Okay so the next question comes from a man with MS in his 40s and he says
because of my bladder problems I've recently been fitted with a catheter
however I found that it has had a very negative effect on my sex life my
relationship with my wife is one of the things that has kept me going through my
MS and the thought of losing our physical relationship is really
depressing - is there anything I can do?
Well there is a lot you can do and certainly
if it's a urethral - I'm assuming it's a urethral catheter
that he's got in. For bladder problems. For some reason he's got
an in-dwelling urethral catheter and it's there permanently
For a lot of men if they are going to have a
urethral catheter in, they'll put a condom over the catheter. So the perhaps they
might have taken their catheter bag off and put a catheter valve on the end of
the catheter so they'll put a condom over the catheter so some people
will do that. I suppose in the long term we would probably suggest a suprapubic
catheter which should be the catheter of choice too.
And what's a suprapubic catheter?
A suprapubic catheter is a catheter that's placed in the bladder in the suprapubic
region as opposed to the urethral.
So you go in through the abdomen, tummy.
And we tend to recommend that if you're going to have a long
term catheter - if you're not going to go back to self-catheterisation or some
people, if they're having an MS relapse , they might perhaps like to go
back to self catheterisation. A suprapubic catheter, you know
in the short term it's probably the one of choice. Certainly from a sexual
relationship point of view from a male point of view, certainly if it's a urethral
catheter a condom can go on. You can actually bend the catheter back and put a
condom on - one that's maybe a little bit bigger than a normal condom size and
they can still have sexual intercourse.
And from the woman's point of
view, would that change the experience?
As long is if you can use -
perhaps the sensation would be different. I could rude here and
say they might actually feel a lot of pleasure, but I think using lubrication but
ensuring that the lubrication - as long as you're not using it for contraception
you can use a lot of lubrication, but you've got to
make sure that you're not using it for contraception. A lot of chaps will choose the suprapubic
catheter. Because I've been told it's sort of a bit uncomfortable trying to have
intercourse with a urethral catheter in. It is possible but it's not the one of
choice. And yes a lot of people will have suprapubic catheter, and that
goes for the female as well even though sexual intercourse is still
possible with a urethral catheter in, it's much more comfortable and it's
for your self - your body image is better, not having a catheter in your urethral area.
So if you're a woman and you have a catheter in your urethra that's there all the
time is it possible for people to have
intercourse? Yeah mostly people will just tape the catheter to their
abdomen. I think for self image and for sexuality it's much
nicer to have a suprapubic catheter because what most people do then
is you know they might even put some kind of scarf around their abdomen to hide
the catheter and it makes them feel much better about themselves
And I think for the longer term, if it is an in-dwelling catheter that's going to be there throughout
Although the one going through the tummy - suprapubic - is often the preferred one
And it's to preserve the anatomy as well. If there is a urethral catheter, it always increases the risk for erosions and complications
and tears, for women specifically. Infection - there's a higher risk as well. And of
course from a sexuality point of view as well, I think it's all the more that if
it seems in-dwelling catheters - what's required, in the longer term would be a suprapubic
And how common is it for people with MS to end up with a permanent catheter - an indwelling
catheter rather than the self catheterisation that you described
earlier when you you can just put the catheter in to empty your bladder and
then take it back out again?
Well that's an interesting question, I think it really depends on
the type of bladder problems. It depends on overall disability and functions for
example - hand dexterity, memory problems - it all has to be taken into consideration. I think the
general impression is when we start initiating a discussion about catheters
it's always that image of someone with a suprapubic catheter or
urethral catheter and that certainly isn't the case and it's probably
for those few individuals who we find that we can't really manage with
who can't manage well with the treatments that are available or perhaps there's a
problem of urinary retention for which there aren't really many medications or
injections that are available - really that's where a catheter is required
So it's reasonably common or not particularly?
It's always gonna be a last
treatment option from the point of view of inflection risk but I think
it's probably a smaller percentage than we think.
You know we've got a predominately young population with MS we'll try and
keep an indwelling catheter out for as long as possible.
But it sounds like there's a lot of other
options that you'd be exploring?
I mean a lot of people with MS will
see people with in-dwelling catheters and think that's their only option and that's
where we're going to end up. Whereas there's a wide range of things out
there before we even consider that. And I think one of the recent
efforts is for that message to percolate down to say - MS teens - whereas
I think before perhaps quite a few people were being
referred to services so that to have an initial discussion of
the bladder I think more and more the MS teams are becoming confident about
discussing bladder, and perhaps to an extent, the bowel, and I think that's really
important because the general impression about is a
catheter going to be the way of life really that actually starts from
that initial conversation with the MS team
And nowadays in fact for example when guidelines for how to manage
the bladder in people with MS are being discussed it's not just a urology
discussion but it's involving neurologists, involving MS
nurses, it's involving individuals with MS and and so in an attempt to
spread the message that indeed there are quite a few options and that
the catheter is say you know the last amongst all these options