Q. I’m in my 10th year as a T8 complete para. While trading “locker room talk” among the friends I roll with, it’s not uncommon to hear tales of people that routinely have volumes of 1,000 cc or more when they intermittent cath! In rehab I was taught that bladder volumes of more than 600 cc can cause problems, but my friends don’t seem to think larger volumes are a big deal. Am I being overcautious? Are large bladder volumes really a big deal?
A. Craig, you aren’t being overcautious: Letting the bladder get too full can cause serious, permanent problems. Avoiding large bladder volumes is an often overlooked and/or misunderstood concept. Ideally the bladder should be emptied when the volume is 400 cc (about 1.5 cups) or less; a volume of 600 cc is considered a very full bladder. To put this in perspective, according to Medline Plus, the average person with normal sensation will feel the urge to urinate when bladder volume reaches around 200 cc. At 400 cc the urge to urinate becomes uncomfortable, as in “I gotta find a bathroom fast!” Between 550 cc and 600 cc the urge becomes so strong it is painful! One can imagine the stress of a bladder volume of 1000 cc or more is putting on the body.
A recent international study of 1,450 intermittent catheter users done by Coloplast found that 50 percent of U.S. catheter users are not catheterizing often enough. Reasons given for not catheterizing more often were expense and inconvenience — which shouldn’t be an issue given greatly improved reimbursement guidelines and the myriad of catheters and catheter systems available.
In terms of expense, Medicare now reimburses up to 200 catheters per month — guidelines include “one catheter (A4351, A4352) and an individual packet of lubricant (A4332) per catheterization episode.” These guidelines also cover Coudé catheters and hydrophilic catheters. Many people with SCI find hydrophilic catheters are more convenient and easier to use than non-hydrophilic coated catheters — a report that is backed up by a study published in the January 2011 edition of Neurology and Urodynamics. The study found, in addition to ease of use, hydrophilic catheters help reduce urinary tract infection and microhematuria (blood in the urine due to trauma from catheterization).
When it comes to intermittent catheterization and convenience, the key is finding out which catheter works best for your body and your lifestyle. To that end, check out United Spinal Association’s webinar on June 7, titled “Accessing the Catheter that Best Works for You!” Sign up or see the archived webinar after June 7 here.
Other ways to find which catheter works best for you include discussing it with your urologist and speaking to your urological supplier — they will be more than happy to send you samples of different types of catheters for to try.