A friend of mine who is also a paraplegic is having trouble at night with bed wetting he is 57 and uses cataders during the day with no problems and it is really getting him down any suggestions to help him would be great thanks

Reduce fluid intake for 3 hours before bed, cath before bed, maybe wake up after 5 hours and cath.

That's the best place to start. If it doesn't stop after trying this for a few days, see a urologist.

I always suggest this if he hasn't tried yet, but bladder spasm medication is designed to help prevent an active bladder from leaking.
Have him see a urologist to see which medication might work best for him.

He may even have to try several kinds before getting one that works. Detrol LA and Oxybutynin are just a few. And what LC said definately helps keep the bladder at a lower level until morning.

If the meds work, he should be able to go 8 hours without a problem, keeping the fluid intake lower at night, of course.

Condom caths and a bed bag at night.....wake up dry guaranteed.......

As long as you superglue the condom cath to the penis and the tube, and don't move at night... At least that's been my experience. I hate those things.

I have bladder spasm and my bladder capacity vary from 200-600ml, and this made it impossible for me to rely on intermittent catheter alone. So for the past 4+ years I use Sheath (condom cath) attached to leg bag all the time and do intermittent self catheter. I had Botox injection in the bladder, though it helped for a month or two, spasms started again. I am now taking Oxybutynin tablets regular, that helps a bit, but not enough to be back on self catheter alone. Driving to work takes 1Hour + and while driving capacity is only 200-300ml, also at work Disabled toilet is not on same floor.

If controlling fluid intake and medicine does not work, Sheath is next best. Initially I had trouble getting it to stick, not stick end together etc, but in past 2 years I have not had any trouble wearing it. In fact I even use some moisturizer before putting sheath on so that it does not stick too much to the skin.

The single most important thing to do for controlling longterm damage from UTI is to drink LOTS of liquid. On the other hand, drinking lots of liquid causes the bladder to fill up, overflow and cause leakage. So there is an apparent trade-off.

However, there is another aspect to the equation, and that is the full bladder incubating bacteria and potentially overflowing, not only into your trousers, but backing up to the kydney where the bacteria can do real harm.

If you are drinking a lot, and if you are using intermitant catheterization and condom caths as a backup, you should really take off the condom as soon as you overflow, and cath. Ideally you should cath before you overflow. This involves taking off and putting on a lot of condoms. I can see why people would slow down the drinking in order to stay on the cath alone and perhaps just back-up with a condom at night. However, that brings you back to the first principle: If you want to stay healthy long-term, you have to pass a lot of liquid.

One thing that can help, is to really practice the art of bladder stimulation. I do this using both percussion (tapping), and massage/pushing. I am lucky enough to be able get the bladder pretty empty by doing this. Many years of practice will get you good at anything.

Long ago, I considered myself continent as long as I was around the house. When I felt it was time, I would go and lie down on the bed where I kept a condom on a night bag, and just roll out the condom on the penis without any glue, and hold it on with one hand while I worked on the bladder with the other. When I went out, I would put on a condom. But I didn't glue them.

After many years of this routine, I got tired of smelling like a horse all the time, and I stated gluing the condoms and wearing them all the time. But I continued my routine of thoroughly voiding the bladder by stimulation, long before it got really full. This is the key. Now, by using plenty of glue, and by also keeping the leg bag empty so it doesn't pull on the condom, and by keeping the voiding volontary instead of involuntary (which causes the condom to fill and fall off), I now wear a condom for four days and have not wet myself more than once in a couple of years.

One good tip: To prevent condom loss at night, you get the tube full of liquid before you go to sleep. That way, when you start to pee during the night, the liquid does not have to overcome gravity and force the air out of the tube (which is where all the accidents happen). All you have to do, is hook up to the night bag, and then void your bladder, hence priming the pump, and then go to sleep.

The goal, is always the same: keep an empty bladder, with plenty of drinking.

Hope this helps,

Gordon

We also use the 3M microfoam tape at the base of the condom as well.......this REALLY helps keep the condom cath on

I've a friend, Gordan, that tells me that he does the same as you,,, but at the five year mark, I still haven't learned that trick of volontary voiding. Are there any hints on how to start,,, like,, what's this "tapping" thing you do?

As for self cathing during the day, while wearing a sheath,,, no probs,, disconnect the tube and insert the cath. Wash your hands first, of course. I've even found that lube isn't generally needed, for some reason.

I've just started using the sheathes with the adhesive strip,,, I'll let you know,,,, but I have noticed that there are different widths available.

Jax,, Yeah, I know,,, they are a pain in the ass,,, but I'ld not like another hole in my body,,,, not for a while yet.
ed

I don't have an extra hole for urine. I have an AUS (artificial urinary sphincter). Funny thing, the urologist went in through an existing scar from the second spinal surgery, where the spinal surgeon had gone in to put in the carbon fiber block... I'll put the pics of the next set of x-rays up on myspace soon as I get them so people can see what I mean. With the AUS, I've not had a leak. Only complication at all was a bit of urethral swelling post-op that made a foley necessary for about 5 days. Since then, no problems.

I will have an extra hole in me after the bowel surgery (ACE), but that's another matter...

Ed,

Let's say you figure you have to pee and you are in your chair.

Shift your butt farther forward so you are slouched backwards.
Unzip.
Assuming you are right handed:
take the penis and sheath in the left hand (so you will feel the flow by the condom swelling and you will also prevent the condom seperating)

strike your lower left abdomen with the straight fingers of the right hand (this might work best lying down where you have better range of movement)

alternatively (maybe better for sitting), with the bone of your left wrist in the lower left abdomen (while you are holding the penis), pound on the left wrist with your right closed fist, and the strike will be transmitted throught the wrist to the bladder.

The idea is to cause the bladder to contract. When it starts to do that, it will try to void all by itself the way it is designed to do. However, the sphincter will still be trying to close, so you have to sort of cause more contractions as the old ones peter out. You will get good at knowing when to hit and when to leave the flow go.

This method will work best when your bladder is almost full enough to start overflowing by iself.

You should get to know the feeling of the bladder at different stages of fullness. When fairly full, and ready to contract, it should feel like a small/medium fairly tight ball. (when you get the sweats and panic, it feels like a football). At this stage, the bladder is already trying to contract, and you are just helping it along a little. To overcome a tight sphincter that won't let go, you can try pulling the penis and scrotum which also pulls on the sphincter and may relax it enough.

But to get your bladder really empty, you have to use a deeper massage. Here, from the same sitting position, still holding with your left, you reach the ends of your fingers straight into the abdomen, and you massage, push on the bladder. you are doing two things. You are directly relaxing the tight mouth of the bladder, and you are stimulating the rest to contract.

All of this takes practice. Just see if you can get any action before you cath. Don't just try it out. Make it part of your routine. At first it may be a total failure, but you will soon see that in certain circumstances you are getting a jet of urine in your condom. And as time goes on, you may be surprised to see how much you get out first, and hence how little is left for the cath. In the end, you might just be cathing once a day to make sure you are really empty and reduce the infection risk.

I don't cath at all.

Also, if you gain confidence that you can fairly easily empty your bladder, you will drink more. That is good.

Good Luck,

Gordon

Thanks Jax,, I think I'll look that up,, maybe mention it to my uro when I goe next month.

And thanks to you, also, Gordon,,, I will give it a try. Feeling my bladder might present a problem, tho,, as I've become a lot more,,,,, rotund. I may even print out the instructions so I don't forget. I can see where that skill would prevent blowoffs,, of which I have too many.
ed

Ed,

The pot belly thing may be less of ahindrance than you think, because the bladder is right down close to the pelvic floor, so your hand should be under your pot.

To begin with, I just suggest this:

When you feel you are overflowing into your condom anyway, just try to take charge and get a little more out, and see how that goes.

Best,

Gordon

Thanks G,, worth a shot.
ed