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Foley catheter leaking & Keflex

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    Foley catheter leaking & Keflex

    Ever heard of such a bizarre thing happening (like what is going on with me right now)???

    I have been a member of this community for nearly a decade and it has been very helpful at times. I am a female C 4/5 complete quadriplegic, 35 years post. I will be turning 50 on July 30 and I am wondering if I am going to make it that far.

    I have had an indwelling Foley catheter for all that time. No problems except the occasional UTIs, sediment presenting itself and then disappearing, etc. etc. etc. Now I am having a very scary "First-Ever" happening that is very strange. My Foley catheter has never leaked around it unless it has been kinked off or unable to drain because of being clogged or whatnot. When that happens my body tells me directly that I have to urinate and have to urinate THEN AND AT THAT TIME and to get it unkinked ASAP before it leaks around around the catheter. Once the reason for it not to be draining is resolved... all is okay and I am back to normal.

    Starting this past Wednesday everything changed almost overnight and urine has been leaking around my catheter nonstop but also draining like I usually do into my drainage bags. Prior to this past Wednesday, I have had absolutely no leaking of my catheter. So......

    I began to have lower abdominal pain (bladder area) and in the past this has always been indicative (for me) as a nonsystemic UTI. I contacted my PCP about this and he wrote me a prescription for Keflex. 500 mg three times a day. It was only a few days after beginning this antibiotic when the leaking around the catheter began. But I couldn't begin to imagine it being related to the Keflex. I have always taken 5 milligrams of Ditropan over the last 35 years for bladder spasms but I have never really had bladder spasms. It was just something that I was put on shortly after my accident and I have taken it for the last 35 years. No problems. Anyway...

    Prior to Wednesday of last week I was getting up in my chair daily and having no problems (catheter problems anyway) except for the constant sediment buildup that I have had for years and therefore instilling and irrigating my catheter twice a day to keep it clear. Ever since I have been on the Keflex the sediment has completely disappeared. Which is great news but at the same time it was only after being on Keflex several days whereby urine began to leak around the catheter nonstop.

    After getting in bed on Wednesday evening -- my pants and underwear were very wet. But I thought it was just a fluke thing. Not to be. I have always stayed on a chux all night (just in case of a potential bowel accident or to absorb my hemorrhoids cream, etc.) and the following morning (Thursday) it was soaked. Yet my overnight drainage bag had just as much urine output as I usually have. Needless to say I did not get up on Thursday because I did not want to be sitting in urine all day because of skin breakdown and not being able to get back to bed or even know IF it leaked because it is extremely hard to tell of that occurrence when I am up in my chair.

    I was clueless as to why this was happening so I first wanted to eliminate a defective catheter. I had my home health agency nurse come out to check back and we changed the catheter to no avail. The catheter was clear inside as well. Since doing that did not stop the leaking I contacted my PCP on Friday (who ironically I just saw Wednesday when I was sitting in urine but did not know it). He suggested having the home health agency nurse to come out to put in a larger catheter. I had been using a size 20 French, 10 cc catheter since 1990. So Saturday morning (yesterday) the home health agency nurse came out and put in a size 22 catheter. That did not work either. And, very unfortunately, after that I contacted the "on-call" urologist and he told me that was the worst thing to do (along with reading that here by SCI nurse in a post some time ago).

    You may be wondering why I did not contact my urologist first. There is a long answer and a short one so I will give you the short one. It is a 45 minute trip (one way) to his office because there are no local urologists. And my PCP could just as easily order a culture and sensitivity and then order an antibiotic to eliminate the lower abdominal pain I had been having.

    Ironically I did not even need a urologist until 2005. I had been living in Tucson Arizona between 2001 and 2012 when my beloved husband passed away in June of 2012 and I had to move back to Pennsylvania where the only family I have left lives. I feel like half of me is gone since my husband's passing. I am living with my sister and brother-in-law but we are pretty much out in the sticks.

    Whenever I feel like I have a problem however, my urologist will listen to me and prescribe an antibiotic if I have a symptomatic UTI over the phone which has been very very few and far between over the last two years I've been here. He understands that I am not able to make it there regularly (in fact I have only seen him once) because the roads are absolutely terrible and I have very fragile skin in my left ischial area because of a stage III wound that I acquired in 2009 and which took a long time to heal but the integrity of that skin will always be in jeopardy. The Pennsylvania roads always makes my skin break down if I am on them too much. Therefore I stay in the immediate area.

    By the time I found out the information that I did about putting in a larger catheter not being a good idea at all, having the catheter continue to leak both before and after the catheter changes, etc. it was Saturday (yesterday). I thought I would call my urologist's office to speak to whoever was on call for the weekend. My urologist is a member of a team of very good urologists. Unfortunately he was not the on-call for this weekend but the doctor I spoke with did not think it was the Keflex that could be causing my "first-ever" problem even though I told him that absolutely NOTHING in my life has changed except for beginning that. He thought it could be erosion of the urethra. My response was "Just happening overnight?" Simply because it was not leaking prior to Wednesday or before that at all.

    But since Wednesday it was like somebody flipped a switch and it has been leaking nonstop since then. He just thought I should need to be seen and I told him I could not travel using my van because of the rough roads and my fragile skin. But I can take ambulance transport so that I do not have to be vertical and just ride on a gurney into my urologist office. He also said it could be bladder spasms but, again, I was absolutely fine okay one day (and the days & weeks & years prior to that) but not the next and the days following that? Very odd happenings!

    This morning I thought I would do a search on "Keflex causing bladder or urethral damage." One of the first articles that popped up was that studies have shown that there has been a relationship between Keflex and "traumatic bladder and urethral injury." Since the Keflex got rid of all the sediment that I had been used to having in my bladder... I wonder what else it could have done... if anything.

    Update: as I was writing this I had a second call into the urologist I spoke to yesterday to ask him about increasing my Ditropan, etc. he told me that I could take 5 mg three times a day. I also mentioned the article about Keflex but he felt that it was very safe and he has been working with it over 20 years. I have also taking cephalosporins before with no problems.

    So I have been laying in bed since Wednesday night and with it leaking regularly (with chux underneath me) it is not helping the skin particularly around my rectum which is where most of the urine pools on the chux. Needless to say we change the chux as often as possible but I have absolutely no idea why this is happening.

    I was so looking forward to this summer after such a long hard winter. And I had just gotten on top of a fungal infection that were on the thigh side of my two ischial areas (which a home health agency nurse originally diagnosed as being pressure related for two months when it was actually fungal!). Prior to that I had had some shearing going on where my big bad wound was in my left ischium but we also got on top of that. So it would have been one thing after another that I just got on top of things and then this had to happen!

    I decided to increase my Ditropan last night and this morning (one extra 5 milligram tablet) to see if that would help but not so much yet. I only have 2 more Keflex (500 mg) tablets to take but my gut instinct is not to take them. I don't believe in coincidences and even though the urologist on call did not think it was the Keflex (and that the Keflex should actually help with bladder spasms and whatnot)... my gut instinct tells me that IS very potentially the source of the problem since that is the ONLY THING different in my life and the leaking begin approximately 4 days after being on this particular antibiotic.

    I am lost, scared and looking at the trauma it takes for me to get to my urologist's office by having to be transported on a gurney in an ambulance so as not to have the very very very bad roads from here to there break open my fragile left ischium. I also do not have the support of my husband who had a great medical background but also the time to take me here and there where my sister and brother-in-law are so busy.

    Feeling lost and alone and clueless to this "first ever" event that practically started overnight. Well, it DID start one day and just continued. Since I started this post I increased my Ditropan twice (last night I took an extra 5 milligrams and this morning I took an extra 5 mg ) and that did not make a difference.

    I had bladder stones removed in August of 2010 in Tucson Arizona and my urologist didn't say anything about "urethral erosion" like the on-call urologist is thinking I may have . my urologist in Tucson also made a comment that she thought my bladder looked like a bladder that never had a catheter and I had had one for 27 years when she made that comment.

    Sue Pendleton... if you are reading this you know me as Lori. Brinda has always been my username here.
    Last edited by Brinda41; 20 Jul 2014, 6:36 PM.

    I am sorry you are frightened. How many days has it been since your stopped the keflex? It takes up to 48 hours to be off an antibiotic to have it cleared for your system. After that time if you are still having symptom of UTI you can get a repeat urinalysis and urine culture and sensitivity.

    If you have had stones in the past and recurrence of infections, it would be wise to get an ultrasound of the bladder and kidney first to look at anatomy. Next you should consider a cystoscopy to check the urethral lining for trauma which can happen to any one who repetitively catherterizes over time. The cystoscopy will also check the interior lining of the bladder for stones.

    Leaking is annoying and can damage your skin I hope you're using a protective cream or emollient for your skin in the meantime.

    I hope things settle down for you soon. Keep us posted on hope things work out.

    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.


      After reading the article on "Keflex and traumatic bladder and urethral injury" (which no doctor will believe including my urologist and my PCP and no doubt others) I considered stopping the Keflex yesterday. I have three more capsules left (from a 10 day dosage) but because it is my body and since that has been the only difference in my life... I took my last one this morning.

      I had a CT scan done of my kidneys and bladder on April 29 and that was clear for kidney stones and bladder stones.

      My PCP wanted a culture and sensitivity next week after I was off the Keflex and when my home health agency nurse came to see me but because we wanted to see if it was a defective catheter problem... my home health agency nurse had the order from my doctor to collect a urine sample for a C&S this past Thursday. Yes, it was while I was still on the Keflex but he just wanted to see if the Proteus Mirabilis was still present. I have had that in my urine since 2010 and unable to get rid of it even after trying to get rid of it by having bladder stones removed, having IV antibiotics for it, and using a gentamicin wash to try to rid myself of the Proteus Mirabilis. That is the only reason he put me on Keflex (even though he knew I had tried all the big guns when I lived in Tucson in 2010 to try to get out of it). I only went to him because of having lower abdominal pain. I never had any lower abdominal pain when I had bladder stones in the past or from having Proteus Mirabilis between 2010 and until the recent time. I went to him last Wednesday because my lower abdominal pain was only getting more frequent.

      Since my husband was a chief medical technologist he told me that Proteus Mirabilis is a "swarmer" and it will hide any other bacterial growth that may be growing when looking at under a microscope. I did have lower abdominal pain this past March and I had a culture and sensitivity done and I was surprised that they were able to see E. coli. I was treated with Nitrofurantoin and the pain went away. The pain came back in April and when a culture and sensitivity was done then... Enterococcus showed up. Both of those times the culture and sensitivity was ordered by my urologist. They decided on Cipro for the enterococcus. When I saw my PCP last Wednesday he told me that Cipro would certainly not be a good choice for Enterococcus. And now that I think of it... I think perhaps that is why he wanted to put me on Keflex (thinking the Enterococcus may still be present even though it did not show up on the most recent C & S.

      When I told him that my lower abdominal pain began to get more frequent only three days after being on Keflex... my PCP just thought I was really getting better and to wait it out. He is a very good doctor and went to Johns Hopkins for his schooling but what I have learned over the last 35 years is that no doctor knows everything yet they will insist that they are right. Although, I am quite happy with this PCP because he is willing to "listen to me" because I know my body best.

      I recently had to switch general practitioners because my last one was not listening to me and my home health agency nurses when my ischium area began to look worse and worse by getting redder and redder and bigger in size (throughout May and June). My home health agency nurse thought for sure it was "pressure" when it ended up being fungal but her hands were tied by my doctor refused to try anything but what I was using. And my doctor would not switch protocol to try something else. I went for 2 entire months when both of my very knowledgeable home health agency nurses couldn't understand why both of my ischium areas (both left and right sides) were getting bigger and redder. It took a home health aide of mine (who also had her LPN) to finally come to the conclusion that it was probably fungal. I was so worried myself but after it cleared up by using Lotrimin and Dimethacone I was so relieved! And it took very little time to clear up.

      I have been through so much medical incompetence living in four different states that it is ridiculous! Then I had a shearing problem which cleared up nicely and then this (Foley catheter leaking for no reason it seems) had to happen. I really can't see it being "urethral erosion" (like my on-call urologist thinks) as it occurred literally like night and day. Last Tuesday (and all the days and weeks and months and years before that) I was fine and then Wednesday I wasn't and it hasn't given up. I know I already said that in my previous post but that is common logic. If I had ~gradual leaking~now and then over weeks or months... I could understand but it just happened in a flash. Again, the only thing different in my life as being on the Keflex. Sorry about being so repetitive with my wording.

      There are not many doctors to choose from in this small town but even after I have said what I just did both doctors (PCP or GP) I have had since arriving here in late 2012 are still quite knowledgeable.

      Yes, I am using protective creams and barrier creams on the areas that are red right now because of urine. Butt Paste has worked the best since that is for diaper rash essentially. That also works for wound healing (after the wound has healed for the most part) as well. I found this out when I was in Tucson recovering from my Stage III wound.

      My husband stayed with me the entire time it took to heal. And this took a long time because it got infected by a wound care nurse not long after it began in 2009. Of course this was found out in hindsight because it was after she measured it with a dirty measuring tape and my wound began to slowly spread down my leg. It was my husband who thought that the only reason that we do that was if it was bacterial and it was him who thought we should get a culture and, sure enough, it was infected. But there was no way to "prove" that she was the one who infected it.

      I spent the greater part of 3 years in bed (statistically speaking because of the wound waxing and waning) but my husband stuck it out and had to feed me dinner and bed for the last 3 years of his life. He was my primary caregiver and after working with my home health agency nurses out there in Tucson and having to go to the wound care Center 7 times for debridement, my husband was the one who really nursed it back to health. I found out about Butt Paste through a surgeon he was seeing for a completely different skin problem he was having.

      I am definitely not looking forward to a cystoscopy (which I am sure my urologist is going to want to do) because that puts more foreign objects into the body along with it being very stressful for me with AD concerns and a rough ride in the ambulance to get there on these rough Pennsylvania roads to and fro the urologist visit.

      I always found out about my bladder stones in the past through CT scans. When I had one done on April 29 of this year... like I said it was clear of kidney and bladder stones.

      I am hanging on to my last thread of sanity while still grieving for my husband.

      Thanks for responding!
      Last edited by Brinda41; 20 Jul 2014, 9:19 PM.


        Brinda, I've had that problem before. Many times. It's a uti and the only way I can clear it up is with levoquin.


          UTI. But also the bladder can shrink with the indwelling in and of course there are spasms. Our urologists recommend all pts iwth indwelling of any kind use Oxybtuynin 5 mg two to three times a day. If pt still leaking with thise dose can increase to 10 mg three times a day-max.
          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.


            Thanks Rainman. And, SCI nurse, I have been taking oxybutynin 5mg twice a day for almost 35 years. On Friday I took an additional one as well as yesterday but that did not help. My urologist told me yesterday (Sunday) that the maximum dose is 5mg three times a day. Always different stories. *sigh* I have a feeling that Rainman may be right because this originally started with lower abdominal pain which has always been indicative of a nonsystemic UTI for me. I got up today for the first time since last Thursday. I will not know if I am wet until I lay down in a couple hours. I am also waiting at a phone call from both a urologist I had for 7 years in Tucson Arizona (2005 until August 2012) and the urologist (team) that I left a message with over the weekend. All of that information is in my previous posts above. Thanks Again!


              I am also not ruling out my problem being related to taking Keflex as very odd as this may seem. I just can't rule it out after reading the following article (below) simply because I have fallen into a low percentage of things happening to people anyway.

              Here is the article describing how Keflex has led to bladder or urethral injury:
              I know it sounds very improbable but I can't rule it out. Again, I have fallen into being a person of less than 3% or 1% of the population having this problem or that problem so I wouldn't be surprised if it was the Keflex since this began very soon after taking it.


                You might tell your urologist to check with a neuro- urologist who have been using it for SCI/D persons for many years. That is the exception. It is given for SCI pts all the time. Myrbetriq is a new medication for overactive bladder. After that it is Botox to increase capacity.
                Women are at high risk of urethral erosion or shortening. That is why long term is not recommended. There is surgery such as an Sptube with closure of urethra but you need to see the urologist and let him figure out what is going on.
                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.



                  I have been taking oxybutynin 5mg 3 times a day for the past 20 years without problems. I have noticed that whenever I have to take Keflex or Levoquin that my sediment clears up while I am on it. I started using Vetericyn instillations about 4 years ago, and after a couple of years of experimentation, have settled on instilling 20 to 30 ml and leaving it in for at least 5 minutes and rarely more than 8 or 9 minutes 2 or 3 times a week. I still get some sediment, but have not had a full blown UTI in over three years. I do IC during the day, and use a foley at night because I was not waking up enough to realize when I needed to cath, and was tired of sleeping on a pad,

                  I'd suggest that you try the Vetericyn instillations for awhile and see if it helps. There is a huge thread at http:///forum/showthread.php?133414-...r-to-Dr-Young)
                  Don - Grad Student Emeritus
                  T3 ASIA A 27 years post injury


                    SCI nurse & Donno ... I do not think there is a neuro urologist within a 2 1/2 hour drive from here. After not hearing from urology group I am with yesterday by phone - I called them today and found out that my doctor is on vacation this week! They got the results of my C&S and it came back negative. But the Proteus Mirabilis has always showed up since 2010 so that is odd. Unless, by far a chance, but Keflex did something that having bladder stones removed, being on IV antibiotics and then doing a direct gentamicin wash in August of 2012 could not do.

                    I got up in my chair yesterday for 5 hours and there was no leakage during that time. But there was leaking around it between 3 PM when I went to bed and 6 PM when I went to roll on my side. Although far less than there has been when this started. There was leaking overnight (not a great amount but definitely enough). Since I was okay yesterday with getting up I got up again today but I will not find out if I am wet until I go to bed around 6 PM when there is someone who is able to do just that.

                    I am still concerned about this happening as though someone flipped a switch. I was okay one day (last Tuesday) and all the days and months and years before that. Then all of a sudden it happens? And continues to happen? I would think if it was urethral erosion or bladder spasms... it would have slowly started a little bit of time here and there. But, again, it was like night and day... literally.

                    Donno - I said this in an earlier post but I took 5 mgs three times a day for two days in row and it made no difference whatsoever. The leaking was just as bad on Friday and Saturday.

                    My sediment that I had been having regularly also immediately cleared up after being on Keflex. I had been instilling my bladder since 2010 (because of the sediment buildup) and irrigating it to keep it clear. Just by using vinegar and saline. Although I have had problems with sediment on and off since the late 1980s or early 90s. Since I moved to Pennsylvania the sediment buildup got significantly got worse (even after having bladder stones just removed and being on IV antibiotics and doing a gentamicin wash) about three months after moving here but without changing anything.

                    Every three weeks when I get my catheter changed now there has been a significant buildup of mucus and sediment in my catheter yet with all that build up... it has never leaked around it. Since my catheter has been extremely clear since starting the Keflex on the evening of June 10 there has been no sediment in it but then my problems with significant urine leaking around the catheter just a few days after starting Keflex... it began to leak spontaneously. I don't believe in coincidences and that is the ONLY thing that has been different in my life.

                    I can't get in to see my urologist until August 28 because that is the earliest they have for appointments unless there are cancellations. When my doctor's assistant called me back today I explained to her everything that has transpired (again) and I also asked her what I should do if I have even more problems between now and August 28... let alone continuous leaking. She said that I should just call back. This group of urologists is quite a large and popular one and there is really no other one to choose from except a lone urologist but I don't think he would solve my problem any better.

                    *Taking a very deep breath and feeling helpless*



                      Hi Lori! Sounds like you hit the Perfect Storm. First, stop using vinegar for instilling. It promotes the growth of a. staph. You may have erosion that has finally reached the point where a uti or an antibiotic can set off the leaking. If you can get another C& S after you've been off the Keflex a full 2 days (3 may be better for you) and you continue to leak then up the ditropan to 5 mg three times a day. Give that a few days to fully kick in. If that doesn't work then I'd suggest the whole ball of wax--urodynamics, new CT and video cystoscopy. Any chance you can get your sister to travel with you? I'm thinking you could get all tests done in two days but you'd need to stay overnight in a hotel. I did this early on when my second opinion on getting full bladder back was up in Philadelphia at U of PA. Unfortunately everything starts one day at some point but unlike ABs we may not notice the first signs of a change. I would put the Keflex on the list of antibiotics you don't handle well if there is a choice. With me it is the cephalexins that kill my stomach.
                      Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

                      Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied and are based solely on my experiences as a SCI patient. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.


                        This probably will not be of any benefit to you but have you tried decreasing the amount of saline that you use to inflate the bulb on your catheters? I was having similar problems not long ago, pain in my abdomen and leaking around my foley. I've inserted catheters too far when replacing mine before and the pain resembled that so I figured that the foley was just irritating the lining of my bladder. I withdrew about 3 cc's of saline and have not had a problem since decreasing the amount.


                          Thanks so much for responding Sue & Brent!

                          Sue - I have been instilling my bladder with vinegar and saline ever since the build up of sediment in my urine became so bad that it was clogging my catheter. 2010. The sediment was/is caused by Proteus Mirabilis (pathogenic bacteria that my husband was very familiar with). Rhetorical question... don't you think my catheter would leak slowly around it very slowly a couple days a week or off & on for a period of time before just been okay one day and not the next day and the following days (and now over a week)?

                          I probably will contact my PCP to do another culture and sensitivity since I have been off the Keflex since Saturday. I will just have to take it day by day. The leaking has gotten less after I began getting up in the chair on Monday. It now seems to be positional. I will always take your input because not taking any input would be folly. :-)

                          Brent -- I did not try decreasing the amount of saline put in the bulb/below out of my catheters simply because I have always kept the same amount in. You might have something there however. Although I am somewhat of a crossroads with being a little bit leery to do that just in case it caused even more leaking and it not doing what works for you but I guess it can't hurt to try for me since our symptoms are the same.

                          Thanks so much!!!

                          Last edited by Brinda41; 24 Jul 2014, 2:36 PM.