Angie writes, “I’ve tried many things to reduce sediment in my bladder, including cranberry tablets, anti-bacterial catheters, frequent irrigation, uva ursi, lemon juice, etc. I even switched to a supra-pubic drainage system. Nothing has worked. I drink as much water as humanly possible but sediment still builds in my bladder very quickly and threatens to block my catheter. I feel it’s the hardest aspect of my disability to manage. What can I do? Will the new Duette catheter help?” To answer this issue’s question, we reached out to Dr. Lynn Stothers, ICORD Principal Investigator and Professor of Urology at University of British Columbia.
Angie, thanks for taking the time to write about a common and difficult situation—that is, sediment in the urine that seems to persist despite people’s best efforts to find a solution. The list as to “why” sediment happens is actually a long one. Getting an answer requires a physical exam, along with other common tests of the urine and blood, and sometimes imaging studies. For this reason, it’s difficult to speak to your individual situation without seeing the results of these types of investigations. The bottom line is that there are many conditions that can cause sediment in your urine, so an evaluation needs to be completed to find underlying causes and determine how they can be treated appropriately. Health care providers can provide insight through their investigations and examinations and create a personalized solution that fits your medical history and your personal needs.
Generally speaking, in the context of SCI, the most common cause of an abnormal amount of sediment is acute cystitis, more commonly referred to as a urinary tract infection or UTI. Unfortunately, there is a clear link between UTIs and indwelling catheter usage.
For most people with SCI, the standard treatment for UTIs is antibiotics. Have you ever had a serious UTI that required antibiotics? If so, think back to the time immediately following treatment—was sediment less of a problem for a period of time afterwards? If so, this could be a clue that your ongoing, chronic sediment problems are the result of a low level UTI that, without antibiotics, is persistent within your bladder.
If your catheter is the culprit, there are essentially two potential problems: improper hygiene during catheterization, and irritation resulting from the catheter being in constant contact with the tissue within your bladder.
I realize that you may be practising the best possible hygiene in your daily routines, but I can’t understate the need for this. Extreme care must be taken to ensure your catheter is clean and sterile, that this isn’t somehow compromised during insertion, that your drainage bag is emptied properly, and that you’re making your best efforts ensure your bladder is fully drained.
Another consideration for those who use intermittent catheters to empty the bladder is to check the technique with ultrasound to ensure that the bladder is emptying with catheterization. Sometimes poor catheter technique—such as not leaving the catheter in long enough to empty the bladder—can result in residual urine. If this is repeated over time, it can lead to sediment. Of specific importance to women is the condition of prolapse—where the bladder can be in a low position. Pelvic organ prolapse or POP can cause extra challenges with catheterization.
Let’s touch on the idea of diet. The foods we eat result in different components entering the urine. In some people, certain components can lead to the formation of sediment in the urinary tract. Stones can form from this sediment, so health care providers may examine patients for the presence or absence of stones. Generally speaking, avoiding caffeine and alcohol, which dehydrate and irritate the bladder, is important to maintaining bladder health for some people.
You’ve indicated that you’ve tried multiple non-traditional treatments. There’s little scientific evidence to definitively conclude that any of these treatments are effective. Nevertheless, many people do anecdotally report that they’ve had success with D-Mannose, cranberry extract and others. One in particular that you haven’t mentioned is cream of tartar, or potassium bitartrate, which is a dry, powdery, acidic byproduct of wine production. On various online communities for people with SCI, such as the CareCure Community hosted by Rutgers University (www.carecure.org), many people with SCI report being able to reduce their sediment from drinking a teaspoon of cream of tartar dissolved in a glass of water twice a day. Again, there’s no scientific proof to support the use of cream of tartar. A key concern is that all intake of both medicines and supplements may have risks and benefits and can be dangerous if not taken in appropriate doses and under medical supervision. Before using any supplements or medications, check with your doctor and get personalized instructions for you.
In conclusion, I will repeat that there could be other factors also at play—for example, excessive sediment can be a byproduct of diabetes and bladder stones, common conditions for many people with SCI. This again underscores the importance of having a thorough assessment, which should lead to a diagnosis and effective personalized treatment plan for you.
This article was originally published in the Winter 2018 issue of The Spin. Read more stories from this issue, including:
- SCI Nutrition
- Adaptive Mountain Biking
- Neuromodulation Research
And more!
