Bladder spasms

Nurses General Nursing

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  • by Vtachy1
    Specializes in BNAT instructor, ICU, Hospice,triage.

Patient's Foley has been in for over 3 months, recently developed painful bladder spasms. Had a UTI 4 weeks ago and was treated. Started ditropan a couple of weeks ago. ANd it is not helping. Sometimes he has 15 per day and it leaks when he spasms.

OUCH! What do you recommend? Do they still make B&O suppositories?

Has it been in too long? I know they usually do a SP cath if its long long term, but that's not going to happen with this patient.

He has a foley because he had skin breakdown that would not resolve with any other methods and he is incontinent and the wife is a rip and gets frustrated if she has to help clean him up. So that's why they need and have to have the catheter for quality of life. ( so patient doesn't get yelled and verbally abused when he is incontinent, yeah, very sad)

Would you try a condom catheter? In the past I have had NO luck with these. Maybe they make them better nowdays?

Specializes in Utilization Management.

Docs where I work prescribe pyridium for bladder spasms, sometimes scheduled and PRN - seems to work very well from what I've seen.

JeneraterRN

256 Posts

Specializes in OB, Med/Surg, Ortho, ICU.

Condom catheters seem to cause a mess you are trying to avoid, and have a high potential for skin breakdown on the member. B&O's are still made and we use them, but are not a good choice for long term management d/t the addictive potential. Has he seen a urologist? A specialist may be able to find the cause of spasms and manage it successfully. It's disturbing that the patient is being exposed to a higher risk of infection because of potential abuse. Do adult protective services need to be contacted? Wound healing is valid, has it been resolved?

Orange Tree

728 Posts

Specializes in Medical Surgical Orthopedic.

Do they still make B&O suppositories?

I've given plenty of them in the past few weeks, so yes!

FLArn

503 Posts

Specializes in Hospice, LTC, Rehab, Home Health.

Levsin may also be helpful for bladder spasms. Also sometimes an overinflated balloon can cause spasms.

Vtachy1

446 Posts

Specializes in BNAT instructor, ICU, Hospice,triage.
Condom catheters seem to cause a mess you are trying to avoid, and have a high potential for skin breakdown on the member. B&O's are still made and we use them, but are not a good choice for long term management d/t the addictive potential. Has he seen a urologist? A specialist may be able to find the cause of spasms and manage it successfully. It's disturbing that the patient is being exposed to a higher risk of infection because of potential abuse. Do adult protective services need to be contacted? Wound healing is valid, has it been resolved?

Wound has healed yes.

We have tried pyridium but the wife had a fit because it was such a ugly color:uhoh3: And it may have stained some of his clothing.

He wears depend undergarments because he is incontinent of stool also.

So if we restart the pyridium, can you take this long term?

JeneraterRN

256 Posts

Specializes in OB, Med/Surg, Ortho, ICU.

What does the wife want, a magic wand?

Specializes in Utilization Management.
Wound has healed yes.

We have tried pyridium but the wife had a fit because it was such a ugly color:uhoh3: And it may have stained some of his clothing.

He wears depend undergarments because he is incontinent of stool also.

So if we restart the pyridium, can you take this long term?

The longest I've given pyridium is TID for about three weeks. From what I've heard though, it seems to be okay to take for the long term.

The wife sounds like a "special" creature :rolleyes:

JeneraterRN

256 Posts

Specializes in OB, Med/Surg, Ortho, ICU.

I found this, hope it helps:

http://www.globalrph.com/bladder_spasm.htm

xtxrn, ASN, RN

4,267 Posts

If the wound has healed, what is the diagnosis for the Foley? Anywhere I've worked required a medical diagnosis- not a dingy wife, to continue a catheter. Medicare is clamping down big time on UTIs. Maybe check this out, and then it's out of the wife's hands. ??? :twocents:

FLArn

503 Posts

Specializes in Hospice, LTC, Rehab, Home Health.

To OP - In what type setting is the patient currently residing? Xtxrn is correct if the patient is in a facility (ALF, SNF) or hospital. This is not necessarily the case if the patient is at home or in an inpatient hospice setting as the guidelines are different there. In hospice foleys may be considered a comfort measure if it is painful to move the patient for transfers to BSC or frequent incontinence care plus in terminal patients there is little to no tissue growth (for wound healing) so prevention (or delay) of skin breakdown is paramount. Also if he is at home and the spouse is unable or unwilling to do frequent incontinence care, then it may be needed to prevent skin breakdown.

i agree the wife needs to have her issues addressed (if he is or has been at home she may be overwhelmed or burned out-it happens to families too). She may need more support either with caring for him or to come to terms with permanent placement in a facility. If she has promised never to "put him anywhere" there could be a lot of guilt in play.

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