric system.

  10. #10
    first you should try to consume little or no water for several hours before bedtime. next you should cath at bedtime so you start your sleep empty. if your major concern is staying dry overnight you can try instilling ditropan at bedtime. systemic side effects are eliminated and it may give you several hours of a quiet bladder.

    swimming is interesting. i can cath right before i swim and right afterward a 45 min swim take out 600+. having the legs elevated in the water, plus their passive mvmt and the overall increased blood flow from exercise increase blood flow to the kidneys, which will in turn increase removal of excess water that is locked up in the legs.

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