Reader’s Question: I had a suprapubic catheter inserted and had trouble right from the beginning. I was in a lot of pain, was having spasms and a lot of urine was coming out of my urethra. I have multiple sclerosis and I have a nuerogenic bladder. That is why the doctor suggested this procedure. I had to have the catheter removed three weeks later. My body just rejected it. My question is, what is the alternative to this procedure? What do you think is the next step?
Dr.Sobol’s Response: Multiple Sclerosis (MS) is a very difficult disease to manage, especially from a bladder standpoint. Bladders all respond differently. In general, there are four ways MS may effect the bladder.
One: no change in bladder function;
Two: Atonic bladder, meaning a bladder that doesn’t squeeze, and therefore doesn’t empty;
Three: overactive bladder; and
Four: overactive bladder with dysenergy of the sphincter, meaning that when the bladder squeezes to empty, the sphincter slams shut and the bladder doesn’t empty, but because it is trying to empty, there are high pressures in the kidneys, and there is a risk of severe kidney damage.
The fourth one is the most dangerous, but can be diagnosed with urodynamics and a kidney ultrasound, and subsequently treated.
Normally, when a bladder senses something in it, like a suprapubic tube(SPT), it squeezes. Unfortunately, not always at an appropriate time. Since I do not know you and I haven’t had the opportunity to exam you or perform tests on you I will answer this question broadly. I do not exactly know why you had a SPT placed, but your bladder certainly didn’t like it. When I have a patient in your situation, I start by maximally blocking the bladder with three medications; an anticholinergic, an alpha-blocker, and imipramine at a low dose. Imipramine at the usual dose is an anti-depressant, but at low doses (like 10mg), it can help increase bladder capacity. The three medications together work synergistically to maximally relax the bladder.
If triple drug therapy doesn’t work, then I would evaluate my patient for a more aggressive way to treat a "misbehaving bladder". Urinary diversion is a surgical procedure which can be performed in a variety of ways. It is an involved surgical procedure using your bowels to help reconstruct the way urine leaves your body. Most of the ways involve a stoma on your lower abdominal wall, either constantly draining into a bag, or you can intermittently catheterize your bladder through this stoma. Like I said, it is a fairly involved surgery, but the overall results are great, and have little complications.
I don’t know which type of bladder you have, and what ways your bladder was managed prior to the SPT, but I hope that you find the above discussion helpful. I hope you find some answers and relief soon.