bladder spasms and foleys - page 2
I am a new charge in LTC. We have a male post TURP that suffers from severe bladder spasms. No Ditropan order: MD made aware. Ordered see urologist if continues or worsens. Vicodan one given q 4... Read More
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May 18, '02Occupation: Utilization Review, prior Intake Mgr Home Care Specialty: 40 year(s) of experience in Home Care, Vents, Telemetry, Home infusion ; From: PA, US ; Joined: Oct '00; Posts: 27,547; Likes: 13,753Cargal:
Glad to see you posted about this problem. I saw you had called the doctor re spasm and ment that it was cruel of the Doc not to oder meds that would help control severe spams. I replied off the cuff and not with usual tact.
Strongest med to control problem is B+ O suppositories. Next would be Ditropan or Probanthine.
Found some info to post re problem. After 25 years nursing, learned something new today from LPN site below re injecting mineral oil into balloon to cause it to rupture if it won't deflate when removing a cath.
Perspectives - Transurethral Resection of the Prostate
http://www.perspectivesinnursing.org/v1n3/wasson.html
TURP FAQ
http://www.sykart.com/keenie/turp/FAQ.html
Intern On-Call: Foley Catheters
http://www.ohsu.edu/cliniweb/intern/3.html
PROCEDURES FOR LPN'S
www.cyber-nurse.com/lpn/lcfoley.htm
I'm sure you'll do your best to help this patient get some spasm relief. Follow-up next week re outcome. -
May 18, '02Occupation: RN Joined: Sep '00; Posts: 735; Likes: 3Thank you NRSKarenRn,
This has all been very helpful. -
Apr 28, '06Joined: Apr '06; Posts: 26; Likes: 4I have a question regarding B & O supositories, i hope its ok to ask for me, its not for a patient.
I have an unusual functional condition...continuous urethral spasm, caused by, it is thought, amylase deposits (I have FMF) in the pelvis, particularly, the urethra, bladder, ureters and kidneys.
the suppositories are not available in Australia. I have tried numerous alternative modalities and many help but there are times I think i am losing my mind.
What is your opinion of their success on patients with urethral spasm? I would be very greatful for any opinions shared...
lisa -
Apr 28, '06Occupation: Utilization Review, prior Intake Mgr Home Care Specialty: 40 year(s) of experience in Home Care, Vents, Telemetry, Home infusion ; From: PA, US ; Joined: Oct '00; Posts: 27,547; Likes: 13,753B + O still used in US but short term24-48hrs only as addiction potential.
If current specialist not helpful, seek second opinion. -
Apr 28, '06Joined: Apr '06; Posts: 26; Likes: 4oh no, my specialist is wonderful, thanks. He was the first to run urodynamics and confirm the condition exists, previous urologists denied it was possible, He is endo/gynae trained. He has exhausted himself trying to think 'outside the box' and find a solution for me.
He found this condition in animals (he gently called it more primitive species) but wasnt willing to adapt the vets solution...putting the animals down as its too cruel to allow them to live with such a condition..and for this i am greatful...well sometimes, lol.
Searching the internet for solutions came up with some ideas, we have tried botox injections, 2 units, 3 times but with no success...we have tried biofeedback, myofacial stretching, accupunture, moxibustion, chinese herbs, massage, cognitive therapy, visualisation, meditation, TENS, along with more traditional antispasmodics, muscle relaxants, narcotics, MS and parkinson's medications and antiepileptics and more...each with limited success.
Reading this thread gave me hope that perhaps belladonna along with some narcotics dissolved within the pelvis could be another solution to try.
Thanks for the feedback -
Jul 14, '06Joined: Apr '06; Posts: 26; Likes: 4followup on my problem, if anyone was interested. 6 suppositories were sent to my doc and he gave them to me. They worked amazingly. The spasms reduced by about 60% to a tolerable pain level and the relief lasted about 5 hrs from onset. The doctor is working on a way to get a regular supply from the US. I posted this to conferm other posters opinions...B & O Suppositories are a very effective way to control spasms in the urethra and bladder.
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Jul 14, '06Occupation: Utilization Review, prior Intake Mgr Home Care Specialty: 40 year(s) of experience in Home Care, Vents, Telemetry, Home infusion ; From: PA, US ; Joined: Oct '00; Posts: 27,547; Likes: 13,753Great to hear that you have found something that works for you. 5 hours of relief at a time impressive after your pain experiences. Hope you can obtain a regular supply as no one should have to suffer needlessly.
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Jul 14, '06Specialty: 1 year(s) of experience in oncology/medsurg ; Joined: Jul '06; Posts: 5lately our docs have been prescribing levsin (spelling) SL for bladder spasms, its usually used to control oral secretions, but works very well and quickly for spasms!
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Jul 15, '06Occupation: RN Specialty: 14 year(s) of experience in tele, stepdown/PCU, med/surg ; From: US ; Joined: Oct '01; Posts: 1,352; Likes: 81Belladonna and Opium suppositories are VERY common in all great hospitals still. It sounds ancient but hey they work! -
Jul 16, '06Joined: Apr '06; Posts: 26; Likes: 4unfortunantly for me, they are not available in australia at all!
what is levsin SL? i appreciate any ideas anyone would have to help control this!
My sanity is wavering! -
Jul 16, '06Occupation: Happily in Nursing Education! Specialty: 13 year(s) of experience in Education, Acute, Med/Surg, Tele, etc ; From: US ; Joined: Oct '04; Posts: 2,757; Likes: 415I would be calling the MD and working with them on a good plan of action for the spasms! Spasms are not good, and can be a sign of trouble big time...sure, you can medicate...but does that find the underlying probelm..no it hides it.
The pt needs more help with their physician to quell this probelm...and better managment for pain and discomfort. Not to mention the emotional toll that takes on people (urniation is seen as a simple act, and having a foley is taking away a lot of control of something they really never had to worry about when they were younger...so it tends to hit hard on the emotions and fears of people...they can think "well if I can't keep control of that...then I must really be sick or dying!".).
When there is bladder and bowel control probelms, I really investigate how my pt is feeling about it...most often there is much more going on than meets the eye as far as powerlessness, hopelessness, depression, anxiety, and fear for life.....that too needs to be addressed. -
Jun 1, '07Occupation: RN Case Manager in hospice Specialty: 26 year(s) of experience in LTC, Sub-Acute, Hopsice ; Joined: Mar '06; Posts: 167; Likes: 130I am right now trying to find info about bladder spasms due to bladder cancer. I am an RN(hospice nurse). My best friend was diagnosed with bladder cancer (stage 3) 5 of months ago. She has not been able to start BCG treatments as everytime she has a uroscopy the cancer has returned (the bladder has to be free from cancer in order to do those treatments). She had biopsies of the muscle wall in March that were negative for cancer, but that is when the spasms started. She had another TUR about a month ago that showed some cancer in the bladder muscle, so now she has a date for surgery to remove the baldder and have an Indiana Pouch constructed, but not until July. The problem is the intense bladder and urethreal spasms that do not respond to anything. She was taking handfuls of Percocet, as her urlolgist had not clue one how to deal with someone in that much pain. His office staff treated her like a drug seeker. He finely told her to see an onocologist for pain management when she broke down in sobs in his waiting room. I took her to the medical director of the hospice that I work for and he started her on Oxycontin CR 20mg BID and Percocet 7.5/325 1 to 2 every 4 hours for breakthrough. She was also on Urosed (spelling?) for the spasms. She continues to have spasms and now is using Belladonna and Opium suppositories 2 times a day.
My pleading question is...What else can we do? My medical director will do whatever it takes, he is a palliative specialist, and will give us scrips, but what else is out there???
