Patient 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 neurogenic 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?
Answer: Having a neurogenic bladder combined with Multiple Sclerosis (MS) is very frustrating. People with MS have variable bladder symptoms. The most common is a bladder that doesn’t work at all, and won’t empty. These people need to catheterize themselves or have an indwelling catheter to empty their bladder. Unfortunately, just because the bladder doesn’t work well enough to empty, many people continue to have bladder spasms, and often incontinence from leaking of urine.
I obviously do not have the ability of examining you and running the different tests I would run if you were in my office, but based on the fact that you had a suprapubic tube placed but experienced a lot of leaking, you likely fall into the category previously discussed. There are many options for you and I urge you to discuss these options with your doctor. I am going to address some options that would help people with urinary retention with continued urgency and incontinence due to Multiple Sclerosis or other medical issues causing those symptoms.
Intermittent straight catheterization (ISC) - This is the most ideal option for emptying the bladder. This involves a person inserting a catheter into his or her bladder through the urethra, letting the bladder drain and then removing the catheter. This is very well tolerated and has the lowest incidence of bladder infection. If someone continues to have urinary leakage, then there are medications which can keep the bladder from having spasms and therefore leaking. This technique is actually quite easy to learn and becomes second nature for most people. It is difficult for people with manual dexterity issues, and those who are very overweight.
Suprapubic catheter - This is a tube inserted through the lower abdomen into the bladder (which you already had done). This can often be helpful, but as you experienced, the bladder doesn’t like having a foreign object and will often have spasms trying to drive the foreign object out. Medications called anti-cholinergics can help with those spasms as I mentioned above. Unfortunately, people with long term catheters are at risk for kidney failure over many years due to the high pressures in the bladder if this isn’t controlled.
Some people, even if they are able to obtain low pressures in the bladder from medication, may have leaking especially through the urethra. If that is the case, surgery can be done to close or occlude the urethra. Urologists used to perform a surgery that involved opening your bladder and actually sewing the urethra shut from the inside called "bladder neck closure". Now we have found that we can do a very tight "bladder sling", which is a procedure we do for stress incontinence. It works very well and the surgery is much less involved, and we still have access to your bladder through the urethra for emergencies.
3.Urinary diversion - There are many different ways to reroute the way urine leaves the bladder. The discussion is too in-depth for IncontinenceNetwork.com, but in general, there are two primary ways that this can be achieved.
A. Continent catheterizable stoma - This involves "borrowing" a piece of small intestines and sewing it from the top of the bladder to the skin. You would be able to empty your bladder by passing a catheter through this small opening in your skin, through this bowel tube and empty your bladder.
B. Incontinent Ileal chimney - This also involves using a piece of small intestines (the ileum) and again goes from the top of the bladder to an opening on your skin, but is would constantly drain urine, and you would wear a bag which is concealed under your clothing. This is a good option for those who would have difficulty handling a catheter.
I hope this discussion helps you when discussing the next step with your physician. I think you have many options, like the ones listed above, and I hope others reading this who may also have urinary retention not only from MS but other conditions as well will find this helpful. Good luck