MANAGING YOUR NEOBLADDER
Your neobladder (“new” bladder) is a storage pouch for urine. It is made from a segment of intestine. The ureters are connected to it, so that urine can drain down from the kidneys. The urethra is connected to it, so that you can pass urine from the neobladder to the outside world. A catheter is left in the neobladder for 2-3 weeks after surgery, to keep the system decompressed until all of the connections heal. Once your catheter is removed, you will need to train your neobladder to work properly.
The following pages contain instructions and tips to help you manage your neobladder. You don’t have to memorize the material…you won’t be quizzed on it! You may feel a little overwhelmed at first, but eventually you will adapt to the surgical changes and develop your own routine.
PASSING URINE (VOIDING)
How to pass urine
Your pelvic floor is the surface of your body that touches the seat of the chair when you are sitting. The pelvic floor muscles support the urinary and reproductive organs and surround the urethra.
PELVIC FLOOR MUSCLES
The muscles used in the following activities are your pelvic floor muscles:
When the pelvic floor muscles are contracted, the urethra is pinched off and urine cannot pass through. When the pelvic floor muscles are relaxed, there is little resistance to passing urine from the neobladder. Try the following exercise to relax your pelvic floor.
PELVIC FLOOR RELAXATION EXERCISE
Once you have relaxed your pelvic floor, you should exert pressure on your neobladder by either contracting your abdominal muscles or by pushing down on your neobladder with your hands. Patients can often empty more efficiently when sitting, however, you can try emptying your neobladder while standing if you prefer.
PROPER POSTURE/TECHNIQUE TO EMPTY YOUR BLADDER:
4. If unsuccessful with emptying your neobladder by contracting
need to set the alarm to wake you at night)
Once you have completed this program, your goal is to store no more than 400-500 cc (about 14 ounces) of urine before emptying your neobladder. The frequency at which you pass urine should be determined by volume. Chronic overdistension of the neobladder may impair your ability to empty it.
If you were not taught how to catheterize yourself prior to surgery, you will be taught to do so immediately after your surgically placed catheter is removed. You will need to pass a catheter into your neobladder for the following reasons:
You will be given a patient education brochure which outlines the steps for self-catheterization and provides illustrations to help you learn. You will be given a curve-tip catheter (Coudé) and straight-tip catheter to try. Use whichever one inserts the easiest. If you are using a curve-tip catheter (Coude'), remember to insert it with the tip curving up. If you are using a straight-tip catheter, you need not be concerned about this. Never force the catheter in because you may cause injury. If you meet resistance with insertion, pull back a bit, try to relax by taking some deep breaths, and then gently continue insertion.
You can re-use your catheter as long as you wash it with antibacterial soap and water, rinse it well, and allow it to completely air dry. We recommend that you use a new catheter each week. If your insurance will cover use of a new catheter daily, do so.
If the catheter isn’t draining well, mucus may be plugging the tip. You can try irrigating (instructions to follow). If irrigating doesn’t help, you will have to pull the catheter out, clean off the mucus, and then reinsert it.
FREQUENCY AND VOLUME CHART
This chart is a very important part of evaluating your neobladder function and of assessing your recovery from surgery. For the first two weeks following catheter removal, you will be keeping a frequency and volume chart. Our clinic nurses will give you the form. Instructions for completing it are detailed on the next two pages. Call us at the conclusion of week #1, to review the results. We may adjust your directions, depending upon how efficiently you are emptying your neobladder. Bring the results of week #2 with you to your clinic visit.
The chart allows us to assess how much you normally drink (fluid intake), how much urine you make (urine output), and how often you empty your neobladder on a daily basis. It will document the storage capacity of your neobladder and tell us how efficiently you are emptying. There is space to record episodes of urinary leakage (incontinence) as well. In general, be sure that the volume of fluid you drink exceeds the volume of urine that you void. If the volume of urine that you void consistently exceeds the volume of fluid that you drink, you will become dehydrated.
Keep the chart with you and fill it out as completely as possible. You will be given a measuring container that fits right under the toilet seat. You can also purchase an inexpensive measuring cup if you are going to be away from home and need to measure urine.
For the first year, we request that you measure and record your fluid intake and urine output for two full days prior to each clinic visit. Pick days which will be convenient for you. They DO NOT have to be two days in a row. On the days that you measure and record, you should pass the catheter, at bedtime, to check for residual urine. The numbers that you provide will help us to identify problems early on and will allow us to take active measures to correct them. It is essential that you complete the chart and bring it with you to each appointment, whether it be with the physician or nurse practitioner.
URINARY INCONTINENCE (URINARY LEAKAGE)
Urinary incontinence is experienced by all patients initially. This improves, over time, as your body heals. Urinary incontinence typically resolves during the daytime hours but may persist, to some degree, at night when you are very relaxed.
You will need to purchase pads or briefs to protect your clothing. Pads adhere to your undergarments and are not noticeable through your clothing. There are several brands of incontinence pads and briefs, including Poise and Depends. At night, you may initially need a larger superabsorbent pad or combination of pad and brief.
You can do exercises (“Kegel”) to strengthen and tone your pelvic floor muscles. “Kegel” exercises can help improve your urinary control and reduce incontinence. Initially, we encourage you to set aside dedicated times to exercise. Once you have gained expertise, you will find that you can do these exercises virtually at any time and in any place, even while doing other activities.
The muscles of your inner thighs and buttocks are NOT the main muscle groups to target. When you squeeze or tighten your pelvic floor muscles, think of it as pulling your muscles up and in. Perform both Endurance and Short/Quick Kegel exercises three times daily.
Your neobladder is constructed from a segment of intestine. The cells which line the intestines produce mucus. For this reason, you will notice mucus draining out with your urine. The mucus may become so thick that it actually prevents you from passing urine. To prevent obstruction from mucus, we advise the following:
The following procedure should be used to irrigate your neobladder. You may use either sterile water or sterile normal saline. Pass the catheter into your neobladder, as described above.
Watch for mucus (mucus is what you want to see).
longer withdraw mucus, you may stop for that particular irrigation.
bacterial soap and hot water, Take the plunger out of the barrel and
IMPORTANT POINTS TO REMEMBER
NOTIFY YOUR PHYSICIAN OR NURSE
If you have any questions or concerns, please do not hesitate to call:
Urgent matters that arise during non-business hours can be addressed with the urology doctor on-call, through the paging operator (734)936-4000.
The illustrations and photographs in this booklet are by Wendy Baker, R.N.
© Team 3 Urology Staff and Pelvic Floor Physical Therapists July 2009, revised August 2010.