problems with cathing

pcamore · 09-13-2004, 02:17 PM

Hi all I had my accident back in 1980 but its only been since 1997 that i have been cathing and taking ditropan 3 times a day .
my problem is this
(1) still leaking even with 3 ditropan a day
(2) having major problems getting the cath past the schincter sometimes it folds back on itself and i wind up bleeding .
What i need to know is if the schincter is spasming would something like baclofen or clonazapam help to relax the muscle so i can get the cath past the schincter .
also have tried gel on the cath and 3 different sized caths.
please advise
thanks

MikeC · 09-13-2004, 02:49 PM

pcamore - I'm sure the nurse or someone who knows more about medicine then I do will reply also but so many people on this site helped me with cathing that I thought I'd add my 2 cents worth. When I first started cathing I had the same problem as you are having of inserting the catheter. It would take me 30 minutes or so to get the catheter in. People on this site told me about applying constant pressure - instead of jabbing. I also use coude tip catheters because I've got an enlarged prostate - not sure if you have that problem or not - it's hard to tell exactly what is stopping the catheter. I only had the catheter fold back once and I knew that I was pusing too hard - didn't do that again. I guess what I'm saying is that hopefully with constant pressure and practice inserting the catheter the process will get easier. Mike

T12 Incomplete - Walking with Walker, Oct 2003

karupt411 · 09-13-2004, 04:33 PM

(1) talk to your doctor about ditropan XL...its once a day slow release...also make sure your dosage is appropriate.

(2) stretch the penis as far away from the body as possible to remove kinks and make a path of least resistance. there are also coude tip caths...but i know nothing about them yet (cross fingers, knocks on wood).

smokey · 09-13-2004, 05:28 PM

pcamore, you might want to try a PVC catheter instead of a latex catheter. They are a bit more rigid and don't seem to wobble as much while inserting them. I had a bit of difficulty pushing mine through the sphincter, but I switched to the PVC type and GENTLY advanced the catheter past the sphincter (where I found the resistance). You have to do it slowly and with 5"-6" of lubricant on the catheter. I find that my sphincter fatigues and relaxes after gentle, firm and constant pressure from the catheter tip. Don't force it or jab it or you will bleed. I can't address your leaking problem but I'm sure your doc will be better suited to advise you after reviewing your medical history. Hope this helps.

Catheters

[This message was edited by SCI-Nurse on 09-15-04 at 12:11 PM.]

SCI-Nurse · 09-13-2004, 06:19 PM

pca, how much Ditropan are you actually taking (mg.)? 3 pills is pretty non-specific as this could be either 15 mg. (moderate dose) or 30 mg. (maximum dose). Have you tried Ditropan XL? Have you tried Detrol or Detrol LA? Have you tried adding imipramine or another tricyclic antidepressant in addition?

What type of bladder capacity do you have? What is your maximum bladder pressure during urodynamics on the meds you are on now?

While it is possible that baclofen or similar drug may help with your spastic sphincter, this may also result in you being wet between your caths. The technique described below with maintaining gentle but constant pressure on the sphincter is best. Never jab or move the catheter back and forth. The sphincter will usually fatigue in 1-2 minutes. Be sure to use plenty of lubricant (at least the first 6-8" of the catheter). Coude tips should only be used for men with large prostates.a Be careful with PVC catheters vs. silicone or latex, as you can do a lot more damage with these.

(KLD)

pcamore · 09-14-2004, 03:57 PM

Hi all
thanks for replying to my problem
I am on 3x5mg ditropan which according to sci nurse is moderate i was told the maximum dose is 4x5mg per day obviously they were wrong and no i havnt tried ditropan xl or detrol or detrol la dont know if they are in New Zealand will check it out.
my bladder can hold about 1100 mils a whole lot but it is very rare to get that much only if im out and cant get to a toilet. sorry cant remember what my urodynamics study revealed apart from that my bladder has become active again. i tell you my bladder is on and off .
i have tried the slow gentle pressure and lube so far am getting a good outcome. and i am using nelaton caths. and now that i am aware of this no jabbing thing i will be more careful .
i would have thought that after all these years i would know all but its good to know that you guys are there to offer me advise and for this i am very grateful

atul · 09-15-2004, 07:53 AM

I have had this problem before, and had also posted a similar question.

The most important thing for me ws to relax, use plenty of lube and apply gentle pressure - I was always stressed and could also break out in sweat when the cath would not go through the sphincter. I have also dropped to a size 14 cath, down from size 16.

I still get the problem occassionally, and a change of catheter usually solves it - my silicon coated latex catheters become softer and somewhat larger after using for about a couple of weeks.

Relax and good luck

leonlarae · 09-15-2004, 11:14 AM

pcamore-All these ideas are good ones. The best one is just to relax and not force anything. Also, I don't know if you've ever heard of oxybutinin, but I have been taking it for 2yrs. That's how long ago I had my accident and started leaking, but haven't had a drop since. Good luck, hope all the info helps.
Leon

Kaprikorn1 · 09-15-2004, 11:37 AM

pcamore...All of the suggestions so far are good ones...I have a few more:

1) Get a scope job by your urologist to ensure that you don't have a "blind pocket" in your urethra that the cath is going into instead of up into your bladder.

2) Stiffer cath's can help but I've found that they are harder to get to make the turn up into the bladder neck.

3) Get some 2% lidocaine gel (by prescription). It comes in a little plastic bottle w/ a funnel cap. Insert it into the tip of penis and squeeze a good squirt into your urethra, hold meatus closed and work the gel down the penis so it "pre-lubes" the urethra. I do this all the time now as the meds I'm taking dry me out so much, just lubing the cath doesn't work anymore.

4) Have you tried Flomax? It works to relax the sphincter in some people...it didn't for me but some have had great results. Your urologist has to prescribe this, too.

5) Remember, your urologist is a sci's best friend. Get a good one and visit him often.

Kap

"It's not easy being green"

SCI-Nurse · 09-15-2004, 03:57 PM

Flomax will not relax the external urinary sphincter, only the bladder neck (internal urinary sphincter). For most, this problem is due to the external urinary sphincter.

(KLD)

09-13-2004, 02:17 PM	#1
pcamore Junior Member Join Date: Nov 2003 Location: New Zealand Posts: 24	problems with cathing Hi all I had my accident back in 1980 but its only been since 1997 that i have been cathing and taking ditropan 3 times a day . my problem is this (1) still leaking even with 3 ditropan a day (2) having major problems getting the cath past the schincter sometimes it folds back on itself and i wind up bleeding . What i need to know is if the schincter is spasming would something like baclofen or clonazapam help to relax the muscle so i can get the cath past the schincter . also have tried gel on the cath and 3 different sized caths. please advise thanks

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09-13-2004, 02:49 PM	#2
MikeC Senior Member Join Date: Dec 2003 Location: Tampa, FL Posts: 1,190	pcamore - I'm sure the nurse or someone who knows more about medicine then I do will reply also but so many people on this site helped me with cathing that I thought I'd add my 2 cents worth. When I first started cathing I had the same problem as you are having of inserting the catheter. It would take me 30 minutes or so to get the catheter in. People on this site told me about applying constant pressure - instead of jabbing. I also use coude tip catheters because I've got an enlarged prostate - not sure if you have that problem or not - it's hard to tell exactly what is stopping the catheter. I only had the catheter fold back once and I knew that I was pusing too hard - didn't do that again. I guess what I'm saying is that hopefully with constant pressure and practice inserting the catheter the process will get easier. Mike T12 Incomplete - Walking with Walker, Oct 2003

09-13-2004, 04:33 PM	#3
karupt411 Senior Member Join Date: Aug 2004 Location: canada, eh! Posts: 102	(1) talk to your doctor about ditropan XL...its once a day slow release...also make sure your dosage is appropriate. (2) stretch the penis as far away from the body as possible to remove kinks and make a path of least resistance. there are also coude tip caths...but i know nothing about them yet (cross fingers, knocks on wood).

09-13-2004, 05:28 PM	#4
smokey Senior Member Join Date: Jul 2001 Location: Massachusetts, USA Posts: 1,864	pcamore, you might want to try a PVC catheter instead of a latex catheter. They are a bit more rigid and don't seem to wobble as much while inserting them. I had a bit of difficulty pushing mine through the sphincter, but I switched to the PVC type and GENTLY advanced the catheter past the sphincter (where I found the resistance). You have to do it slowly and with 5"-6" of lubricant on the catheter. I find that my sphincter fatigues and relaxes after gentle, firm and constant pressure from the catheter tip. Don't force it or jab it or you will bleed. I can't address your leaking problem but I'm sure your doc will be better suited to advise you after reviewing your medical history. Hope this helps. Catheters [This message was edited by SCI-Nurse on 09-15-04 at 12:11 PM.]

09-13-2004, 06:19 PM	#5
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,304	pca, how much Ditropan are you actually taking (mg.)? 3 pills is pretty non-specific as this could be either 15 mg. (moderate dose) or 30 mg. (maximum dose). Have you tried Ditropan XL? Have you tried Detrol or Detrol LA? Have you tried adding imipramine or another tricyclic antidepressant in addition? What type of bladder capacity do you have? What is your maximum bladder pressure during urodynamics on the meds you are on now? While it is possible that baclofen or similar drug may help with your spastic sphincter, this may also result in you being wet between your caths. The technique described below with maintaining gentle but constant pressure on the sphincter is best. Never jab or move the catheter back and forth. The sphincter will usually fatigue in 1-2 minutes. Be sure to use plenty of lubricant (at least the first 6-8" of the catheter). Coude tips should only be used for men with large prostates.a Be careful with PVC catheters vs. silicone or latex, as you can do a lot more damage with these. (KLD)

09-14-2004, 03:57 PM	#6
pcamore Junior Member Join Date: Nov 2003 Location: New Zealand Posts: 24	Hi all thanks for replying to my problem I am on 3x5mg ditropan which according to sci nurse is moderate i was told the maximum dose is 4x5mg per day obviously they were wrong and no i havnt tried ditropan xl or detrol or detrol la dont know if they are in New Zealand will check it out. my bladder can hold about 1100 mils a whole lot but it is very rare to get that much only if im out and cant get to a toilet. sorry cant remember what my urodynamics study revealed apart from that my bladder has become active again. i tell you my bladder is on and off . i have tried the slow gentle pressure and lube so far am getting a good outcome. and i am using nelaton caths. and now that i am aware of this no jabbing thing i will be more careful . i would have thought that after all these years i would know all but its good to know that you guys are there to offer me advise and for this i am very grateful

09-15-2004, 07:53 AM	#7
atul Junior Member Join Date: Jan 2002 Posts: 10	I have had this problem before, and had also posted a similar question. The most important thing for me ws to relax, use plenty of lube and apply gentle pressure - I was always stressed and could also break out in sweat when the cath would not go through the sphincter. I have also dropped to a size 14 cath, down from size 16. I still get the problem occassionally, and a change of catheter usually solves it - my silicon coated latex catheters become softer and somewhat larger after using for about a couple of weeks. Relax and good luck

09-15-2004, 11:14 AM	#8
leonlarae Junior Member Join Date: Jul 2004 Location: HOUSTON, TX U.S.A. Posts: 10	pcamore-All these ideas are good ones. The best one is just to relax and not force anything. Also, I don't know if you've ever heard of oxybutinin, but I have been taking it for 2yrs. That's how long ago I had my accident and started leaking, but haven't had a drop since. Good luck, hope all the info helps. Leon

09-15-2004, 11:37 AM	#9
Kaprikorn1 Senior Member Join Date: Sep 2002 Location: S.F. Bay Area, Calif. Posts: 1,369	pcamore...All of the suggestions so far are good ones...I have a few more: 1) Get a scope job by your urologist to ensure that you don't have a "blind pocket" in your urethra that the cath is going into instead of up into your bladder. 2) Stiffer cath's can help but I've found that they are harder to get to make the turn up into the bladder neck. 3) Get some 2% lidocaine gel (by prescription). It comes in a little plastic bottle w/ a funnel cap. Insert it into the tip of penis and squeeze a good squirt into your urethra, hold meatus closed and work the gel down the penis so it "pre-lubes" the urethra. I do this all the time now as the meds I'm taking dry me out so much, just lubing the cath doesn't work anymore. 4) Have you tried Flomax? It works to relax the sphincter in some people...it didn't for me but some have had great results. Your urologist has to prescribe this, too. 5) Remember, your urologist is a sci's best friend. Get a good one and visit him often. Kap "It's not easy being green"

09-15-2004, 03:57 PM	#10
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,304	Flomax will not relax the external urinary sphincter, only the bladder neck (internal urinary sphincter). For most, this problem is due to the external urinary sphincter. (KLD)