A Supra Pubic Catheter or Tube is commonly called Super Pubic Catheter. I’ve had an SPC for 16 years now without to many problems. There is not a lot of first hand info on the net so I will share my personal experience. An SPC is a method of bladder management. A fairly simple procedure usually performed under a general anesthetic. An incision is made about three inches below the belly button and small hole poked in the bladder. Usually the incision is low enough to hide below your pants belt line. A catheter is inserted and held in place by plugging a syringe onto the catheter port inflating a 5 to 40 cc balloon with sterile water. The syringe is unplugged and drainage bag connected to the catheter flange.
It took three weeks for my Supra Pubic Catheter site (catheter insertion point) to settle and stop bleeding. I no longer keep it covered with any type of dressing. You must always keep a catheter in place as your bladder heals quite fast, in as little as ten minutes without a catheter you may not get another in. Your body treats the catheter as a foreign object forming it’s own tube around it from stomach wall to bladder. As your body is constantly trying to expel the foreign object (catheter) the catheter site never totally heals and will always require a little cleaning. We use an alcohol wipe each morning and night. I’d much rather my carer clean around the Super Pubic Catheter site than the pointy end of business (I’ll call him Sarge) as with indwelling catheters. Especially when your primary carer is family.
CHANGING A SUPRA PUBIC CATHETER
Silicone Foley catheters like these above are good for three months however I change mine every two months. Even then it often requires a little tug to remove. Some rotate the catheter frequently to keep it free. Sterilize all equipment and around the catheter site. Deflate the old catheter balloon by firmly plugging an empty 10 cc syringe onto the catheter port and drawing backward. Remove catheter taking note of how far it was inserted, so you know how far to push the new one in. Lubricate and insert the new catheter, inflate the balloon, it should then slip back a little and rest against the bladder wall. Holding the plunger depressed remove syringe and plug a new clean drainage device onto catheter flange.
We once pushed my catheter in to far, through the bladder and half way out my urethra. When we inflated the balloon it ruptured my urethra. Sarge was wounded by friendly fire! I bled from the penis for three days. The same can happen if it’s not in far enough. A little bleeding is common after a change or trauma (accidentally yanking the catheter) but it should stop quickly.
Plug a leg bag or whatever drainage receptacle you prefer. I use a 16 gauge Silicone Foley catheter with a 4-Sure 2000 cc overnight drain bag in a cover slip hung up under my power wheelchair. The 4-Sure is emptied morning and night, changed weekly. The boys get jealous when we have a session at the pub. They run back and forth to the bathroom while I don’t need to go at all. Check and top up the amount of sterile water the catheter balloon contains monthly as some osmosis can occur, you don’t want the catheter falling out when asleep etc.
LIFESTYLES - DIET FLYING SEX AND SWIMMING
Drink anything you like. A lower urinary pH can be of benefit in reducing sediment and bacteria causing UTI’s. Some pH lowering drinks, and those of general benefit to Supra Pubic Catheters are cranberry juice, coffee, naturally brewed beer, wine, buttermilk, distilled and filtered water. Eating like drinking is unrestricted, foods that lower urinary pH are meat, fowl, fish, corn, gravy, eggs, sour cream and whole grains. Please keep in mind it’s all about balance, a healthy pH range is between 6.5 and 8.0
Flying is no problem though be aware silicone slightly expands at 20 000 ft. Some like to use a smaller gauge catheter on international flights. The main reason I chose a Super Pubic Catheter was sex. How can I put this… Sarge is always battle ready, free to stand to attention at anytime. No folding an indwelling catheter back and covering with condom or having to do a quick self catheter drain to prevent leaking during sex. I’m good to go anytime. Now I need to find someone to have sex with! Haha. A friend tapes her SPC to her side during sex but I guess that depends how rough you like it. Drinking is essential with a Supra Pubic Tube (Catheter). It’s recommended you drink at least 3 liters daily to keep sediment levels down and the catheter eyelets clear.
Swimming is not a problem. Disconnect your drainage device and press a stint (sterile cone shaped stopper, can use anything really) into the catheter and splash on in. Avoid drinking to much before and during swimming. If for some reason the urine cannot be drained via the catheter you will usually bypass. The sphincter muscle which controls urination can only hold so much pressure before it will leak and you go the old fashioned way. That’s a good thing, while inconvenient at times it’s like a safety valve.
Sleeping puts your bladder into a dormant state, yes it sleeps too. Sleep on your back, side or front as long as it doesn’t kink the catheter or tubing. Having a large drink just prior to sleeping will help your urine remain clear overnight. Keep your tubing and drainage device lower than your bladder. I clip the tubing full of urine onto my bottom sheet so it can’t pull on my catheter. A quick look around this web site will show there is little quadriplegia or an Supra Pubic Catheter prevents me from doing in life.
URINARY TRACT INFECTION PREVENTION
You will never completely stop Urinary Tract Infections (UTI). Anytime you have broken skin you’re vulnerable to bad bacteria, especially when you have a catheter pointing the way in. Good hygiene is very important. I suffer less than one UTI/yr. The only indicator my urine has a stronger odor and is darker in color. Other quadriplegics may shake, shiver, sweat, suffer headaches, blotchy skin or possibly display anotomic dysreflexia symptoms. Females seem more prone to adverse reactions to UTI. The latest research suggests drinking large amounts of water to flush the infection through works as fast as antibiotics.
Hiprex tablets or Ural an anti-infection drink can help. Hiprex is a pro-drug absorbed from the gut passing into the urine where it’s hydrolysed to formaldehyde. Formaldehyde causes the breakdown of proteins/sediment essential to bacteria. However this only occurs if urinary pH is less than 5.5 acidic which is considered an unhealthy level. It’s a big pill to swallow and tastes like horse piss but they work. Recommended twice daily, one every three days was enough for me.
Cranberry products, naturally brewed beer and wine are also good UTI preventitives. I have a few beers near everyday and haven’t needed anti-sediment medicines for a number of years now. The site itself is also at risk of infection. If the Super Pubic Catheter site becomes red, warm to touch, crusty, scungy, tingles, smells bad and/or is pusy you probably have a site infection. A doctor can take a swab to confirm. Keep hair trimmed back away from the site as it promotes bacteria, exposure to the sun, saltwater baths, clean with an alcohol wipe morning and night, keep it dry and with good air flow all help avoid site infections.
Silver is a highly effective antibacterial substance which can be applied to various types of catheters. Multiple studies have suggested that silicone urethral catheters coated with hydrogel and silver salts reduce the risk of developing bacteriuria. Specifically, silver alloy catheters (coated on both internal and external surfaces) were shown to provide a significantly greater reduction in the development of catheter-associated bacteriuria over silver oxide (coated on the external surface only), silicone foley, and standard laytex catheters respectively. Silver alloy catheters cost around $5 more than standard laytex catheters but if you find you are prone to urinary tract infections they are worth trialing.
MEDICATIONS AND DRUGS OF BENEFIT
Infections at one time were so frequent we had to change my Super Pubic Catheter every two weeks. Bacteria grows on sediment and can build up blocking the catheter’s draining eyelet’s. We would use sterile bottled water or cooled boiled water and flush the catheter with a large syringe every few days. Then I found Hiprex (Mandelamine, Ural, Urex etc. - see “Urinary Tract Infection Prevention” above) or you may pefer to try D-Mannose. Everybody produces sediment, “regular” people just don’t notice it. Tell them to pee into a jar and wait 6 hours, they’ll see sediment.
With an SPC the bladder is constantly draining and over time may contract or shrink (like any muscle does) frequently spasming. The condition is called an overactive bladder. Ditropan, Vesicare, Enablex and Detrol LA are bladder specific muscle relaxants prescribed to prevent this. You can imagine how hard it would be to get a replacement catheter located correctly if your bladder was the size of a grape. Of course please consult your doctor before taking any new medications.
CEASING USE OF SUPRA PUBIC CATHETER METHOD
No need to be nervous wondering if a Supra Pubic Catheter is going to be the right bladder management method for you. If for any reason you become unhappy with the SPC it is fully reversible, just leave it out and resume your old method. Of course you must consult your doctor first, last thing anyone wants is a raging infection left trapped inside their body. Basically you restrict fluid intake remove the catheter cover the site and cease all activity for a few days to allow healing. Keep clean but avoid showering and over-distending the bladder. Generally the bladder will seal itself off within 10-60 mins, the catheter site takes a few days to weeks. Like I said however please consult your doctor first.
Kind Regards
Graham Streets
MSC Founder
Why would someone need a super pubic catheter? And how long would they have it in? I’m a nursing student trying to figure things out. Your site was helpful. Thank you.
thank you so much for this article. I had four perennial surgeries, the last ending in a hole in the bladder. I have to use super Tena with a super pad inside. it is uncomfortable and smelly. I will ask my Dr. about this. It sounds good, thanks.
Is having the Super Pubic Tube painful or uncomfortable on a daily basis?
My friend has MS and she has had a Foley Catheter for a long time. She recently developed a stone that was removed by her urologist. The doctor also saw inflammation and is suggesting the use of the Super Pubic Tube. She is freaking out about the need for this procedure. I am a non-medical person so I am asking what is maybe a very naive question. If she decides she doesn’t want the Super Pubic Tube or the Foley Catheter, is it an option to go without anything and wear a super-absorbent diaper with rubber pants instead?
K.T: Anyone with a long term or permanent condition which renders them unable to void (urinate) voluntarily or self catheterize. Such as those with Quadriplegia, Paraplegia, Acquired Brain Injury, Multiple Sclerosis, Motor Neuron Disease, etc. In general those with weak bladder control, poor mobility, loss of function or further complications often benefit from a Supra Pubic Catheter. It is a life long permanent method of bladder management for most, or at least until the condition requiring an SPC is alleviated.
Maureen: For some yes, not usually painful but if you have full sensation just like a pebble in your shoe long term it can become annoying. A simple numbing agent like a babies teething gel can ease irritation. Having a Supra Pubic Catheter (Tube) won’t stop stones though it will avoid the inflammation indwelling catheters cause. I have a quadriplegic friend who sat in his wheelchair and watched his doctor perform the procedure under a local anesthetic. I’m not suggesting this for your friend but there’s no need to be freaking, that’s how simple it can be. And, it’s reversible as described in the article.
Going without anything isn’t a good idea, reflux of the kidneys leading to renal failure can cause death. To put it simply, your kidneys do not like drowning in their own urine. Personally I find adult diapers humiliating. And don’t ever try to pull a bib over my head. If you can’t feed me without spilling food all down my front I simply won’t eat. While at different rates for different people Multiple Sclerosis is a progressive condition. A Supra Pubic Catheter will be an increasingly viable option for your friend. It’s not something she has to decide overnight. Have another talk with the urologist about the pro’s and con’s. Meanwhile moderate inflammation isn’t a good enough reason to stop using an indwelling catheter.
Your comments are very helpful. However, it appears they are female situations. Do males have similar results or do men occur other problems? I am a 78 year old male, active & in good health. I underwent TURP, 11/2003, for persistent urinary retention. Since the TURP, I have not voided. I, CIC 5 times daily. My urologist has suggested Super Pubic Catheter.
Any suggestions & or comments would be appreciated.
Hi Ronald, Both males and females can benefit equally from a Super Pubic Catheter. TURP (Transurethral Resection of The Prostrate) surgery allows for the continual flow of urine. People who have this procedure often have to wear a urine collection device. CIC (Clean Intermittent Catheterization) is a good means of bladder management for those who are able to do so as it’s more the normal pattern of filling and emptying. The bladder retains some tone etc.
As your urologist has suggested a Super Pubic Catheter you need to weigh the advantages of each method of bladder management. And which best suits your lifestyle.
Some advantages – It’s away from the genital area and less prone to infection. Less embarrassing, no need to find an accessible toilet and/or toilet 5 times a day. Decreased risk of UTI (Urinary Tract Infection) common with self-catherization. Freedom of sexual activity.
Some disadvantages – Catheter must remain in place or the opening may close over. Urine may still leak via the urethra especially if catheter is blocked or the drainage tube kinked. Any tube going into the bladder can provide an entry for infection. Some are not comfortable with the thought of a tube going into their abdomen. You must wear a collection device.
I have had my spc for three years now,it has caused no trouble and I have it changed every nine weeks.It is nothing to be scared of and with a flip flow valve you dispense with the bag altogether.
I have just been told to consider an SPC. Can I go about my life without a bag on?
Yes you can but most use a bag Mrs C Jones. With a Super Pubic Catheter it is recommended that you drink at least three liters of water/fluid a day. Not everybody finds they need to but most do to prevent the catheter eyelets clogging up with sediment. The average adult bladder can hold half a liter so if you use a valve or tap you will have to empty your bladder quite frequently. I output on average 1.5 liters overnight so would have to wake at least once in the middle of the night to empty. A disposable overnight drain bag could solve that though.
Over-distending your bladder can cause problems. The catheter balloon gets forced against the bladder wall and can irritate or cause bleeding. You may also bypass – urine gets forced out past the catheter or via the penis/vagina. And frequent excessive urine retention is not good for your kidney’s. So while entirely possible not to, most wear some kind of collection device.
Hello, I have a SPC but a little different situation. I catherize through my naval with a 14 French catheter tube that I keep with me daily in my pocket. I simply keep the tube in a plastic snack bag and then enter it through my naval and into my bladder and then urinate. I have been doing this for eight years now. The downside to this is when my bladder is too full at times I can have a wet shirt. It can be embarrassing but it has not happened too many times and no one could ever figure it out anyway. Could be a plus for traveling ???? Does anyone else have a naval SPC ????
Graham thanks for the great info. I’m a paraplegic and my nurse keeps pushing SPC. I could find nothing on web md. Unfortunately my sex is over, removing 1 reason for SPC. Especially thanks for Hiprex as sediment is a real Foley problem for me. I will ask my urologist about it knock on wood, I’ve never had a UTI. just a note: I’m told cranberry juice is not as much help as once thought. I’m not convinced. I’m told beer is much better. I’m not a beer lover, but I’m learning. if it works good i may try it for irrigating. anyway, bottoms up. Tom
Hey Tom, that is mostly true. I know many paraplegics and quadriplegics, on average I’d say 60% notice a reduction in bladder sediment when drinking a substantial amount (1.5+ litres/day) of cranberry juice. However the same 60% can be said for 1.5+ litres/day of beer, especially naturally brewed beer as it seems to be the yeast + hops which reduces sediment. I drink a few naturally brewed beers everyday and for quite some time haven’t needed any other method to reduce urine sediment.
I am certainly not advocating or condoning beer as a good sediment control choice. Long term the side effects of consuming 1.5 litres/day can make beer more harmful than good. Sclerosis of the liver, dehydration, alcoholism, legal consumption age etc are not associated with cranberry juice. So again it’s a “whatever works best for you” thing, which is in most cases a balance.
Since being fitted for a suprapubic catheter I have continue to have the feelings that I am about to urinate normally. I have been told these are bladder spasms. Is there anything I can do to reduce this sensation, or must I just learn to live with it?
Hi Paul, I have heard of this a couple of times from people with supra pubic catheter’s and imagine it would be quite an annoying sensation. I’ve mentioned the antispasmodic drug Ditropan here a few times, there can be side effects, my skin gets very dry. Ask your doctor about it.
Ditropan (Oxybutynin chloride) relaxes bladder smooth muscle. In patients with conditions characterized by involuntary bladder contractions, cystometric studies have demonstrated that oxybutynin chloride increases bladder (vesical) capacity, diminishes the frequency of uninhibited contractions of the detrusor muscle, and delays the initial desire to void. Oxybutynin chloride thus decreases urgency and the frequency of both incontinent episodes and voluntary urination. Here is an excellent article on Ditropan.
My dad is 82 with cancer. Before being diagnosed though, he struggled with an enlarged prostate and was on Flomax and Avodart. Neither really worked for him. For the last several months, he sets the alarm each hour to wake up and go to the bathroom because he doesn’t feel the urge until too late and he moves too slowly to get to the urinal and won’t purposely go in the adult diaper. Believe it or not, the incontinence was more of a misery to him then his terminal cancer. A nurse suggest the supra catheter and we asked my dad’s urologist who performed the operation today. We are keeping our fingers crossed and hope he’ll get a good night’s sleep (he won’t have to set the alarm anymore)so that his last remaining time isn’t spent fussing with incontinence. Any helpful hints for these first few weeks? He was saying shortly after coming home from the hospital that his belly felt like a burning sensation inside, if that makes sense. My mom will call the doctor tomorrow but was wondering if you ever heard of that? any input would be appreciated.
Hi Kim, My sympathies for your fathers terminal diagnosis. The burning sensation is common. Ask his doctor about Xylocaine or Lignocaine (Lidocaine) based gels. While often used when inserting catheters, you can continue to apply them topically to ease discomfort. Use sparingly, at full strength these numbing agents are quite powerful anesthetics and can have severe side effects, irregular heart beat, seizures, liver damage, slowed or stopped breathing. Given your fathers age and condition I suggest you try a weaker strength product like Orajel (teething gel), Topicane, Emulgel or Ametop first (be aware these may sting broken skin), ask your Pharmacist.
Keep the supra pubic catheter site clean and as sterile as possible in the early stages. Reduced activity will assist healing and ease irritation. Keep the fluid intake up to avoid any blockage type problems. Best wishes to you, your father and family.
How would you pass a kidney stone with a SPC? I was wondering because I get them alot. Also I heard that SPC causes a tumor after 10 years is this true?
Hi Thracia, kidney stones are treated a little different in Super Pubic Tube users. Often the stones are not able to be laser blasted into small enough fragments to pass via the catheter, as the catheter eyelets are very small. A larger size catheter/eyelets may be used for awhile or another means of providing a large enough passage to expel the stones. If that is not possible the stones are surgically removed. As you are prone to kidney stones prevention is better than cure.
While yes studies show long term supra pubic catheters increase the incidence of bladder cancer, it is in general less than one percent. A 1991 study of 2900 spinal cord injury survivors found eight cases, (less than 1%) of bladder cancer. In the Craig study of 2660 indwelling catheter users showed a 3.8% increase of cancer incidence in the first 10 years. By 30 years, in a group that was relatively small in size, the risk of bladder cancer had risen to 9% for indwelling catheter users. It is clear the largest cause of bladder cancer amongst Supra Pubic Catheter users is irritation. Tumors have been found inside the bladder where the catheter rubs, and in the path where the catheter lays. Also urinary tract infections, smoking, and kidney stones increase the risk. This is a good article: CraigHospital.org
My wife can’t walk anymore or get to the bathroom so I’m interested in this surgery for her.
I’ve just had surpra pubic catheter after a year of urethal one. I’m so scared of having it changed I’ve been told its really painful is it?
Hi Sheridan, I don’t know if you are hyper-sensitive in that region or not but even then, no. It should not be painful. As I suggested for Kim (see above) numbing gels can be applied prior and post changing catheters to ease discomfort. Most, like myself, just feel a little bit flat afterwards. Try not to stress. It is a simple procedure that must take place. I am very keen to hear from you again to learn of your experience.
Hi, Just wondering if anyone has some thoughts or suggestions. My daughters had a spc, but she goes through her navel, and some times she does end up with wet shorts or shirt. She’s had the spc since she was 2 years old, and now will be heading to middle school soon. I cant stress it enough to her to be more aware of being wet because kids will and have made fun of her because it smells when she’s wet. What else can we do to help with that, or is this a normal for kids this age to be so involved with other things they don’t take the proper time while at school, she’s fine at home, on vacations, weekends. I do remind her alot more at home. I feel so bad and want to help, because kids now days are so mean to each other.. Thank you.
Hi Terry, yes it’s normal for children to be so involved they neglect their health just as many adults do. She may be able to use a larger gauge silicone Foley catheter to prevent bi-passing or leaking, consult your doctor. If it’s possible for her to wear a collection device such as a leg bag it will extend the window of time needed between draining. Her teacher may hold a few spare sets of clothes for when she does become wet. Every child has incontinence problems, only the duration varies. Education is key to good management. And you are teaching her well, stick at it. I’m sure she will conquer this before to long.
I’m a nurse taking care of a patient with spc. I don’t understand why it keeps falling out. The Foley is able to slide out easily up to the opening. Could it be that the entrance of the bladder has enlarged somehow? thank you
Yo no escribo ingles. Me disculpan. Mi eposo Jeffrey sufrio un accidente 8 meses atras. El tiene brain and spinal cord injury, es paraplegico, su njurt fue en la T-12. El esta usando foley por atraves del pene. El va a tener la sirugia pronto para ponerle el supra pubic cath. Ustedes piensan que en su condicion es lo mejor? Muchas Gracias.
i am a nurse also who is taking care of a patient with a supra-pubic she often complains of leakage subsequently, her urologist has ordered irrigation’s with 100-200cc’s twice a day I was under the impression that opening a closed system so often would increase the chance of UTI’s very interested to read what you think thanks
My husband is writing this because I am paralyzed. I also can not verbally communicate. I have had a Foley Catheter for 8 years. It is hard for me to tell my husband or others that the catheter is caught on some thing and then gets pulled out. This usually happens during transfer into the shower, hot tub or bed. I am going to get a SPC to eliminate this. Our theory is that the SPC will be higher and will not get caught. Any comments before we have it installed?
have you any information re albumen build up in super pubic catheters
please notify me of any new information on the SPC, Thank You
I will attest to the benefits of Ditropan (oxybutynin chloride) as a relaxant for the bladder. I have had an IDC for 26 years but the only time I started bypassing with an IDC in, I had accidentally not taken the Ditropan when I had a mild UTI. I got advice from the spinal unit and took a Ditropan and within 15 to 20 minutes, the problem stopped.
I did have a suprapubic catheter put in last year. The surgery etc when fine. The first catheter change did not. The first catheter change is done by a professional nurse but she had not put the catheter in far enough which resulted in me going dysreflexic and bypassing the catheter completely. Because I was at home and had no choice nor any idea what to do, I got my support worker to remove the SPC and replace it with an IDC. I was desperate and knew that the IDC would at least work. This is not meant to be a negative towards a suprapubic catheter but just a suggestion that when you have your first catheter change, stick around the hospital all be able to get to a professional nurse to check the situation WHEN you have your first catheter change. Take note of what Graham said about checking the distance that the catheter goes in. Once you have the correct distance, keep a note of it so that you do not have any problems with catheter changes in the future.
Colleen, have you tried using micropore to tape the end of the catheter directly to your skin? It is something I would recommend whether you stay with an IDC or use a suprapubic catheter. Hopefully the latter will lead keep the catheter out of the road a bit. The surgery is quite simple — but you do go under a general anesthetic.
I’ve been on holiday, thanks for helping oiut Vicki
B: It sounds as if the bladder opening has been stretched. This happens more frequently in elderly patients. I use a 16 gauge silicone Foley catheter which recommends 5cc. I put 10cc of sterile water in and sometimes after 4 weeks it’s down to 3-4cc again, so check the balloon size every 4 weeks. Push the catheter in gently until you feel it touching the bladder wall then tape the catheter in place so it can’t slide back out. In time the stretched bladder opening should shrink back down. You really should consult a urologist and have an ultrasound to see exactly what’s going on.
Jackie: S’ un supra cat’ter p’bico convendr’ Jeffrey bien. Es una T-12 e’l puede tener alguna sensaci’n all’ tan el bajar ellos pueden hacer incisi’n el mejor. Muchos con el hallazgo de la sensaci’n que lo irritando. Si eso le sucede siempre puede reasumir apenas su m’todo actual.
Deborah: I haven’t had to irrigate my bladder for years. And yes any time the catheter is open infection can get in. I prefer to find a way to reduce sediment and do away with the need for irrigation. I’m surprised your urologist didn’t suggest reducing sediment with Hiprex or Ural etc, ask your pharmacist. If then you notice reduced sediment cut back the irrigation. Meanwhile I hope you are using plain clean sterile water not saltwater.
Collen: As Vicki said taping the catheter down will help. Being more visible an SPC will likely be better. Pulling a catheter out is not only painful it damages the pathway. Your carers need to pay more attention to where the catheter and tubing is. Prevention is far better than cure.
Chris: You mean albumin? Albumen is egg whites. If you are getting a build up of the protein albumin you need to see a doctor and I advise you to quickly. If it is just sediment look where we’ve mentioned Hiprex here and ask your doctor about it also.
Vicki: Hi! Hope you are well :) We once inflated my Super Pubic Catheter balloon when it wasn’t in far enough. I bled straight away from the site so we knew and repositioned it. It’s unfortunate it didn’t work out for you. I imagine sitting on an indwelling catheter all day long would become quite annoying but suppose that depends on the amount of sensation you have in that area.
So happy I found you!!!!! Just because I’m an RN doesn’t mean I’ve had mega experience with SP-Tubes!!!! My male friend with MS and a neurogenic bladder had one put in about yr. ago, after continued problems. We STILL have UTI’s, but sediment is the biggest problem. Our Urologists’ never suggested Hiprex, is it easy to get? I’ve been discouraging his overuse of ABT’s, and have opted to make him have more cranberry juice & water saccharine mixture, the only way he will take it. One of his Urologist’s also took him OFF Ditropan, stating it was only for people who need help in actually urinating in the normal way. He did however make a good suggestion in upping the cath. size to 20 from 16 but the sediment continues; at times causing great discomfort until it is irrigated away. He had a Psudomonas UTI about 2 months. ago that sent him to the hospital. I have NOT been impressed by either Urologist we’ve had in comparison to his Neurologist and PCMD who have been outstanding.
My question now is: Does the amount of fluid in the balloon matter if it’s 10, 15 or 20 cc’s with a 20 cc balloon? (all have been used). Sometimes I swear the catheter bubble leans against his bladder wall, as it seems to be positional at times, causing more uncomfortable “clogging”. He’s also on monthly steroid IV’s that also aren’t helping. The Uros have offered no additional help, other than “bandaid” when we are STILL having problems. Also, please tell me if it’s OK to pull back on the irrigation syringe when I have to? I try to do it gently, the Uro’s have been vague about all these things!!!!! There is actually more to the Pseudomonas story, which I will explain to you upon request… but enough for now.
I’M SO HAPPY TO HAVE FOUND YOU!!!!!!
Hi Anne, UTI – I’m sure you’re aware they’re difficult to control anytime you have a foreign object piercing the skin as you are open to infection. So the ‘prevention better than cure’ grass roots approach is usually best. Good hygiene in cleaning around the Supra Pubic Catheter site with an alcohol based wipe regularly, sterility changing the catheter, healthy diet, and at least 3 litres of water a day.
Sediment – Hiprex (Hexamine) is readily available and assists in reducing sediment though is primarily administered to kill bacteria (as does Nitrofurantoin, Nalidixic acid, Trimethoprim), there are many similar effective options in many forms, capsule, tablet, powder, drinks. I suggest you ask your local Pharmacist and consult your doctor. I am not one for pills, I took myself off Ditropan. 6 months later we found replacing/positioning correctly a new catheter near impossible. An ultrasound showed my bladder had shrunk to the size of a golf ball only returning to a manageable size after 2 months back on Ditropan. Keep the drainage devices well below the Supra Pubic Catheter site to prevent build up. Frequent drinking and moderate activity helps.
Balloon – The sealed packet your catheter comes in has a maximum recommended balloon size on it. While I do often exceed it, know there’s a greater risk of rupturing. Let alone getting a replacement in quickly, you do not want fragments of balloon in your bladder. Size matters, take one of your catheters an old used one even. Inflate it slowly and watch, often when there is not enough or too much fluid in the balloon you will see it bulge on one side. This can press the catheter eyelet’s against the bladder wall blocking them. Some suggest inflating to test prior to installing. While good advice I remind my carers, “A quick change is a good change.”
Overall Anne, 20cc is near golf ball size already so keep a regular ultrasound eye on bladder size if you discontinue Ditropan. Check the balloon size every 2 weeks. Encourage your friend to drink fluids regularly, perhaps even a few naturally brewed beers nightly. Not all people in wheelchairs require a dead flat floor. Something as simple as a thick rug might be annoying to have to bump over several times a day but jiggling will help prevent sediment building up in the bladder. So grab some beers put your favorite music on and wriggle what you can for medicinal purposes.
Thanks SO much for your suggestions. As stated, I am in search of another Urologist who will work with us better. The present one seems to poo-poo everything, unless he thought of it, otherwise he or his Medical Assistants get my questions/info’ wrong. Glad to find this fabulous resource site! Sincerely, Anne. PS: RE: balloon size, the catheters they’re now sending him are #20′s with a 20cc balloon. Do you think 20cc is too much, and could interfere? I will try to check balloon prior to using, but must also keep equipment sterile as possible, as you know. TX again, A2
Hi Anne, I want to be very clear, I am not a Doctor nor a Urologist. The information contained on this website is purely personal experience’s. Can you please check on the packaging of the “#20′s” and confirm it is a Silicone Foley 20fr catheter ((fr is the French unit of gauge. Foley (or Foy) is the name given to all balloon in-dwelling catheters))? These catheters typically have a 5cc(ml) balloon for children, 10cc adults, 30cc post-operatively for haemostasis or where the neck of the bladder is torn/stretched too large to hold a 10cc balloon. For an MS patient in general, long term 20cc sounds excessive. That said I cannot, will not, go against any doctors advice. Any changes to daily practices should be monitored closely. You should just move in with this guy or adopt him. Your tremendous compassion evident, care giver’s like yourself are rare and much appreciated. Need a side job? We are looking for article writers.
It is an insurance supplied Bardex #20fr. w/a 20cc Ribbed Balloon, the packaging recommends a 25cc “installation.” I don’t use that much, but the MD’s in the hospital did. (Sorry about the 30 vs 20cc balloon size error). I am QUITE interested in what YOU have to say; MD or not, because you’ve made more sense than them already. It makes sense to ME about bladder changes without a medicine like Ditropan. Perhaps that is what I’m dealing with. Anyhoo… with the stinky Urologists we’ve had who haven’t even helped, or listened as well as you. I’m presently better off without them until I find a good one. Not to worry, I know where the MD/experienced Pt.line should be drawn. In the future, when I have more time, let me know how my writing can help!
Bill is on Baclofen 20 mg. bid….(My assistant has been pre-filling his medications, so it slipped my mind). It’s also known as a muscle relaxant but do you think it’s as good for SPT use as Ditropan? I also could call the Pharmacist, but thought you might know. Many people must be very grateful for the fabulous work you do. Your site (alone) is one of a kind! Sincerely, Anne
Oh my goodness! This is such a great site! This is the first time I have ever blogged anything. I have a 22 size French suprapubic catheter for the last seven years. I have dealt off and on with sediment and I am very encouraged about what I have read to remedy that. I recently had a foul smelling coming from the suprapubic site at and I have some bad luck with urologists as of late, actually since I moved from Minnesota to Arizona. Good health care is precious. I am assuming after I get my husband to change my catheter tonight I will use alcohol wipes on a daily basis and hope that clears up my problem. Thank you so much
Hi Anne: Baclofen is a good muscle relaxant. A quadriplegic friend of mine takes 20mg 4x daily. Needless to say he has very few spasms. I found it destroyed my memory, that is to valuable to me so I won’t take it. Ditropan makes my skin very dry but have to take 5mg x2 daily. While Baclofen is beneficial, Ditropan actually targets the bladder specifically.
Hi Dorothy: Yes use an alcohol wipe before a catheter change. Start at the catheter site and wipe in increasingly larger circles until you have a 6 inch sterile area around the site. Repeat after your catheter change and then daily. It sounds like you have a “site infection” Your doctor can take a swab and confirm, they usually prescribe antibiotics in that case. Exposing the site to sunlight and/or saltwater is good. The ocean is a little far from Arizona lol, but a saltwater pool/bath even a glass pressed to your tummy will help.
I am fairly new to all of this. I have had Foley (14) for 5 weeks, prior to that I had a 24 Foley with a 30cc balloon for 2 weeks that was agony no matter how many antispasmodic medications I took. My bladder was cut along with my right urethra during a hysterectomy at the end of Dec. I need more reconstruction and in the mean time my urologist wants to put in a supra-pubic. Where does the bag go? Do you always have to use one? I need more info, not enough space.
Hello Kim: Most people do use some kind of bag or collection device. Wheelchair users can hook a 1000/2000cc bag onto their chair, many also use what’s called a leg bag 500/750cc which velcro’s to your thigh or calf. It’s recommended you drink at least 3 litre’s(3000cc)/day to prevent the catheter from blocking with sediment. On average a female will need to urinate 6 times daily, a male 5. If you have enough function, mobility you can use a tap (eg: flip flow valve) directly on the end of the catheter as martyn suggests above. p.s. You can keep typing once you use up the white space the box will expand.
I want to thank you for this. My son is 21 years old and is thinking seriously about getting the SPC. I was very skeptical until I read this information. I can understand now why he is wanting to do this and I am all for it. Thank you very much on behalf of my son and myself. My son’s name is Denver Champion.
In my experience, the Supra Pubic Tube beats the Indwelling Catheter by a mile, or many meters!!!!! The IDC has lots more area (length) of irritant, and ie, more avenues for increased irritation/potential infection, by it’s (longer) length itself. Graham has mentioned that anything unfamiliar, (particularly a tube to your bladder) introduced into your body…. wants to object to it in every way it can, but, despite the problems, the Foley presented FAR more serious ones than the SPT thus far (about a yr. with SPT). I’m hopefully learning all the time to make it better still. My Pt. favors it much more as well! Sincerely, Anne, Nurse/Caregiver/Friend.
Does it hurt to have it removed or changed? I recently had a Jackson-Pratt (wound) drain removed and could not believe how painful it was. I’m putting off the Super Pubic Tube because of the huge fear it will be like that wound drain. Someone let me know, I have yet another surgery on Monday and my urologist is really pushing for the SPT.
Hi Kim: As a quadriplegic I have limited sensation in that area so it’s hard for me to say. I can feel it’s there but it doesn’t hurt. Most who have full sensation complain of irritation more than pain as evident on this page. Sure it will sting for about 2 weeks after the initial operation, once that settles any irritation can be eased by using a numbing gel like Xylocaine or Lidocaine on the Super Pubic Tube Catheter site. I use these when changing the catheter and it doesn’t hurt. I’d say go for it, if it doesn’t work out for you or you no longer require an SPC resume your old method and it will just heal over.
Hi I’m a t3 t4 can I use spc if my sphincter was cut? I use a 20fr 5cc it leaks all the time.
This message is to Kim, but also to anyone/everyone to clarify my 2/15 entry a bit. The same length/type Foley is used for an IDC as for a SPT. In the case of my male Patient. he is tall, & has a long torso so when he had the Foley catheter in as an IDC, it almost went up as far as the junction where the balloon port is; ie using a lot more “length” than he needs for his SPC which has several more inches of the Foley out of his abdomen, not touching his urinary urethra (penis to bladder “tube”) which saves a lot of the afore-mentioned irritating “rubbing against”, which increase the chances of UTI even more. He had AWFUL UTI’s with the IDC. We’re still working on the SPC, with Graham’s help but it definitely beats the IDC for us!!! Graham, I admire how you explain some of these details .much easier to state than write, I’m finding out.
Anyhoo.. back to Kim, as I think I can help here. My Pt. Bill has MS, and MOST of his sensation. He hardly feels it when it’s changed, as the “balloon” is completely deflated, so it comes out easily. As far as his initial surgery to have it put in; that was a rather simple day surgery procedure, which required routine MD ordered Dressing changes, seemed for less than a week it was healing well. MD did 1st & 2nd Catheter change 4 wks after initially, then about 5 wks after that. I was then taught the simple procedure to change it, as outlined by Graham above. About a year later, our biggest problem now is the sediment build-up, causing more frequent changes than there should be. Graham has given me some great suggestions I’m trying to incorporate into Bill’s PT care, just need more help from my *&%^&%$#@ urologist with some order changes. Bill seems to be a heavy sediment “producer”, and I’m not sure the MD thinks it’s a problem, but a catheter. change every 1-21/2 weeks, in MY estimation as an RN. IS!!! He will hear from me when he gets back Mon.
NOTE TO GRAHAM: Yes, I had to change his catheter. again this morning 1 week since last change. He was in severe pain, and the irrigation was NOT cutting it. Same type of blockage as last week. He drinks LOTS of fluids, and pivots to and from W/C. Going to PT again next wk for strengthening, etc. As I mentioned, some of his allotted supplies are inferior. I’ll work on THAT as well. Bet on it! Until later, Anne/Nurse/caregiver/friend.
Randy: Yes you can use a Supra Pubic Catheter. Unfortunately having a sphincterotomy (external sphincter cut) means you will always have leakage. Your external sphincter is controlled by the pudendal nerve and voluntary nervous system. Meaning it’s under your control, you decide when to let it open. As a T5 you cannot, so they cut it, this is common up to T12. I believe it is possible to have the external sphincter or internal (called a Feneley Procedure) sphincter sewn closed again. In that event yes you could use a Supra Pubic Catheter no problem. Sewing either sphincter closed can have serious repercussions. You must consult a urologist.
Anne: I should point out that hexamine hippurate (Hiprex) is a pro-drug absorbed from the gut passing into the urine where it’s hydrolysed to formaldehyde. Formaldehyde causes the breakdown of proteins/sediment essential to bacteria. However this only occurs if urinary pH is less than 5.5 acidic. Proteus and some Pseudomonas bacteria increase urinary pH inhibiting the production of formaldehyde so Hiprex and many antibiotics will not prevent infections due to such organisms. Ural will also raise urinary pH and render Hiprex ineffective. Ascorbic acid (4g) daily may lower urinary pH enough to allow conversion of Hiprex to formaldehyde but it can be difficult to consume that much ascorbic acid. So if you try them don’t use Hiprex and Ural together.
Hello Anne, I am also an RN, however, I worked in a nursing home and did not encounter any Super Pubic Catheter’s. I saw one in clinical and that was it. Anyway, I had another surgery yesterday and opted to not have the SPC mostly because of fear of pain. I have another new Foley 14F which I plan to change in about 4 weeks. If I weren’t able to irrigate and change this catheter I would have gone with the SPC. My situation is different from what I’ve been reading. I had a total abdominal hysterectomy in Dec. that resulted in a severed urethra and an significant injury to the bladder itself. There have been several complications since then so now I wait. Of this entire experience the wound drains have been by far the worst, that and not being able to work. I have another procedure in two weeks, it’s possible that by then I will have had enough of the catheter.
I have Multiple Sclerosis & have been having trouble with terrible painful spasms. I was leaking @ they inflated the balloon to 15 & it stopped. But the bladder spasms continue & my Urologist does not even bother to see me. He refers me to his assistant. Not right. Need a little advice on what my problem is.. I would appreciate any help at all. Thank you.
Hi Mary: Hope I can help, along with Graham. Need to know 1st if your catheter is an indwelling, or a Suprapubic one. (I, also have had trouble with Urologists in general. My friend has MS, and I am his RN caregiver). Please give us more info on your catheter size, and where it’s placed. Thanks, Anne
To Graham: Hooray, I finally got a script for Mandelamine 1 Gm. qd, but my Pt’s insurance has yet to approve it, so we pd.cash. Would you believe the MD. After all this time with such a sediment problem agreed it would be a good idea to try….after 3X/in a row weekly cath. changes. He recommended it w/500mg of Vitamin C. Any other helpful hints greatly appreciated.. best time of day to take it, etc. Thank you again for your specialized help! I’ll keep you informed. Anne
Hi Anne: I’m so glad you’re finally being heard and hope Mandelamine proves beneficial to your patient’s sediment problems. Mandelamine (Hiprex) 1 mg is usually taken twice a day, try to keep it regular but it’s no big deal if a dose or two is missed occasionally. Long before cranberry juice vitamin C has been suggested as a sediment preventative. I tend to group them together, both proven somewhat effective in the majority of quadriplegic and paraplegic supra pubic catheter users. It’s important to listen to the person in the chair. Vitamin C (half an orange – even post injury) makes my cheeks sweaty as the body can only store so much vitamin C expelling the surplus. Half an orange these days makes me sweat across the back of my shoulders. Quadriplegia is like taking an electrical cable carrying 50 billion messages/sec slicing it clean through with a samurai, turn 90? and press together again, let’s see what works.
I can’t imagine what that must feel like. I’m so glad your environment and care seem great! I don’t wish MS on anyone, but I wish you could help with that, as well as the SPC. Bill has some other very strange Sx. at times and I can’t figure out if they’re from the MS or WHAT, because they could affect any part of his body at any time, and are for varying lengths of times. He looks to me for the answers. I certainly don’t have them lots of times but I’m happy to have found this terrific site to solve SOME of the mystery’s/problems!!! Thanks again, Graham for starting this site! Anne
Hi, I have just found this site and read some very interesting things about super pubic catheters. I am a 48 female with a spc of 3 years now due to a narrowing of the urethra and urine retention. I the last three months I have had an infection I just cant get rid of i have been on loads of antibiotics, and I take cranberry tablets has anyone else had an infection for this long if so what help to clear it up. It is really getting me down now some days I have a job to walk when I’ve been to wee as the pain is so bad do you no why this is? I have a flip flow on my spc any comments and advice would be great. sharon
Hi Sharon: This will be brief, as it’s a political day here in the US of A. I’m helping out. I would strongly suggest you read all of Graham’s tips located throughout the site. As an RN, I don’t believe in the overuse of antibiotics, as we are becoming immune to certain strains that are “mutating.” UTI’s, as you will read above, are VERY common with indwelling, as well as SPT’s .reasons also listed above. Plenty of fluids, Cranberry juice and excellent, sterile as possible care of your SPT also helps. Recently, My Pt. with M.S. has been put on Hiprex, along with Vitamin C. as suggested by Graham (Thanks again to him) which is starting to REALLY make a difference. I’m also starting to use more expensive Teflon, or other coated caths, so the sediment “slides” off easier; ie helping it not to collect around the catheter part that’s in your bladder as easily. His urine has been wonderfully clear, as of late! For anything further, I would directly ask Graham. who is quite knowledgeable in this area! Hope I’ve helped! Anne
I’ve had an indwelling catheter for 3+ years and after a recent infection the urologist suggested a spc (my home health nurse had mentioned it too) and I found lots of helpful info on your site. FYI I had a very good experience w/ the urologist. I also have a sediment problem and cranberry juice sounded hopeful, but I’m on Warfarin and the instructions say to avoid cranberry juice or cranberry products. Any suggestions?
Sharon: In my experience women suffer more adverse reactions to a urinary tract infection than men in general. As Anne said drink alot to flush it through and empty twice as frequently than you usually do. The longer urine stays in your bladder the more bacteria grows. Switching to a collection device for awhile like a leg bag with anti-backflow valve will help to keep your bladder empty. Ask your Doctor or Pharmacist about Hippurate (Hiprex or Ural) or similar as they kill most bacteria in urine.
Patricia: I’m also on Warfarin at the moment due to my second DVT (Deep Vein Thrombosis) I’ve also had a PE (Pulmonary Embolism). You can take cranberry products in moderation just keep it regular. If/when it alters your INR levels they will change the Warfarin dose to suit. I’m sure you’re aware alcohol raises INR greatly. I still have several beers everyday (keyword everyday) and take 3mg Warfarin daily to stay between 2-3 INR. I hit 7 once, 10 is death. I spoke to a Warfarin rep recently who confirmed it’s ok to take Hiprex with Warfarin. That will help reduce urinary sediment as well
I know about alcohol and INR so avoid drinking except for a sip of cognac last New Years Eve and “might” have something on St. Patrick’s – I’m Irish after all! I’ll try some moderate use of cranberry juice and Hiprex sounds very helpful because sediment is a real problem. Would like to continue to keep my INR between 2-3 because it’s been constant for a long time and that means fewer blood tests. I’m still learning more about the spc but it’s probably the way to go. I’m completely bedridden so anything that makes life better and w/ fewer complications is welcomed.
I am a T10 paraplegic. I am 43 years old and have been in the chair for 25 years. I have had the Supra Pubic Catheter for most of the 25 years. I saw a urologist yesterday and he says the bladder looks good but really thinks I should get rid of the SPC. He believes the SPC is a huge health risk. He put the SPC in for me so he is willing to do it but does not recommend it. I can void through the penis if I plug the SPC and the bladder fills up. I plugged the SPC yesterday while I was in their office and put on an external catheter. I have tried twice to leave the SPC and go to the external collector but have quickly gone back to the SPC. The externals blow up, fall off, etc. etc. I also have a lot of spasms when the bladder voids on its own so that is uncomfortable for me however it does let me know I am voiding so I can help keep the external on.
I have a good friend that has been in the chair as long as I have and has had a Supra Pubic Catheter as long as I have and he is now dying of cancer. He was diagnosed with Bladder Cancer, that cancer has spread and he has very little time left to live. They have removed his bladder and part of his colon but it is too late. I have not read the Craig article yet but wanted to ask your thoughts about my SPC since I have had it so long. I am very concerned about my SPC and cancer but absolutely hate the external collector. I also worry about back pressure on the kidneys since there is so much spasm while I void. Do I just suck it up and take the external along with all the problems or would you say there is such a small percentage with problems that I should be OK? Eddy
Hi Eddy: Yes it is a very small percentage especially when compared to the general population. Studies do show a slightly increased incidence rate of cancer tumors in Supra Pubic Catheter patients. This rate increases the longer you have used an SPC or IDC. They believe rubbing a cause, although simply the older you are the higher the rate of tumors in anybody. At 25 years you should be having annual ultrasounds and abdominal x-rays to look for tumors amongst other things. Early detection is key.
I’m sorry to hear about your friend. I had my annual checkup this week. They found a cyst on my right kidney, they believe it’s benign but will keep an eye on it. I encourage you to go for tests Eddy to ease your mind. External catheters are a pain and if you’re spasming. Well look at it this way, after 30 yrs with an Supra Pubic Tube you have a %9 chance of bladder cancer, if detected early the mortality rate is less than %1. Of all wheelchair bound people today about %15 die of renal complications and %20 to Cardio Vascular Disease. However respiratory illness is the number one cause of death among people with Spinal Cord Injury.
I am a caregiver to my mother, she is 86 years old and bed fast. Her catheter keeps leaking and I am thinking of having a super pubic cath put in her at this time. The urine is breaking down her skin and we are unable to keep her totally dry all the time as we did before. She has had a regular cath in her for 2 years now. The thing I am wondering about is what you said about “the Balder being the size of a grape,” would that be a problem?
Thommy: No I wouldn’t think so. A shrunken bladder can make replacing any catheter difficult. However as you are currently able to get the indwelling catheter in place without to many problems it would be the same for a Super Pubic Catheter. It’s really just another entry point to the bladder. See Kim’s post 13 Nov 07, her father’s experience my be of benefit should you go for the Suprapubic. In either case I would ask your Mother’s Doctor about Oxybutynin (Ditropan or Urotrol). It assists the muscles that control the sphincter, or valve, that stops urine leaking from the bladder.
I just received my Supra Pubic Catheter 3 days ago and was wondering how gentle do we need to be with the tube? I have the tube going to the right toward my hip area and then down on the outside of my right leg. Is it OK for the tube to be going directly to the side (horizontally)? How long do we need to keep the incision site bandaged and after surgery should I have been taking antibiotics to prevent infection? Also, I have bleeding out of my urethra — is that normal?
Thank you for this web site — I have learned a lot as their is no other information that I have been able to find.
Kidd: Yes be gentle and restrict activity for the first 2-3 weeks at least to assist the healing process. What I do is make a palm sized loop with the catheter where it comes out. So it points straight out, curves to the left then passes back under itself and off to the right. Doing this also allows some slack in the event the catheter or tubing is pulled on. Keep the site clean, sterile and covered for as long as you like, in general until it looks pretty much healed, 2-3 weeks. If the skin around the site becomes quite red and warmer than normal to the touch you might have a site infection and require antibiotics otherwise no. Slight bleeding via urethra and tube is common. If it’s bleeding heavily or doesn’t settle within a week see your doctor.
This is Eddy again.. I talked a couple weeks ago about my buddy getting bladder cancer and was passing away. He passed away last Thursday night and we buried him yesterday. A sad time for sure…
I also have the SPC, had it 24 years When all this happened to my buddy I went in and had my bladder scoped, then had the bladder, kidneys and all scanned. They called me an hour ago to let me know that everything looks clear on me. What a Relief. I just thought I would add this to put minds a little more at ease. The Supra Pubic Catheter is a superior system compared to all others I have tried, just get your check ups and do the maintenance to keep you and your supplies clean. My Dr. has recommended me going in every 6 months for a scope now since I am 43 and have had the SPC a long time.
I’m sorry for your loss, my condolences Eddy. I’m glad you got the all clear and thank-you for the update.
Thanks for your reply could you tell me what hiprex is and what its for. I’ve had an infection on and of now for about 6 months now I’ve been on all sorts of antibiotics as soon as I stop them it comes back, I drink cranberry and take cranberry tablets nothing seems to be doing any good at the moment some days it quite pain full when I walk any advice would be welcome.
Sharon: Drink alot of water, most can be flushed out of your system if you drink well in excess of 3 liters (5.5 pints) a day and empty your bladder twice as often as normal. Your infection sounds like a bad one, Hiprex won’t cure all but is worth a shot. I explain it here on my 18 Feb 2008 post. It’s also known as Mandelamine or Urex.
What a wonderful site, thank you so much for so much info. I have had a IDC for 1 year, I used to self-cath, but after 18 months. of every hour I asked for the IDC. I have an app. to see the urologist next week re SPC and wanted some info, this site has helped. I now use Vesicare for a bladder relaxant, very new and I have also used Enablex another new one, no side effects, Hiprex and a new tablet with Cranberry & acidophilus Bio Organics. I am free of infections after adding these into my daily life. I have Ural & cranberry, it tastes fine. I haven’t decided on the SPC yet, as I don’t feel the IDC when I am sitting down. I will check this site for more info. Your wonderful.
Gail: Thank you that’s very interesting. Ditropan (Oxybutynin) makes my skin very dry and therefore itchy. Vesicare and Enablex also list dry mouth as a side effect same as Ditropan but I’ll ask my doctor about trying them. As things are working well for you I’d be hesitant to make any changes like that to a supra pubic catheter unless it’s for health (tumors etc), comfort (the IDC is very irritating), maintenance (an SPC can be left in for upto 3 months), sexual (you feel the IDC unattractive or it gets in the way during sex) or some other lifestyle reason. Still there are alternate solutions to these problems. As they say, if it ‘aint broke don’t fix it.
I need information on pubic catheters for women. one that is put in permanently. can you help? thank you
My doctor just put in a super-pubic last Tuesday. I needed this because of so many UTI’s. Fortunately, my wife is an RN and I’m being cared for greatly. Concerning sex, does the suprapubic operation affect erections at first? I’m having a hard time getting an erection since surgery. It’s probably nothing, but any comments?
Hi James, No a Supra Pubic Catheter does not usually have any effect on obtaining an erection. Once you become more comfortable and familiar with the SPC your function should return. I don’t like to write it off as a “mental thing” but that is most likely the case. Stressing won’t help so give it few weeks and if you’re still having difficulty certainly, go see your doctor.
I once went to my doctor re: a persistent stomach ache. He gave me a whole lot of sample Viagra boxes, two pills per box. I had to laugh, it sure did get my mind off my stomach ache for awhile.
So happy to finally find some info from someone who has a SPC. With the privacy thing now ,medical personnel don’t dare give our names of users so we can communicate. My husband is 84 and has recurrent prostate cancer. 2 years ago he had surgery for bladder cancer, which is presently controlled. Approximately a year ago, he began having difficulty emptying his bladder. In Sept we began intermittent caths. I do this procedure. For about 3 months we got by “doing the plumbing” only once daily – at night before bedtime. However, this has accelerated to where it has now taken over our lives – -every 3-4 hours, with occasional 5-6 hour intervals. In spite of the advanced prostate CA & some bone metastasis, John has no pain(which puzzles the Docs). We feel we’d like to be using these good times to enjoy life which is becoming increasingly difficult with the need for such frequent caths. Our urologist has made us aware of SPC but seems reluctant to perform this because he feels John may dislike that more than the present situation. We question this & feel the freedom the control of an SPC would offer outweighs the negatives. We know his whole situation is not ideal but feel SPC would improve our quality of life & at this stage isn’t that what it should be all about! Incidentally, John is an excellent patient – tolerant & cooperative & sharp enough to care for the SPC himself( he cannot manage self caths). The info we found on your site has been so needed % appreciated. Thanks!!! Would enjoy hearing your thoughts about this choice for us.
First of all, before I shed some light on John E. Gerholdt’s situation, I’d like to say thank you very much to Graham for replying about my erections after the procedure. My urologist said the very same things you told me, and my erections are starting to come back… THANK YOU Graham! Your words helped.
Dear John, and John’s wife, I was in the same situation with my own wife concerning daily intermittent caths every 3 to 4 hours, because of bladder infections caused by not emptying my bladder (it’s a life consuming process for both of you). But since my procedure, I’ve been emptying out my bladder (because of the SPC) without the life altering intermittent daily process. I can’t say for sure how it will work for you, because It’s been since April 15, 2008 when the procedure was done on me. But so far, its been great.
You’re welcome James, I’m glad to hear you’re getting back on track.
I too agree with your wife John. Age 84 poses a unique situation. There are bladder relaxing drugs mentioned above, Ditropan, Vesicare, Enablex which may help you reduce the frequency of emptying. These are not often prescribed for older patients due to stress on the heart, reduced mental alertness, etc. But certainly whether you IDC or SPC they are worth looking into. I’m not a Urologist but feel the benefits of a Supra Pubic Catheter for John would outweigh the negatives. You could connect a collection device when sleeping and use a flip flow valve when you go out. Some of the valves don’t require alot of hand strength or dexterity to operate giving you back some independence. There is a risk of bladder cancer with any permanent catheter in place 10 years plus. But as stated, quality of life for you right now is what’s important. If in the eventuality the Supra Pubic Catheter doesn’t prove beneficial you can always just resume your current method. In you’re case I feel you have nothing to lose by trying the SPC method.
I catheterize myself 3 times daily and have infections thus far continuously. I only been doing this 3-4 months. My diceticulus sack is 1/1/2 the size of my bladder and will always retain 300 to 500 cc after catherization. my Dr. now recommends the super pubic catheter targeting the extra sack in my bladder PLEASE ADVICE
What a relief to find your page. A horse fell on me, ruptured my bladder and destroyed my pelvis. After several surgeries my urethra was sealed and a SPC inserted in my right side. I experience sever bladder spasms (taking Detrol LA)and have wound up in the ER often. I did not know I could go swimming? I am glad to have the “support cyber-group” here, as I have felt very isolated living alone. When I have my tube change usually it is VERY painful and it is ripped out. I am getting uptight when it is time to go have it changed. Putting it in is painful also. Any suggestions? Also, I sleep with a leg bag on – is this o.k.? God bless you for helping Supra Pubic Catheters wearers.
Hi. I like to be known as Chris. I’ve had surgery 3 times this year. I’ve had a catheter for 10 months. It’s been out for 3 months and I’ve been to hospital today. I’m in a lot of pain not passing urine as I should. I keep going into spasm. I’ve been self cathetering for 3 months and things are the same. I feel like I’m in hell at times and I’m very depressed. I’m not feeling any better one year on. I’ve been told today to consider an spc. Thank goodness for all your articles I’ve read today. I need it done soon so I can get on with a better quality of life and get back to my job as a nurse. thank you all so much.
I had a super pubic put in, the pain after surgery was terrible, with none stop infections afterwards until the first charge done by the doctor and nurse at the hospital. They never warmed me on the pain, and because it was stuck, they end up ripping it out as hard as they could to remove it. I was on endone for the pain for every since as the bleeding never stops and the changes are like the first one over and over again. I have a weak immune system and bleed from the the bladder a lot. I need the Catheter to be changed every 6 weeks, but they have had to change it 6 times in 5 months, and once had the catheter pushed right through the other other end. I only get it done through the hospital and my local doctor. Would never recommend it to any one. As I do not go through a single day with total pain caused by the super pubic catheter site and it never stops bleeding. Yes the balloon have a habit of deflating if and the Catheter will fall out as we found out. The hospital left me waiting 6 hours before replacing it and end up using a wire to rupture my bladder wall to feed the catheter back through. Try that without pain killers. I don’t use a leg bag at all for ladies they have a habit of causing urine infections too often if you aren’t on your feet a lot and I am in a wheel chair.
I have had my ilestomy for three years now, and have just come to terms with it. now I have been told I need a super pubic line as I’m not able to empty the bladder leaving about 60%, and due to a para stoma hernia, I have to catheter 6-8-a day. or bear down and this can cause the hernia to increase in size. The hernia can be fixed and the bag moved again but with the urine problem I think this will come back (so please help me super public line or not. is there anyone with the same history out there.
I’ve been wearing a Foley catheter for almost a year – my urologist told me with continued use of it my penis would be reduced to half its size – he’s pushing me for a spc or a urostomy. Is he giving me a true fact?
Leroy: I’m not an M.D. but that sounds like it would work fine. I would go with your doctors recommendation, a Supra Pubic Catheter should reduce the risk of infection and it’s reversible should it not work out for you.
Tobie: Yes you can go swimming no problem as I described in the article. Being a quadriplegic I often use a car tyre innertube, sit my butt in it and paddle around. To ease the discomfort when changing your Super Pubic Catheter try using Xylocaine or Lignocaine, these are numbing gels. If they’re hard to get use a baby’s teething gel or similar. We coated a mates leg in Xylocaine once then woke him up, was hilarious watching him try to walk. Sleeping with a leg bag on is fine but I would suggest keeping any collection device lower than your bladder as back-flow increases risk of infection.
Liz: I’m sorry to hear that you’re having so much trouble. If you rotate the catheter say twice daily it might prevent sticking. Just twirl it around a few times at the catheter site. Some cheap catheters do stick easily so make sure they are using a Silicone Foley Catheter or I’ve heard of a silver coated catheter which also prevents sticking. Endone is an addictive heavy duty drug, basically a tablet form of Pethadine/Morphine (I take it when my shoulder dislocates) so I understand your reluctance to take it. As in Tobie’s case above a numbing gel applied topicly might aid in reducing the pain you’re experiencing.
Rita: You can have an Ileostomy and a Supra Pubic Catheter, many do. You will need to keep the SPC entry point away from the Parasatomal Hernia bulge as generally Parastomal Hernias increase in size over time. With small Hernias wearing a wide, firm Colostomy/Ileostomy belt can help otherwise you may require an operation to repair it. The SPC drains your bladder constantly, you won’t need to bare down or self-cath anymore. That should reduce your other problems, so I would say yes, try an SPC.
Josh: No, that is not true. An indwelling catheter does not reduce the size of your penis.
My mom has MS and has had a SPC for years now. For the past couple of years she has been very miserable. She constantly gets UTIs which in turn requires her to take antibiotics, which we know is not a good this. With or without infections, she leaks constantly through the catheter opening and vaginal area becoming completely soaked with urine. She has gone to a couple urologists and they don’t have answer or solution for her. She has also visited an infectious disease doctor. She is at the point of complete frustration and there are no answers for her. Also, she is really good about drinking plenty of water. Her quality of life in diminishing. Do you have any suggestions or resources we can explore?
thank-you Graham, my hernia is the size of a large orange on the right, to mend it the bag will have to be moved just below the breastbone the 3rd move. yes spc is the best way to go i will let you know how it goes, THANK-YOU
I had my super pubic catheter put in 4 day ago and I’m in excruciating pain still.
Hi! i’m 17 and have had a foley in for about a month. My dr. is putting a spc in on friday. he’s doing this because the foley causes so much pain when i walk. i’ve also had a severe uti with the foley. i’m a little nervous about the surgery. can you explain what it will be like the days following the surgery? will i be able to swim in chlorine or is that bad for the tube? will write back after surgery.
hey gippy im 16 and I had my spc put in nearly 2 weeks ago its very painful process but cant tell u much more. l good luck
This was the most informative article I’ve found anywhere. Can’t thank you enough for writing it. I’ve had my prostate removed because of prostate cancer and have had nothing but trouble with bladder leakage ever since. So far I’ve had four holmium laser surgeries for bladder neck contracture (bladder neck scars over and heals shut)to open my bladder. I have to self cath 2x daily to keep it open a little hassle but not too bad. Have to wear male guards constantly (more hassle). My Dr. wants me to consider Supra Pubic Catheterazation but I’m extremely leary. Don’t want to get into something deeper than what I am now. I would like your input on this if possible. It’s not something I have to do so I want all the info I can get. Thank you so much for your time and info.
I have to change my Super Pubic Catheter every 2 weeks because there is a lot of sediment which causes the catheter’s to clog up. I flush my cath once a day, but still have problems with sediment. Does Hiprex really cut down on sediment? I asked my doctor about Hiprex he didn’t think it would help, but he is not familiar with quads. Any suggestions would be greatly appreciated. Excellent site great info.
Had my spc installed yesterday(7 July) and the home health care RN is coming this afternoon to change the dressing and show my daughter/caregiver how to keep the site, etc. The MD will change the spc in about 5-6 weeks and then home health care will take over. My indwelling cath went down the left side but the new spc goes down the right so I’ll have to think before I move something, etc. So far so good except for some bruises from the IVs.
The MD said that the urethra was starting to show some deterioration ( after 3+ years) so I’m glad to have made the decision to change. Thanks for your good work and info.
Hey Guys, I’ve been on holiday, let me try to offer some answers. Again I remind you I’m not a Doctor nor Urologist, simply an experienced Supra Pubic Catheter user.
HW: Has your Mum tried incontinence medications and/or a larger gauge catheter to rectify the leaking? As you have already consulted several Urologists these avenues have probably been explored to no avail due to the muscle debilitating MS. In that case unfortunately all your Mum can do is undergo further surgery to tighten the sphincter muscles and catheter site or use pads, adult diapers etc. It’s not common and certainly should not be necessary however how about trying two catheters? One Super Pubic Catheter and one Indwelling at the same time to be sure the bladder is emptying fully.
Lynda: Try a numbing gel like Oragel, Lignocaine or Xylocaine.
Gippy: Avoid swimming in anything for two weeks post surgery as you risk infection. Restrict activity of any kind to give the new site it’s best chance of healing. As Lynda said a new catheter can hurt, chlorine will only irritate it more. After two weeks or so you should be able to swim in chlorine no problem.
Michael Vibbert: Your Urologist would know better than me, still I would be leery too! You might want to continue to self cath 2x daily for sometime after the SupraPubic Cath just to keep the neck open. Should an SPC not suit you and you wish to resume your current method you will want to be able to. Keeping it open will also serve as a safety release valve should your SPC catheter block.
Jeff: Hiprex helped reduce my sediment. If you read all the comments you’ll see many suggestions from cranberry products and vitamin C to beer.
Patricia: Although a Supra Pubic Catheter may exit to one side or the other usually you can pass it down which ever side you like no problem. I’m glad to hear things went well for you.
I wish you all good health and happiness.
I have had a Supra Pubic catheter for 2 years. I used to be able to go 1 month before a change, now slug build up is making it need a change every two wks. My nurse is afraid of too much trauma. I use an 18 ch/fr 5/10 ml/cc latex (siliconized) catheter. I have a latex allergy. I am on a blood thinner. My site still doesn’t seem totally healed. I do take Hiprex twice a day. Do you have any suggestions for my slug problem and my site taking so long to heal. I would love to have it last 4 wks. again before a changing is needed (or longer). I would love waiting 12 wks. like you! Thanks, Robin. P.S. I also take Detrol LA.
Hi Robin, Sediment build up is a common problem with any catheter. Additionally for most the catheter site never totally heals. There are many suggestions above to reduce sediment as I just said to Jeff like cranberry products, drinking at least 3 litres/day etc, read through the comments here for more suggestions. With your catheter site, exposure to sunlight, keeping it dry, cleaning around it with sterile saltwater or an alcohol wipe once or twice daily and use a true Silicone Foley Catheter. Usually blue or green in color and a bit more expensive, about $100 USD/dozen but these are more effective in reducing sediment sticking and cause less irritation at the site.
Thanks Graham!
with a spc, can u clamp the tubing? If so is there an advantage to doing so? I heard it can improve bladder strength.
Hi Josh, yes you can clamp the tubing off. I use a small plastic G clamp and/or a stint (cone shaped stopper pressed into the end of the catheter) when I go swimming. Nurses also often clamp it for five minutes to build up enough urine to take a sample when testing for urinary tract infections. Just be sure to unclamp it. Backing up your bladder is fine but backing up or stopping urine flow from your kidneys is very dangerous. To put it simply, your kidneys do not like drowning in their own urine, it can lead to renal failure (kidneys shutdown). Backing up your bladder doesn’t improve strength, it does however help keep your bladder stretched and therefore able to hold more. As I say in the article, your bladder is a muscle and like any muscle if not stretched and exercised it will contract (shrink). Drugs such as Ditropan, Vesicare and Enablex can also prevent your bladder from contracting.
Graham, Does Detrol LA also work like Ditropan to keep the bladder from contracting?
Yes Robin, it will avoid contracting. Detrol LA or Detrusitol XL, Ditropan, Vesicare and Enablex are all prescribed for an overactive bladder and are essentially the same drug with the same effects and side effects.
Thanks again Graham!
Can you cut the end off the cath to help the flow and to prevent clogging? Also, do you think it would help to drink purified water instead of soft water? We use a water softener so didn’t know if anyone has had same problem? Thanks for all your help…Just trying to help this sediment problem because my spasms get bad and can’t lay still…
My husband who is quadriplegic has a spc, the problem we have is the tube running from his stomach smells. He downs water all day. thats pretty much all he drinks. I can’t handle the smell anymore. Do you have any suggestions?
Jeff: No! Don’t ever cut the end off a catheter if you intend to use it. Read all the comments above for ways to reduce sediment. Soft water is fine. Spasming can actually be good for sediments sake. You see, when your bladder is dormant sediment builds up as a lining, think of it like an eggshell inside your bladder. Spasming (especially bladder spasm) breaks the eggshell up and away from the bladder wall so you can pass it. Studies show all people have more sediment in their urine of a morning than night. They believe this is due to two main reasons. 1; No fluids for eight hours. 2; When sleeping our bladder like all muscles is dormant. When we wake and start moving around the sediment gets broken and stirred up. I know what you mean though Jeff, some days my legs spasm so bad I want to cut them off. Antispasmodic drugs like Baclofen, Ranitidine and/or passive exercises (someone stretching your legs for you) can help ease spasming.
Michelle: It sounds like he has a site infection. Your doctor can take a swab have it tested then prescribe antibiotics if needed. Meanwhile (well always), keep hair trimmed back away from the site. Clean around the Supra Pubic Tube morning and night with a sterile solution or alcohol wipes. Exposure to sunlight, saltwater baths, keeping the site dry and allowing air flow will also help.
Hi Graham. My 6 year old nephew had a supra pubic catheter put in about two weeks ago. He is having terrible pain during the night and no problems during the day. Any suggestions, we are flushing the superpubic tube daily or rather nightly when the pain comes and there does seem to be a lot of sediment.
G’Day Lori, Can he tell you where the pain is? Avoid flushing, it’s a last resort when all else fails (see comments above for sediment reducing tips). Post op once clear of blood clots most never need to flush and pass sediment just fine. I would look for a different cause of pain like a UTI (Urinary Tract Infection) or medication side effects and cut flushing back to every second night, third, forth until you only do it weekly. Stay weekly for awhile and monitor sediment. If no problems drop flushing all together. I’ve only flushed my catheters maybe 5 times in the last 10 years. That was only because we suspected it blocked and pushed sterile water in to try and clear it. Sediment doesn’t cause pain, a blocked catheter can. If it is blocked he should bypass urine via his penis. Just monitor his output. In short, if it doesn’t require flushing don’t flush it. All your doing is opening up an avenue for UTI. If his pain is at the site (the Supra Pubic Catheter entry point) gently apply some baby’s teething gel or similar Lidocaine based numbing agent around the site at night. Let us know how you get on. Have a great day!
Graham, How often should you or is it ok to irrigate the sp catheter?
Hi Robin, Yes flushing and irrigating are the same thing. Generally it’s only done post-op for a couple of weeks to prevent blood clots blocking the catheter. Or when sediment is very heavy and blocking catheter, even then it’s not a good long term solution. So as above, I don’t recommend irrigation’s unless you really need to. It exposes you to risk of infection, electrolyte imbalance, cost of supplies and there’s always the possibility you may damage your bladder. Additionally some people especially those with quadriplegia just feel plain awful after irrigation’s. For most drinking 3 liters (6.3 pints) or more per day is enough to avoid the need to irrigate.
I am a quadriplegic and my doctor is wanting me to get the super pubic catheter do you think it is a good ideal? I have had a indwelling for 9 years and have suffered with UTI’s and bladder stones off and on the whole time. Will it cut down on these?
Hi Michael, I have quadriplegia too, C4 complete and an SPC. Yes I think it’s a good idea. Here are some pro/con statistics. The incidence of Urinary Tract Infections is significantly lower with Supra Pubic Catheterization (SPC) 12% compared to Indwelling Urethra Catheterization (IDC) approx 16% and Clean Intermittent Catheterization (CIC) 26%. However, the incidence of bladder stones and possibly kidney stones increases with SPC 9% compared to IDC 4%. Over a 10 year period approx 36% of people with long term SPC will develop bladder stones. Amongst this 36% a high urinary pH is common. With all three catheterization methods above, in the first 10 years the incidence of bladder cancer tumors increases slightly 3.8% and in 10 to 30 years 9%. While higher, it’s not a significantly higher occurrence rate than that of the general population. Bladder cancer incidence for SPC and CIC at 0.7% compared with Indwelling Urethral Catheterization IDC at 0.17% is also of little significance.
Indwelling SPC and IDC catheters do not eliminate the need to take bladder spasticity medication also beneficial in CIC. The anti-cholinergic oxybutinin (Ditropan etc) medication for users of indwelling catheters significantly reduces the incidence of kidney damage at 3% compared to 23% in those not taking oxybutinin. An SPC markedly lowers bladder pressure, improves bladder morphology, and abolishes ureteral reflux. So in short, Supra Pubic Catheters offer many major advantages over indwelling and even intermittent urethral catheterization, particularly for people with cervical spinal cord injury.
This site is great! I was doing some general research and stumbled upon it. I’m a quad. Originally on a Foley, now intermittent and thinking about a SPC. I have gotten more into than I thought possible. It looks like a viable option. A couple points – I’m on 2 x 40 Baclofen and still get spasms, which are becoming more frequent, thus checking out SPC. I’m lucky in that my medical team from general to specialists involve me as a primary member. Sorry to see that that often is not the case.
I have a different question. my 89 yr old mother has just had a Foley put in. From everything I have heard read and experienced, I know the value of fluids. Does the same maxim hold true for an old frail body? Thx in advance
I have a comment about the elderly lady wearing the Foley cath, My grandmother was in her 80′s and she wore one and it did help her bc she felt more secure from urinating on herself and they don’t have to make all those trips to the bathroom or risk of falling, although they need to try to drink lots of fluids to keep from getting dehydrated fluids help to flush out the kidneys especially cranberry juice and water. This was my mother that told me to tell you.. And Graham thank you.
My bladder has a “burning” sensation. What would be the cause? I have a spc with frequent sediment… Also, I’ve researched Hiprex, should I test my acid level in my urine to make sure its acidic before taking Hiprex? I have to give this a shot cause my spc plugged off last week. I was also wondering if by taking Keflex everyday if that’s killing some good bacteria causing more sediment?
BobS: A quadriplegic mate of mine with a Supra Pubic Catheter had terrible spasms, now taking Baclofen 5 x 20mg daily he has none. I can’t take it, destroys my short term memory. Guidelines for an SPC are the same for all whether young old, male female, sickly or healthy.
Jeff: You can test pH if you want, just for the benefit of knowing. Hiprex and Keflex can be taken together, Keflex is a course of antibiotics and not meant for long term use. As far as I know Keflex should not cause increased sediment. The burning sensation is most likely due to irritation, an anti-cholinergic like Vesicare can help as they reduce bladder spasm. I would also have an ultrasound to check for stones.
Graham/Michael, Thanks for the info. In my own mind I was sure of what you said, however one of the care workers told her that all she needed was about a litre (2 pints) a day as she was elderly. Thx for the validation. Re: Memory – reading used to be a major past-time. Now I don’t have the concentration power – still much better than the spasms!
I’ve had my super pubic catheter about 3 weeks – I keep reading about sediment – what is the indication of sediment buildup? What is the best way to prevent it?
Read through the comments Josh, your questions have been answered several times. If your urine output is cloudy or has chunks in it that is sediment. Most people avoid sediment build up simply by drinking +3 litres/day.
Hey:) Thanks for posting about this! I was doing a search for back flushing the bladder when you have a SP Catheter and came to your page. My son, Bryan, is a C1-2 quad on a ventilator 24-7. So your one comment about quads being able to do ANYTHING, is not quite true in all cases. :( Here’s my question. Someone, and even his recent visit to the urologist, suggested doing a back flush of the bladder to remove sediment, or whatever make it a healthier bladder. He was injured almost 4 1/2 years ago and has had recurrent UTI’s almost consistently. Urologist did put him on the Hiprex and did a renal sono, cystogram and an IVP to check him over. Do you or anyone.. know of a good safe back flush solution routine for him? Thanks again, Sandy :)
Thanks for this helpful page – my dad (aged 79) is due to have this operation this week and really i had very ittle information about it – many thanks
Sandy: Hi, where did I say people with quadriplegia can do anything? We’re all bound by physical limits and can’t always get what we want. I know handsome wealthy intelligent men who have never found true love. I feel that makes them poor. Bryan might like to be a pilot but simply wouldn’t pass the physical exams to even begin obtaining a pilot’s license. He could however be strapped into the front seat of a light plane and experience what it is like to be a pilot. Sometimes when I feel a strong breeze on my face I close my eyes and feel like I’m flying. Looking deep into my beautiful girlfriend’s eyes I feel ten feet off the ground. It’s all about attitude and perception.
Flushing the bladder is not something I recommend as a supra pubic catheter is a closed drainage system. Anytime you open it you are open to infection, but I’m not a Urologist. If you do bladder washouts just be as sterile as possible. Frequency will vary, as you are doing it to try and prevent infection I suggest every 2 or 3 days and see if it makes any improvement. I’m putting together a procedure kit I hope to make available through this website with footage of changing a catheter, flushing the bladder etc. Until then follow these steps.
Gather a large (50cc) sterile syringe, a bottle (250ml) of sterile water (or at least cooled boiled water in a sterile container), an alcohol wipe, new clean drainage bag and sterile gloves (or use a hand sterilizing solution). Remove the cap from water bottle. Wipe around where the catheter and collection device (drainage bag in this example) plug together with alcohol wipe and loosen the connection. Pull on gloves or sterilize your hands. Draw water into the syringe until full, pointing it skyward squeeze any air out. Plug syringe onto catheter and slowly push the water into bladder. Slowly draw back on the syringe removing water bringing any sediment with it. Should it not completely fill the syringe again do not force it, it will be fine. Unplug syringe and empty of sedimentary water. Draw more sterile water up and repeat the procedure until you’ve used all 250ml. It’s a good idea to leave the last syringe full in the bladder and quickly plug a new clean drainage bag onto the catheter. You can then immediately see if the catheter is draining correctly. To reduce costs you can reuse these utensils by soaking in a sterilizing solution like Milton or Hibitane. Or even less costly simply bring to boil in a pot of water on the stove.
Caff: Thank-you and I hope all goes well with your Father.
Hi, I don’t want to hog the space here, but I feel that I must enter the fray on motivation. I am a partial – C3-7, anterior and posterior laminectomies last year(2 different operations). At first they were surprised that I could use a manual chair, then when I could shift in the chair. They planned to kick me out of rehab using 2 quad canes. I objected strenuously and left using one single point each time. My physio and I have set a goal of walking without a cane – haven’t determined distance yet. I mention this only to support the idea of pushing oneself to the limit, and then setting higher goals. I know that it won’t work for some, but we all should push to our ultimate limit. None of us will know where that is until we reach it. I learned this lesson from a gimp who has a number of Olympic medals as a quad.
Now for the reason for my note. I currently intermit catheter. At night I don’t wake when I naturally void in a bottle. Often the urine ends up over me and the bed an the bottle doesn’t leave the bed. Is is advisable to put in a SPC, shut it off during the day, except when traveling, and use the SPC and night bag for night? Thanks again – BobS
This site was so helpful. I’ve been in a relationship with someone for two years and finally, I know what the scar is, and why he’s so secretive about certain things. At first I thought he suffered from ED. Which I’m still not to sure about due to his smaller penis size(I can’t help but think, one thing has to do with the other). My friend just recently started spending the night at my house and he wet the bed. I got so mad cause I thought it was from him drinking too much the night before, but then he did it again the following night. We had an argument and I noticed he was very sensitive about the situation but still he didn’t spill the beans!! Last night I came across the catheter,(by the way I always would hear rustling of the garbage bag in the bathroom, or notice something tube-like in his pocket.)He was hiding it under a bin that sits on top on my toilet. I always knew he was hiding something but I never asked him, I felt, when he was ready he’ll tell me what’s going on with him. I didn’t say anything to him, cause really its no big deal I’m really here out of curiosity. I’m more worried about his health, and mental well being. **** Now my question. Should I approach him or just leave it alone? I want to make sure he’s taking care of himself and not doing harm just cause he’s trying to hide this from me.
By the way I know I mentioned I thought he has ED but that’s because he can have an erection anytime(really ANYTIME) and he doesn’t ejaculate normally. But boy oh boy is the sex wonderful and I like the scar on his belly. :)
Hey Graham :) This is the comment you made that I was referring to “A quick look around this web site will show there is nothing quadriplegia or an SPC prevents me from doing in life” I think it would be pretty much impossible to get Bryan into a plane :/ Unless you were just speaking figuratively… He was married for 10 years and his wife left him a little over a year ago… and I am sure he feels he would never be able to have another adoring woman in his life. He has a young daughter who lives with her mother. He feels he pretty much has no control over his life or future. He is only 32. He has the same level of injury as Chris Reeve did… but we aren’t millionaires to get treatment and superb health care as he did. But what he does have is a very loving caring and dedicated family including 2 sisters(and their husbands) myself and his Dad. Ok.. sorry.. got off the topic:) Thank you for your input about the bladder flush… I forgot to ask the urologist today what his prescription was for the flush. Seems like there were 2 ingredients. When I find out… hopefully omorrow.. I will share it here. Thanks again:) Sandy :)
BobS: Nice to see you revisiting us. You have quite a story to tell, how would you like to be published? If you would like to write your experiences down at length and email to me for review I’ll make a page for you here. Anyone reading this is welcome to do the same. We’re always looking for interesting articles from people living with a disability and would love to hear all about you. I find setting goals a good practice, some call me a dreamer but I assure you all, dreams can come true. For someone as active as you Bob I’[d be hesitant to go for a supra pubic catheter, your level of sensation would be another factor to consider. Could you pass a catheter at night like when you intermit only inflate the balloon and leave in overnight? You could also try a urodome, it’s like a condom with a tube on the tip end, most use a skin glue with these and it can be a bit messy. I would explore all alternatives first, if unsuccessful and you still want to try an SPC I see no reason why you can’t.
The Girlfriend: You answered your own question, he will tell you in time when he’s more comfortable in your relationship. It’s not usually something a guy will blurt out on the first date, Oh, and I pee through a straw.? All you need do is show an interest in his well being and assure him he can tell you anything. I encourage you both to build on an open and honest relationship. It sounds like you see the man not the chair, that is a very good sign, it’s what my girlfriend says to me and she is simply amazing. Many people think wheelchair bound people can’t get an erection or have the same emotions as everyone else. Fact is we do, the majority are quite capable lovers and will see beauty in you where no other can. I find scars attractive too, I think it’s because each one has a story behind it.
Sandy: Welcome back, yes there is little in life that quadriplegia prevents me from doing, but that’s just me. Billy Crystal, Robin Williams and others donated millions to Christopher Reeve, still he died from a septic pressure area. We are very fortunate to have free public health in Australia and are quite a wheelchair friendly nation. Those on ventilators are strongly advised to stay in hospital until government funded equipment (from vent to cue tips) and carers are trained and put in place. A friend of mine, Perry Cross (perryx.com) is on a vent, he met with Christopher Reeve in 1997. Perry has just returned from India where after stem cell treatments he can breathe unassisted for hours at a time. He plans to seek further treatments. Tell Cody I said to look at it this way, his life isn’t over, a new way of life is just beginning. Set small goals, one of my earliest was to feel the sun on my face. By taking the positives and leaving negatives behind he will become a people magnet, and a great source of courage and strength to all who love him. If he can find himself and be ok with who he finds, a loving woman will in turn be able to find him. Re; bladder irrigation you may be thinking of saline (salt water)? I advise plain water as saline can cause the formation of small crystals in the bladder, which can become problematic. I know how terribly hard it is to see your boy go through this, hang in there Sandy.
Graham, Thank you for your advice. I must let you know that he is not wheelchair bound at all. He lives a ?Normal? life. The only thing he’s told me about the scar is that he was stabbed. I’m sorry if I mislead you in any way. It’s just nice to see regular people talking about it. I’ve searched on the internet quite a few times trying to figure out what is going on with him, and then the other day I found a visual. So back to the net I went!! I looked up urine tubes (Don’t Laugh), and found a picture of what I seen. I looked at so many articles but everyone knows medical journals are very confusing. I came across your site and it was the first that I could understand and had human touch to it. I’m sure there is more to his story and you’re right I have to wait for him to be comfortable enough to tell me. There could be a possibility that I’m wrong about the whole thing. But I’m pretty sure I’m right. My main concern is letting him know its okay, he sometimes has anger and trust issues and now I can understand more why he’s like that. Again thank you so much for your advice. I really appreciate it.
I use a big night bag when I go to sleep what’s the best position for sleeping with this bag? It seems I’m putting a strain on my catheter and it pinches me. Have u heard of this complaint before?
Josh: By “a big night bag” I take it you mean something like a 2000cc overnight drainage bag. I haven’t heard of pinching, some get red marks which can become blisters if say, the catheter is caught under your pants belt or very heavy blankets press it hard against your skin. In such a case the only long term position to avoid would be any that presses the catheter hard against your skin like laying face down. Whether sleeping on your back or side keep the catheter tubing and bag lower than the catheter site. Most drain bags come with a clip attached to the tubing, clip it onto your bed sheet to void the weight of the tubing pulling on the catheter. You could use a rubber band and bulldog clip to the same effect.
Graham, Have you read the article about the “The water catheter kit” ? If so what do you think ?
Hey Graham:) You sure know a lot about all this stuff!!:) Have you had any medical training.. or do you just research/read a lot? I finally have the info on the bladder flush from the urologist. He said to use 1 oz. of vinegar with 1 liter of sterile water. Actually, he just said “water” as in tap water or whatever. I think I would feel safer with sterile water or at the very least like you suggested boiled tap water. Our water is kind of hard here and we usually have to filter the water we drink to make it palatable. The doc said to do this flush like 3 times a day!! I was surprised. I thought more like 2-3 times a WEEK!. So.. I guess I’ll give it a try tonite when I go over there to be with him. Thanks again for you advice Graham! :) Have a great day/night! Sandy :)
Geoff: I think that is allot of messing around. Silicone Foley and most Bard catheters have tapered eyelet’s, no 90? sharp edges. Generally a little Lidocaine or similar numbing gel is all that’s required. Quote; “2 or 3 references that clean practice is satisfactory and sterile practice is not required” is not true, sterility is very important! Male or female we have spinctor muscles at either end of our urethra for good reason, to keep bacteria out. Introducing bacteria into the urethra will for most cause painful UTI infections and/or secondary bacteraemia (infection in the blood). Other than that it’s really a matter of experimenting to find what works best for you. My self-cath mates simply pre-lube the tip of a sterile catheter and carry in a sterile zip lock bag.
Sandy: I’m no MD, just a keen learner. I dated a nurse for 10 years prior to my 14 years of living with quadriplegia and have been in and out of more hospitals than I care to remember. You get to know these things. Vinegar acts as a mild sterilizer which is fine as long as you don’t over do it. A ratio of 1 oz (which is 2 Tblsp or 30ml) per liter is right. Even at this weak strength some find the vinegar irritates the bladder. Vinegar or not I strongly suggest at least using cooled boiled tap water, hard water is ok, filtered may be better. Three washouts per day does sound excessive. Poor Bryan will never get any sleep, I would think daily sufficient. Keep in mind studies prove bladder washouts only effective in reducing bladder sediment not bladder nor urinary tract infections. Various antibiotic and antiseptic solutions have been used as washouts over the last few decade in aim of preventing and treating catheter-associated infection. There is concern that their use can damage the bladder mucosa and increase infection rates due to opening the closed system. Current UK National Health Service guidelines specify that antibiotic solutions are not effective in prevention nor treatment of catheter-associated UTI’s (NHS QIS 2004) and are therefore no longer advised.
Graham, Have only just discovered your excellent site and I wish to thank you for it and the efforts you put into it. Thanks again for your answer to my last question. My query now is about itchiness around my spc entrance into the bladder together with blood in the urine. Is this a common problem ?
Thank you Geoff: Itchiness is a sign of site infection, as is redness warmth or strong odor at the site. Your doctor can take a swab for testing. Keep the site clean, dry and with good airflow if possible. Bleeding is common in new Supra Pubic Catheter installs, the bleeding should subside within 3-4 weeks. Trauma (pulling on the catheter) can also cause bleeding so avoid it. If you have had blood clots or blood discolored urine in your tube for some time I suggest you go for an ultrasound to see if you have stones or some further problems.
Graham, Thanks for the advice, much appreciated. I understand what you mean about good air flow but it is rather difficult.
Hi Graham, What are your suggestions for giving the site good air flow? How often do you clean your catheter bag? What steps do you follow and what do you use to clean it with?
Bacteria thrive and multiply in a warm moist environment. I’m a slender build and still tend to fold near the catheter site. Meaning, you can’t see my catheter site when in a sitting position, it disappears into a crease. Yes it’s difficult to avoid that. Good air flow won’t always cure infections but will help prevent them. Sit in the sun and press on your tummy to expose the site sunlight, not something you might do at Bondi but sunlight kills some bacteria, dries and helps heal the site. On hot days take a clean towel drying any sweaty creases occasionally, using a fan and taping a dressing on may also help. Keep hair trimmed back as it promotes bacteria. Wipe around site morning and night with an alcohol wipe. Use a ‘breakfast in bed’ type tray under bed sheets to keep them off your site allowing air flow, this is often done for new supra pubic catheter users in hospital. Corn starch or baby powder, I’m not a fan but you can try them. I’m sure you could come up with many more ideas but there’s a couple.
You can clean and reuse drainage bags or any equipment by soaking in a product like Sporicidin, Cidex, Metricide or Milton. Use two Milton tablets or 50 mL of Milton Solution per four liters of clean cold water. After squirting the solution through the bag tubing etc, completely immerse all items avoiding air bubbles. Use a china plate to keep submersed. Boiling drainage bags is not a good idea. Have a great day guys.
Hi Graham, thanks for the information. This is a great site. Am I to understand that a stoma can be established from the bladder to the outside allowing a person to intermittently self catheter with lesser risk of infection than using a Supra Pubic Catheter? Thanks, Nick.
Lorna, thank you for the quick info. I needed that.
Yes it’s possible to connect ureter’s (tube to bladder) or urethra (tube from bladder) to the outside. No it doesn’t provide less risk of infection and is not as easily reversible as an Supra Pubic Catheter. In general an SPC provides less risk of infection as it’s a closed drainage system where a self-cath type stoma has to be opened frequently and a foreign object (catheter) introduced creating opportunity for infection.
Graham, I am using a teaspoon of vinegar on a piece of paper towel to wipe around the site.
Pretty nice site, wants to see much more on it! :)
Thanks John, We’ll be publishing more articles soon I hope.
Graham, Thanks for your reply, I needed a little conformation on using vinegar. By the way this may be of some use to your readers. I attach my catheter using the flip lever of the tap to the bottom of my underpants which eliminates straps and sticky tape. The only drawback is the underpants need to be fairly long and body hugging. Kind of awkward as far as air flow goes but I am working on it. You close the tap lever over the edge of the underpants but you do need the sown ridge on the underpants leg otherwise the lever won’t hold. With the right type of underpants the catheter is held in place very well. Hope you understand all that !
Thankyou for your page which I have understood, even better than hospital describing. I am due for this procedure shortly and very unsure. I have been self catheterizing for 19 yrs now, now not successfully, I am 70 yrs old and told that this is my only option, but still very unsure, as I get so many infections. But I thankyou again for your info
Thank you so much for your page. It was the most informative thing I could find on the internet for my Ma. She’s had a catheter for ten years now and is looking into having an SPC. Her greatest fear is contracting an infection in the hospital during her procedure as she has gotten them there before, due to her low immune system from the MS. But my point is, thank you thank you thank you. I wish there were more people out there like yourself that such informative websites!!
Just wanted to say thank you for your candor and informative site.
My Husband became a paraplegic in April after a fall in rehab. He is a t10 incomplete. He currently has a foley catheter but his neurologist has recommended a SPC. He was given no info but an appt was made for a consult with a urologist. We cancelled it after home health nurses being negative. Also my daughter is an activity director in a nursing home and says she sees people every day that have had foleys for years and sees no need for a SPC. It would be great for my Husband to be able to have OP water therapy. Would this be possible with a SPC. What about sex? He is 69 and I’m 61 and all of a sudden he is in a hospital bed in the livingroom and suffering from severe pain from a bedsore. We are reeling from all this and a SPC decision seems overwelming at this point. Any SPC info or good sites that would help us get on with our lives would be helpful. I am taking the federal leave act to care for him but am still working 20 hours a week so he has to be left alone during those periods.
I am a 59 year young female who is a paraplegic. I am not able to transfer by myself so I have to wait until my husband gets home in the afternoon to go to the bathroom. I have never had to have a catheter of any kind — lucky me. As I get older I find that urination is getting harder to control — especially when I have water retention bouts. I only take a diruretic (?) when my husband is off and can help me go to the bathroom. I am considering a supra pubic catheter- just so I can go when I need to and don’t have to worry about leakage. I am trying to get as much information as possible. I would love to urinate whenever I need to and drink as much as I want. Should I be worried about this procedure or give it a shot.
Graham, The reason I clip the outlet valve to the hem of my underpants is to keep the valve from flopping around when I walk. This avoids using a holster or a strap, etc to keep the valve down. The underpants are the hugging type and have a turned up hem. (as explained in my previous comment). I still need to tape the catheter itself to my upper thigh. Hope this makes things clearer.
Thank-you all for the positive feedback, it’s much appreciated!
Nancy: I suggest you re-book an appointment with a urologist, they will not perform the super pubic operation right there and then. If your husband can’t attend due to pressure areas take a tape recorder or cell phone. As a T-10 I expect he has little to no sensation below his naval, therefore the neurologist suggested an SPC. I have a saying, “Many opinions make a balanced choice.” Sex, you will have to experiment, be patient and try new things. To me sex is more than the act, it’s tantric foreplay on all five senses. Just as the blind develop a heightened sense of hearing, losing feeling/use of your legs heightens all your other senses.
Jeannie Duncan: Try an IDC (Indwelling Catheter) first. It’s the same as a superpubic catheter only inserted through your urethra not stomach wall. Yours is a lifestyle choice so see if IDC and self emptying works for you. You leak now you will leak with an IDC but the point is a trial of lifestyle not appearance, sensation or stigma. If the method improves your lifestyle then sure, go for an SPC.
Great articles. Thanks so much. We have a son injured 1 year ago and are thinking of a new method rather then CIC.
Thanks for the suggestions. I hate to sound dumb but is a foley catheter the same as an IDC? If not, what is the difference? It seems so good to have someplace I can connect with others in this same situation, We have a support group that meets monthly but it’s an hour away and we have no way to get there at this time. Having this is like having a lifeline for me. Thanks.
Nancy, hi The simple answer to your question is yes the Foley catheter is the same as the IDC. The Foley is a name of catheters used to drain urine from the bladder held in place by an inflated balloon. They are usually latex but silicone are also available. The catheters can either be used as an IDC, inserted into the bladder through the urethra or as a SPC.
My urologist just prescribed UREX to help prevent infections.. What do you know about Urex? Thanks.. Eddy
My husband is disabled, paralyzed down the left side. How easy is it for him to manage cleaning etc. with only the right arm working?
Hi Paulette, after practice people often become very skilled using one hand to do things. There are also gadgets/aids available that can also make it easier eg to hold jars/bottles when trying to open, to help putting on socks. When dressing put clothing on the left side first and sit to put on lower garments. If buttons and zips are hard they can be replaced with velcro. Shoes today can be bought with velcro fastenings, laces can be replaced with elastic laces that remain fastened but stretch when putting on the shoe. Initially it will be difficult but with practice it will become easier. Your husband will get very frustrated at times, which is understandable because a once fast and easy activity now takes allot of time and effort. If you have access to an occupational therapist they help your husband ways be more independent. There are also sites on the internet that explain dressing techniques to make it simpler.
Eddy: Urex is the same as Hiprex.
Paulette: Cleaning around the site, emptying collection device etc. should be easy enough with one arm. One thing that might be difficult for him but not impossible is changing the supra pubic catheter. Holding the catheter in place and syringe plugged in while inflating the balloon can be hard even with two hands.
Hi Graham, Thank you for your prompt reply and information. My husband is a stubborn man. He says he will consider it a little longer. If I am not at home to help with SPC I think he would need a nurse every day to help him? P.
Paulette, I have had a SPC for 24 years now. I think the only think I might add is this: If your husband has to cath one way or another, the SPC is the easiest way to go for everyone involved. The SPC has to be changed like them all but a max. of 2 times a month but usually much less than that, instead of cathing many times a day. The SPC can be plugged when not needed or connected directly to a day or night bag for continuous drainage. Sorry for butting in, I just though I may be able to help.
I encourage anyone to post helpful replies Eddy and thank you, Shaddow and all who do. I was thinking similar, hubby could use a flip flow valve (a small lever tap plugged into the catheter end) and empty a few times daily in bathroom or into a receptacle. As a quadriplegic I have no wrist or finger movement in either hand and my carers only come for a few hours each morning and night. I spend the entire day alone using a 2000cc drain bag hooked up under my wheelchair. No good pushing stubborn people, I should know ’cause I’m one, haha. Just remind him it’s always reversible. Have a great day guys, life’s to short.
Graham, As I told you I am now taking urex. I was initially taking it morning and night as prescribed. You stated once every 3 days is enough for you.. How would we know how much to take? I am experiencing a lot more bladder spasms since I started taking Urex. Could urex be causing these spasms or is it just coincidence? Since I think it is causing it I am going to cut back on the urex and see what the spasms do. Any thoughts?
Graham, Have you heard of anyone having urinary tract infection problems with wine or the preservative Sulphur Dioxide?
Eddy: Urex is not a necessity so it’s safe to cut back just don’t overuse. I’m unaware of Urex causing bladder spasms, find the balance between spasm and sediment levels that suits you best.
Geoff: Sulphur Dioxide is safe for moderate consumption and is reduced by your liver to harmless sulfate excreted in urine. It prevents discoloration of white wine. Wine can lower urinary pH reducing some bacteria and therefore sediment. I recently added some beneficial to supra pubic catheter food/drink info to the article under “Lifestyle.”
Graham, Thanks for the info on sulphur dioxide and wine.
I’m having trouble with my leg bag. I have an spc and it seems when the bag gets half full it really pulls down on my catheter-any suggestions for this? I got it real tight around my leg. I’ve had my spc about a month. I use a leg drainage bag. If I were to use a plug how often would I have to drain it?
Hi Josh, I have had the SPC for 24 years now. In your first question you say the bag starts filling and pulls on your SPC. I am assuming you are not using an extension tube? I have the SPC in place, then I hook an extension tube cut to the right length in between the leg bag and the catheter.. Have you tried that? Your second question is determined by how much you are drinking. The bladder can only hold so much and then needs to be emptied. Everyone’s bladder holds a different amount. My bladder for example will not hold much at all so plugging it would not work for me, I have to have the constant drain or my bladder will void/leak on its own
A big HI to you, Graham! Sorry it’s been so long since I’ve posted, but you know how life can get @ times! Hope you’ve been keeping well. RE: Bill’s SPT. I can’t believe he’s had it in almost 2 years (I think) already. For many months, Mandelamine(Methanamine) MD 1 GM. q.d. worked pretty well, cutting my cath. changes way down to about q. 3-4 wks. HOWEVER, The good old U.S. of A. fairly recently stopped making it. I can only get Methanamine HIPP, which is similar, but for SOME dumb reason, his sediment has since been back full force; as are the q.wk.cath. changes. I have to irrigate, using about 30-40 cc’s q.d. of NS….I pretty much stick to sterile technique, but you must know how difficult it is to get sufficient equipment, RN or not. He can’t overdo the cranberry juice, so I’ve been mixing it with water and sweetener, any more and we have the diarrhea back, “catch 22″!! He takes as much water and other non-caffeinated fluids as tolerated.
Do you have any more info’ about the difference between the Meth. MD, and HIPP that would account for this? MD/Pharmacist don’t know there are a few chemical property differences, but the MD/Pharmacist both state it shouldn’t make that much of a difference, but I know you’ll believe me when I say it does!!!! Any other medication similar to try? It would have to be an antibacterial like Meth., and NOT an antibiotic he can’t stay on. Again, I’m not offered by MD much more help so I thought I’d try my “Super Pubic Tube” expert again!!!! Any suggestions are always welcome by you! Sincerely, Anne
Hi Anne, I wouldn’t think there’s any difference between MD and HIPP, certainly not to the degree Bill is experiencing. The only things to try are other Methanamine brands – Hiprex, Ural, Urex and there may be some generics available. Diet could also be affecting urinary pH lessening the effect of Methanamine. Keep urinary pH down at 5.5 or lower to ensure the hydrolyzation to formaldehyde and ammonia occurs. I listed some pH lowering foods under “Lifestyle” in the article. Nice to hear from you Anne. All the best.
Graham, How much urine is left in the bladder after using the super pubic catheter? There must surely be some remaining.
I am a 58 year old c-5/6 quad from diving accident 39 years ago. I have been using an external condom catheter all this time and now I am experiencing urinary tract infection after urinary tract infection as my bladder seems to just be warn out. My urologist is suggesting a Super Pubic Catheter and I am hesitant. I’m of the old school I guess. I wear a back brace and a seat belt and am very active. Has anyone got an answer on how to get around this problem? I’m not happy about this change to begin with and I need to have these questions answered before I say yes or die from kidney failure. Thanks, Jimbo
Geoff: The volume your bladder can hold varies from person to person. I’ve held over 1000 ml before. For most the urge to void starts around 300 ml. Any catheter supra pubic, indwelling or intermittent should drain your bladder to it’s relaxed state leaving 20 to 30 ml. The ability to bear down would leave even less.
Jimbo: If you have tried medications and all other avenues of Urinary Tract Infection prevention a Supra Pubic Catheter is a good option for you, as you say better than renal failure. Don’t forget it is reversible should it not work out. I think you will find an SPC has many advantages over condom type catheters.
Graham, Thank you again for a thoughtful and precise answer to a question. The reason I asked about the residual after using the super pubic catheter was about the chance of an infection beginning in the 20 to 30 ml left each time even after drinking three litres of fluid a day as you suggest. I am now drinking about the 3 litres a day including cider vinegar in some water and and lemon juice in other. Have you any advice re these attempts to prevent infection?
Geoff: An SPC works best as a closed system with a collection device attached so the bladder is constantly draining. The benefit is little chance of a Urinary Tract Infection developing or getting into the system. The best treatment for UTI is to stop them from ever starting. Diet can help avoid UTI though remember if you take a Hiprex or Urex type preventative you want to keep a 5.5 pH. Plain or filtered water lowers pH. If pH is not important apple cider vinegar, cranberry and lemon juice are good, avoid coffee tea and carbonated drinks. A healthy pH is 6.5-7.5 so give yourself a break periodically.
I am due to have a Super Pubic Catheter fitted in 2 weeks. I was told initially that it would be a day procedure, however when I saw the Consultant he said it is more complicated than they first thought & wants me to go in the day before & stay the night of the op too!
I have coughed out two catheters when I had a bad virus & the district nurses are finding it more difficult to insert a change as my urethra has gone into my vagina. I don’t understand any of this really & why I need to stay overnight in hospital when I am more comfortable in my home. I am scared about having this done as I have some feeling in my tummy & don’t want to be in pain. I get blood in my bag often & have infections often. I also bypass a lot. I just don’t know whether to have it done or not?
Hi Suzan, nobody can force you to stay in hospital but it’s probably best to do as they suggest. Having sensation there you will have pain for a few weeks then it should settle down. Ask for a numbing gel like Lidocaine or Xylocaine and apply it to the site. Considering your current complications I think an Super Pubic Catheter would be beneficial to you. Some discomfort is surely better than bleeding, bypassing, infections etc. Should it not work out it is reversible.
Hi Graham, Thank you for your reply. The Consultant said he might have to remove part of my bladder & close off down below so I don’t have any leakage as he couldn’t guarantee that a Super Pubic Catheter would completely resolve my problems. Is this normal in a lot of cases as I am getting more scared by the day? Plus if he closes off down below & the SPC blocks how will the urine come out without bursting?
I am so glad I found this site as it is very informative with both positives & the negatives.
My son has had a Supra Pubic Catheter for the past 4 years, however the nursing home he is in has removed this, the reason I have been told is because of constant urinary infection. Could he have this procedure done again and would he need a general? At the moment he has pads which I am not happy about. He suffered brain damage five years ago so he is disabled and cannot do anything himself
Suzan: I see, that must be a very intimidating thought. I am not an MD nor Urologist, if you’re unsure I can only recommend a second professional opinion. Given your further info I totally agree with staying in hospital. Two nights will pass quickly, we’re talking about lifestyle, plumbing, your womanhood. Closing of down there is usually achieved by stitching the neck of your urethra closed, that is the start of the draining tube from your bladder. Especially in females this is not usually reversible. I would inquire as to the chances it won’t be necessary, alternatives and even if, can’t it be done later if proves needed? When the only exit from your bladder is a Supra Pubic Catheter which blocks you will generally bypass urine around the catheter. I don’t know your case history but feel an SPC alone would have to be an improvement on your current status. Try to let go and not be scared, as we do you’ll look back and think what was I so worried about? Have a great day Suzan
Hi Graham and Susan. — Susan, My SPC has been in place for almost 24 years. I also have leaking through the penis when I over strain to lift something or maybe if I am pinching the tube off.. Like you have said, that is your emergency relief valve and once it is stitched closed it cannot be used as the relief valve.. I live in Denver Colorado and Craig Hospital is one of the leading Hospitals for spinal cord injury. My urologist at Craig uses Colegen/contigen (sp) to close off the the urethra passage where it connects to the bladder. What he does is insert the needle at the opening and inject the collagen in causing the opening to be obstructed or swollen which will not allow the urine to easily pass by.. He injects around the opening many times causing the obstruction. This collagen does wear off after a couple years on me as the body absorbs it. I then go back in when I start leaking again and have it done again, a 15 minute procedure.. This also allows a catheter to be used if need be, a little extra pressure is needed to insert the catheter past the collagen site.. This is reversible as the collagen wears off so it is not permanent. This could be an option for you.
I am so confused. My husband just got the super pubic tube with a leg bag. The doctor didn’t explain anything really and one question I didn’t think to ask is about bathing. He said to keep a bandage on and replace the bandage just like it is now and then every 4 weeks we go back to him to put another tube in. But after I got home, I was confused about bathing. Do I take the bandage off, leg bag, and just leave the tube hanging? Wow… I feel so dumb about this and not happy with the doctors neglect in explaining more. Any help would be greatly appreciated.
Wow Eddy that is fascinating. Could you please email me with your experiences at Craig Spinal Denver, that would be awesome. I’ve friends in Denver. I’ve heard of collagen in lips and butts but don’t know anyone first hand with it in their bladder neck, that’s very interesting.
Lynda: Yes a Supra Pubic Catheter can be re-performed, usually about an inch away from the original site. Typically someone with an Acquired Brain Injury is given a general but it may not be necessary if he will stay calm. An Super Pubic Catheter is one of the best methods to avoid UTI so I would look into the sterile practices of who has been changing the catheter.
Kitty: Drain the leg bag and leave it connected. Most people have two sets of leg straps replacing the wet ones after bathing. If you mean a site (catheter entry point) dressing/bandage leave it on during bathing then clean and replace afterwards with a new clean dry dressing/bandage. The dressing is usually only required for a couple of weeks, then leave uncovered and use an alcohol wipe or similar to clean around the site morning and night.
Hi, I had a supa pubic catheter fitted 10 weeks ago now. The procedure has worked really well, yes I did have a lot of pain from the site to begin with put the site is now really healing well and is draining perfectly. My problem is that 10 weeks on I am still experiencing terrible spasms daily that I am struggling to cope with due to the level of pain and I am also bypassing due to the spasms and continually have wet pads, which is why I had the procedure done in the first place to get away from wet pads. I have tried a number of different medications – oxybutynin, Lyrinelxl, and now had Usistas recommended to try. Up to know nothing seems to be making any difference, and my Urologist says after trying this she has no other answers only taking it out. I really really don’t want to have to take it out because in every other way its working perfect. Please have you any help or ideas, as the pain is pretty horrendous at present.
Many thanks
Hi Kerry, I take it you are talking about bladder spasm known as an overactive bladder, for this Oxybutynin (Ditropan) is one of the best available treatments, were you taking the maximum dosage? For more general muscle spasm many take Baclofen. It sounds as if something is irritating your bladder, check your catheter balloon size is at the manufacturer’s recommendation, consider a catheter with smaller balloon. There must be a considerable amount in your bladder in order to bypass, be sure it’s draining well. While it’s good to use as small a gauge (diameter) catheter as possible a bigger gauge might prevent some of the bypassing. Have an ultrasound done to check for stones or some other irritant. You will want to get this sorted Kerry as they’ve found catheter irritation/rubbing increases the incidence of tumors. Other than these I’d put any action off for a few more weeks and rest to be sure it’s healed. That’s why you should rest especially in the early stages, to give the best chance at forming a tight seal around the catheter.
Hi Graham, I am so grateful for the information you have given me, this site is so helpful, so thank you for that.
Firstly yes your are correct in thinking I meant bladder spasms, sorry I was not more specific, I have already tried Oxybutynin/ Ditropan 5mg tablets and Lyrinelxl which my doctor started at 5mg and then up’d the dosage gradually until I was on 20mg daily but sadly neither stopped the problem, I have now been prescribed Urispas 600mg daily to try. The points you have made have been a big help and I will certainly look into them all. I find the bladder spasms are so painful to cope with, I struggle to sit in my chair with them, so am spending alot of time lying down just to cope at the moment. My Urologist is wondering if my condition plays a part in the problem. I have a hemiplegic Paralysis, I have no movement or feeling down the whole of the right side of my body, so am wheelchair bound. Thank you for your help and encouragement, I will certainly preserver with it for a few more weeks as you advise. Many Thanks once again.
Kitty — I’m kind of new at this. I’ve had a Super Pubic Catheter for about 2 months. I always remove the bag before taking a shower — yes the tube simply hangs down. Before I get out of the shower stall I dry myself and put the leg bag bag on. It works for me just fine. I do this all in the shower stall in case there is any leakage. Hope this helps, Josh
What a great place to share a common problem… Thanks! I visited a rehab doctor yesterday at the request of my urologist. The rehab doc is a member of a group of Spinal Cord Injury docs in Phoenix. My problem is residual urine in the bladder causing frequent infections. The urologist has done a sphinctorotomy and a prostate resection trying to open up my urine pathway so I could continue using an external condom catheter. It darn near killed me because of the bleeding that I had as a result. My research told me this was a common thing and that’s why this procedure was nearly discontinued in the late 50′s. I was told with the use of a laser this would not happen. To make a long story short, the laser didn’t work so they went back to the old fashioned way while I was on the table and I nearly bled to death. Now the passage is open, but I still have residual.
A Supra Pubic Catheter is much easier to manage than an external condom catheter. As you have probably experienced even with skin glue they can come off and/or leak. I am quite active and the Super Pubic Catheter doesn’t stop me in anyway. If you wear a leg bag or drain periodically it will be the same, use a tap or plug the catheter onto wherever you tap/plug your condom catheter now. I know of the bladder electrode stimulus, most find it has limited success and isn’t really a good long term option. I can’t believe they did a prostate resection, especially without your consent. Frankly Jimbo I would go straight for the SPC. Do you take Hiprex, drink three litres/day, cranberry juice, etc for infection prevention? Try all the tips here and you may be able to continue with your current method.
Hi Graham, thanks for the feedback. The only questions I believe I have left is How do I deal with the back brace and seat belt issue? It seems like both of these will be in the way. I guess I’m wondering how to deal with this and not result in any kinking. Any ideas? Jimbo
Jimbo: The Super Pubic Catheter entry point (site) is usually below your pants line, that is in a sitting position about level with the top of your lap. An inch above the pubic hair area. As a C4 quadriplegic I also wear a seat belt type strap at lap height and cover with my shirt. I make a loop in the catheter in pants and run the 2000cc drain bag tubing out between pants top and strap. No one notices the strap or tubing. Many prefer to run the tubing down pants leg to leg bag, drain switch or drain bag. Those with a tap simply tuck it in their pants. So unless your back brace is of the kinky lace up crutch less corset variety it won’t be a problem. Just kidding, actually even if it was it would still be fine. I wear tight jeans and the only problem is the tube marking my skin. You can always tell the surgeon you want it as low as possible but stay out of the hairy areas as hair can promote bacteria and therefore infection.
Dear Graham, What a wonderful website this is for the world! I was looking for reasons my 61 year old brother keeps getting crystallization in the tubing of his Superpubic Catheter, also what causes the sediment. Hard to find anything relating to this. He has been wheelchair bound since 16 years old – just got SPC 4 months ago. Urologist has issued “idiot orders” for caregivers at group home. Most problems seem to stem from not enough fluid, cranberry juice as ordered. Trips to ER every couple of weeks with resulting UTI’s are very hard on Terry. Dark urine is usually followed by crystallization in tubing, then no output. Orders to flush 1 time a week by LPN issued – problem replacing leg tube & bag unless it’s leaking – sediment & cloudiness seem to always happen after we notice urine is very dark orange even if fluids are increased and urine turns lemonade yellow (our family term) Our next visit (if no more ER visits) to urologist for SPC change I am going to inquire about Hiprex. Thanks so much for that hint. Any other suggestions would be greatly appreciated.
Josh and Graham…. thanks so much for the help… I super appreciate it.
I spent new year at the beach with family. Hope you all had an excellent Xmas and this new year brings your dreams into reality. Stay positive guys!
Thanks Kitty and Tina: Tina, dark urine is indicative of UTI, it will help to drink steadily through-out the day maintaining lemonade yellow or even better clear. Everyone has bacteria in their urine which causes sediment to form. By drinking constantly the bacteria get flushed through before building up sediment. Alot use cranberry, many have posted other tips here from lemon juice to beer and certainly Hiprex or Urex type products are worth a try. Prevention is better than cure, stock him up with his favorite drink. It’s important to push constant fluids. More than 3 liters (6 pints) per day.
Hi Graham, I am afraid I am back with some more questions to do with my Supra Pubic Catheter catheter. A few days ago my tube got totally blocked with sediments (although I’m drinking the required amount), when my nurses came out to change the SPC they were here over an hour and they really struggled to get it out, eventually it came, and a new one was put in. However since all these problems my catheter keeps blocking for hours at a time and then just starts up again, there is no obvious reason for why its blocking at all but when it does I bypass large amounts, today my tummy has swollen right up and i feel like I can’t swallow, so I’ve been on to my GP who has told me I’m showing a klebsiella infection, which could be causing all the problems, she said its quite a bad infection. Do you think it could all be being caused by this infection, or have you heard about this infection?? I’m feeling very unwell and worried by the internal swelling and wonder if I’m to seek further advice or will this all rectify itself in time. Many thanks once again for your help.
Wow, I am glad I found this site. My husband is a quad and is going in the morning to have a super pubic started. I was quite questionable as to what to do afterwards. Just to give you some back ground on him… he is 38 years old having been a quad for 20 years now. He has had CHRONIC urinary track infections for about a year now. As soon as he gets off antibiotics he has another uti show about 2-4 days later. His neuro suggested the sphincterotomy but with his age, the new technology coming all the time, not to mention us still being somewhat newlyweds this didn’t sound like a great idea for us. We have since consulted with a urologist and he suggested this SPC as (like you said) if it doesn’t work or if he has any problems he can simply remove it. I feel much more confident in what to do once I get him home and it’s all for me to take care of.
I do have one question still. My husband does suffer from extreme disreflexia at times (the sweats/shakes/etc you spoke of), which can be very life threatening. He suffers extreme peaks in his blood pressure while suffering the disreflexia. He has used the Foley catheter in the past while hospitalized and it seemed to cause disreflexia. Is this something we should expect from the SPC also? Our urologist seemed to think possibly the balloon was filled too much (when in the hospital) and that may have been what caused it. I haven’t read anywhere else that this would be something to watch for but with him having it so often I want to be sure if it does happen we’ll know what’s causing it.
Oh… and what types of beer are naturally brewed? My husband used to drink a beer or two a day thinking this would help with the uti’s. We found that at times the uti’s were yeast so he stopped drinking the beer in fear it was making things worse. He drinks cranberry and also has cranberry pills… There is also another type of drink he gets from a company called Kordial it’s “On Tract” powder (D-mannose) this works well to prevent uti’s if there is anyone out there that may be looking for a natural alternative.
Thanks again for your site and info… I am sure I will get back on after his procedure and keep up to date on the “in’s and out’s”… no pun intended. :D
My 92 year old mother voids >1,000 cc at night but very little during the day. For years she was getting up every hour or so to urinate. I requested the md order a foley catheter which has given her full nights of sleep but causes UTI’s, bladder spasms and leakage’s. If she were to get a Supra Pubic Catheter, could she void normally during the day (pinching off the tubing) and then attach a large bag at night?
Kerry: It’s common for a supra pubic catheter to stick, requiring a firm tug. First! it’s essential to ensure the balloon is totally deflated. Klebsiella is a nasty infection resistant to many antibiotics. No it won’t just go away. Typically contracted in hospitals by people with a pre-existing illness associated with low immune systems, it could be the cause of all your problems. If your Dr. advised no treatment I strongly encourage a second opinion especially as you have Hemiplegic Paralysis. Kill the Klebsiella infection asap.
Megan: Amongst quadriplegics a Foley catheter through the penis (IDC) commonly causes irritation along the urethra and tract to bladder resulting in Autonomic Dysreflexia. A Supra Pubic Catheter may cause the same, or more severe at least for several weeks post-op then it should settle and be less irritating than the IDC method. Any incidence of UTI should also decrease. You should be prepared for blockages carrying a spare ‘quick change kit’ when away from home as you would with an IDC. Newly weds, how sweet :) Congratulations! I too would avoid a sphincteroctomy even if I were a monk. Consult your local alcohol outlet re: naturally brewed beer. Most yeast is killed in the gut, any residual should be flushed through quickly as beer like most alcohol is a diuretic, so follow up with water. Kordial sounds interesting, I haven’t tried it. I will reply to your quadriplegia post when I get a minute and look forward to hearing how hubby and yourself are doing.
Margie: At your Mothers age if she has full sensation I would be hesitant to suggest an SPC. A larger gauge catheter/balloon may sting more to put in place as numbing gels like Lidocaine, Xylocaine can have adverse side effects for elderly folks, KY etc are fine. Pinching the tube off is better done with a tap inserted into the catheter end rather than leaving it open to infection. A tap and/or drain bag can be used with an IDC or SPC. Some taps allow a drainage bag to be plugged onto it, open the tap overnight, close and remove bag during the day. I understand the hindrance leaving an IDC in 24/7 can cause. My concern is the initial trauma and ongoing pain an Supra Pubic Catheter may cause your Mum.
Hi Graham, Well here I am a week later. Wow, where do I start!? The procedure went ok, as good as could be expected I suppose. After the three hour ride back home we could tell it wasn’t going to be a “good night”. Yep, here comes Mr. Dysreflexia. Thankfully we already have medication to help with that or we would have been in a real pickle. He was in quite a bit of pain and was passing a lot of blood and clots, of course when I mentioned dysreflexia I don’t have to go into all the shivers and shakes and crazy b/p readings or sleepless days and nights. We talked to the doctor every day and I really thought my hubby was going to want it OUT before he could give it a chance. Luckily or maybe finally. I think it was on Friday the doctor sent a Rx for bladder spasms. Woohoo!!!! He took one that night and it worked miracles. The bleeding has stopped and he hasn’t had any more clots either. It is definitely emptying as where we were emptying a normal leg bag maybe twice daily it has gone to at least five times daily, and being completely full! Same at night of course and thank goodness no more in/out catheterization! I know he will feel relieved once he gets used to things being different. We go back on Thursday to have it “upsized”. Keep Mark in your thoughts and prayers that this round will go much smoother, and at least this round we’re prepared with the meds he may need.
Also, just a note to anyone who hasn’t been through this or is looking at having this done in the future and those spouses and caregivers out there. The most important thing for the person who is having this treatment done is to keep them positive. We (“normal people” as you may have it) cannot even begin to imagine the frustrations that come, the feeling of having something “strange” and unusual “plugged” into your belly, the discouragement of being down (again, for some). When you are going through the recovery process with them be sure and tell them how great they are doing, how much better they are going to feel in the long run, how quickly they are catching on, etc. Suffering from quadriplegia can be bad enough, then you have another drastic thing to go through and make you feel “different” they need our support!!! Best of luck to everyone and thanks Graham for the great info. I am sure we’ll keep you in touch as to how things go this round.
I am a 48 year old female with Multiple Sclerosis. My bladder has always been a very difficult thing in my life. I have been taking ditropan and detrol for a couple of years now and find them to be helpful. I was suppose to be in a study for botox for the bladder that I was quite excited about. It’s been a long time coming and is finally going to happen the beginning of Dec. But in the meantime I am having a very difficult time with getting on off the toilet, but reading some of your responses it seems to be necessary to still take the ditropan and detrol, which was what the botox was hopefully going to eliminate as well as pads. I have not been able to walk for almost 3 years not and the strength in my legs will no longer hold me up to lift up my pants. I have recently been told about the Supra Pubic Catheter and am quite intrigued, but a little scared. Where does the bag go? If it is on the leg can you wear jeans and how do you empty it if you have jeans on but can’t get them on or off to do so? and what about shorts in the summer time?
Hi, I am a 44 year. old mom who’s deaf and disabled with moderate Cerebral Palsy. Just had a Super Pubic Catheter done this past August. What an experience it has been. My question I have is pertaining to showering. Because of me now having a stoma, is it BEST to shower everyday to prevent possible infections? I feel embarrassed asking this question.
Cathy: There are many types of collection devices. Latex leg bags can hold around 750 ml in general and can be worn on the thigh or calf, in jeans the calf is better. The drain tube with tap is accessed at the bottom of jeans leg. In shorts a smaller thigh 500 ml bag is better, drained the same way. If you can empty frequently simply plug a tap straight onto the end of the catheter and keep it tucked inside your jeans/shorts/panties/etc. If unable to frequently drain, a 2000 ml drain bag is often used hung bedside bed/wheelchair drained morning and night.
Trishie: Don’t be embarrassed hun you’re amongst friends here. No you can continue your regular shower routine. A shower does not remove all bacteria. If you’re worried frequent use of alcohol wipes or any sterilizing preps will help prevent cross infection. Use a different wipe around each area.
Graham, thank you for the advice… I have been using baby wipes, but maybe alcohol would be BEST??? As for showering, I was doing it every other day, seems like I should be doing it everyday instead to prevent Urinary Tract Infection’s from happening. I experience urethra pain, like stinging and burning sensations everyday, I see my Urologist next week, and will mention this to him. Any more advice, new friend?? :0) Have a GREAT day! Trishie :0)
As a working professional Quad I have managed for 36 years with intermittent cats 3x per day. My very amazing wife who married me 10 years ago has been by me through all the urinary tract infections, hospitals and good times as well.
As I have a bit of a large belly over the years will this kink or pull the cat as I am forward in my chair at the keyboard most of the day and how much time off from work do you think I will need after the superpubic catheter is installed.
Trishie: Alcohol wipes are better as they kill any bacteria on the skin. The burning might be an infection, best ask your urologist.
Robert: It shouldn’t be a problem. I’m pretty slim yet still have a crease where the supra pubic catheter site is. Just be aware it increases the risk of site infections as bacteria thrive in a warm dark environment