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  • Bleeding after catheterization

    So first and foremost, yes I've been in touch with my urologist about this already, but I wanted to see if the nurses here had any additional thoughts, or if any of my fellow CCers have experienced similar issues.

    I finally got that bladder botox procedure about a month ago, and experienced about a day or two of bleeding after that because I always seem to bleed after a cystoscope is inserted (although it might just be this doctor's technique since I don't remember bleeding issues the few times I got cysto with my previous urologist), plus the obvious injection sites themselves. What followed was a few days of it being really hard to cath because of a narrow urethra, which also seems to happen after a cysto, I'm guessing due to an inflamed/swollen urethra.

    A week after the procedure, things were fine and dandy again, but then two weeks ago (so about 3 weeks after the procedure), I noticed the narrow/inflamed urethra issues again where it was really hard to insert my catheter. That lasted for almost a week, but around the same time the inflammation went down, I started getting some light bleeding (a few drops worth) about once a day or two after I cathed (as would be seen in the liner pads I wear). This bleeding always seemed to happen after I would encounter some resistance during cath insertion, but rather than an all-around resistance (that I associate with inflammation), it was more like it would get stuck on something (which I assume was probably my prostate?). I know strictures are a concern, but given that it seems inconsistent, I imagine it's not that at the moment.

    So, to summarize a bit, my questions for folks here are:
    • Is bleeding after a cysto always expected? (The scope is definitely larger than my cath size of 12FR)
    • Is inflammation/narrow urethra expected after cysto?
    • Has anyone else who's done botox experienced cath resistance (weeks) afterward? What would cause this?
    • If the bleeding continues to happen, does that constant trauma/injury drastically increase my risk of stricture formation?
    • Any ideas for what's going on? We've ruled out UTI, and the nurses I spoke with are suggesting I try a coude tip since it sounds like I might be encountering issues getting around the prostate (which is supposed to be pretty vascular and prone to nicking).

  • #2
    Try a Coude catheter. If you have better success with that then you may have issues with your anatomy where the urethra goes through the prostate.I have terrible problems with insertion about three quarters of the way in, probably right at the location where my urethra takes a sharp turn and a regular straight catheter digs in straightaway and cannot negotiate to turn.

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    • #3
      Yeah, that's on the list of things to try. The oddest thing right now seems to be that this only consistently happens after the first time I cath in the morning, but rarely again afterwards, so I'm not sure why I'm meeting more resistance in the mornings.

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      • #4
        The Coude catheter is a good idea, along with possibly using a hydrophilic/lubricious catheter. It is possible that your urethra is swollen after having a cystoscopy, but i would also want to be sure that you do not also have a false passage. Did your urologist mention this as a possible problem??

        (KLD)
        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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        • #5
          I brought up the false passage as a possible concern, but they were saying that if that were the case, I'd be encountering that wall/resistance almost every time I cath, and not just in the mornings: they're thinking that it might have something to do with not cathing for so long overnight? (My only guess is pre-botox I might have have micro-leakages that kept my urethra moister, and post-botox it dries up a bit overnight?)

          I gave the Coloplast coude Speedicath a try and that was a mess because it's way too difficult to keep the coude tip up during insertion, but the Lofric Origo's been working pretty so far! I've managed three days without bleeding now, so it does seem to be helping.

          What I don't get is why I experienced the swelling again so long after my procedure :/ I've never had random urethra swelling like that except immediately post-cysto.

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          • #6
            Do you have any urethral discharge? If so, you could have urethritis, which is an infection of the mucosa of the urethra.

            (KLD)
            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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            • #7
              Discharge like pus, etc etc? Definitely not now, but I don't recall having it back when I encountered the inflammation a second time either (two weeks ago, but three weeks after my procedure).

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              • #8
                SCI-Nurse : just looked at some anatomy diagrams and I didn't realize the external and internal urethra sphincters were so far apart (before and after the prostate). When talking about tight sphincters during catheterization and needing for it to relax before the catheter can be passed, does that refer to the external or internal, or can it happen with both?

                I'm definitely noticing consistent resistance right before the cath enters the bladder, and that usually requires me just waiting with the cath there for a while until the (I assume) internal sphincter relaxes. I am also occasionally getting resistance about maybe 2" before that point, and I'm wondering if that might be external sphincter tightness, or if that's more likely to be a potential false passage? Again though, the latter doesn't happen all the time, maybe just 1/3 of the time I cath?

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                • #9
                  While called a sphincter, the internal urinary sphincter is not a true sphincter muscle, and rarely is responsible for resistance in catheterization. It rarely interferes with catheterization, but can interfere with reflex voiding.

                  The prostate and the external urinary sphincter are usually the culprits when you have difficulty passing the catheter. If you have videourodynamics, your urologist can determine what your internal urinary sphincter does as the bladder fills and tries to empty by fluoroscopy. Activity of the external urinary sphincter, which is actually just a part of the pubococcygeal muscle, can be measured by EMG during urodynamics, usually with either a needle or surface electrode at the anal sphincter, which is also part of the puboccygeal muscle.

                  A normal prostate is smaller than a walnut, so resistance 1-2" before getting into the bladder neck (internal sphincter) and seeing urine flow is usually spasm of the external urinary sphincter, which is extremely common in people with SCI. This is part of the neurogenic bladder syndrome of detrussor (bladder muscle)-(external) sphincter dyssynergia. Does your urologist normally include a digital prostate exam in your annual check-up?

                  The internal urinary sphincter is smooth muscle and regulated by the sympathetic nervous system. If there is proven spasm there, sometimes sympathetic blocking medications (like Flomax) can help, although in our experience this helps less than 50% of the time.

                  The external sphincter is striated muscle and regulated by the nerves coming from S2-4 in the spinal cord. Baclofen and other striated muscle spasm drugs may help with its relaxation, but during catheterization it is usually best to pause when you get this resistance, maintain gentle pressure with the catheter, and wait 1-2 minutes until the striated muscle fatigues and relaxes, allowing the catheter to pass.

                  (KLD)
                  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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                  • #10
                    I am routinely amazed with the useful information on this website. Though I don't have a bleeding problem when cathing, there were several useful bits of information in this post. For instance, in addition to some bladder/sphincter function I've never learned in nine years of SCI, now I know why when I need to cath, I often feel like I need to have a bowel movement and vice versa. Thanks KLD.

                    Comment


                    • #11
                      Originally posted by SCI-Nurse View Post
                      The prostate and the external urinary sphincter are usually the culprits when you have difficulty passing the catheter. If you have videourodynamics, your urologist can determine what your internal urinary sphincter does as the bladder fills and tries to empty by fluoroscopy. Activity of the external urinary sphincter, which is actually just a part of the pubococcygeal muscle, can be measured by EMG during urodynamics, usually with either a needle or surface electrode at the anal sphincter, which is also part of the puboccygeal muscle.

                      A normal prostate is smaller than a walnut, so resistance 1-2" before getting into the bladder neck (internal sphincter) and seeing urine flow is usually spasm of the external urinary sphincter, which is extremely common in people with SCI. This is part of the neurogenic bladder syndrome of detrussor (bladder muscle)-(external) sphincter dyssynergia. Does your urologist normally include a digital prostate exam in your annual check-up?
                      Huh, interesting, I wonder what's going on then. I'm basically getting what I think is bladder neck resistance every time I cath now (resistance about 1-2cm before urine comes out), and external sphincter resistance maybe half the time. Both of these can be passed if I just wait for a bit / take some breathes / relax, but it's odd to me that this all started happening post-botox.

                      I actually just had a urodynamics done to see if the botox was effective at improving bladder compliance, but they skipped the (voiding?) pressure check w/ the rectal catheter since they weren't as concerned about that metric this time. I don't think I've ever had a prostate exam done yet, I'll bring it up with her!

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                      • #12
                        Definitely should have the prostate checked . What did the pressure check say?
                        ckf
                        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.

                        Comment


                        • #13
                          Originally posted by SCI-Nurse View Post
                          Definitely should have the prostate checked . What did the pressure check say?
                          ckf
                          Oh no what I mean is they didn't do the rectal/voiding pressure check this time around since my doc was only concerned about the compliance/filling numbers, so unfortunately don't know :/

                          Also, while I'm still meeting resistance, trying a different type of lube also seems to make my previous non-hydro caths pretty slippery again. Not sure if that means the KY I have now has just degraded in quality, or it just wasn't that slippery to begin with.

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                          • #14
                            I am not sure what you are saying about the lube.... can you rephrase it for me?
                            Sorry-
                            ckf
                            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.

                            Comment


                            • #15
                              Originally posted by SCI-Nurse View Post
                              I am not sure what you are saying about the lube.... can you rephrase it for me?
                              Ah yes, sorry, I just meant that trying a different lube seems to have helped a lot with the usage of my old catheters as well, so I think the KY I was using before either is no longer effective, or has degraded in quality? Still meeting resistance though with both the old non-hydro and the new hydro caths.

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