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Urology (Expert Forum)
Frequency 8-12 times a night
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
Frequency 8-12 times a night
by AMSB, Oct 11, 1998 12:00AM
My wife has Multiple Sclerosis. It turned nasty this past year. One of the noticeable symptoms has been a bladder problem. She had a number of bladder / UTI infections. Also has increased frequency and urgency to urinate. We are up 8 to 12 times a night. The lack of sleep is a killer!
My wife ended up in the hospital for a couple of months. Same frequency and urgency to urinate drove the staff nuts. Every time they measured her bladder, it was less than half full, consistently, but she had the urge.
She is now back home and we are still dealing with it. The urologist performed a videourodynamics test. He said the bladders not functioning, nerve signals not getting through. Disconnected somewhere in the spinal cord/brain. Her bladder is full all of the time, a turn or strain causes the urge to empty (bedtime). Low liquid consumption sets her up for infections – drink more. And stop bladder medications: Oxybutynin 5mg and Detrol 2mg and see if this improves cogitative/other functions! The medication did not appear to be working anyhow. Schedule appointment to learn self-intermittent catheterization.
We went to the urologist to learn catheterization. I questioned him about testing results. In particular, how could the bladder always be full? It was emptied dozen of times in the hospital and was always less than half full. He said, "I know". The tone of his voice indicated it was not what he expected to find. He said something changed! So we proceeded with the catheterization lesson. I expected as I think he did to see a volume of urine when this was done. All we got was a trickle <50cc. What's going on – he said, come back in three weeks?
So I started doing the catheterization, and here are the results:
Night 1 – catheterization =<50cc, then up 8-12 times total additional volume 375cc.
Night 2 – catheterization =<50cc, then up 8-12 times total additional volume 500cc.
Night 3 – catheterization =<50cc, then up 8-12 times total additional volume 350cc.
I really thought emptying the bladder would get us to sleep through the night.
Can you shed any light on our situation?
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Dear AMSB
Thanks for your question. I do sympathize with your hardship.
As you know, MS symptoms vary during the course of the disease. Thankfully these bothersome symptoms can and do change. In your wife’s case a full bladder sensation does not mean a full bladder of normal volume ( 300 cc). Catheterization is usually prescribed when the bladder does not empty properly and should work if this was your wife’s case. The bladder may not have emptied during the videourodynamics. Sometime the test in the lab does not reflect the natural situation at home but videourodynamics is the best modern medicine has. Catheterization volumes of less than 50 cc means that her bladder is emptying well . Catheterization may not be helping her urgency but maybe helping to prevent pressure damage to her kidneys. The pressure in the bladder is dependent on the volume of urine stored. Cath frequently can effectively lower the pressure. .. Ask your doctor if this is the case and if not would he/ she recommend stop cathing since it is not helping these symptoms.
If there is no change in her thinking since she has been off the Ditropan and Detrol, your urologist may resume these medications in an effort to create an inability to void and keep her dependent upon intermittent catheterization. Thus, she will have lower bladder pressure, decreased urge to void and need to have her bladder mechanically emptied. Sometimes long term antibiotic prophyllaxis is required to keep her urine from being infected, but if she is not having symptoms from this, then she may really not need any treatment. There is not much I am aware of to offer you and your wife that you have not already tried. Fine tuning may be the answer. You are in my prayers.
More individualized care is available at the Henry Ford Hospital and its urban campuses by calling (1 800 653 6568). We can also arrange local accommodations through this number if this is your need. Please bring any physicians’ notes and lab test results that you may be able to obtain. These will help us greatly.
This information is provided for general medical education purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.
Sincerely;
HFHS M.D.-MS
* Keyword: Multiple Sclerosis, frequency, urgency, self cath, catheterizing
