Suprapubic Catheterization (SPC)
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Archives1
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Hi Julian. I had a SPC, but I had to have it removed after roughly two weeks because the pain was too intense. To start with the urologist said they could put it in at their office. I opted for that approach, but they couldn’t get it in properly so I ended up having it surgically put it. From that day forward, I had this intense urge to urinate. The urge to urinate was so great it hurt. I told them about the pain, but they told me it was not uncommon and would pass in a day or two. It never stopped hurting. After two weeks I had another appointment with my urologist and again I told them about the pain. Again, they told me it would pass. They didn’t care about the pain. So I finally got upset and told them to get it out. They reluctantly took it out and immediately the pain was gone. I know several people who had it done and they love it. I couldn’t tolerate it. I can’t say it won’t hurt, mine did. I now catherize myself twice a day and wear diapers. Not the best solution but it works for me. My incontinence is caused because the nerves between my bladder and spinal cord don’t work. Good luck to you. If you decide to have it done, good luck to you and enjoy life to its fullest.
Archives1
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The folks I’ve seen talk about theirs on social media (oddly all women) don’t seem to complain about pain. They have a pretty positive attitude about them. But they all chose it as a ‘no other choice’ kind of thing.
I could never do it, but only because the idea of a tube coming out of me gives me an irrational level of anxiety and panic. Even a normal foley requires mental resilience for me.
I could never do it, but only because the idea of a tube coming out of me gives me an irrational level of anxiety and panic. Even a normal foley requires mental resilience for me.
Archives1
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@JustAGuy
When it became clear I had to use a foley catheter for a longer period of time I asked my continence nurse about a suprapubic catheter. Partly encouraged by a female friend / patient who got one rather easy and quickly. The nurse told me for women it is often considered due to the bigger risk for women to contract an infection, with a suprapubic catheter these changes are smaller. Downside is when a wound infection occurs it is very painful and can be dangerous.
For that reason it is not so often recommended for a man. The chances to contract bacterias in the bladder through the catheter entrance is not as big for men as for a woman. When a man needs a catheter for a longer period of time the ability to have intercourse is most likely the reason to choose a suprapubic over a foley catheter. Or a medical condition to the urethra.
Like you mention, every body-intrusion comes with adaptation of the mind. When quality of life improves it is easier to go along with it. But every situation and reason to need medical help is different.
@Jgsvch
When you go along with it let us know how it goes. It is always good to hear experiences. Good luck to find the right solution,
@Chris318
I never understood why it is considered normal to have pain. The way you describe it no one should have to go through that level of pain. It just increases anxiety and lack of confidence for the medical staff or confidence in your own body. It’s a good thing you found the best solution for yourself.
When it became clear I had to use a foley catheter for a longer period of time I asked my continence nurse about a suprapubic catheter. Partly encouraged by a female friend / patient who got one rather easy and quickly. The nurse told me for women it is often considered due to the bigger risk for women to contract an infection, with a suprapubic catheter these changes are smaller. Downside is when a wound infection occurs it is very painful and can be dangerous.
For that reason it is not so often recommended for a man. The chances to contract bacterias in the bladder through the catheter entrance is not as big for men as for a woman. When a man needs a catheter for a longer period of time the ability to have intercourse is most likely the reason to choose a suprapubic over a foley catheter. Or a medical condition to the urethra.
Like you mention, every body-intrusion comes with adaptation of the mind. When quality of life improves it is easier to go along with it. But every situation and reason to need medical help is different.
@Jgsvch
When you go along with it let us know how it goes. It is always good to hear experiences. Good luck to find the right solution,
@Chris318
I never understood why it is considered normal to have pain. The way you describe it no one should have to go through that level of pain. It just increases anxiety and lack of confidence for the medical staff or confidence in your own body. It’s a good thing you found the best solution for yourself.
Archives1
Staff member
In all of these comments, I have not heard one word about condom-type external catheters. (And drain tubes and leg bags.) Thousands of men are using them. I HAVE USED THEM FOR ALMOST 14 YEARS. If we are talking about "the next day after surgery" I can understand that. I had an internal catheter for two days after prostate surgery. But, when I stopped bleeding and it was altogether a urinary problem, the internal catheter was a moot question. IT WAS GONE! AN INTERNAL CATHETER IS NOT FUN! In the mix, I called a nurse at our church and she suggested that I take AZO tablets. They enabled me to urinate. (Good ole AZO tablets!!!)
Archives1
Staff member
Hi @DanCarr
I do agree, it is no fun having to use an internal catheter. But just as a tablet can be a relief for pain, or a condom catheter or diapers for the ability to go out in public without worries, a foley catheter can improve one's situation.
I guess you have normal sensations and I cannot relate to your situation but I can imagine the pain after just having had surgery and the pain that goes along with that and also having a catheter in your bladder. That must have been horrible.
But if you can't urinate and self catheterization is not an option, the only thing left is an internal catheter. The choice between a condom catheter and a foley catheter is one of completely different medical needs. You are right about drain tubes, leg bags, night bags etc. That is very important for comfort when needing any kind of catheter. It's, just like finding the right diaper that fits one's situation, very personal and can take quite some time and cause frustration.
But every situation is different and we've all found ourselves in situations we'd rather not be in and want to make the best of.
I do agree, it is no fun having to use an internal catheter. But just as a tablet can be a relief for pain, or a condom catheter or diapers for the ability to go out in public without worries, a foley catheter can improve one's situation.
I guess you have normal sensations and I cannot relate to your situation but I can imagine the pain after just having had surgery and the pain that goes along with that and also having a catheter in your bladder. That must have been horrible.
But if you can't urinate and self catheterization is not an option, the only thing left is an internal catheter. The choice between a condom catheter and a foley catheter is one of completely different medical needs. You are right about drain tubes, leg bags, night bags etc. That is very important for comfort when needing any kind of catheter. It's, just like finding the right diaper that fits one's situation, very personal and can take quite some time and cause frustration.
But every situation is different and we've all found ourselves in situations we'd rather not be in and want to make the best of.
Archives1
Staff member
LIVING WITH A SUPRAPUBIC CATHETER
In January 2013 an accident left me with spinal injury at the base of my neck, paralysis below that site, severe spasticity and double incontinence. My urethra and anus are permanently closed except when opened by manual intervention. I was in a spinal injuries hospital until the end of July. A suprapubic catheter was installed about four months after my spinal injury. Until then nurses used intermittent urethral catheterisation. I was due to be discharged from hospital soon, and because I have very little use of my hands, intermittent self-catheterisation would have been impossible.
It was installed as a minor operation of less than an hour using a local anaesthetic. It goes directly into my bladder about two inches below my navel. My catheter is connected to a leg bag (750ml.) which is emptied around 10am, 5pm and 8.30pm by carers and changed weekly, and overnight, to a night bag of 2 litres, emptied around 10am and also changed weekly.
I wear my catheter outside my trousers instead of inside. This allows easier access to it and avoids minor sores which often developed on my left leg where the joint between catheter and leg bag caused some rubbing of my skin when my catheter was inside my trousers.
URINARY TRACT INFECTIONS AND CATHETER BLOCKAGES
Between May 2013 and January 2016 I had occasional urinary tract infections (UTIs) treated successfully with Nitrofurantoin (3x50mg tablets per day for a few days). Then from January until July 2016 I had 23 catheter blockages, all between about 11pm and 1am. I still had occasional UTIs treated successfully with Nitrofurantoin. A blockage is a terrible and dangerous experience: sweating, spasms jolting, throbbing, an urge to move my legs which I can not do, skin rashes, itching - and this will continue until relief arrives by unblocking or replacing it. The threat of a blockage had become a big concern and made me apprehensive of going to bed.
Following two blockages the previous night, on 24th July 2016 I had another bout of sweating. I thought it was another blockage. It wasn't. It was a UTI: it became clear to me that many of the blockages had occurred at the same time as the UTIs: it appeared that the same bacteria were causing both: so if the UTIs could be stopped, so too would the blockages.
To stop the UTIs I started to use Nitrofurantoin to prevent them (previously I had used it to cure them); so I took 50mg each evening for 30 days, then gradually reduced it to about 3x50mg tablets per month. This worked very well: I had only a few minor UTIs and no blockages until 2020 when I contracted cellulitis.
I do not know for how many people with catheter blockages Nitrofurantoin would work. Not all blockages are caused by bacteria on the Nitrofurantoin hit-list. Anyone who tries it without success might try a different antibiotic preferably preceded by an analysis of their catheter contents at the time of the blockage to find out what other bacteria could have been responsible. Also, it should be remembered that Nitrofurantoin kills the bacteria which commonly create sediment causing blockages. It stops the production of more sediment but it does not dissolve sediment already in the catheter: so it is possible to get a blockage after taking Nitrofurantoin.
As well as blockages in the catheter, it is possible for other parts of the drainage tubes for a suprapubic catheter to become blocked by sediment from the same bacteria as can block the catheter. The tube connecting the catheter to the leg bag is much wider than the catheter: so the contents move more slowly than when in the catheter and so are more likely to deposit any sediment being carried. (Some catheters are also wider near the exit to the leg bag and are prone to block there for the same reason). Being visible, these can usually be cleared by manual manipulation, but can cause problems overnight, especially for those who live alone. This is a good reason to replace leg bags after about a week or sooner if there is a considerable amount of sediment.
Sometimes a catheter can block when there is very little sediment visible. The sediment can be in the two or three inches inside the bladder: if in doubt take Nitrofurantoin.
SUPPORTING METHODS TO PREVENT UTIs AND BLOCKAGES
If the blockage is in the visible part of the catheter (often near the end where it becomes wider to attach to the leg bag), or in the tube leading to the leg bag, it might be removable by manual manipulation.
For several years starting soon after the blockages I had weekly bladder wash-outs, now only occasionally. These have the advantage or reaching the last few inches of my catheter inside my bladder but occasionally have caused blockages. When there has been some sediment in my catheter, they have washed it down and caused a blockage in the last few inches. One the other hand, a blocked catheter can sometimes be unblocked by a bladder wash-out.
Drinking plenty of liquid is widely recommended to wash out sediment, although it will exacerbate any blockage that does occur. Also, care must be taken not to exceed provisions for emptying leg bag and night bag.
Bacteria can be curbed by an acidic environment. Vinegar on food has helped me; lemons are often recommended.
CELLULITIS
In January 2020 I contracted cellulitis. This was cleared using Clarithromycin which had a number of side-effects including high pulse rate, high temperature and skin rashes. Following that I had more sediment than previously in my catheter. Although Nitrofurantoin still cleared them, I had to take more of it than previously. I was not aware of this at first: and so I had a few blockages, during the daytime (previously they had all been after going to bed), usually cleared by manipulation of my catheter to loosen the sediment.
During this period I also had a few blockages where the narrow tube of my catheter becomes wider to connect to the tube from the leg bag and where the flow of urine decreases in speed, depositing any sediment. These were relatively easily cleared by manual manipulation. I have now returned to much the same condition as that before I contracted cellulitis, although I now take about 10x50mg tablets of Nitrofurantoin per month.
OTHER CAUSES OF CATHETER PROBLEMS
Not all blockages are caused by sediment. Sometimes the flow of urine has been obstructed by the end of the catheter pressing against my bladder wall. This can be fixed by moving the catheter sideways. I avoid lying on my catheter or leg bag tube and check to ensure there are no bends sharp enough for the tube to collapse.
My drainage system depends on gravity to flow. In bed I need to ensure that the system points downwards everywhere.
OTHER ISSUES WITH MY CATHETER
It has probably been the best option available but there have been problems:
It has probably caused some, if not most, of the fairly frequent urinary infections. These seem likely to have been at least partly the result of bacteria entering around my catheter site.
Another problem of my suprapubic catheter has been that there is often a small amount of leakage around the place where it enters me. I pull my incontinence pad (Abri San Premium 6) far enough up at the front to cover my catheter site.
How often should suprapubic catheters be changed? Changing a catheter usually leaves trauma around the site, additional leakage for a while and more opportunity for bacteria to enter and cause UTIs. I could not find a good answer as to why 12 weeks is the conventional period, so I tried a little longer. It worked to some extent, but after the catheter came out on one occasion I have returned to 12 weeks. Longer than that does appear to result in an increased risk of deterioration of the mechanism holding it in place.
Costs: my pad is changed only once each day and costs around £10 for 36; washable unisex fixation knickers cost around £7 for 25 which will last at least two years. Leg bags cost around £2.50, night bags £20, each changed weekly; the catheter costs £7 and is changed every 12 weeks.
SOME REFLECTIONS
For me a suprapubic catheter has probably been the best option available; despite many problems it has enabled me to get a night's sleep usually without interruptions and has enabled me to retain some independence by living at home. My overnight urine production averages about 2 litres - impractical to deal with using an intermittent urethral catheter.
Being confined to a wheelchair, the appearance of the leg bag is not an issue for me (I simply lay it on the upper parts of my legs) but it might be for those who are more active.
Compared with other ways of accommodating incontinence, I do not get much mess needing protection and cleaning - just a small amount of leakage around my catheter entry point.
Nurses tell me that they spend a considerable part of their time unblocking catheters, especially overnight. It is unfortunate that more attention is not given to preventing them.
In January 2013 an accident left me with spinal injury at the base of my neck, paralysis below that site, severe spasticity and double incontinence. My urethra and anus are permanently closed except when opened by manual intervention. I was in a spinal injuries hospital until the end of July. A suprapubic catheter was installed about four months after my spinal injury. Until then nurses used intermittent urethral catheterisation. I was due to be discharged from hospital soon, and because I have very little use of my hands, intermittent self-catheterisation would have been impossible.
It was installed as a minor operation of less than an hour using a local anaesthetic. It goes directly into my bladder about two inches below my navel. My catheter is connected to a leg bag (750ml.) which is emptied around 10am, 5pm and 8.30pm by carers and changed weekly, and overnight, to a night bag of 2 litres, emptied around 10am and also changed weekly.
I wear my catheter outside my trousers instead of inside. This allows easier access to it and avoids minor sores which often developed on my left leg where the joint between catheter and leg bag caused some rubbing of my skin when my catheter was inside my trousers.
URINARY TRACT INFECTIONS AND CATHETER BLOCKAGES
Between May 2013 and January 2016 I had occasional urinary tract infections (UTIs) treated successfully with Nitrofurantoin (3x50mg tablets per day for a few days). Then from January until July 2016 I had 23 catheter blockages, all between about 11pm and 1am. I still had occasional UTIs treated successfully with Nitrofurantoin. A blockage is a terrible and dangerous experience: sweating, spasms jolting, throbbing, an urge to move my legs which I can not do, skin rashes, itching - and this will continue until relief arrives by unblocking or replacing it. The threat of a blockage had become a big concern and made me apprehensive of going to bed.
Following two blockages the previous night, on 24th July 2016 I had another bout of sweating. I thought it was another blockage. It wasn't. It was a UTI: it became clear to me that many of the blockages had occurred at the same time as the UTIs: it appeared that the same bacteria were causing both: so if the UTIs could be stopped, so too would the blockages.
To stop the UTIs I started to use Nitrofurantoin to prevent them (previously I had used it to cure them); so I took 50mg each evening for 30 days, then gradually reduced it to about 3x50mg tablets per month. This worked very well: I had only a few minor UTIs and no blockages until 2020 when I contracted cellulitis.
I do not know for how many people with catheter blockages Nitrofurantoin would work. Not all blockages are caused by bacteria on the Nitrofurantoin hit-list. Anyone who tries it without success might try a different antibiotic preferably preceded by an analysis of their catheter contents at the time of the blockage to find out what other bacteria could have been responsible. Also, it should be remembered that Nitrofurantoin kills the bacteria which commonly create sediment causing blockages. It stops the production of more sediment but it does not dissolve sediment already in the catheter: so it is possible to get a blockage after taking Nitrofurantoin.
As well as blockages in the catheter, it is possible for other parts of the drainage tubes for a suprapubic catheter to become blocked by sediment from the same bacteria as can block the catheter. The tube connecting the catheter to the leg bag is much wider than the catheter: so the contents move more slowly than when in the catheter and so are more likely to deposit any sediment being carried. (Some catheters are also wider near the exit to the leg bag and are prone to block there for the same reason). Being visible, these can usually be cleared by manual manipulation, but can cause problems overnight, especially for those who live alone. This is a good reason to replace leg bags after about a week or sooner if there is a considerable amount of sediment.
Sometimes a catheter can block when there is very little sediment visible. The sediment can be in the two or three inches inside the bladder: if in doubt take Nitrofurantoin.
SUPPORTING METHODS TO PREVENT UTIs AND BLOCKAGES
If the blockage is in the visible part of the catheter (often near the end where it becomes wider to attach to the leg bag), or in the tube leading to the leg bag, it might be removable by manual manipulation.
For several years starting soon after the blockages I had weekly bladder wash-outs, now only occasionally. These have the advantage or reaching the last few inches of my catheter inside my bladder but occasionally have caused blockages. When there has been some sediment in my catheter, they have washed it down and caused a blockage in the last few inches. One the other hand, a blocked catheter can sometimes be unblocked by a bladder wash-out.
Drinking plenty of liquid is widely recommended to wash out sediment, although it will exacerbate any blockage that does occur. Also, care must be taken not to exceed provisions for emptying leg bag and night bag.
Bacteria can be curbed by an acidic environment. Vinegar on food has helped me; lemons are often recommended.
CELLULITIS
In January 2020 I contracted cellulitis. This was cleared using Clarithromycin which had a number of side-effects including high pulse rate, high temperature and skin rashes. Following that I had more sediment than previously in my catheter. Although Nitrofurantoin still cleared them, I had to take more of it than previously. I was not aware of this at first: and so I had a few blockages, during the daytime (previously they had all been after going to bed), usually cleared by manipulation of my catheter to loosen the sediment.
During this period I also had a few blockages where the narrow tube of my catheter becomes wider to connect to the tube from the leg bag and where the flow of urine decreases in speed, depositing any sediment. These were relatively easily cleared by manual manipulation. I have now returned to much the same condition as that before I contracted cellulitis, although I now take about 10x50mg tablets of Nitrofurantoin per month.
OTHER CAUSES OF CATHETER PROBLEMS
Not all blockages are caused by sediment. Sometimes the flow of urine has been obstructed by the end of the catheter pressing against my bladder wall. This can be fixed by moving the catheter sideways. I avoid lying on my catheter or leg bag tube and check to ensure there are no bends sharp enough for the tube to collapse.
My drainage system depends on gravity to flow. In bed I need to ensure that the system points downwards everywhere.
OTHER ISSUES WITH MY CATHETER
It has probably been the best option available but there have been problems:
It has probably caused some, if not most, of the fairly frequent urinary infections. These seem likely to have been at least partly the result of bacteria entering around my catheter site.
Another problem of my suprapubic catheter has been that there is often a small amount of leakage around the place where it enters me. I pull my incontinence pad (Abri San Premium 6) far enough up at the front to cover my catheter site.
How often should suprapubic catheters be changed? Changing a catheter usually leaves trauma around the site, additional leakage for a while and more opportunity for bacteria to enter and cause UTIs. I could not find a good answer as to why 12 weeks is the conventional period, so I tried a little longer. It worked to some extent, but after the catheter came out on one occasion I have returned to 12 weeks. Longer than that does appear to result in an increased risk of deterioration of the mechanism holding it in place.
Costs: my pad is changed only once each day and costs around £10 for 36; washable unisex fixation knickers cost around £7 for 25 which will last at least two years. Leg bags cost around £2.50, night bags £20, each changed weekly; the catheter costs £7 and is changed every 12 weeks.
SOME REFLECTIONS
For me a suprapubic catheter has probably been the best option available; despite many problems it has enabled me to get a night's sleep usually without interruptions and has enabled me to retain some independence by living at home. My overnight urine production averages about 2 litres - impractical to deal with using an intermittent urethral catheter.
Being confined to a wheelchair, the appearance of the leg bag is not an issue for me (I simply lay it on the upper parts of my legs) but it might be for those who are more active.
Compared with other ways of accommodating incontinence, I do not get much mess needing protection and cleaning - just a small amount of leakage around my catheter entry point.
Nurses tell me that they spend a considerable part of their time unblocking catheters, especially overnight. It is unfortunate that more attention is not given to preventing them.
Archives1
Staff member
I just now read this. The thread is talking about internal catheters to relieve blockages of the urethra. Been there. Done that. If I should have a BLOCKAGE and AZO tablets would not solve the problem, I would RUN to get an internal catheter!
When I had a PROSTATECTOMY, by the time I awakened, my urethra was swollen shut and the MEDICS had inserted an internal catheter. When they removed the catheter I still could not make water.
A hospital nurse at our church told me about AZO tablets...which worked and allowed me to pee. (They used AZO tablets routinely in the hospital.) No one in the surgeon's office or surgery center told me about AZO tablets or external catheters and leg bags. I had to find them on my own. My surgeon saved my life but I give him an F-minus grade on patient care.
When I had a PROSTATECTOMY, by the time I awakened, my urethra was swollen shut and the MEDICS had inserted an internal catheter. When they removed the catheter I still could not make water.
A hospital nurse at our church told me about AZO tablets...which worked and allowed me to pee. (They used AZO tablets routinely in the hospital.) No one in the surgeon's office or surgery center told me about AZO tablets or external catheters and leg bags. I had to find them on my own. My surgeon saved my life but I give him an F-minus grade on patient care.
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