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  • Urinary Incontinence

    Hello everyone~

    I have been perusing this site for some time now and finally decided to register and post a question. I would be incredibly grateful for any feedback and suggestions that you might have. My issue is this:

    Starting at the beginning of last week, I've been experiencing excessive leaking around my indwelling catheter, to the point where very little urine is actually accumulating in my drainage bag. I am easily able to irrigate the catheter tubing without any resistance, and I am taking in adequate amounts of water. This has happened before and my urologist suggested a minor procedure that would essentially lift the neck of my bladder. After doing some online research of my own, however, I discovered Ditropan, and although my urologist didn't think it would benefit me, he prescribed it and it worked like a charm. I am currently taking 5mg three times per day and am wondering if the dosage needs to be increased. I started a week long prescription yesterday to clear up a UTI, and am wondering if that will help the situation, but I feel like it has to be about something more than that. I am not experiencing any UTI symptoms, and was only able to detect it because of an urinalysis. I would appreciate hearing from anyone who has experienced this, or anyone who has any helpful suggestions or recommendations. I am getting tired of being soaked in urine day and night, as you can imagine, and I am unable to meet with another urologist (who actually has some experience with SCI individuals, albeit limited) until June. Thank you in advance for you help, and please forgive me if I haven't posted this in the appropriate forum.

    For reference, I am a complete T8/9 and 3.5 years post injury.
    Somewhere, something incredible is waiting to be known. - Carl Sagan

    How wonderful it is that nobody need wait a single moment before starting to improve the world. - Anne Frank

  • #2
    Hello and welcome!

    You are posting in the right forum. Ditropan and that class of medication does usually help with leaking around catheter. If it was controlled and now is worening, you may benefit from increase or consideration of a long acting form of medication.

    A UTI can definitely worsen leaking, so you may want to hold off if you can until the antibiotic takes full effect. Also, please be warned of the CDC diagnosis of a UTI, which requires more criteria than an abnormal urinalysis to treat as a UTI- especially if you have an indwelling catheter. Google search CDC UTI guidelines.

    What type of bladder management do you use? Also, check out the sticky post "Bladder Managment for Adults with SCI" at beginning of this care forum.

    AAD
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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    • #3
      Thank you so much for responding... and for the warm welcome! The bacteria I am being treated for is Pseudomonas, which I have been treated for once before. I have had a foley catheter in for the full 3.5 years since I was injured, and it is changed roughly once per month. It oftentimes has to be changed sooner than that due to complications (usually buildup that is clogging the passageway.) I have also been on a daily dose of generic Macrodantin, but with this most recent occurrence, I have been advised to stop taking it and instead start taking 500mg of Vitamin C twice per day. A home health nurse came to change my catheter on Easter Sunday because I could not get the plunger on the irrigation syringe to even budge for over an hour, and there was quite a buildup at the tip of the catheter, but the excessive leaking has continued just the same. During this time, she noticed a pressure sore beneath my right buttock, so my visits will be once per week rather than once per month. I'm guessing that until I get this incontinence issue cleared up, the pressure sore will have a hard time healing. Thank you again for responding so quickly, and for offering your suggestions. I will definitely look into the CDC guidelines and check out the CareCure source you mentioned.
      Somewhere, something incredible is waiting to be known. - Carl Sagan

      How wonderful it is that nobody need wait a single moment before starting to improve the world. - Anne Frank

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      • #4
        The first sign that I have a UTI is leaking, it usually goes away after 2-3 days of antibiotics.
        c3/c4, injured 2007

        Comment


        • #5
          Any reason for not doing intermittent catheterization (IC)? I am also a T8 and used an external cath with bag for years. Now that I have been doing IC for the past 4 years and can definitely say it has improved my life. It comes with its own challenges but is better than a bag 24/7!

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          • #6
            AHHHH... big sigh of relief. After two full days of taking the antibiotic, I am finally drying out from my week and half long sprint of daily urine baths... you were right on, Sh1wn. Sledboy, do you have to strictly monitor your fluid intake and cath. accordingly? Immediately after my injury, while still hospitalized, I tried to learn intermittent catheterization, but I could not stay dry. Urine would literally gush out of me at unexpected moments, and the hospital staff began referring to me as "Little Niagara". Before going on Oxybutynin, I was leaking around my catheter on a regular basis, but that medication did the trick. Perhaps now self catheterization wouldn't be such a problem. I drink a lot of water throughout the day, which is why I asked about whether or not you have to closely monitor your fluid intake. How often do you cath. in a typical day, if you don't mind me asking? I have been considering this, and plan to discuss it with a urologist in June. It seems the body would prefer not to have a foreign object stuck in it around the clock, like mine currently does, but I also don't want to be cathing 5 or 6 times a day. Also, did you have to augment your bladder after having an indwelling catheter?
            Somewhere, something incredible is waiting to be known. - Carl Sagan

            How wonderful it is that nobody need wait a single moment before starting to improve the world. - Anne Frank

            Comment


            • #7
              Originally posted by Ptarzan80 View Post
              Sledboy, do you have to strictly monitor your fluid intake and cath. accordingly? Immediately after my injury, while still hospitalized, I tried to learn intermittent catheterization, but I could not stay dry. Urine would literally gush out of me at unexpected moments, and the hospital staff began referring to me as "Little Niagara". Before going on Oxybutynin, I was leaking around my catheter on a regular basis, but that medication did the trick. Perhaps now self catheterization wouldn't be such a problem. I drink a lot of water throughout the day, which is why I asked about whether or not you have to closely monitor your fluid intake. How often do you cath. in a typical day, if you don't mind me asking? I have been considering this, and plan to discuss it with a urologist in June. It seems the body would prefer not to have a foreign object stuck in it around the clock, like mine currently does, but I also don't want to be cathing 5 or 6 times a day. Also, did you have to augment your bladder after having an indwelling catheter?
              I have never had an indwelling cath for an extended length of time so I don't know much about the augmentation. However, I have also heard that if an indwelling cath is in for awhile, the bladder shrinks.

              I had an external or condom cath for quite a few years until my bladder kind of "wore out" and could not generate enough pressure to completely empty on its own. I needed to do something different so I checked into IC but I was scared of it from my memory and experience of IC in the hospital shortly after my accident.

              However, I have been very fortunate. When I started converting over to IC, I tried to closely monitor my fluid intake and cath accordingly. But I would still leak at times and it was frustrating. But in about a period of a month, I gradually stopped leaking or voiding on my own. Currently, I don't leak at all. This is mostly a blessing because I don't have any accidents. But I have to be very careful to always have a catheter with me because if I don't and need to go, there could be serious problems. But so far, this has not been an issue and carrying a catheter or two or three with me all the time has become part of my life.

              I am quite sure that there is medication that would help control or manage uncontrollable leaking. Or maybe the Oxybutynin you are taking is already managing this??? If so and if your bladder can hold enough, IC might be a good option for you!

              I usually cath between 3 and 6 times a day. I can kind of feel when the pressure builds up and when I need to go. Kind of makes me feel normal again. I can drink what I want when I want and just hit the rest room when I need to go!

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              • #8
                When you were using an external or indwelling cath, could you feel fullness in your bladder, or is that something new with intermittent cathing? I currently experience no such sensation. I'm hoping the new urologist I will be seeing will have knowledge about this, as well as possible helpful medications. My current urologist does not. I had never even heard of Ditropan/Oxybutynin until my leaking started getting more and more troublesome, and I started searching for solutions online (which is how I found this site, coincidentally.) I don't know if I could deal with cathing 6 times a day, and given my fluid intake, I have a feeling it would be that often, unless as you said, there is a medication that could help me retain larger amounts of fluid for extended periods. I'm guessing, and correct me if I am wrong, that it is probably easier for men than women to self cath, given their... uh... more easily accessible "equipment", shall we say?
                Somewhere, something incredible is waiting to be known. - Carl Sagan

                How wonderful it is that nobody need wait a single moment before starting to improve the world. - Anne Frank

                Comment


                • #9
                  The external cath would allow my bladder to fill up until I reflex voided. I could not feel it, per say, but could feel the pressure that my full bladder would put on the rest of my organs. Kind of like feeling full after over-eating. After years of paying close attention to how your body feels, you kind of learn what is going on. Currently, I can verify if my bladder is full by gently pushing inward with my hand just above my pelvis. If my bladder is full, I can feel the firm bladder through the skin.

                  It makes sense that you can not feel your bladder filling since you have an indwelling catheter and your bladder never gets full. There is no way to answer if you will be able to feel it until after you get the indwelling out.

                  Cathing 6 times a day isn't that bad for me. How many times did you go to the restroom before your accident? Usually, I don't go more than 5 times a day with 4 or 5 being the average. Once when I get up, once before I go to bed and then 3 times during the day. It really isn't that bad.

                  And yes, from what I hear, it is easier for us guys. We don't have to drop our drawers and pull them up again (a MAJOR pain)! I really feel bad for you gals that have to cath but from what I have heard, it gets easier with time and as you get more familiar with the procedure.
                  Last edited by sledboy; 04-29-2011, 12:38 AM.

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                  • #10
                    Thank you so much for being so honest and discussing this with me. I'm really glad I decided to join this site... I'm very isolated and have a minimal support system, which essentially consists of the nurse I see once or twice a month to have my cath changed, so it's nice to converse with people who have first hand knowledge and are willing to share their experiences. Even before my injury I didn't have the strongest bladder around. I've always consumed lots of water throughout the day, and had to void often. I think you're right... like anything else, with repetition, self cathing would probably get easier. I currently get into bed to take my pants off and put them on. I CAN do it in my chair, but it's a struggle. Hopefully, if I decide to start intermittent cathing, it will become second nature.
                    Somewhere, something incredible is waiting to be known. - Carl Sagan

                    How wonderful it is that nobody need wait a single moment before starting to improve the world. - Anne Frank

                    Comment


                    • #11
                      Originally posted by Ptarzan80 View Post
                      Hopefully, if I decide to start intermittent cathing, it will become second nature.
                      I say go for it! If it doesn't work out, you can always go back to the indwelling. Good luck with whatever you decide. And keep us informed on how it is going for you!

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                      • #12
                        For years I tried the intermittent cathing , Even would bounce back / forth and do the indwelling one

                        After 2 years of that fiasco my urologists kept talking me into having a super / pubic Cath 2 years ago I had the surgery and in my case I did not have to go through bladder augmentation , I rest so much easier finally could sleep without being wet as I sleep deep .
                        The only problems i've had being I've used all types of these Caths for years is Possible encrustations on the indwelling catheters it did not matter if it was Regular Indwelling Catheter or Now my Super Pubic Catheter

                        some people with long term indwelling caths like me are prone to these mineral formations .

                        The best part of Having a S/P Cath over the other2 is One can have sex if he or she wants .... Next is that this is reversible and over time one can train their bladder to hold more fluids etc.... I have a neurogenic Bladder . No Augmentation surgery ....


                        Intermittent cathing for me used to cause my urethra to become irritated .

                        Good luck and all
                        Sincerely ;
                        GL

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