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  • intermittent cathing with leg bag?

    Long story short, after many years I have stopped all bladder meds due to cognitive side effects that aren't worth it to me anymore. I still have botox done every three months but it doesn't last that long for me so I eventually have to use a leg bag/condom catheter. My question is when the botox is out of my system, I can't go an hour before my bladder starts to leak (hence the legbag) and when I do cath there is very little output but quite a bit in the bag. So if most of the urine is getting out on its own, is there any reason to cath 5 times a day? Would 3 or even 2 be ok, if I drain the bag as needed throughout the day? The reason I'm asking is because every once in a while after I take the condom catheter off but before I can put the regular catheter in to drain my bladder, urine starts to come out and goes everywhere, it's incredibly frustrating.

    For what it's worth, I did ask the nurse at my urologist's office and she said it is fine to cath once in the morning and once at night, and I shouldn't be any more prone to UTI's since the urine is draining out on its own. But I wanted to ask here to see if that is the general consensus as well, or if anyone had any other experience with this situation that may be helpful.

  • #2
    Originally posted by Brad09 View Post
    Long story short, after many years I have stopped all bladder meds due to cognitive side effects that aren't worth it to me anymore. I still have botox done every three months but it doesn't last that long for me so I eventually have to use a leg bag/condom catheter. My question is when the botox is out of my system, I can't go an hour before my bladder starts to leak (hence the legbag) and when I do cath there is very little output but quite a bit in the bag. So if most of the urine is getting out on its own, is there any reason to cath 5 times a day? Would 3 or even 2 be ok, if I drain the bag as needed throughout the day? The reason I'm asking is because every once in a while after I take the condom catheter off but before I can put the regular catheter in to drain my bladder, urine starts to come out and goes everywhere, it's incredibly frustrating.

    For what it's worth, I did ask the nurse at my urologist's office and she said it is fine to cath once in the morning and once at night, and I shouldn't be any more prone to UTI's since the urine is draining out on its own. But I wanted to ask here to see if that is the general consensus as well, or if anyone had any other experience with this situation that may be helpful.
    Have you done urodynamics studies recently. Urodynamic studies are the only way you are going to know how much residual urine is in your bladder between catheterizations. High residuals and high bladder pressure are the perfect recipe for frequent and recurring urinary tract infections. And, you run the risk of harming your kidneys due to back flow of urine through the ureters. You may find it is healthier for you to go on a 4-6 times a day catheterization schedule and stop using the condom catheter.

    A new drug Myrbetriq (Mirabegron) works differently than the typical anticholinergics. Myrbetriq is a "class of medications called beta-3 adrenergic agonists and is not expected to cause memory loss." (https://www.aarp.org/health/brain-he...ss.html#quest1) So you may want to give that a try. Expect it to be fairly expensive, unless your insurance covers it or you qualify for assistance from the drug manufacturer.

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    • #3
      Originally posted by gjnl View Post
      Have you done urodynamics studies recently. Urodynamic studies are the only way you are going to know how much residual urine is in your bladder between catheterizations. High residuals and high bladder pressure are the perfect recipe for frequent and recurring urinary tract infections. And, you run the risk of harming your kidneys due to back flow of urine through the ureters. You may find it is healthier for you to go on a 4-6 times a day catheterization schedule and stop using the condom catheter.

      A new drug Myrbetriq (Mirabegron) works differently than the typical anticholinergics. Myrbetriq is a "class of medications called beta-3 adrenergic agonists and is not expected to cause memory loss." (https://www.aarp.org/health/brain-he...ss.html#quest1) So you may want to give that a try. Expect it to be fairly expensive, unless your insurance covers it or you qualify for assistance from the drug manufacturer.
      Thanks for the reply, I've tried Myrbetriq (and most other big name bladder meds over the years). While the side effects weren't as bad as other meds, they were still there. But it didn't help with leaking nearly as well as Oxybutinin did. Even if I cath 4-6 times a day I still have to wear a condom catheter. My bladder will start leaking an hour or two after I cath, and I can't cath 10+ times a day. It's been a few years since I've had a urodynamic study done.

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      • #4
        Originally posted by Brad09 View Post
        Thanks for the reply, I've tried Myrbetriq (and most other big name bladder meds over the years). While the side effects weren't as bad as other meds, they were still there. But it didn't help with leaking nearly as well as Oxybutinin did. Even if I cath 4-6 times a day I still have to wear a condom catheter. My bladder will start leaking an hour or two after I cath, and I can't cath 10+ times a day. It's been a few years since I've had a urodynamic study done.
        Unfortunately what you are experiencing is what I have experienced in my 36 years of spinal cord injury. I started out wearing a condom catheter and leg bag. Twelve-thirteen years in, I had too much bladder pressure and too much residual urine and could longer continue with a condom catheter. I had to go to intermittent catheterization. I was fortunate enough to have anticholinergics work for me and at the time, no one spoke much about cognitive side effects, so that wasn't an issue. I cathed for about 13-14 years. I had Botox injections 4 times before it no longer worked, and started to have to cath about every 2 hours around the clock. I am a complete quad and could not cath myself...my wife cathed me. Our quality of life was miserable, we weren't getting any sleep, and I was having frequent and recurring urinary tract infections.

        I saw a neurobiologist who gave me several alternatives, all, except one, were major surgeries (major body alterations) with lengthy recovery times. The most appealing alternative was the supra public catheter. I decided to give it a try as a baby step toward other methods of bladder management. I've had the supra pubic for about 8 years, and I am only sorry I didn't have one placed years before. I don't have to watch my fluid intake, I don't have to find a place to be cathed when we are out or hurry home to be cathed or interrupt my wife's schedule to cath me...and we sleep through the night.

        I know at T5, you probably have resistance to this idea, but give it some consideration and if you can, get to a neurobiologist who can help you evaluate your alternatives.

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        • #5
          gjnl speaks the truth. My experience mirrors his. Started out with a leg bag and external condom. No meds, no cathing. Worked for a few years but I always had trouble with UTI's. Finally got bad enough that I stopped wearing the external and the legbag. Started cathing 4 times a day with LoFric hydrophilic catheters and went on 10mg Oxybutynin daily. This has worked well for me for several years now. Supra pubic catheters used to be SOP for SCI back in the day and are still a viable alternative when you are up against a wall, just as gjnl says. The constant leaking means your bladder spasms are excessive; don't let it go too long or you risk kidney issues. I was diagnosed with hydronephrosis on one kidney because I waited too long to increase my cathing frequency. I've since got it in control, but there is always a risk when you retain urine and your bladder is hyperactive.

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          • #6
            Has anyone been able to keep your external catheter on and intermittent cath through the opening? I know you lose some sterility but you do drain the bladder.

            For example, you cath in the morning as part of changing your external cath. Then you intermittent cath three additional times through the day while the external cath is on but disconnected from the leg/night bag.

            Comment


            • #7
              Originally posted by Patton57 View Post
              Has anyone been able to keep your external catheter on and intermittent cath through the opening? I know you lose some sterility but you do drain the bladder.

              For example, you cath in the morning as part of changing your external cath. Then you intermittent cath three additional times through the day while the external cath is on but disconnected from the leg/night bag.
              Intermittent catheterization is supposed to be done under clean conditions, which means a new catheter for each cath and cleaning the meatus area before and after the cath. If you cath through the external catheter (while you are still wearing it), you don't have a chance to clean the area and the catheter is likely going to come in contact with the walls of the external catheter. I think you are just asking for trouble from frequent and recurring urinary tract infections. Many years ago, there was a condom catheter that could be taken apart, leaving the sheath on the penis, but exposing the meatus for cleaning and allowing for direct entry of the catheter without the possibility of contaminating it. After catching the external catheter could be put back together and the leg bag attached. I haven't seen that catheter on the market for many years. It seemed like a good idea, I don't know why it is no longer on the market.

              Comment


              • #8
                Originally posted by gjnl View Post
                Intermittent catheterization is supposed to be done under clean conditions, which means a new catheter for each cath and cleaning the meatus area before and after the cath. If you cath through the external catheter (while you are still wearing it), you don't have a chance to clean the area and the catheter is likely going to come in contact with the walls of the external catheter. I think you are just asking for trouble from frequent and recurring urinary tract infections. Many years ago, there was a condom catheter that could be taken apart, leaving the sheath on the penis, but exposing the meatus for cleaning and allowing for direct entry of the catheter without the possibility of contaminating it. After catching the external catheter could be put back together and the leg bag attached. I haven't seen that catheter on the market for many years. It seemed like a good idea, I don't know why it is no longer on the market.
                I haven't clean (used the alcohol or betadine) cathed myself in 28 years. I wash my hands, cath myself and that is it. Adding the external cath into the mix doesn't seem to be that much of an additional contaminent to me. Now if someone was cathing for me, I can see that requiring a purer clean technique. gjnl, I appreciate your feedback and insight. I'm not trying to be argumentative just lay it out there more practically/realistically.

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                • #9
                  I've cathed through my external cath for the last 10-12 years, morning and night, and frequently mid-afternoon as well. Never had an issue. I had a urology appt last week and was discussing my methods with my Dr. He said there are no studies indicating it is harmful or risky.

                  Originally posted by Patton57 View Post
                  Has anyone been able to keep your external catheter on and intermittent cath through the opening? I know you lose some sterility but you do drain the bladder.

                  For example, you cath in the morning as part of changing your external cath. Then you intermittent cath three additional times through the day while the external cath is on but disconnected from the leg/night bag.
                  "It is every man's obligation to put back into the world at least the equivalent of what he takes out of it. Try not to become a man of success but rather try to become a man of value." - Albert Einstein

                  Comment


                  • #10
                    Those last two posts pretty much blow up everything I was taught about IC. 'Course, my urologist once told me that he has a patient that carries a red rubber cath in his boot for use whenever. I guess it all depends on your resistance to bugs.

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                    • #11
                      Originally posted by Sit-N-Fly View Post
                      Those last two posts pretty much blow up everything I was taught about IC. 'Course, my urologist once told me that he has a patient that carries a red rubber cath in his boot for use whenever. I guess it all depends on your resistance to bugs.
                      I had a friend that carried one in his pocket. Pull it out, spit on it, cath, rinse it off with water and stick it back in his pocket for the next time! Do I recommend it? Absolutely not, but it worked for him.
                      "It is every man's obligation to put back into the world at least the equivalent of what he takes out of it. Try not to become a man of success but rather try to become a man of value." - Albert Einstein

                      Comment


                      • #12
                        Originally posted by gjnl View Post
                        Unfortunately what you are experiencing is what I have experienced in my 36 years of spinal cord injury. I started out wearing a condom catheter and leg bag. Twelve-thirteen years in, I had too much bladder pressure and too much residual urine and could longer continue with a condom catheter. I had to go to intermittent catheterization. I was fortunate enough to have anticholinergics work for me and at the time, no one spoke much about cognitive side effects, so that wasn't an issue. I cathed for about 13-14 years. I had Botox injections 4 times before it no longer worked, and started to have to cath about every 2 hours around the clock. I am a complete quad and could not cath myself...my wife cathed me. Our quality of life was miserable, we weren't getting any sleep, and I was having frequent and recurring urinary tract infections.

                        I saw a neurobiologist who gave me several alternatives, all, except one, were major surgeries (major body alterations) with lengthy recovery times. The most appealing alternative was the supra public catheter. I decided to give it a try as a baby step toward other methods of bladder management. I've had the supra pubic for about 8 years, and I am only sorry I didn't have one placed years before. I don't have to watch my fluid intake, I don't have to find a place to be cathed when we are out or hurry home to be cathed or interrupt my wife's schedule to cath me...and we sleep through the night.

                        I know at T5, you probably have resistance to this idea, but give it some consideration and if you can, get to a neurobiologist who can help you evaluate your alternatives.
                        Do you think if I cathed three times a day (every 8 hours about) and used the leg bag that it would be enough to avoid the issues you had with residual urine that caused you to stop using the condom catheter? What caused the increase in your bladder pressure?

                        Comment


                        • #13
                          Originally posted by Brad09 View Post
                          Do you think if I cathed three times a day (every 8 hours about) and used the leg bag that it would be enough to avoid the issues you had with residual urine that caused you to stop using the condom catheter? Hard to say, everyone is different.

                          What caused the increase in your bladder pressure? Natural progression of a neurogenic bladder.
                          You really need to get the urodynamics studies and the advise of your urologist. In any case, if I were making the choice for myself, despite the two opinions written above about cathing through a condom catheter, I would not practice cathing through the external catheter.

                          Comment


                          • #14
                            Hollister quit making the condom cath with the "lid" for cathing.
                            Botox every 3 months to the bladder is quite often. WE do only every 6 months0 5 months if issue.
                            Hopefully in the future they will try Dysport to the bladder to see if helps.
                            Mirgabetron does not work as well as Oxybutynin. We are using both Trospium ( less side effects than Oxybutynin) and Mirgabetron. It has helped some.
                            The only side effect I have seen with Mirgabetron is increased blood pressure. But if you did have side effects that would rule that out.
                            We use low dose Trospium and higher dose Mirgabetron or Trospium highest dose with Mirgabetron 25 mg daily-lowest dose.
                            The bladder augmentation is the surgery you are talking about. It is a major surgery.
                            SPtube is another choice.
                            The thought is intermittent catheterization has less UTI's than an indwelling.

                            There are some promising studies using electrical stimulation.

                            UDS- what was your voiding pressure? filling pressure
                            Sometimes these are high and you need the medication to keep low to ensure no backing up in to the kidneys.

                            CWO
                            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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                            • #15
                              Well I wasn't going to say anything, but after a couple other guys did, I'll chime in. This works for me! It may not work for you or anyone else! I was like you. For the first couple months I was hurt I cathed every 4 hours. Then one day I started to pee all over the place. Grandma said: what the hell are you a dog, marking your way home? So I put on a condom catheter and was fine. Didn't intermittent at all. Seemed to work fine for about 20 years. Only problem was finding a catheter that would stay on. I saw a new urologist about that 20 year mark and she suggested I cath a couple times a day. I cut the first inch or so off the extension of the condom and cath. I pour betadine in first when I disconnect my leg bag tubing (hard, clear plastic, from the hardware store, it doesn't kink and stop the flow like that dam surgical tubing). Then insert the catheter. I will cath an extra time in I'm going out drinking. I cath when I take a shower so I don't pee all over my chair when I get out. Been doing that for 16 years. I also use a reusable leg bag. THat plastic junk sucks. I clean the leg bag with a mix of 50/50 cheap walmart betadine and Dawn ( if its good enough for an oily duck its good enough for me) in the shower. I disassemble the bag once a month and really clean it. I also reuse my catheters. I'm paranoid. I don't trust the people in third world countries, that are making them, have good sanitary conditions. I wash them in the same 50/50 solution in a zip lock, then wash them again with Zest, the law them on a clean towel to dry. I get a year or more out of the leg bags and have had the same catheters for 10 years. I don't get UTI's.
                              FORMOST: this works for ME. I have no way of proving it will work for anyone else.

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