Voiding and Avoiding a catheter?

[dlissexy]

Hello everybody out there I just want to try and get some opinions from you people. As a result of a bladder scan my doctors have told me that I get urinary retention which means they've given me all kinds of fun techniques to help me to “void” which doesn’t always seem to help.

This tends to make the process of going to the toilet a bit longer and a bit more unpleasant than it would be normally. The doctors have suggested that if as a result of my next bladder scan they decide I'm still retaining too much urine there will be recommending home catheterization on a daily basis. Just using the tube not the bag and pouring everything back into the toilet bowl. This is something I'd like to try and avoid.

The protective equipment that the doctors have provided me with is just those triangular Shields that men get which in this case is the ID Level 3.

Often when I go out to a meeting in the evening and come back on the bus and then between getting off the bus and walking to the house I often get rather a lot of urgency and occasionally have the experience of waiting. However yesterday I didn't get that. My assumption is that I have chosen to put on a large machine washable products, I think it's called a pocket nappy. It has a bamboo Terry towelling insert and a Velcro fastening rubbery cover. And I chose to wear that for most of the day. I have a personal theory that when I'm wearing, the body can relax and therefore anything that's been caused up inside the bladder will then come out into the product.

The question I want to ask is, is it a common practise amongst people on this forum to attempt to empty a bladder through dripping into a nappy for a few hours on a daily basis for those people who have urinary retention? Could I therefore avoid the possibility of catheterization as a result of mapping myself regularly in allowing the body to do what it feels most comfortable with?

 

[babykeiff]

Hello everybody out there I just want to try and get some opinions from you people. As a result of a bladder scan my doctors have told me that I get urinary retention which means they've given me all kinds of fun techniques to help me to “void” which doesn’t always seem to help.

This tends to make the process of going to the toilet a bit longer and a bit more unpleasant than it would be normally. The doctors have suggested that if as a result of my next bladder scan they decide I'm still retaining too much urine there will be recommending home catheterization on a daily basis. Just using the tube not the bag and pouring everything back into the toilet bowl. This is something I'd like to try and avoid.

The protective equipment that the doctors have provided me with is just those triangular Shields that men get which in this case is the ID Level 3.

Often when I go out to a meeting in the evening and come back on the bus and then between getting off the bus and walking to the house I often get rather a lot of urgency and occasionally have the experience of waiting. However yesterday I didn't get that. My assumption is that I have chosen to put on a large machine washable products, I think it's called a pocket nappy. It has a bamboo Terry towelling insert and a Velcro fastening rubbery cover. And I chose to wear that for most of the day. I have a personal theory that when I'm wearing, the body can relax and therefore anything that's been caused up inside the bladder will then come out into the product.

The question I want to ask is, is it a common practise amongst people on this forum to attempt to empty a bladder through dripping into a nappy for a few hours on a daily basis for those people who have urinary retention? Could I therefore avoid the possibility of catheterization as a result of mapping myself regularly in allowing the body to do what it feels most comfortable with?

Most of what you are asking, in my humble opinion, should have been discussed between you and your medical professional.

However, bladder retention is caused by incomplete closing (emptying) of the bladder - a muscular bag that when closed, has little to no space for urine, but expands to hold urine from the kidneys. In your case, your bladder might not be closing completely and therefore, some urine is being left there. The medical suggestion from your doctors indicate that they have a concern to the amount of urine that you are retaining.

Since this is retention, even if you wore a full mat diaper 24/7/365, there would still be retention - diapers can contain urine within their core, but they do not act as a suction device to suck the urine from your bladder.

The sheilds that your doctors have provided suggest to me that they may also be concerned with possible overflow, where the bladder overfills and one voids just the overfill.

I don't know your history, and most on this site would not. As a result, again I advise you to revert to your own doctor for the relevant knowledge / advice on this, and also talk to said doctor about your ideas to wear diapers etc as mentioned via the larger pads etc.

 

[dlissexy]

Understood. Its just that sometimes I can ask peoples opinion and I can work out what to do for myself as well as what to ask the doctor. Sometimes I get random things appearing in a feed after I have posted a question that gets the mind turning and helps me work out what is right for me and what to discuss with qualified medical practitioners. Your point of view has been taken on board.

 

[Pongoandperdi15]

I suffer from retention with that comes overflow incontinence. I'm on a daily schedule of ISC and honestly the process of ISC isn't actually as bad as it sounds once you get used to it, becomes Second nature I still leak between doing it so have to wear a pad but no where near as much as I used to. The one thing I'm battling with at the moment is UTIs but I can't be sure that it's the ISC to blame for that as everything about my process is sterile there's something else in it that I'm missing so Ive a few questions for my urologist next time I speak to him. I've been offered a few alternative options sacral nerve implant, suprapubic catheter or urinary diversion surgery. They also tried medication but that had some terrible side effects (couldn't sleep) so I decided against that.
Now I will tell you I walked out of urology several years ago told them to stuff all the treatments and decided to go it alone and just use incontinence pads to manage my incontinence, I've a funny feeling that's why I'm now stuck in a never ending cycle of UTIs so my advice is try and work with the urologists as much as you can I wish I had.

 

[babykeiff]

Understood. Its just that sometimes I can ask peoples opinion and I can work out what to do for myself as well as what to ask the doctor. Sometimes I get random things appearing in a feed after I have posted a question that gets the mind turning and helps me work out what is right for me and what to discuss with qualified medical practitioners. Your point of view has been taken on board.

There are many ways to deal with retention, and your willingness to wear diapers IS a key bit of information that your urologist needs to know as it opens the door to other possible medical interventions which @Pongoandperdi15 has listed a few.

I suffer from retention with that comes overflow incontinence. I'm on a daily schedule of ISC and honestly the process of ISC isn't actually as bad as it sounds once you get used to it, becomes Second nature I still leak between doing it so have to wear a pad but no where near as much as I used to. The one thing I'm battling with at the moment is UTIs but I can't be sure that it's the ISC to blame for that as everything about my process is sterile there's something else in it that I'm missing so Ive a few questions for my urologist next time I speak to him. I've been offered a few alternative options sacral nerve implant, suprapubic catheter or urinary diversion surgery. They also tried medication but that had some terrible side effects (couldn't sleep) so I decided against that.
Now I will tell you I walked out of urology several years ago told them to stuff all the treatments and decided to go it alone and just use incontinence pads to manage my incontinence, I've a funny feeling that's why I'm now stuck in a never ending cycle of UTIs so my advice is try and work with the urologists as much as you can I wish I had.

If I read this correctly, you seem to link incontinent pad usage with urinary tract infections. That is simply not true unless you are putting the pad up the urinary tract - which is kind of impossible. Even a soaked and dried cloth diaper doesn't due to the simple process of urine exiting via the tract. The catheter, being a tube, allows urine out of the bladder and bypasses the washing action of urine passing down the tract.

Urinary tract infections mainly come from bringing the bacteria/virus from the outside world into your urinary tract. In your case, even though your intermittent self caturisation procedure is sterile, I would still guess that is the source of the infection. Even in a hospital setting, that process has introduced bacteria/virus into a paitent, so I would not be too self critical if I were you.

There is also a secondary issue with retention in that it provides a home for the bacteria/virus to multiply to infectious levels - which is one of the primary reasons that processes are in place to attempt to remove the retained stale urine.

 

[dlissexy]

I th9ink there is a difference a need for daily catheterisation and voiding (which is just getting as empty as you can). If I cant void naturally, I will go back to nappy voiding when I can fit it in. If and when the doctors say, I will go the catheter route. But I feel that the wearing of all in ones of other high volume things as a way to help get me to void when I cant naturally (in the toilet) will be important for the moment.

 

[EcoIncon]

I th9ink there is a difference a need for daily catheterisation and voiding (which is just getting as empty as you can). If I cant void naturally, I will go back to nappy voiding when I can fit it in. If and when the doctors say, I will go the catheter route. But I feel that the wearing of all in ones of other high volume things as a way to help get me to void when I cant naturally (in the toilet) will be important for the moment.

I would be careful about this and again discuss with a medical professional. The advice I was given by a urology NP was to continue to try to fill and empty your bladder to maintain the muscle tone in your detrusor. Simply empyting your bladder constantly (whether in a diaper or whatever), from what I was told, will actually serve to increase retention. I'm not an expert here... just passing along information that was shared with me.

 

[Pino]

Constant voiding will not solve the retention problem. It just wont.

There are several techniques to relax the pelvic floor to reduce the retention and you could try a TENS training as well. Did not help me though.

In the end to get rid of retention is ISC the best solution, much better than an abdominal catheter or or a bladder pacemaker.

ISC is not that difficult, you need to try out several products in the the beginning to find the best for your personal situation, i got used to it really fast, @Pongoandperdi15 already said something similar. The fact that you do not like to hear it will not help to solve that problem.
The alternative is to live with retention, risking UTI or kidney damage, the choice is yours.

 

[ILuvDiapers]

It really depends on what is causing the retention? Only your urologist will be able to ascertain this after carrying out a series of tests. Usually they will cary out a flow test to accurately measure the amount of urine remaining in the bladder. This is usually followed by an ultra sound scan to see if there is inflammation?

They will usually ask for a pee sample, also to carry out a dip test to check for a build up of protein in the urine, also whether it is cloudy or a strong odour is present, which are signs of an infection. Sometimes the presence of an infection can be the reason for the retention, other times there is an underlying reason.

There are tablets you can take for water retention, which relax both the bladder and prostate, allowing you to pee more frequently and reduce the build up of urine retention. They can make you dizzy when you first start on them, but once your body gets used to them, they work well.

The default position of urologists, certainly in the UK is self catheterisation daily, but that's mostly cause they seem to have an aversion to people wearing adult diapers?

I personally don't like catheters, and avoid them at all costs. my personal opinion is that they lead to more infections not less. My urologist knows, that my preferred method for dealing with permanent urinary incontinence is wearing diapers, and water tablets medication.

It really is a personal choice, and so don't allow yourself to be pressured one way or the other, i do still get UTI's but around 3 times a year. I know that using catheters daily can lead to considerably more infections, but everyone will have their preferred method.

Hope you can find a workable solution, in conjunction with your Dr/Urologist. Reoccurring UTI's are very unpleasant, I'm currently on antibiotics for a UTI, which spread to my kidneys, and i didn't even know i had, until it was picked up at a routine visit to the urologist.

 

[Pongoandperdi15]

If I read this correctly, you seem to link incontinent pad usage with urinary tract infections. That is simply not true unless you are putting the pad up the urinary tract - which is kind of impossible. Even a soaked and dried cloth diaper doesn't due to the simple process of urine exiting via the tract. The catheter, being a tube, allows urine out of the bladder and bypasses the washing action of urine passing down the tract.

No years of not voiding properly is probably one of the causes of my current situation, I void in spurts of 100ml meaning my bladder is always distended

 

[daylight]

The question I want to ask is, is it a common practise amongst people on this forum to attempt to empty a bladder through dripping into a nappy for a few hours on a daily basis for those people who have urinary retention? Could I therefore avoid the possibility of catheterization as a result of mapping myself regularly in allowing the body to do what it feels most comfortable with?

A question for your doctors. As others said, it depends on why you need to cath. Do you retain large amounts? Is it putting pressure onto your kidneys? Or?

 

[babykeiff]

No years of not voiding properly is probably one of the causes of my current situation, I void in spurts of 100ml meaning my bladder is always distended

Voiding in spurts of 100ml when the bladder capacity is on average 400ml, and can stretch to 600ml, combined with your statement that your bladder is always distended, to me from that information would lead me to conclude the you are dealing with overflow leakage combined with retention.

As you are stating that years of not voiding properly led to this, the behaviour would be holding it until you are bursting, voiding a little to remove the pressure and repeat - but that behaviour would also need to continue overnight to effect your bladder today which would fail as overnight you would relax relevant sphincters and void full bladder once the 600ml was reached.

Somehow, I doubt if your situation is self induced, and it is more on the lines of weakness within the bladder muscle and/or bladder overdistening which would prevent the bladder from constricting enough to empty - thus resulting in urine being left in the bladder after every voiding. The subsequent issues are in order:-

• retention + bladder infection
• intermittent self caterisation
• urinary tract infection + bladder infection
• Medical intervention to find a solution to ISC to remove infections due to growing resistant strains.

400/600ml is the average adult bladder capacity and distention. Certain trades can force larger and/or smaller bladder capacities, but from a medical perspective, these are the normal values used.

 

[Pongoandperdi15]

Voiding in spurts of 100ml when the bladder capacity is on average 400ml, and can stretch to 600ml, combined with your statement that your bladder is always distended, to me from that information would lead me to conclude the you are dealing with overflow leakage combined with retention.

As you are stating that years of not voiding properly led to this, the behaviour would be holding it until you are bursting, voiding a little to remove the pressure and repeat - but that behaviour would also need to continue overnight to effect your bladder today which would fail as overnight you would relax relevant sphincters and void full bladder once the 600ml was reached.

Somehow, I doubt if your situation is self induced, and it is more on the lines of weakness within the bladder muscle and/or bladder overdistening which would prevent the bladder from constricting enough to empty - thus resulting in urine being left in the bladder after every voiding. The subsequent issues are in order:-

• retention + bladder infection
• intermittent self caterisation
• urinary tract infection + bladder infection
• Medical intervention to find a solution to ISC to remove infections due to growing resistant strains.

400/600ml is the average adult bladder capacity and distention. Certain trades can force larger and/or smaller bladder capacities, but from a medical perspective, these are the normal values used.

I've been in a retentive state for years on end and that cycle of improper voiding has caused my issues now I.e I should have been doing ISC all this time to mimic voiding. Retention and overflow incontinence go hand in hand that's what I'm diagnosed with. Your bladder fills up but it still only has a max albeit a bigger one than most at which point it spasms or overflows hence the 100ml leakage you still retain X ml of urine. If you go to the toilet it's difficult to pass. I will go to bed do ISC before hand take out 500ml, wake up with a soaked conti pad and then proceed to take out 700ml with the catheter I've occasionally had more than 700ml but that's rare so I've come to conclude that my bladder spasms involuntarily at around 500ml mark, clearly something about night time allows it to fill further into a more distended state.

 

[AttilaThePun]

I've been in a retentive state for years on end and that cycle of improper voiding has caused my issues now I.e I should have been doing ISC all this time to mimic voiding. Retention and overflow incontinence go hand in hand that's what I'm diagnosed with. Your bladder fills up but it still only has a max albeit a bigger one than most at which point it spasms or overflows hence the 100ml leakage you still retain X ml of urine. If you go to the toilet it's difficult to pass. I will go to bed do ISC before hand take out 500ml, wake up with a soaked conti pad and then proceed to take out 700ml with the catheter I've occasionally had more than 700ml but that's rare so I've come to conclude that my bladder spasms involuntarily at around 500ml mark, clearly something about night time allows it to fill further into a more distended state.

It could be that your increased overnight capacity is related to position. Standing, our intestines can press on the bladder and thereby reduce its capacity. Lying down, a reduction in pressure (applied by intestinal contents and gravity when upright) allows bladder capacity to increase. The relaxation of sleep also can play a part in this, of course. So can any spinal stenosis or nerve root pressure increase/decrease brought about by being upright or lying down, affecting nerve function related to bladder muscle control/spasm/relaxation. Even constipation can play a part in urinary incontinence, because increased stool burden tends to reduce space for the bladder to hold urine. And, of course, anxiety/worry/stress about whether or not there is an ability to hold urine or an inability to empty can make urinary issues truly multi-factorial.

Of course, these are speculation (although well-grounded factually) and some, all, or none of these may apply to any particular person. I'm simply sharing knowledge acquired through years of education and experience in the hope it is useful to anyone who might have need of it.

 

[Edgewater]

With the information above, you should be able to have an excellent discussion with your MD and find a package that works for you. Doing nothing is not a plan.

 

[babykeiff]

I've been in a retentive state for years on end and that cycle of improper voiding has caused my issues now I.e I should have been doing ISC all this time to mimic voiding. Retention and overflow incontinence go hand in hand that's what I'm diagnosed with. Your bladder fills up but it still only has a max albeit a bigger one than most at which point it spasms or overflows hence the 100ml leakage you still retain X ml of urine. If you go to the toilet it's difficult to pass. I will go to bed do ISC before hand take out 500ml, wake up with a soaked conti pad and then proceed to take out 700ml with the catheter I've occasionally had more than 700ml but that's rare so I've come to conclude that my bladder spasms involuntarily at around 500ml mark, clearly something about night time allows it to fill further into a more distended state.

The only advice I can offer is for you to see your medical team and get this dealt with - while you are able.

700ml+ bladder volumn is putting imense pressure on your kidneys and indirectly on your body. This process of fluid balance works by osmosis - excess fluid in cells transfer to blood (due to blood fluid being less than cell fluid percentage), and is filtered by kidneys and placed into bladder. If this process is not working due to an over full bladder, your cells are in a way, drowning and dying.

There are medical procedures to reduce bladder capacity, but may require full mat diapers instead of conti pads - which may be an option for you - if you discuss it with your medical team. In a way, it is engineered diaper dependance where also an internal pressure relief valve is inserted bypassing the urinary sphincter. At the moment, you need to bypass same due to your incontinence - uncontrolled sphincter - where the risks include infection (from ISC), bladder bursting (failure to ISC), kidney failure (back pressure) etc if you fail to self catherise.

 

[longislandguy]

I’m actually dealing with a similar situation. I had an ultrasound before and after voiding. 930 ml of urine prior to voiding and 300 ml remaining after. Now, in fairness, I did kind of rush the voiding a little bit, but that’s still a lot lest inside. I’m awaiting my follow up in two weeks to see what’s up.

 

[longislandguy]

I’m not asking for advice. Just throwing it out there in response to the OP.

 

[Pongoandperdi15]

The only advice I can offer is for you to see your medical team and get this dealt with - while you are able.

700ml+ bladder volumn is putting imense pressure on your kidneys and indirectly on your body. This process of fluid balance works by osmosis - excess fluid in cells transfer to blood (due to blood fluid being less than cell fluid percentage), and is filtered by kidneys and placed into bladder. If this process is not working due to an over full bladder, your cells are in a way, drowning and dying.

There are medical procedures to reduce bladder capacity, but may require full mat diapers instead of conti pads - which may be an option for you - if you discuss it with your medical team. In a way, it is engineered diaper dependance where also an internal pressure relief valve is inserted bypassing the urinary sphincter. At the moment, you need to bypass same due to your incontinence - uncontrolled sphincter - where the risks include infection (from ISC), bladder bursting (failure to ISC), kidney failure (back pressure) etc if you fail to self catherise.

I'm aware of all this I was warning of the dangers of keeping your bladder in a retentive state that's what I did for many years just dribbling into a conti pad (I use slips) and I was quite happy then I got a kidney stone and my slippery slope started and this nightmare of a year erupted. If only I'd listened to the urologist all those years ago and actually integrated ISC correctly into my life then I might not be where I am now. I've been chatting to urology all this year and have an appointment coming up soon to discuss my ongoing options.

 

[babykeiff]

I've been in a retentive state for years on end and that cycle of improper voiding has caused my issues now I.e I should have been doing ISC all this time to mimic voiding. Retention and overflow incontinence go hand in hand that's what I'm diagnosed with. Your bladder fills up but it still only has a max albeit a bigger one than most at which point it spasms or overflows hence the 100ml leakage you still retain X ml of urine. If you go to the toilet it's difficult to pass. I will go to bed do ISC before hand take out 500ml, wake up with a soaked conti pad and then proceed to take out 700ml with the catheter I've occasionally had more than 700ml but that's rare so I've come to conclude that my bladder spasms involuntarily at around 500ml mark, clearly something about night time allows it to fill further into a more distended state.

I'm aware of all this I was warning of the dangers of keeping your bladder in a retentive state that's what I did for many years just dribbling into a conti pad (I use slips) and I was quite happy then I got a kidney stone and my slippery slope started and this nightmare of a year erupted. If only I'd listened to the urologist all those years ago and actually integrated ISC correctly into my life then I might not be where I am now. I've been chatting to urology all this year and have an appointment coming up soon to discuss my ongoing options.

• Long distance truck drivers stretch their bladder capacity over years to 800-1000ml without issue.
• Young toilet trained children 2+, tend to hold their bladder when focused on something like TV etc., to such an extent that they start the potty dance before wetting themselves / rushing to a bathroom etc.

... there are loads more of this type of behaviour of stretching bladder / cycles of improper voiding behaviour that doesn't cause / enhance bladder retention / disorder. Medical science has proven that bladder retention is not a direct or indirect result of paitent behaviour.

Bladder retention is caused by :-

• scaring of the bladder wall - mainly from infection
• tearing / partial tearing / stretching of bladder wall - possibly from accident / injury
  • usually impact injury i.e. from seatbelts / child carrying and impact damage from infant in womb.

Both creates sections of the bladder wall where the musclar layer is weak and can't completely constrict. Thus, the bladder does not completely empty.

In other words, despite @Pongoandperdi15 statements, retention is not self induced unless one punches oneself in the bladder. As a result,

I was warning of the dangers of keeping your bladder in a retentive state...

is impossible as one can't keep ones bladder in a retentive state!

...that's what I did for many years just dribbling into a conti pad

This is suggesting that using any form of pad / diaper is contrary to bladder health, which is also incorrect.

Therefore, I answered your question although you state that you weren't asking a question!

Your failure to comply with medical instructions in relation to evacuating the retained urine has most likely led to the formation of calcium deposits in your bladder / kidneys - commonly referred to as kidney stones. I would suspect that you are/have been dealing with multiple bladder infections also - all side effects of urine retention.

As stated in prior posts

As you are stating that years of not voiding properly led to this, the behaviour would be holding it until you are bursting, voiding a little to remove the pressure and repeat - but that behaviour would also need to continue overnight to effect your bladder today which would fail as overnight you would relax relevant sphincters and void full bladder once the 600ml was reached.

Somehow, I doubt if your situation is self induced, and it is more on the lines of weakness within the bladder muscle and/or bladder overdistening which would prevent the bladder from constricting enough to empty - thus resulting in urine being left in the bladder after every voiding. The subsequent issues are in order:-

• retention + bladder infection
• intermittent self caterisation
• urinary tract infection + bladder infection
• Medical intervention to find a solution to ISC to remove infections due to growing resistant strains.

400/600ml is the average adult bladder capacity and distention. Certain trades can force larger and/or smaller bladder capacities, but from a medical perspective, these are the normal values used.

which you quoted, and ignored.

What I am trying to impress is - ISC is not a solution as it will lead to an emergency procedures to deal with kidney / blood poisoning. If one is needing to to same to empty bladder, it should only be a temporary stop gap procedure while waiting on a sphincter bypass operation of some kind. ISC creates a path for infection despite best intentions and clinical cleanliness.

This level of query should be referred to your urologist / medical team - which should always include the question "What long term solution do you see in relation to my X issue" ... and if you get the answer "let's deal with this and see!" type of response, I strongly suggest that you find yourself another medical specialist.