Probably a dumb question: "I have to pee even though I have a catheter in!"

[NurseyPoo7]

I've had a few patients tell me this. They're cath is normally draining fine, and often times their urine looks clear, no sediment, etc. I normally irrigate anyway, but they still complain. Because their urine is clear I don't suspect a UTI. What else could I do?

(Crap, I noticed I type "dump" instead of dumb. lol. Sorry, I worked last night)

[Halinja, BSN, RN]

nerdtonurse? said:

I had a cath after some dental surgery where we found out that if I'm given codeine, I stop breathing....ended up intubated, IV's everywhere, tubes everywhere.

Here's what the ICU nurse told me, and it's worked with my patients, at least sometimes. Your urethra will clamp down on the catheter. So, tell the pt to relax, just like they have to pee. They "declamp" the tube, and the sensation will let up.

Of course, with our little HOH dementia folks, you sometimes are in their room yelling, "PEE, MR SMITH." 10 times a shift....

I've heard it several times, and usually tell them its from the irritation of having something in the urethra, as mentioned above. But I had one woman who was able to clamp down incredibly firmly on the cath. I was getting nothing from the catheter unless I told her to relax, then she'd pee. Finally she said she didn't want to. I let it stay in a bit longer, then pulled it. She had 1000 mls she was holding in. On purpose. She felt it was undignified to pee in the catheter.

[Lily C.]

Yeah, the one time I had a catheter (10 years ago) I remember that I felt like I had to go all the time. It was terrible. Now, I just tell the pts. to expect the feeling.

[WSUCougarBSN]

I've had patients tell me this too! I've heard everything... from the pressure of the catheter inside the bladder -- to the "foley is too full." Honestly, I don't know how the bag being too full would have any effect, but I've heard it! :-)

[Iam46yearsold]

As far as meds go. It is a shame the stopped using those old B+O suppositories. They worked wonders on the discomfiture associated with foleys. I have not see those used in about 20 years now

[Zana2]

Yes, you do still feel like you need to pee, even if you have a cath. I was out for the counts, heavily sedated, after massive surgery, and kept ringing the bell that I need to pee (I wasn't even aware I had one in). It's just that the button I was pressing was my PCA, I kept on knocking myself out for a few hours before I realised what I was doing. Everything else but my urge to PU was a blur.

[Roy Fokker, BSN, RN]

I have a sneaky feeling it's because of the balloon and where it sits in the bladder (once it's inflated, doesn't it sit right by the sphincter?) This puts pressure on the sphincter and the sphincter keeps telling the brain "Gotta go! Gotta go!"

We're getting these new silver-coated foley's now in an attempt to reduce CAUTIs.

cheers,

[truern]

In October I had a complete hysterectomy and the WORST part of recovery was the bladder spasms from having a foley overnight!! Add to that the continuous feeling of having to void while the foley was in and you have a completely miserable experience

[kurlykay]

It is really important to make sure the foley is anchored to the leg with a stat lock, tape, or whatever else you can come up with. The less the foley more around and puts pressure on the spincter, the better and more comfortable it is for the patient. I have found numerous foleys not anchored with the patient's really complaining they have to pee, once I anchored the foley, the sensations was greatly decreased and the patient felt better.

No matter where I have worked, for some reason foleys are never anchored to the leg.

[mpccrn, BSN, RN]

I always thought the feeling of the "Need to pee" with a foley came from the fact that the meatis is open because the tube in keeping it open. On a rare occassion the foley is gravity sensitive and the feeling can be relieved by playing with the tubing to assist draining. As far as thigh straps go.....I hate them. In theory they are a good idea, in practice they fall waaaay short. The thigh straps always fall down the leg and pull on the catherter in the process.

[alices]

Does anyone know of any studies on the issue of feeling the need to void when catheterized? I hear it from patients all the time but would like to know prevalence, etc.

Thanks, all.

[nurseprnRN, BSN, RN]

Two things: your urge to pee is related to the first (internal) sphincter. When the bladder is full, the first one opens (that's why you you have to go) and the second one, the one under your conscious control, is there for you. Alas, when the first one is held open by a piece of foreign body all the time, you always feel like you have to go, and your second sphincter is going nuts because it's open too. And the balloon can cause painful spasms. Been there, done that.

Second: if you go look at a cross section of male anatomy you will see that if you secure a foley on a male in a downward direction (to the thigh) it makes an "S" shape as it exits the bladder and then puts pressure on the bulbourethral junction, meaning you are making pressure on the inside of the urethra where it bends. This can erode the mucous membrane inside of the urethra. To decrease this, male foleys ought to be taped up, to the lower abdomen. This will also almost completely prevent them bouncing around during ambulation. The thigh taping looks good and seems right, but from an anatomical standpoint, it's bad. So sayeth the urologists. Unless they don't.

[Biffbradford]

Those bladder spasms SUCK! After getting run over by a truck when riding my bike, I had a Foley for 3 months until the hole in my bladder healed. Then, when I finally got it out ... that first 'normal' pee was terrifying. Once it got going though ... AHHHHHHHH. That's more like it!