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About Arthur Goldstein, M.D.
Expertise
Any problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, impotency, etc.
Experience
I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in male impotence and endourology.
Organizations
American Medical Association, American Urological Association, American College of Surgeons
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You are here: Experts > Health/Fitness > Urology > Urology > Long Term Catheter Use
Expert: Arthur Goldstein, M.D.
Date: 9/12/2008
Subject: Long Term Catheter Use
Question
Hi, my dad has had a catheter for about 3 months which has now been removed. But he now finds that the muscles to control the urine are not very strong and the urine just runs out, he is unable to control it very well. How long will it take for this control to return to normal.
Answer
Lisa Meyer, this all depends on the underlying disease that made catheterization necessary and his present urologic state. The common reasons for catheterization in a man would be urinary retention secondary to an enlarged & obstructing prostate gland or a variety of nerve diseases that affect the bladder (neuropathic bladder disorders). Now that the catheter is out, you have to understand that there are several types of urinary incontinence (involuntary loss of urine). STRESS incontinence occurs when there is leakage of urine from the urinary bladder associated with coughing , sneezing, straining or any other activity that causes the diaphragm to lower, thus pushing the abdominal contents against the bladder. It is most common in women, especially those who have had children but can also occur in nulliparous women and in men. It can be improved by Kegel exercises (many internet sites can describe this), biofeedback therapy, and surgery. URGENCY incontinence means an intense desire to void but the person loses urine before getting to the bathroom. This may be due to a variety of conditions such as infection, urinary stones, nerve disorders (so called neurogenic bladder), tumors of the bladder, etc. INVOLUNTARY incontinence means the loss of urine without associated stress or urgency. The person is unaware that they are incontinent until they feel they are wet. Often the incontinence is a mixture of the above types. For example, if a person is unable to empty the bladder well and retains excessive urine, they may have urgency, stress or involuntary incontinence. In the latter situation, the bladder may be so stretched and full that the person has lost all sensation. When the bladder capacity is reached and it can’t hold any more, urine just leaks out – so called “overflow” incontinence. In males and obstructing prostate gland is a common cause for this. Because of the many diseases and types of incontinence, a full urologic evaluation is generally necessary to find the cause. Such studies would typically include a history and physical examination, urinalysis (and possibly culture), cystoscopy with measurement of residual urine, and some urodynamic studies (cystometrogram, sphincter pressures, uroflowmetry, etc). Only after identifying the cause, can a proper plan of therapy be instituted.
Pure urge incontinence is usually treated with medication. These drugs relax the bladder to prevent unwanted contractions. Examples would be Ditropan, Detrol & Vesicare. These drugs may need periodic adjustment depending on symptom control & possible side effects. Sometimes, one medication may work and be tolerated better in a given individual. However, these medication are contraindicated with overflow incontinence. There really are no good drugs to stimulate a hypotonic or overstretched bladder. (The drug Urecholine has been used with limited success and but it has significant side effects). Occasionally the implantation of a bladder stimulator may help. In most instances, incontinence in men can be treated with a penile clamp or condom type drainage sheath over the penis that leads to a leg bag. If the incontinence is due to excessive residual urine, the treatment options would be self intermittent catheterization, an indwelling penile catheter or a suprapubic tube. The latter is much preferred to a penile catheter because it goes directly into the bladder through a small opening in the lower abdomen. It bypasses the penis and is a much more comfortable option.
The bottom line is that an incontinent patient is best evaluated by a urologist so that the type of incontinence can be determined. It is also important to be sure your father does not have a urinary infection from the catheter which can exacerbate his symptoms. Based on the urologist's diagnosis, a rational treatment plan can be instituted. Good luck.
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