www.incontinentsupport.org

This is really a new topic for John but it might be handy for anyone. So, Urinary Retention can be a serious problem because it brings with it the risk of infections. It will also, usually, mean that any incontinence a person has will be much worse than it needs to be.

If one has a bladder that can hold 500mls before it leaks, that give a pretty good time between voidings and a fair chance of avoiding using protection. However, if one finds that after voiding there is still 400 ml left in there and only 100 ml has been voided it is easy to see why leaks happen often - as most of the space in the bladder is never used. So, most people will be told to perform Intermittent Self-Catheterisation (ISC) to regularly drain the bladder. So how does that help apart from reducing the risk of infection.

So, one's bladder, for example retains 400 ml and leaks at 500 ml. A bit before leakage, pop in the catheter and drain the whole bladder rather than the 100 ml that might otherwise come out. Now, with an empty bladder, there's 500 mls to fill up before it leaks again. Along with care in reducing drinking in the late afternoon and evening, that could be the difference between waking up wet and waking up perfectly dry in the morning.

Now, of course, everyone is different and everyone has differing amounts of retention and capacity. Often, with gravity not affecting the bladder as much when lying down, people hold more urine at night than they might during the day for example. However, working with the idea of draining the bladder before it leaks, many people might manage better. Watching drinking and then voiding using ISC at suitable times is the way to go. personally, I am probably a cheater! My bladder refuses to leak at all but I do get more and more uncomfortable so drain at 800 - 1,000 ml during the day and, in a good night, wake up in the morning and drain up to 1,400 ml! Other nights I have to drain off in the night.

Post here if you want to ask anything - it's better on the forum then others can see the answers.

Wheels, thanks for starting the topic.

As I am just a newbie insofar as catheters are concerned, here are a bunch of questions to kick this off.

Of course, I don't know what the urologist initially will prescribe. If I am correct, when a urologist prescribes catheters he specifies the exact brand and specific type of catheter. Once you have tried those catheters, can you order a different type without going back to the urologist for another prescription? This of course may be different for those of you in the UK.

Can you have a prescription for two different types of catheters at the same time? I am thinking of something more normal for home use (less expensive?) and perhaps something easily carried and concealed like the Coloplast Speedicath for use out of the home or during travel.

What about the Coude tip catheters? I understand that they are less uncomfortable when passing through the prostate. Do you have to have a very enlarged prostate for the Coude to be of value?

Regarding the number of catheterizations per day, am I correct that it depends to some degree on the volume of your post-void residual? For example, at 13 ounces of residual would I be likely to be told to cath just morning and evening or every 2 to 4 hours?

What about the French sizes? What is most common and how does the size affect passing the catheter through the prostate.

What about the material and stiffness. Same issue - which is better for someone with a prostate problem?

What do you guys recommend. As I am a total newbie, should I have the temerity to suggest something to my urologist or just start with whatever he prescribes?

How do you order samples to try different catheters? Do they ask for a copy of your prescription?

What else should I know and what should I bring up to my urologist?

--John

Ok, John, this is what I can't answer for you - as I am in the UK, I have no idea how prescribing etc is done in the USA and nor do I know what prices are charged. That said....

The only way to work out what sort of catheter a person likes and works for them is, frankly, to try them. Some people do better with something that is a bit stiffer, like the Coloplast Speedicath whilst other get on better with softer and more flexible ones. It is the same with the different sorts of tips. The only way is to ask manufacturers for samples and try them out. most are only to happy to help out.

As to the size to use - well, it all down to convenience versus speed. Obviously a wider gauge catheter with drain faster but a narrower one will be easier to push in The Speedicath, for example, is a 'one size fits all' device and it is slightly slower to empty that, say a standard 14 FG catheter but there isn't much in it. That brings us to convenience as its fine to be using all sort of things at home but it all gets worse if we have to do things away.Losing a full-size used catheter is a bit fiddly whilst the the Speedicath merely goes back into an anonymous green tube to be tossed away.

So, really, if you are going to have to use them, get as many samples as you can and try them out.

Wheels,

How did you order the samples? Did the manufacturer send them to you directly and not ask for a prescription?

-John

Yes, I found websites and either phoned or left a message and samples came out. Catheters are prescription only in the UK too but samples seem to get out fine.

Of course, your urologist, if he suggests IC might also provide some samples for you to try - well, he'll probably make money if you carry on and order them - so that's worth a try too.

Robert

Wheels, that is very interesting. Thanks a lot. I'll try asking my urologist for some samples.

--John

Left my urologist's office with a handful of sample catheters. I was instructed to self-cath twice a day. Once home, I catheterized for the first time in 23 years. That felt a bit strange but went ok although I felt a burning sensation the next time that I peed. I am not worried about that as I sort of expected it, but I also had a spot of blood on my diaper. I think that also is not something to be concerned about - so long as it does not continue.

The nurse provided me with a wide range of samples, different French diameters (one was only 8 FR), and including some with a Coude tip and some with a hydrophilic coating. I have no experience with these. Guys, what are your thoughts on these? Are any of you using them?

Unrelated to our topic of Urinary Retention, I also received a prescription for a condom catheter.

--John

Well, sorry for being a bit late answering this.

I'm glad you got a lot of samples as it makes it easier to find what suits you. As you know I use the Coloplast SpeediCath compact which comes in a handy green tube which can be used for disposal. It is brilliant to use when one is out. However, John, if you our only draining twice a day, the non-compacts will work just fine as you will be using them at home. Probably, unless you like waiting a lot, the larger gauge catheters are going to work better as they drain faster. I had some ordinary length ones in 14 fg when my usual ones were out of stock and they were significantly faster to drain - I am draining 800 - 1,000 mls at a time, which is quite a lot!

As regards the condoms (external caths), how practical might they be for you? If you are dealing with stool loss as well, I can't see how they might help as the nappies (diapers) will deal with both 'ends' at once.

So far I have had good luck with the hydrophilic coudé tip catheter in size 14FR (free sample). It is more comfortable to insert and I now do not have any spots of blood on the catheter. I do not yet know what health insurance will cover, but these would be nice.

What about removing the cath? I felt more irritation on withdrawing the catheter even though I was careful to keep the bent tip properly oriented.

Wheels, the condom cath would primarily be for nighttime when I do not have bowel accidents and could risk going without a diaper, and the early morning hours after my preemptive enema when I am relatively safe. At about noon, or before leaving the house, I still would have to apply barrier cream and put on my diaper and plastic pants to be prepared for a possible bowel accident. It is not foolproof, but I potentially could eliminate 2 premium disposable diapers per day - probably a savings of over $1,200 a year! The same applies to travel or cruising. Reducing two diapers per day really would help. However, this all is TBD.

Meanwhile I am having GREAT success with cloth diapers at night. My folding and pinning technique is working out well. Thanks everyone for helping me with this. Four pins are working best for me as I am pinning the cloth snugly at the legs and have NO fear of leaks!

--John

I am learning slowly. Last night I used a sample I had and found it to be surprisingly uncomfortable to insert. There was some blood when the tip passed into the bladder and upon removal. Upon examining the cath I found it to have rather large eyelets with sharp edges. I guess that the edges scraped agains the narrowed portion of the catheter when it passed through the prostate or the sphincter. Boy, I'll never buy that type and brand.

--John