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Greetings,

I am going through a difficult urinary experience that I would like to discuss for publicís benefit.
I had a foley catheter in my bladder for 5-weeks starting June this year then switched to self-catheter for last 3 weeks. I self-catheter 4 times a day to drain my bladder because I cannot void on my own. I self-catheter 11pm before going to bed and usually drain about 450cc, then I do it again at about 3am and drain about 750-800cc which wakes me up real bad and cannot go back to sleep for another 2-hrs or so. My next catheter is at about 7:30am after taking my shower which I drain about 500cc and the next one at about 3-4pm for 450cc, and the cycle repeats. I stop drinking water after 5-6pm and water is the only thing I drink, hoping that at middle of the night my load would not be heavy but no matter if I go to bed at 10pm or 11pm or 12 pm my early morning load is always the heaviest about 750-800cc. Recently I realized that in the morning about 7am when I get the urge, I go and I push hard for almost 20 seconds continuously and void about 50cc on my own and more push does not do anything. Then I get another urge at about 2 minutes later and I void another 50cc with another long and continuous push of about 20 seconds. Within the next few minutes I most likely get 2 more urges and I void another 50cc each. Then I go to shower and during 15 minutes of shower I get at least 2-3 more urges which require long and continuous push of 20 seconds each. Yesterday morning with all 7 different urges I got and long pushes of 20 seconds I made for each one, I voided 400cc within a period of 1 Hour. Then I did my self-catheter and drained another 400cc. The other facts are that my cystoscopy showed no blockage/obstruction and no Inward growth of the prostate and no strictures (narrowing) of the urethra.

So, my questions are:
1- Since I have no blockage why do I have to push so much to void so little?
2- How can I reduce my 3-am volume to about 400-450, of course I cannot wakeup every 2-hrs to self-catheter because that way I wonít be able to catch any sleep at all?
3- Pushing long and continuous like that for 20 seconds till cannot push any more, will that help me eventually to regain the muscular bladder control I need, or too much push will thicken my bladder again and is counter productive?  

Best Regards,
Ivan.

Answer
Ivan:

First, you probably should be cathing instead of trying so hard to void first.  A single attempt is not unreasonable but you appear to be trying and trying with some effort first and this isn't necessary or helpful.

If there is no blockage, then the most likely cause of your urinary trouble is a hypotonic or atonic bladder.  When the bladder muscle is badly weakened or damaged, it cannot empty to matter how hard you try to "push" which is why you need the catheter.

Reducing the overnight urinary volume would start with limiting fluids starting after dinner, keeping the feet up or raised until bedtime and possibly the use of vasopressin (anti-diuretic hormone) which would limit urine production temporarily until morning.

Pushing hard when there are minimal results is only going to further damage the bladder and not help.  It is counter-productive.

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Stephen W. Leslie, MD

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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