Bladder Spasm
Many people find that even though urine drains quite freely through their catheter most of the time, there are occasions when urine leaks around the side, making them wet. This is called catheter bypassing. Some people feel their bladder contracting as they leak, but others do not. Those with suprapubic catheters may find they leak from their urethra (the passage where you naturally pass urine), instead of around the catheter.
Why does it happen?
A catheter is a very thin tube and so is only able to carry a slow flow of urine. When your bladder contracts it produces a very fast flow of urine. Even if you have a catheter there is always a little urine in your bladder. This means that if your bladder contracts while you have a catheter in place, some of the urine will have to spill around the catheter instead of going through it.
So why does your bladder contract when you don’t want it to? Sometimes it is because of a disease of the nervous system or a spinal cord injury, but many otherwise healthy people develop irritable bladders as they get older. These people find that they pass urine more often than they used to and sometimes need to rush to get to the toilet. It can be very mild so that people hardly notice it, or very severe so that they often leak and need to wear pads. This is known as bladder spasm, or in medical language, detrusor overactivity.
In some people their severe bladder spasm is why they needed a catheter in the first place, but the catheter does not make this problem go away. In fact, because a catheter is a foreign object in the body, it irritates the bladder and can make the spasms worse.
How do I know I have this problem?
You will find that you bypass urine quite unpredictably. Particularly important is that you will bypass urine just as often when you have a new catheter as when it has been in place for a few weeks. When you examine the catheter, it does not contain the crystals of encrustation which cause true catheter blockage.
What can be done?
Changing the catheter when you start bypassing does not help, as there is nothing wrong with it.
The catheter is an irritant, however, and you may find things improve if you only fill the catheter balloon with 5ml of fluid instead of 10ml. You should also use the smallest sized catheter you can.
Some substances you drink can make your problem worse. You should avoid drinks containing caffeine, such as tea or coffee. Alcohol will also make your bladder more irritable, as do fizzy drinks.
If these methods do not help, you could try drug treatments, although you will need to use these as well as the methods mentioned above, not instead of them. There are several different types of medicine available for bladder spasms. These are completely different to the antispasmodic drugs you may be taking for other muscle spasms.
Some of the commonly used drugs are oxybutinin, tolterodine, trospium and propiverine. They all have side effects, the most common being a dry mouth. You will probably need to take the medicine for a few weeks before it starts to have an effect. If one medicine does not help, or the side effects are too troublesome, you can always try one of the others until you find one that suits you.
What else could be tried?
There are methods to treat this problem with surgery. These are major operations which have side effects of there own, and are not suitable for everybody. You will need to discuss these in detail with your doctor.
Finally
Bladder spasm is sometimes a problem that cannot be completely cured, but by following this advice it should be reduced in severity. You may have to continue to wear pads as well as use your catheter.
You should discuss the information in this article with your own health care professional before making any changes to your management.
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