Catheter questions

A couple of things that someone may be able to clear up for me, the first I’m just curios, the second is more important.

My wife had an indwelling catheter fitted back in May while in hospital, there were some problems initially until they increased the size from a 12 to 14, (the size relates to the bore of the tube, I’m told). She did still by-pass now and again but nothing like as often. She takes one drug to control bladder spasms and when this was changed (she’s at home by now) the by-passing stopped. She did still frequently spit the whole thing out (still inflated) which DN said was caused by bladder spasms. She gets no by-passing at all now, but (and here’s the curious thing) when she sits on the commode for a poo, she often pees into the commode as well. How does that happen?

In March she is due to have a Supra Pubic catheter fitted, What I’m not sure of is that there appears to be nothing done to block the normal exit from the bladder, so why does the wee go down the catheter tube and not just out of the bladder and down the urethra as per normal?

Nobody here got any experience of SP Catheters? I really don’t need another GP appointment.

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Sorry Ajay, can’t be any help

Nor me Ajay… not yet any way!

Hi. The indwelling Catheter is inserted via the lower part of the stomach straight into the bladder. The urine will flow via the catheter as it is by gravity. As there is no catheter via the urethra the muscle holding the urine in will be in place Just like holding your wee in by pelvic floor muscle. That’s why it will divert into the indwelling catheter. Make sure the date the day of insertion is recorded.

Thank you Elizabeth, let’s hope that that particular muscle is still working. I have my doubts.

Hi Ayjay

I was interested to read your query.
My Mother has had a permanent Urethral Catheter for a few years now.
Occasionally when she uses the commode the open her bowels a little wee leaks into it too.
We have always been told that when the bowel is very full it can press on the bladder - maybe that is something to do with it?
I hope all goes well with the Supra Pubic Catheter.

Best wishes.

That makes perfect sense. Especially if you saw the size of her Richard’s. I know they’d make my eyes water. .

We have a phone appointment booked with he GP to discuss the potential problem, but have also spoken to one of the District Nurses this evening (current catheter has by-passed three times in the last four days and I’m tired of washing trousers,knickers and hoist slings, and disinfecting wheelchair cushions now), and she said that yes. it can happen that you by-pass with a Supra Pubic, but as yet, no-one has been able to say why you don’t all the time.

Why does the wee expel itself through a tube instead of the urethra?

Oh dear. I can only sympathise. I don’t know why the wee would pass down a Catheter tube and not the natural tube unless it has something to do with muscles. I’m not a medical person so am just guessing. Has she had a TWOC (Trial Without Catheter)? When Mother had one, she could not pee and was in agony due to retention of wee.
She has had numerous problems over the years (some Nurses tell us we could write a book about it!). We spoke to a Consultant about a Supra Pubic but have decided to stick with the Urethral as we were told it could block just as much and we have frequent problems with blocking, i.e. we have had occasions when it has been washed out in the morning and blocked again at night resulting in more Nurse call outs and 111 if they have finished work.

Wish I could be more help, but unfortunately not.
Keep your chin up and I hope the GP can be more informative/helpful.

If it’s anything to do with muscle control then I think she may have to stay with the Indwelling Catheter

One of her carers managed to pull out her catheter a couple of weeks ago, I left her on the bed on Inco sheets (and changed them regularly) whilst we waited for the DN. At about 3:00 pm she said she thought she wanted a pee and would I put her on the commode for that. Just at that moment the DN phoned and took up a few minutes of time - when I hoisted her to move to the commode she promptly peed on the floor en route.

Not sure about TWOC, I’m not getting up four times during the night to put her on the commode, (I’m fairly unwakeable anyway - I die when I go to sleep). She did Bladder Training after they first fitted the catheter, but from memory that consisted of having a tap on the tube and her turning it on/off when required.

She has very little feeling/sensation in the nether regions, often doesn’t know when she’s bypassed - or presented me with the occasional small solid smeared everywhere.

She doesn’t get blocking problems, and I discovered yesterday that our DN team don’t do washouts any more - I got in touch with them about her current bypassing - we’ve had none for months but three or four in the last 7/10 days since having a catheter change. They did come out last night and re-position it, and it’s been OK so far today - but interestingly, I got very conflicting information about a couple of things related to her current catheter (size) and tube positioning - conflicting with what we were told by the Urology Dept at Southampton GH and the Western CH where the catheter was originally fitted. Following their advice has solved problems we had - following the DN advice yesterday would re-introduce them.

Poor you. I do feel for you both.
I was shocked, and somewhat alarmed, to hear the Nurses don’t do washouts any more??? (maybe different Areas work differently). AND that a Carer managed to pull the Catheter out???
We have had a lot of conflicting/different information too…some Nurses say infections cause bypassing, some say a Catheter size that is too big (yes, not too small) can cause bypassing, some say the bladder going into spasm caused by the Catheter touching the side can cause bypassing.
I would be interested to know what you have been told about tube positioning - does the Catheter have a thigh strap to help keep it in place? Is it detached from her leg at night?

Yes, me too about the washouts, they did one few months back, so it must have changed since then. I managed to pull one catheter out quite early in my “career” as a carer, so I can’t say too much, here’s hoping she’ll be extra careful in the future.

The first bit of conflicting information was when the DN said that to reduce bypassing they reduce the size of the catheter. The size relates to the bore of the exit tube. When her catheter was first fitted (in hospital) she bypassed very often, they increased the size from a 12 to a 14 and the bypassing dropped by about 90%.

With regard to positioning, my wife has quite long legs, we initially had leg bags with a short tube (70mm from memory) the bag always ended up with its top right on the knee which never looked right/comfortable to me. I should say that I use a thigh strap on the catheter tube and a stretchy net-bag around the leg bag. I made up (from other bags) an extension piece for the leg bag tube (about 70mm long) which solved the fitting problems as it dropped the leg bag below the knee.

During an appointment at the Urology Dept at Southampton General - my extension tube got a bit of a verbal pasting. I explained the reason for it and that I disinfected it whenever I changed the bags, but they said use a bag with a longer tube.The next size up from the 70mm [or 140 with extension] is 250 mm, which I said would be too long, but they just said to strap the catheter outlet further back up the thigh - the DN didn’t like that at all as the tube goes down, and then back up again (although it’s mostly horizontal as she’s seated all day) and said it can lead to bypassing, but in fact we’ve been doing it like that and it hasn’t been a problem months now, until the last catheter change.

No problems now since the catheter was repositioned on Friday evening.

I’m glad you seem to have solved the bypassing issues - long may it continue.

Mother started off with a size 12, then it was upped to 14. She has been having a 16 Open Ended (as opposed to side openings) for a few years now.

I think Mother has quite long legs too; she was 6 foot(ish) tall in her younger days. When I have to change the leg bag (every 5 days), the top of the leg bag fits into the Catheter about a third of the way down her thigh. The leg bags we use are called Prosys 500ml Long Tube Click Close Tap leg bags. The tube goes down the outside of her knee and the bag fits below her knee and rests down the side of her calf.

I guess everybody is different and its whatever works for you.

Hi Ajay
I just wondered how things are going with your Wife’s Supra Pubic Catheter?
Best regards.

A bit early to say yet, it only went in at 5:30pm yesterday, but it’s all working OK at the moment, urine has cleared from last night’s pink colour to normal pee colour.

As is usual with Soton General there were elements of farce on view: they brought her back from theatre on a different bed to the one that she was hoisted from to go to theatre. The mobile hoist wouldn’t fit under the bed, the nurse raised and lowered the bed several times before realising that the offending bed base didn’t move at all, just the bed. I went out for a smoke at one point, when I returned, she was on the bed with the sling we use to get her in and out of the car nicely installed under her on the bed, it’s the wrong sling, it won’t work with the mobile hoist.

Here’s another comment/complaint, when you go in for “Day Surgery”, it’s very common for everyone to have the same appointment time, so why do the reception staff have no idea of where you are in the order of things? It must be one of the most common questions that they get asked.

Gosh, only had it done yesterday evening, sorry I wouldn’t have asked so soon had I known that. I thought it was happening in March.
Oh dear, what a mix up with the sling/bed etc, I do feel for you.
I hope all goes well now.
Best wishes.

DN has been this morning to inspect the wound site and change the dressing, she said it’s looking perfect, no problems at all. That’s a bit of a relief as I’ve seen a fair few horror stories with wounds infected and not healing properly for months.

Ayjay, great to hear some good news for a change.

Yes, very pleased for you both. Hope all continues well!

Not so good this morning. Wednesday is a no-carer day so the washing and dressing is up to me. I was a bit suspicious of the smaller than usual amount of wee in the night bag, but before I could investigate that further she asked for the commode - usually the rolling associated with washing and dressing triggers that, so this was earlier than usual, (but not significant).

Removing the bed covers, I then spotted that the tube at the top of the leg-bag was full of wee which wouldn’t drain into the bag when encouraged - also the Brolly sheet was wet and stained, hence the light load in the night bag. Removing her knickers, I could see that the wound site was weeping and the skin was a bit red in one area outside the dressing. I put her on the commode and changed the leg-bag.

Back on the bed to get her washed and dressed and she managed to fall off when I’d rolled her away from me to wash her bum. This is the sort of thing that really bugs me - she doesn’t appear to have the nous to know how not to fall off - and it applies to many other situations too - her hand was under the mattress to support her but had it been on top she wouldn’t have rolled off. I picked her up and put her back on the bed - seemingly no harm done.

The DN is coming later today to take a look.