Donna: couple of ideas. I had this problem with Bruce early on, getting better now three years in.

Bruce's leg became over-toned at about nine months post stroke. He was put on Zanaflex and Baclofen, as well as Botox injections. The incontinence got worse. The first Physiatrist who put him on the Baclofen, also put him on Ditropan. Said if the leg was over-toned, so then was his bladder. When all the other drugs were added, no one considered the Ditropan. Finally, found a Urologist who was willing to listen to me, upped Bruce's Ditropan and Bruce is now almost 90% continent and that may be the best we ever get. Please take a current list of his meds to the Urology consult and have Doctor really go over them. I am assuming he is on meds for the enlarged prostate, so maybe something else or up the dose? With the cancer tho, honey, that may not help and Urologist will be honest with you.

You can take the indwelling catheter out and put the texas catheter (condom) on him for caregivers and overnight. Takes care of the leaking. You check the input and output, check the level in the bag and know if you will have to catheterize when you get home. All caregivers must mark down exactly what he takes in fluid. That is easy.

There is also a good chance Hubby can learn to self cath one handed. There are new, stiffer catheters, easier to put in. That way he could take care of business with the overnight caregiver himself, before getting up.

I understand unwilling to catheterize someone. But unable, especially a man, is not realistic. Once you get up to the prostate and take your time, go easy, learn the "feel", it is not that difficult. And again with the newer, thinner, stiffer catheters, even an enlarged prostate can be dealt with.

And you can always leave the texas on, even if you still have to go in and get the rest. At least with a leg or drainage bag, you have some idea of what he is putting out as opposed to putting in and it will give you an idea of when you have to go in and get the rest. You will avoid catheterizing for insignificant amounts.

It will be imperative, if you choose to take out the indwelling, to keep an accurate journal and all caregivers must be on board. All cups and glasses he used must be marked to a certain fill level, so you can document what he takes in. And anyone who empties a bag must mark down time and amount. Limit all fluids after 5pm and make sure he is empty-either by drainage bag or catheterizing before he goes to bed. The kidneys are night organs, they do their best work then.

You will also have to step up the movement. You will have to insist that he at least stand often during the day, take some steps. Think about areas in the house where you can bring the WC, but he has something to hold onto: kitchen counters, deck or patio rails. He balances while you bring the WC to him. Bruce does the morning dishes in the WC, but I pull it back a bit, he stands, balances and he holds onto the counters, good day he walks the counters and the WC is right there. You are already working on this and will have to continue. Limit salt, lots of fruits and veggies. And fresh air.

Just some things to think about. This is such a hard decision. I have an MS patient who must have an indwelling catheter. He can not stand or transfer. He will spend the rest of his life dealing with the consequences of that. He is lifted to his motorized WC, which he can manage. So, up side for him, is that he is out of bed, socializing, does not have to worry about skin breakdown. Yes he suffers numerous infections, but it is the only way for him. Consider Lauren's quality of life and the decision, while difficult, will work itself out.

Debbie, caregiver to Bruce, Stroke March 2009

Hi Donna I,too had/have problem with over active bladderwas just emptying after stroke & didn't understand felt shamed. talked to my Brother -an MD who told mr there was a pill to help that none of the specialists thot of it - so I was able to ask a doc for it - the the ditropan (oxy butonen) Debbie mentioned.

Matbe see what Doc thinks in my experience the pCP is better .

10 yrs after severe damage to rt brain I still struggle with holding ( keegals would help ) although manageable wear depends all the time- just in case...

I would think if he doesn't get off the cath - his body may never learn to be continent.

Susan

Hi Donna, welcome to the site. I am sorry being a caregiver is made an even harder job with the incontinence problem. I dont have anything to add to that so I hope the suggestions from Debbie and Susan will help. I do want to leave you some links to good info though unrelated to your present problems. I hope these will resolve themselves with time. All the best to you both.

mc

A survivor's Bill of Rights

http://www.strokeboard.net/index.php?showtopic=2094

The Five Stages of Grief

http://www.strokeboard.net/index.php?showtopic=857

A Letter From Your Brain

http://www.strokeboard.net/index.php?showtopic=83

Classic Postings and Advice

http://www.strokeboard.net/index.php?showforum=23

misc. info

http://www.ehealthmd.com/library/stroke/stroke_recovery.html

Caregivers’ Bill of Rights

http://www.strokeboard.net/index.php?showtopic=781

Caregivers’ handbook

http://www.strokecar...rg/handbook.htm.

Thanks Debbie, Susan, and mc for your responses. It's been quite a day. Lauren had a grand mal seizure in the shower this morning. We had a private duty aide last night and she was the one with him in the shower. By the time I got there, all I saw was him laid out on the shower chair unresponsive and with seriously labored breathing. I thought he was going. He's in the hospital overnight and then we'll start dealing with stroke-induced seizure disorder. Every time I think I can't handle any more I get more to handle.

The reason Lauren has a catheter is not really because of the incontinence but the retention. Every time we try to remove the catheter he goes back into retention and can't pee at all. It's pretty awful. His tone kicks up and his left leg goes rigid. One time I couldn't get him out of the car and had to go to the ER where it took 4 people to pull him out backwards because his leg wouldn't bend. Now it doesn't take much urine in his bladder to make that happen.

I'll talk to the urologist about ditropan. He's on Toviaz, which is supposed to relax the spasms he has. Without the med his bladder is in an almost constant spasm.

Thanks again. I'll look back over your responses when I stop reeling from the day.

Donna

Donna, My husband fist stroked seven years ago and we went through a lot of this the firs year. Dick regained much of his contenence just a couple months post stroke but by that time he had all ready had numerous UTIs. In my opinion UTIs are a bigger concern than leakage. Because Dick was retaining at least some urine every time he uninated I used the straight cath. After a while I learned that I only really had to straight cath a few times a day to avoid infections. I used the mens Guards which are similar to sanitary pads for the leaks and dribbles. It took over a year to get Dick up on his feet much but that indeed helped a LOT and we had no incontenence for several years. I found that an anti-spasmotic for the bladder helped a lot too.

Ruth