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Thread: Strange catheter problem (CIC)

  1. #1

    Strange catheter problem (CIC)

    Hey there

    I'm a young, male, incomplete paraplegic from Europe, who is having a very strange problem, when i use a catheter (CIC) to empty my bladder. I used to have problems with bladder-spasms, but after i've had a Botox-treatment, this is no longer an issue, and the urodynamic shows that my bladder can contain between 800-1000 mL (cc), without producing pressures that can harm my kidneys.

    Anyway, the problem is as follows: The first time i cath each day, everything works just fine, and after this, i can be dry for approx. 5 hours (sometimes more). Then, when i cath the second (and following) times, it's way harder to get the catheter to entry the bladder, and when it finaly succedes, i can only empty 50-100 mL, before the urine-stream suddenly stops. It's clear that my bladder is not emptied as this point, but even if i try again with a new catheter, i can't get more out. After an hour or two, i'm incontinent in small portions, and it feels like my bladder is full, and that the incontinence is due to overfilling of the bladder.

    I'm beginning to become pretty desperate, since i haven't been able to get any helping advice from the doctors and nurses at my locale SCI-center. They have adviced me to try another brand of catheters and to check if the catheter is blocked, but none of these suggestion have helped in any way. What really freaks me out is, that the problem never occurs when i cath the first time in a day (or if i wait 10-12 hours since last cathing), but always occurs when i cath again later.

    Thanks alot for any kind of advice.
    Best regards
    Jens

  2. #2
    I have problems with catheters pushing out and not emptying my bladder fully sometimes also. I'm on bladder spasm meds now but still occassionally have the problem. Could you have an UTI? I credit my problems to spasms still.

    Aerodynamically, the bumble bee shouldn't be able to fly, but the bumble bee doesn't know that, so it goes on flying anyways--Mary Kay Ash

  3. #3
    Difficulty passing the catheter is probably caused by sphincter spasm. The best way to handle this is to advance to the point of resistance, then hold the catheter in place with firm pressure (no jabbing or moving) until the sphincter fatigues and relaxes (usually 1-2 minutes). The sphincter is a different type of muscle from your bladder, so would not have been injected with the Botox and can still have considerable spasticity. You would not want it to be relaxed as this would result in continuous incontinence. Using a lubricious catheter as well will sometimes be helpful.

    As far as emptying, are you using Crede (pushing on your lower abdomen very hard) at the end of your catheterization to be sure you are empty? Since you have had the Botox, it is likely that there is not enough pressure inside your bladder to fully empty. Using Crede at the end (or even at the beginning) is needed often when the bladder is flaccid. Crede should ONLY be used when you have a catheter in place so that there is no resistance to urine flow.

    (KLD)

  4. #4
    Thank you for the response.

    To KLD: I'm aware of the firm-pressure technic, and i'm already using it. Regarding the Crede-method, i haven't tried this, but i will definetly try it today. Where exactly should i push, and for how long? Anyway, i'm not sure that the problem is lack of bladder-pressure, because the first 50-100 mL of urine flows with a pretty high pressure, and then the flow suddenly stops, without running at a lower pressure first. Can the catheter be blocked by something in the bladder? Is it possible for the sphincter to press so hard on the catheter, that it blocked?

    Thanks again.
    Jens

  5. #5
    Senior Member Kaprikorn1's Avatar
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    Jens...try inserting the catheter about 1/2" or so further into your bladder when you first begin to void. Then, when you have stopped voiding...slowly pull it out a little at a time...stopping each time a new urine stream starts and holding until that stream stops...then continue the slow removal.

    I have noticed that as the bladder empties and the sphincter relaxes, it tends to close around the tip of the catheter, blocking the holes. When the catheter is inserted further...this doesn't happen and you should be able to void almost all of your bladder. Then, the slow pull out allows it to pick up the remaining urine at the bottom of the bladder.

    Kap

    "It's not easy being green"

  6. #6
    Kaprikorn: Thanks alot for your answer, but i am already using the technique that you describes.

    /Jens

  7. #7
    Senior Member smokey's Avatar
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    Jens, you may have to drink more fluids to make sure your urine is not a little "thicker" than normal or have some debris in it. That would stop the urine flow. Also, I've found that tiny chunks of mucous or lubricant can clog the catheter eyeholes and I simply hold my breath, lean forward and push a bit and the flow continues.

  8. #8
    Thanks for your answer, smokey. I will try out your suggestion, and return with some feedback. I has also been adviced (by the hospitals nurse) to try a larger catheter, so i have ordered some nelaton ch. 18, that i will try out. Does anyone know if there is any disadvantages in using a larger catheter?

    Jens

  9. #9
    You may need to have a cystoscopy and urethrogram to determine what is causing your problem. You could have a false passage, stones or sludge in your bladder or some other structural abnormality. See your urologist for an evaluation.

    (KLD)

  10. #10
    I had my last Botox-treatment (where they used a cytoscop) a few months ago, and they did not mention any structural abnormality. Could they have missed this?

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