Is your urinary catheter clogged some percentage of the time? That could mean several things, and some of them are very dangerous. Here is something that might well help you.
Below is an amazing article from one of our readers – Barry Simpson – who graciously allowed us to post it here. He was having hellacious problems with his catheter getting clogged. He was able to solve his problem, going from having basically 1 blockage per week for 7 months, to having none for the past 9 months!
Before we get to his story, I need to post this disclaimer.
DISCLAIMER: This information is from the story of Barry Simpson. It absolutely worked for him. And it might very well work for you. But this kind of data is not “clinical” or “scientific” in that the sample size was very small – just one guy, Barry Simpson. Your mileage may vary.
OK, so now that’s out of the way, what follows is Barry’s story in Barry’s words.
URINARY CATHETER BLOCKAGES
NOT SOMETHING WE CAN LIVE WITH (by Barry Simpson)
I had 23 catheter blockages between January and July 2016. Then I found a way of stopping them. I have had none since. This has left me with the impression that blockages have been too readily accepted as a normal part of having a catheter by the medical and nursing professions and are meekly accepted by trusting patients.
Catheter blockages are an additional misery for people who, in many cases, have other serious conditions; they are more dangerous than is widely recognized and waste a great deal of nursing time unblocking catheters which do not need to be blocked.
Here is the method which stopped my blockages immediately, completely and without any noticeable side-effects. I do not know for how many others it would be suitable.
BLOCKAGES: CAUSES AND REMEDIES – NITROFURANTOIN AND CATHETER REPOSITIONING
An accident in January 2013 left me with a spinal injury, almost complete paralysis below my shoulders and very little hand movement. I had a suprapubic catheter installed in May 2013.
From 16th January until 24th July 2016 I had 23 catheter blockages. All of these were at night. I would waken up sweating profusely and trembling with violent spasms, typically between about midnight and 1am – long enough for urine to build up if my catheter had actually become blocked immediately after going to bed.
At least two-thirds, but not all of my blockages were accompanied by sediment in my catheter. The last two blockages both occurred on the night of 23/24th July. My catheter was replaced after the first of these. The second blockage was described by the nurse as ‘positional’. Attending an earlier blockage, a different nurse had suggested that a possible cause was the catheter intake pressing against my bladder wall. So there seemed to be at least two causes of the blockages: by sediment and by the position of the catheter.
Why were all my blockages shortly after changing positions from sitting in my wheelchair to lying flat in bed? That is a better question than is my answer to it. The positional blockages were likely to have been caused by my catheter coming up against my bladder wall or the intake becoming too low for drainage of urine by gravity. The sedimentary blockages might have resulted from the catheter moving to a lower part of my bladder where sediment had collected.
Late on the morning of 24th July I began sweating heavily and my spasms became more severe. I took these to be signs of a urinary infection: I took 50mg Nitrofurantoin and it was soon cleared. This was not the first time that symptoms of an infection followed a blockage. It appeared that the bacteria causing the infections were also creating the sediment which caused most of the blockages. So using Nitrofurantoin to prevent infections (rather than to cure them) in my case, also prevented catheter blockages. From the evening of 24th July I started taking 50mg Nitrofurantoin each day at about 8pm. I have had no blockage since.
In these circumstances, I try to maintain an awareness of the symptoms of septicaemia, the infection, and sepsis, the body’s inflammatory reaction to it and to be aware that urinary infections can develop into septicemia and sepsis:
And because I have a spinal injury, also autonomic dysreflexia:
What about the blockages not caused by sediment – the ‘positional’ blockages? To prevent these I simply gently pull my catheter forward each night immediately after going to bed to pull it away from my bladder wall. At the same time I also unstrap the catheter and leg bag from my leg and lay it flat on the bed to help gravity by ensuring that as much of my catheter as possible is at a lower level than the intake.
The Users’ Information Leaflet says that the normal dose of Nitrofurantoin for preventing infections is 50mg or 100mg daily at night but does not say for how long. On the principle that it is best not to take more medication than necessary, after 30 days taking 50mg, I began tentatively to omit it on a few nights and risk the horror of a blockage. For about 3 months I took 50mg on 3-4 nights per week and then reduced it further to only nights when I had a considerable amount of sediment in my catheter or sweating which could warn of a urinary infection.
SUPPORTING METHODS TO PREVENT CATHETER BLOCKAGES
The district nurses started giving me weekly bladder wash-outs soon after my blockages started: so the first few nights I omitted Nitrofurantoin were wash-out days. Wash-outs probably reduced the number of blockages but did not eliminate them.
Not long after I reduced Nitrofurantoin to less than every night, I did begin to get sediment in my catheter. This seems to have been kept in amounts insufficient to cause a blockage by carers rolling the catheter between their hands to disturb it and by consuming natural antibiotics, including adding vinegar to food and drinking lemon tea.
To make lemon tea, I simply cut an unpeeled lemon in half, cut up the half into pieces or slices put in a cup and add hot water, topping up several times and squeezing the lemon with a spoon. Lemons can be used in many other ways too:
I will never know whether rolling my catheter and taking natural antibiotics would have been sufficient to stop the blockages without Nitrofurantoin. I started them in January 2017, six months after my blockages had been stopped. However, it does appear that they have allowed a reduction in the dose.
COULD THE BLOCKAGES HAVE STOPPED BY SOMETHING ELSE OR BY CHANCE?
Could something else have stopped my blockages immediately, completely and for such a long time? All I can say is that I am not aware of doing anything else on and following 24th July that could be expected to stop blockages other than taking Nitrofurantoin and catheter repositioning.
I had 23 blockages in a period of 190 days from 16th January to 24th July 2016, no blockage since (250 days up to the end of March 2017). The probability of Nitrofurantoin and catheter repositioning having had no effect can be calculated as the probability of 23 random occurrences in a period of 190+250 days all being in the first 190 days.
The probability of any one of them being in the first 190 days is 190/(190+250) = 0.4318;
The probability of two of them being in the first 190 days is 0.4318 x 0.4318 and so on until …..
The probability of all 23 being in the first 190 days is 0.4318 multiplied by itself 22 times = 4.0879e-9 = 0.0000000040879 which is a little over 4 chances in a thousand million (a thousand million is the number that 0.0000000040879 would have to be multiplied by to get 4.0879).
The base is 0.4318 and the exponent is 23.
So the probability that Nitrofurantoin and catheter positioning were not associated with stopping blockages is 0.0000000040879; therefore the probability that they have been associated with stopping blockages is 1 – 0.0000000040879 = 0.9999999959121 where absolute certainty equals 1.
The binomial distribution can also be used with the same result:
where N = 23, k = 23, p = 0.4318 and the answer is p(k out of N)
The multinomial distribution can be used too:
where the number of outcomes is 2 (blockage on a day in first 190 days /blockage a day in following 250 days), the number of occurrences 23 and 0, p = 0.4318 and 1-0.4318 = 0.5682.
These calculations are based on cautious assumptions. The probability of there being no association between taking Nitrofurantoin and the absence of blockages is likely to be even smaller than the very small probability of 4.0879e-9. On about 10 of the 190-day period with blockages I took Nitrofurantoin to cure urinary infections. I had no blockage on these days. So there is a case for reducing the period to 180 days, or fewer if the effect of Nitrofurantoin lasted for more than one day, and adding 10 or more days to the blockage-free period.
If the period were reduced to 180 days The probability of all 23 blockages being in the first 180 days would become (180/(180+260))23 = 0.409123 = 1.1805e-9. There is no practical difference between using a period of 190 days, 180 days or fewer. In all cases the probability of all 23 blockages being in this period by chance is so small as to be negligible; and the probability of Nitrofurantoin having had no effect is becoming even smaller every day I do not have a blockage.
This very small probability means that it is virtually certain that Nitrofurantoin and catheter repositioning were associated with stopping my blockages; it is not the probability of having a blockage tonight; nor is it a prediction of when a blockage can be expected.
PREDICTING FUTURE BLOCKAGES
Prediction methods rely on making inferences from the past: so while the treatment is never followed by a blockage, the prediction will remain zero for any period into the future.
However, where treatment sometimes fails, any of several methods can be used to estimate when future failures will occur.
If I were to have a blockage, the negative binomial distribution, also known as the Pascal distribution, could be used to predict the probability of a further blockage on each of the days following.
The number of trials is the number of days after the first blockage, the number of successes is the number of blockages to be predicted (1 if the next blockage is to be predicted, 2 if it is to be the blockage after that and so on), probability of success on a single trial would be 1 divided by the number of days between the start of my blockage-free period and the first blockage and the negative binomial probability is the probability of the chosen blockage (1st, 2nd or whatever was chosen) occurring on the chosen number of days after the first blockage.
A cumulative version, which can make some calculations less laborious, is available at:
The geometric distribution is a particular case of the negative binomial distribution where the number of successes, in my case, blockages, is equal to 1: so if the timing of only the next blockage is to be estimated, it can be used instead of the negative binomial distribution.
Here, the number of successes is the number of days without a blockage before the next one occurs, the probability of success is as for the negative binomial distribution and the maximum number of trials is the number of days for which you require the probability to be calculated. This calculator can save time by using the probability mass function, which shows the probabilities of a blockage on the days leading up to the day chosen.
It is possible to predict the number of blockages within any specified period using the Poisson probability distribution:
For example, suppose we wish to predict the chance of 1 blockage in a period of 7 days, the Poisson random variable would be 1. The average rate of success is the average number of blockages which in the past have occurred in 7 days (number of blockages/number of days in observation period x 7). To predict the chance of 2 blockages in 28 days, the Poisson random variable would be 2 and the average rate of success would be the average number of blockages in 28 days. As long as there are no blockages on nights following taking Nitrofurantoin, the average number of blockages for any period is 0: so until there is a blockage, the prediction of future blockages for any period is zero.
The negative binomial distribution, the geometric distribution and the Poisson probability distribution rely on the events (blockages in this case) being independent – not connected to each other, even indirectly by a common cause – and randomly distributed. This is liable to introduce inaccuracies into the predictions if the connections are not taken into account. On the other hand, if predictions from these techniques do not fit observations, that will be evidence that there are connections between the events (blockages) and that there is likely to be a common cause.
It might seem inconsistent that the effectiveness of Nitrofurantoin and catheter repositioning was demonstrated by the lack of randomness in the distribution of the 23 blockages between the 190 days without the treatment and the 250 days with it, while the techniques for predicting future blockages rely on them being randomly distributed. Not necessarily so; the predictive techniques would be used only in the period when the treatment is taking place.
NITROFURANTOIN AND CATHETER REPOSITIONING STOPPED MY BLOCKAGES BUT WHAT STARTED THEM?
I do not have a good answer to this. I had my catheter for 2 years and 8 months before I had a blockage.
On the evening of 16th January 2016 I was overheating so I took 500mg Paracetamol. That was the first time I had taken any since my catheter was installed. A few hours later I had my first blockage. The coincidence looked too close to believe that the Paracetamol had not played a part. I took no more Paracetamol but continued to have blockages about a week or ten days apart.
After a few of these I convinced myself that they had nothing to do with Paracetamol: on 16th January I had a urinary infection and should have taken Nitrofurantoin instead of Paracetamol. So I left this out of the earlier paper:
Nevertheless, I have taken no more Paracetamol (Tylenol). Even without an analysis of the contents of my catheter at the time of a blockage, it is possible, by using a filtering process and information from the Internet, to identify the most likely bacterial culprits for my blockages. This might be important in identifying what other antibiotics are likely to be effective in preventing blockages for those who have an adverse reaction to Nitrofurantoin.
The filtering process comprises three stages:
1. Against what bacteria is Nitrofurantoin effective?
Before the blockages started I had more than a dozen urinary infections, readily stopped by Nitrofurantoin.
Nitrofurantoin has been shown to be effective against the following bacteria:
Citrobacter species, Coagulase negative staphylococci, E. coli, Enterococcus faecalis, Klebsiella species, Staphylococcus aureus, Staphylococcus saprophyticus, Streptococcus agalactiae.
Many or all strains of the following genera are resistant to Nitrofurantoin: Enterobacter, Klebsiella, Proteus, Pseudomonas
Obviously, whatever bacteria caused the pre-blockage infections did not create enough sediment to cause a blockage. These bacteria must be on the Nitrofurantoin hit list; so too must those that did cause blockages, but they were not necessarily the same ones or in the same concentrations as those that did not cause a blockage.
2. It has been established that most of my blockages were associated with urinary infections, so which of these bacteria cause urinary infections?
E. Coli and Proteus mirabilis are often the cause of urinary infections:
‘Escherichia coli or E. coli, is responsible for more than 85 percent of all UTIs, according to a 2012 report in the journal Emerging Infectious Diseases.
Several other common bacteria also cause UTIs, including Staphylococcus saprophyticus, Pseudomonas aeruginosa and Klebsiella pneumonia.’
Pseudomonas, Klebsiella and Proteus are on the list for which Nitrofurantoin is not likely to be effective: so that leaves us with E. Coli and Staphylococcus saprophyticus.
3. Which of these bacteria cause sediment which could block a catheter?
Cloudy urine, but not sediment, is mentioned as a consequence of E. coli.
Sediment is associated with Staphylococcus saprophyticus:
That leaves Staphylococcus saprophyticus and E. coli as the prime suspects. Although Staphylococcus saprophyticus is the better fit to the information I have been able to find, E. coli is a much more common cause of urinary infections. Without any analyses of the contents of my catheter at the times of infections with or without blockages, it is not possible to be sure. I can only guess how many of my blockages could have been avoided if taking a sample of the contents of catheters were standard practice when a blockage occurs.
There might have been other mechanisms starting the blockages: an increase in urine pH, a change in brand of catheter …..
FOR HOW MANY PEOPLE MIGHT THE METHODS DESCRIBED BE EFFECTIVE?
What I have reported is, of course, my own story. I do not know for how many other people it might be effective but there seems to be a reasonable expectation that it might work for others – male or female – whose catheters are being blocked by sediment created by bacteria for which Nitrofurantoin is effective.
So it seems that blockages caused by bladder stones would not be prevented by Nitrofurantoin because the bacterium involved is Proteus mirabilis:
Nitrofurantoin will not be suitable for everyone. The Users’ Information Leaflet lists many precautions and possible side effects. I have not had any at the doses explained but others might. Nitrofurantoin was used to stop the bacterial blockages simply because it was the only antibiotic I had.
Some web sites suggesting other antibiotics for Staphylococcus saprophyticus, E. coli and other bacteria causing urinary tract infections are as follows:
HOW SERIOUS ARE URINARY CATHETER BLOCKAGES?
Living alone, being almost completely paralyzed from the chest down and with very little movement in my hands, wakening up in the early hours of the morning, sweating profusely and with tremendous shocks of spasms, the task of ‘phoning for a nurse is quite a demanding and troubled one. Then there is the wait of between about 40 minutes and 2 hours 15 minutes with the sweating and spasms progressively becoming more severe.
Is there likely to be any lasting or permanent damage? I am not aware of having any myself but serious kidney and bloodstream infections, septicemia and autonomic dysreflexia have been experienced by others:
How many deaths result from catheter blockages? We are not likely to get an accurate estimate because some of them are liable to be recorded as autonomic dysreflexia, sepsis or something else. Recorded deaths from sepsis are many and increasing:
It has been estimated that about 2,100 deaths per year result from the Foley catheter (but not all resulting from blockages?):
About 450,000 people in the UK have permanent catheters and as many as a half of these experience ‘recurrent infections with blockages and leakages’:
The same paper quotes that ‘In the UK, permanent catheters are used by 3% of people living in the community and 13% of care home residents’.
Blocked catheters are at least traumatic, at worst they are killers, they are expensive in terms of nursing and other medical staff time and resources and occur on a scale which makes them one of the most common healthcare problems. Some of the papers quoted in this section make the often-heard call for better catheters, which would empty the bladder completely and so reduce infections and blockages. Sadly, it is no surprise to read this, but until they are available, there remains a need for preventing blockages in the catheters which we have.
P.S. Still no blockage since the night of 23rd/24th July 2016.
28th April 2017