I need advice -- urine retention

I had my hysterectomy about a month and a half ago. One of the things that was done was a bladder suspension for a cystocele using TVT. I had complications after the surgery including two pulmonary embolisms one week apart. Now I'm on Warfarin to keep my blood from clotting too much.

I also have a strange urine retention problem. I came home from the hospital with a Foley catheter because I couldn't urinate on my own. After about three weeks, I could finally empty half of my bladder. I had to straight catheter the rest. What's funny is that it is always half of what's in there, whether it's 400 ml or 200 ml.

I also have pain in my urethra when I go, like the sphincter is stretching and won't stay open long enough for continue emptying my bladder.

I had this surgery done mainly for stress incontinence, so it's ironic this is happening to me now. I see my urogynecologist next week, but I'm wondering if anyone else has had this problem and if it was cured somehow. Did you have surgery, or can something be done short of surgery? I won't be able to have surgery for awhile because of my blood clotting problem. I will have to go back to work next month and I don't want to be catheterizing there; also I've had three UTI's since the surgery, probably due to self-catheterizing.

I'm pretty depressed about this, so any suggestions would be appreciated. The people in this forum have always been great to me.

Thanks

Malie,
I'm sorry to hear about the problems you're having. I had a sling procedure done on 2 Dec, and have had the same problems you're describing since then. I'm still straight-cathing as well, and having constant, really painful, bladder spasms. My uro finally referred me to a super-specialist, and has said I will probably need a procedure called urethrolysis to correct the obstruction causing all the problems. I don't know exactly what that involves (i'll be posting to see if anyone does). I'm also having serious incontinence problems with the spasms, and usually can't tell whether my bladder is full or empty.
I've also gone back to work, but only part-time as I just can't take the pain for the whole day. When you see your doc you should really push for a solution before you go back to work. I know my doc's been waiting to see if the problem will correct itself---but it obviously isn't. I'd just hate to see someone else get put off for months for a problem that won't fix itself.
Please keep me posted on your progress, and I'll be keeping you in my thoughts. Best of luck!

Julie

I am 7 months PO from SAH and STILL have to self-cath to empty my bladder. I've had 9 uit's since surgery and I take antibioitcs everyday. I've been on everything from MAcrobid, Trimethoprim, Cephaflexin, and Cipro. I don't have any incontinence issue, just retention and chronic uti's.

I'm SO tired of dealing with it and the last few uti's I have gotten really sick feeling.

My uro guy said just live with it, keep self-cathing 2-3 times a day and keep on antibioitics for life, (whatever, I'm only 40) gyno says he has no idea what's up, he says it's not related to the hyst. (well didn't ahve this much trouble before the hyst)

I keep hoping each uti's is the last one. I guess my next step will be to try and find a uro-gyno person.

Do you use the little disposable silicone catheters? They are so easy to use and you only have to squirt them with saline solution. They are easy to travel with because you can just throw them. I wash them when I'm home and re-use.

[size=1][font=century gothic][color=blue]
Malie,
I am 3 years post op from a TLV and 2 years post op from my bladder sling and cystocyle repair. I understand how you feel because I to have been battling the same problems. I had a foley while in the hospital and did self-cath for about a week when I came home. My bladder had fallen so far that it had collapsed my vagina and rectum. To make matters worse my husband was deployed to Iraq during my suspension surgery. Believe me having gone through that surgery by myself, I can really say that I understand where you are coming from. I have had incontinence problems since my TLV. To add insult to injury my incontinence is both urine and fecal. After seeing a GYN, URO and a UROGYN, I have to say that by far I have gotten more answers from the UROGYN. There is "steriotype" that comes with our problem. One that is undeserved. Keep your chin up. I am here if you need to talk. Just an e-mail away.....

Hi,

I writing to update you on my urine retention problem. I'm still having it at 9 weeks and it's gotten worse. I'm due to see my urogyn. at 12 weeks but I may need to get an appt. sooner. I'm now back at work, so I can't be emptying my bladder every half hour, but if I don't it sometimes it's getting overfull and I can't urinate. It's worst in the morning. I checked this morning when I couldn't go and I catheterized myself and it was 600 ml. I'm now sore from all the catheterizing, so I'm taking Prosed again for pain and inflammation. I am also getting UTI's from self-catheterizing.

My doctor said he never cuts the bladder sling before 12 weeks, but I hate all of this pain and frustration. My doctor put it to me like I would have the incontinence problem again if I didn't wait 12 weeks at least. So I know how you're all feeling.

I am also wondering if I will have to go off my blood thinning medication (warfarin) if I have to have the sling cut. The doctor said they can just make a tiny incision through my lower abdomen and cut the sling at one end. Is that what other people have had done? Good luck to everyone with this problem. It's so unfair to have surgery for incontinence only to find that you have the opposite problem and pain when you go as well.

Malie

All of the self cathing you're having to do is adding insult to injury. It makes the urethra swollen so it's even harder to urinate on your own. Also, when the bladder gets overstretched by urine retention, it weakens the detrusor muscle almost rendering it useless, therefore you may be able to start your urine flow, but the muscle won't be able to finish it's job and empty completely. I know you haven't had any choice in the matter, but it really fries my that these drs don't give you much of an option. First, to give you some insight, this is highly common after a sling procedure and I've seen it time and time again. I know it's frustrating, but there are things that can be done. Some are not too pleasant, but really can help. Getting the sling cut, and cut soon, would be your best bet to reverse this problem and get you back to "normal". You could also see about having it loosened. It may simply be too tight, not necessarily too high and tight. This would enable you to still have your incontinence procedure, but actually have it work right. Then there is dilation, which I had to have done(but I did not have a bladder suspension, just severe urine retention after my surgery that no one was ever able to explain to me, just know it wasn't there before surgery). It can help to open the urethra, making it easier to urinate and keeping your PVR low. I would suggest finding another urologist, if the dr you have now won't do something NOW for you. I honestly don't think they have any idea what it's like to not have the freedom of urinating when you need or want to without pain and frustration. There are drs out there who care and want to help you. In the meatime, there are some measures you can take to prevent more problems. One is to make sure that you are using the smallest, SELF lubricating silicone(not rubber)catheters that you can get. Lowfric size 10 is a perfect choice. Way less irritation, less swelling and since you don't touch the tip, you won't accidentally infect the sterile field. Other things to do is to keep your water intake high, but spread out throughout the day. You should truly drink at least 6 to 10 glasses of pure water a day, but you have to spread it out properly so that you only need to cath every 3 to 5 hours. Keeping your urine clear will prevent some of the spasms that come from concentrated urine making the bladder irritable. No caffiene, tea or citrus, either. These act like diuretics and will overfill your bladder before you know it. Taking warm baths everyday to relax the muscles will help with pain and irritation. Ibuprofin and vitamin E(check with your dr on both)can relieve swelling. Stopping fluids 2 hours before bed is also a good way to prevent your bladder from getting too full at night. And, to add some hope, I am 11 months post op and dealt with bladder retention for 7 months, but I am doing fine now. The bladder is the most difficult muscle to retrain, and sometimes the longest to get back to normal, but it can and will happen. I know how miserable it is to deal with and I totally sympathise. It WILL get better though.

s!!!!!!!!!!!

Julie,

Thank you for all of the advice. Where do you get the silicone catheters you mentioned? Can you get them without a prescription from a pharmacy or do you have to get them from your doctor? Right now I'm using a rubber one I got when I was in the hospital and using bleach to sterilize it once or twice a day. My doctor did give me some silicone ones, but I've run out of them. I also didn't know that an overfull bladder could cause the detrusor muscle to weaken.

My doctor is nice but very decided about certain things. He told me I would be given an epidural and something to relax me but not put me totally under for the hysterectomy and repairs. No other option was mentioned. The anestheologist gave me the option of that or being put completely under. I chose the latter because I didn't want to know what was going on and I'm glad I did because the operation took 5 1/2 hours. I wouldn't want to be aware of what they were doing to me for that long. Eeeek!

Thanks again for the great advice.

Malie

I took my original script to the pharmacy and they actually suggested these little silicone ones since I was going to be traveling. I find KY to be quite irritating, so I'm glad I can use saline with these. They are about 6 inches long and each come individually packed. You can use them and toss or wash them. I was one and use it for about a week. They are SO much slicker than the rubber ones, so hang onto them. LOL

Malie,I'm just so glad to see your post. Except for the PE's,you've described exactly what's going on with my repair. I'm 71/2 weeks postop and it's making me crazy among other problems I still have.
The uro gyn put me on Valium 5 mg 2's a day just to get my bladdder started as it just shut down after my initial bout of urinary retention the day of and after they pulled the catheter out.
I'm a nurse and I've tried to read about it and understand and I've seen the MD so many times since my surgery but I still think something is wrong that she's not getting because it just doesn't make since unless I have IC or she needs to loossen the sling by cutting the tape(which I've discussed and she just keeps saying my bladder is and will get better.I keep having bladder spasms with urine sometimes and with gas or BM's but I think it's weird that it's in the vaginal area and or urethra that I feel most of the pain and it's not there every time. She said I didn't have IC but that's not in her operative report that she looked as she said she did.
I stopped cathing on 4/6 and then last week on Monday or tues stared to cut back to one a day on the Valium. My wt is up and down 5 lbs overnight at times.
Today I worked last PM and then went to the ball field had to go pee every 30 min to an hr times about 5 or 6 and the last time I voided 175 cc and then cathed 300 cc's so because I just hurt so much.
most of the time though when I was cathing laike you it was half the amoount and i have iinterrupted flow like some will void and if I sit there klong enough I might be able to go 2 ore times in 5 minutes.
I'm wondering if the problem is further up in my kidneys or if I damaged my bladder and or kidneys with the 1st UR as they initially got out 850 cc's and then 1500 over about 2 -21/2 hrs.
Guess I'll go for another Urine check as I been off the Bactrim DS since Monday also.I'll read more of this thread and try to keep up. Seems like the LAVH itself was easy compared to the bladder vaginal and rectal repairs!TIA, Sharon

dID THEY BY ANY CHANCE PUNTURE YOUR BLADDER,TOO?