Bladder problems post rectal resection

[CancerDad]

Has anyone had any experience with bladder difficulties post Rectal resection surgery? The tumor they resected on me was approximately 2-3 cm from the anal verge... very low. I am a 31 year old male and I was diagnosed with stage IIIC Rectal cancer-- had chemo and radiation prior to the surgery, then a colo-anal pull through with lymph node removal and creation of a temp ileostomy. It took two excellent colorectal surgeons 7 1/2 hours for this first operation as they painstakingly tried to save my rectum. A urologist did stent off my ureters during the procedure to avoid cutting by the surgeons, but removed them prior to my waking. This was in January 04. I recently had my ileostomy reversed, but still cannot urinate without extreme pressure. The urologist says all I'm doing is pushing my intestines down on my bladder to empty-- which causes incomplete emptying. As a result, I must straight catheterize every less than 6 hours. On top of it all, I am impotent. Any suggestions or commentary would be appreciated.

[CancerDad]

Alison:
I decided to post this topic as a question and hope you will find this response to a question you raised under another thread.

The urologist feels that the way they manipulated my bladder during surgery weakend it so even though I can urinate if I push with my might, he used a balloon analogy-- all I'm doing is using my intestines to push down on my bladder and have incomplete emptying.

Another doctor told me he believes since I can't function sexually, he believes they cut and/or damaged the two nerves responsible for these actions. Regardless, they say time may cure and that I really won't know that it is permenant until about two-years after my body is no longer assaulted with chemo/radiation/or surgery. Apparently it takes a really long time for the nerves to repair. They stented my ureters during the procedure to make certain they didn't cut them, but removed the stents before I woke up. In the mean time, I straight cath when I need to every less than 6 hours. Does your husband still have a foley cath in all the time? That increases his risk of infection-- is he opposed to cathing himself? It really is easy (difficult at first like anything, but becomes old hat after a few times). Also, there are drugs to shrink his prostate-- Flomax is one of them, which will allow the urine to flow down the urethra-- right now his prostate is causing a blockage. Let me know, and thanks for bringing this up.

[Nassau one]

James, I have asked about this problem of yours in another post that I responded to this evening. My husband has, not the same problem, but somewhat similar. His prostate is large but he never had a real problem with it before his rectal surgery. It was after that that he could not urinate and they put in a catheter. At least you do not have one in all the time. At one point, the catheter was taken out and it seemed my husband could urinate but the bladder was not emptying properly and he had terrible spasms, so the catheter had to go back in or his kidneys would have been seriously affected. We were told that even though the urinary system and the digestive system are separate, they do affect each other and I suppose that when one is compromised,the other can act up too. Are the doctors saying your problem will resolve by itself in time? My husband is to have prostate surgery very soon and we are worried that, even if it is successful, his bladder may have lost its ability to empty. I have heard that self catheterization is tricky...how would you respond to that?

I believe you said that your job has gone now and that you will have to find something else to do.....how about medicine!! You seem to know such alot about it already.

[CancerDad]

Alison:

I'm so glad you found the new thread I posted. I wanted to carry it under a new topic instead of clogging up Chashim's threads! Self cathing is EXTREMELY easy and I would tell your husband to call up the doctor tomorrow to call the visiting nurse and tell him you want it OUT! They can show him how to self cath-- not to be too graphic, but just buy some KY-- wash your hands and the catheter, hold the bottom of the penis and tug it outward and upward toward the abdomen, then lube the catheter and insert easily. He will feel the point at which it enters the bladder, and if he hold his penis upward, it helps get over the little "ledge" leading to the bladder. I would do this in a heartbeat instead of a foley. Number 1-- you're right... having a foley in for so long will make him lose tone, and number 2-- will increase his risk of infection. Doing self-cath at home is actually a non-sterile procedure. (In the hospital, it's different because there are so many germs that your body is not used to-- at home it's different, your body is used to your germs, so it can be non- sterile). I would tell your husband once the nurse releases the bulb (that is inflated at the top of his urethra to keep the catheter in) have him demand that he will pull it out. That way he can do it slowly at his own pace and it will hurt A LOT less.

Otherwise, self-cathing is painless once you know what you're doing, and that way he can urinate as well to practice again, then cath to make sure he's emptying. The nurse should provide you a couple cath kits, but like I said, it's non-sterile-- no gloves needed for him.. just wash up. I find the liquid KY works best. GOOD LUCK and let me know what he decides.

[Nassau one]

Thanks for that...we are online at the same time so I knew you would reply quickly. We are hoping that once he has the surgery, the foley catheter will not be necessary but it is something to keep in mind...that if he can still not urinate, self catheterization is an option. I would not want to jump the gun but it is good to keep these things in mind. You have been most helpful....I do not think I will bring it up with him yet as he is still hoping the surgery will work. As to the meds, he was on them for some time but apparently his prostate is very large. You are so right about infections. He has to have the foley catheter changed regularly as he does get problems after a while. Thanks James...as I say, I will keep all this in mind in case he needs to learn how to self catheterize.

It is so good that they stented your ureters during surgery...if they had done that, maybe my husband's would not have been cut...bit late now!

I must say though that they were able to do the resection without a colostomy, which was the only pleasant surprise we had when he woke up...all the other news was pretty bad!!