Catheter Insertion Problems

[BeeVee]

Hello. I am a C3-4 incomplete spinal cord injury. I have been so since 2001. I am 21 years old now.
Lately my mother, who is my care provider and was trained to do catheter insertions, has been having a lot of trouble getting the catheter into the bladder. Trouble started about a year ago - apart from UTI's, we had never had such problems before - and has gotten worse in the last couple of months.
The thing is, the catheter goes into the urethra, but once in there, it doesn't go straight into the bladder like its supposed to, it goes into the vaginal area.
I went to a Urologist a week ago and he said I have a fissure in the urethra wall just before the opening in the bladder, and the catheter sometimes goes through this fissure hole.
The problem here is, because I have little to no sensation below the shoulders, I can not tell when the catheter is in the correct spot or not. And my mother can not either, usually. And not only us. I've been to the hospital several times now, and once the nurses themselves attempted to insert a catheter.
They did so, and some urine came out of the catheter, so they assumed it was in the correct spot. Looking at an ultrasound, with dye in the bladder, though, they saw it wasn't in the bladder at all. Anyways, they finally got it into the correct spot and everything was good for a while. Until it was time to change it again.
Now, I can feel when I am in pain, especially my abdomen area. Pain usually signifies to me that something is not right. But with so many recent attempts with cathing, and the Urologist going into my bladder to have a look around, not to mention an ovarian cyst, my whole abdomen area is painful and I just can't separate the different pains.

This brings me to my other problem: Urinating.
It used to be that I could be without a catheter as long as I had a bed pad underneath, and not worry about the urine not coming out. When there was urine in the bladder, it would spasm, urine would leak out.
Now however, urine doesn't come out, even when/if I spasm.
When the catheter is in, and in the right place, it works, urine comes out nicely for a while. But then it stops. Also, if I am moved say, from my bed to a chair, or if I go out - any major movements really - my catheter, as I say, "freaks out". It stops working. Or rather, I stop urinating. No urine comes out through the cath. This worries me and makes it so I hardly go out at all anymore. I get maybe 2 or 3 inches of urine during several hours, sometimes all day. My mom has to move it to try to see if more comes out. If nothing more comes out, we change the catheter. Sometimes we change it daily. Is this normal? Is there anything I could do to alleviate the problem, even a little?

The urologist didn't seem too worried about the fissure..
He gave me Oxybutynin, 10 mg, to take once daily. This is to decrease the spams in my bladder, which, over the years, have caused the bladder walls to thicken. It is the Extended Release version, however, and because I can't swallow pills (usually crush them and take them with applesauce) I am afraid crushing them will increase side-effects or something else. Is it okay to crush them?
My general doctor isn't taking this as seriously as I am. Maybe I'm just being paranoid. I just want to make sure nothing is wrong.

If there's any help at all anyone can give, I'd greatly appreciate it.

I realize this is long.. oops..

[bigtop1]

If your doctor is not concerned, then perhaps you could relax a little about it too. The alternative would be to have a supra pubic cath inserted. Have you tried any different size caths to see if they work better for you? Good Luck. Keep an open mind and a positive attitude about this.

[SCI-Nurse]

Hi,

This situation sounds very frustrating and I agree- I would not feel comfortable continuing as is. If you have a fissure and a passage to your urethra that is faulty, I would suggest either, having the urologist always place your catheter(which is rarely a feasible solution due to distance,etc) or discuss your options in terms of surgical repair of this problem or placement of a suprapubic tube. It is unacceptable that you or your mother should be expected to have this complicated way of guessing whether your voiding is working right.

You could bring this up to your urologist or seek a second opinion maybe better through a urologist who deals with sci at a large teaching institution.

On your medicine question, extended release medications should never be crushed as the distribution is disrupted and the proper dosage is not assured. Discuss with your doctor another method or short acting medication.

Hope this helps and keep us posted.

AAD

[maryonwheels46]

Good grief, I can't imagine. I would have to seek a second opinion and tell them I want it fixed. I have enough problems just finding the urithra.
Mary

[SCI-Nurse]

Urethral fissure? I have never heard of this. Anal fissures, sure, but not in the urethra. Did he actually use this term, or was it one of the following?

• Fistula?
• Diverticulum
• False passage?

Usually the treatment for a false passage is to put the catheter in (by the urologist) and leave it in place to heal.

A fistula is a serious condition that usually requires surgery.

I assume you are using an indwelling (Foley) catheter and not attempting to do intermittent cath, is that right? Did your urologist suggest a suprapubic catheter if so? If you want to do intermittent cath, was a Mitrofanoff procedure discussed?

(KLD)

[BeeVee]

It was Fistula, yes. I'm sorry. I couldn't remember the term.
And yes, I use an indwelling foley catheter.
The Urologist did mention the suprapubic catheter, saying it was another option, one I was previously reluctant to take, but think now, after all this, that it may just be the best option.

[SCI-Nurse]

A fistula is an abnormal opening into an organ. Where does yours lead? Was a fistulagram done? You could risk putting a catheter into another organ bowel, and there could be a risk of urine going into that organ, or stool, etc. coming through the fistula into your urinary tract. You need to ask more questions about treatment, not just about urinary management.

(KLD)

[coolbreeze]

False passage is what the nurse encounter in my urethra. On two separate occasions I was rush to the ER within 5mos post injury.
So I had plenty reasons to get a supra pubic. No regrets so far .

[thehipcrip]

KLD, what causes fistulas like this to develop?

[SCI-Nurse]

Friction or pressure of a catheter or tube, or an infection are the most common causes of fistulas. We see them sometimes in pressure ulcers too.

(KLD)