Blood in Urine: Concerns for Long-Term Catheterized Patients

Long-term catheterization in bedbound patients can lead to hematuria?

My father had a brainstem stroke and has been bedridden for almost a year.
Last month, he choked on phlegm and went into shock, requiring 20 minutes of emergency resuscitation.
He has a tracheostomy and previously did not need mechanical ventilation, but after the choking incident, he now requires assistance with breathing.
He used to be able to urinate on his own, but now he relies on a urinary catheter.
Currently, the urine has blood in it, along with some small blood clots, not just blood streaks.
I asked the home care nurse, and he mentioned that it is normal for my father to have blood due to not urinating completely for a long time and that the catheter may have caused some irritation, leading to slight bleeding.
However, I am concerned that there might be an issue with the urinary tract causing the hematuria.

Rou Rou, 30~39 year old female. Ask Date: 2013/08/12

Dr. Li Yilun reply Urology

Your father's condition is more complex.
Long-term indwelling catheters can lead to fragile urethral mucosa in some patients, making them prone to bleeding.
Therefore, it is essential to use adequate lubrication when replacing the catheter.
However, sometimes, due to individual health factors, it may not be entirely avoidable.
It is important to monitor the catheter for patency and urine output.
Given the complexity of the patient's condition, I cannot provide specific advice based solely on your description.
Therefore, I strongly recommend consulting a professional physician for evaluation and examination to avoid any delay in treatment.
Physicians often need to conduct a thorough medical history inquiry, physical examination, and diagnostic tests to determine the appropriate diagnosis and treatment plan.

Reply Date: 2013/08/12

More Info

Blood in urine, or hematuria, can be a concerning symptom, especially in patients who are catheterized for extended periods. In your father's case, given his history of a stroke and subsequent complications, there are several factors to consider regarding the presence of blood in his urine.

1. Catheter-Associated Issues: Long-term catheterization can lead to various complications, including urinary tract infections (UTIs), bladder irritation, and trauma to the urethra. The friction from the catheter can cause micro-tears in the urethra or bladder, leading to bleeding. If your father has not been able to fully empty his bladder, residual urine can also contribute to infections and irritation, which may result in hematuria.

2. Infection: UTIs are common in patients with long-term catheters. The presence of bacteria can lead to inflammation of the bladder (cystitis), which can cause bleeding. Symptoms of a UTI may include fever, chills, increased urgency to urinate, and foul-smelling urine, in addition to hematuria.

3. Bladder and Kidney Health: While the immediate concern may be the blood in the urine, it is essential to consider the health of the bladder and kidneys. If the bleeding persists, it could indicate a more serious issue, such as bladder stones, tumors, or even kidney problems. Regular monitoring and imaging studies, such as ultrasounds or CT scans, may be necessary to assess the underlying cause.

4. Assessment and Management: It is crucial to have a healthcare professional evaluate the situation. A urologist can perform a thorough examination, including urine tests and possibly cystoscopy (a procedure to look inside the bladder), to determine the cause of the hematuria. If the bleeding is due to catheter-related trauma, adjustments in catheter care or switching to a different type of catheter may be necessary.

5. Preventive Measures: To minimize the risk of complications associated with long-term catheterization, it is essential to maintain proper hygiene and care of the catheter. Regularly scheduled catheter changes and ensuring that the catheter is not kinked or blocked can help reduce the risk of infection and irritation.

6. Communication with Healthcare Providers: It is vital to communicate any changes in your father's condition to his healthcare team. If the blood in the urine continues or worsens, or if he develops additional symptoms such as fever or increased pain, immediate medical attention is warranted.

In summary, while some bleeding may occur due to irritation from the catheter, persistent or significant hematuria should not be ignored. It is essential to investigate the cause thoroughly to prevent potential complications and ensure your father's overall health and comfort. Regular follow-ups with healthcare providers and open communication about any concerns will be crucial in managing his condition effectively.

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