Constipation and urinary rentention

[bananaskin123]

My DH was prescribed Zapain by the GP on Friday for osteoarthritis of his hip which had become very painful. Unfortunately this contains cocodymol as well as other things and he always has a bad reaction to this, ie constipation etc. He kept the dose at 1 in the morning and 1 in the evening for a couple of days but this morning he was in absolute agony not being able to pee or poo.

We went to A & E. They did a scan which showed retention of urine which they drained with a catheter. He'd taken Lactulose earlier. They were happy, said the constipation was caused by the pills and urinary retention. They discharged him with a catheter in situ and an appointment to attend a clinic where they would decide whether he needed the catheter or not.

Had only been home an hour when we discovered he was peeing blood into the catheter. Back to A and E where the nurse we had seen in the morning said this could sometimes happen. We elected to wait and see a doc who was a bit concerned the blood could clot and cause retention so suggested fitting another wider-type catheter and bladder washout. This is now happening and the urine going into the bag is more Rose than Merlot! They are keeping him in so he can see the urological team tomorrow but just wondered if anyone else had ever suffered from this. I'm just so concerned for him.

Hi
I fit catheters frequently and it is quite normal for there to be some blood after insertion. The urethra is a very delicate thing and passing a silicone or latex tube along its length is not something it likes. There's a slight bend and narrow area around the prostate area and that is often where the 'trauma' can occur. It can also be that not enough lubricant was used, or just one of those things whereby it's irritated the urethral lining.
Drinking plenty of water to keep it flushing through is important.
There may be clots as the bleeding calms down and they can block the holes in the catheter, yes, so a larger catheter will have larger holes but tbh if a clot will block an average size one then they'll block the larger ones too and a larger catheter can cause more irritation. But it's a very good sign the itinerary is passing more rose than claret! He may also be prescribed antibiotics just in case.
I hope he's on the mend soon and can have the catheter removed for a trial without catheter (twoc).

Just noticed a typo
Good sign the urine is passing more clear, not the itinerary!

Thanks Mama. Your message has really reassured me. They mentioned the TWOC clinic. I'm going to ring the ward later. We've been together over forty years and hardly spent a night apart so its been a bit of a shock!

As above, blood in the urine isn't terribly unusual after a catheter.

Zapain doesn't 'contain cocodamol as well as other things' - it is cocodamol. While it can cause constipation, 2 tablets for 2 days would not make you so constipated it caused urinary retention unless he was pretty bunged up before hand. Unfortunately for men of a certain age (which given how long you've been married, I'm guessing he is) this may just be a co-incidental thing & more to do with having a big prostate (which is almost universal in older men) than side effects of drugs. Hope he's on the mend soon.

Thanks for your replies. Just an update: the uro team removed the catheter this morning. DH thought he would pee instantly but it was more of a dribble and then a very urgent dash. However they discharged him at lunch time. Still has some blood when he goes but that's probably to be expected for a few days. Still feels a bit weak. We've decided to make an appointment to see a urologist in a few weeks just to make sure everything is OK and how we can avoid it happening again.

@bananaskin123 I'm really pleased to hear he's home and peeing!
As walkingthroughwalls says, he hadn't taken enough cocodamol to cause constipation, certainly not enough to make him go into urinary retention.
Hopefully this was a one off and won't happen again. Might be worth a chat with his gp to ask for a DRE (digital rectal examination) of the prostate and a PSA blood test. There's rules to when he can have the blood test etc but the gp will talk him through it. Hopefully the urologist team will do a follow up in the next few week to check all continues to be well

Mama I think he had two DREs whilst an inpatient. We have decided to bite the bullet and make an appointment with the consultant. Its rather scared us to be honest and I think if we can sit down with just one person it will help us. He's peeing reasonably OK but obviously its still quite sore. The slightly worrying thing is he said when he passed a stool there was some blood tonight. Wondered whether this could be from the DREs he's had. He's had so many examinations and catheter changes over the last few days .........

Quite possibly the blood has come from having the DREs, yes. If the blood was bright fresh blood on the stool itself, then it's likely to be from the lower end of the bowel, the rectum, and from the examinations. If the blood is within the stool and or the stool is dark almost black then it's from higher up and not to do with the exams at all and he must see his gp. Poor chap, he's been poked and prodded hasn't he! I hope you both feel better and more relaxed tomorrow x

Codeine does constipate yes
And it does cause retention
Get him on the toilet and off the codeine and see if he does better
He may fare better with Tramadol as it is synthetic and has less issues with constipation
Has he been given anti biotics to help prevent infection after this catheter? Blood is scary but normal in catheters I had one for months and it was grim

Just thought I'd update re DH. We decided to bite the bullet and see a urologist privately and I'm so glad we did. The retention started on Sunday and we went via A&E and never actually saw anyone to really discuss things with as it was the weekend and they were so busy.

Today the consultant thought that everything had been done as it should but DH should have been given antibiotics and Tamsulosin on discharge. He gave us a prescription for these. He thinks its an enlarged prostate (as someone said earlier, probably due to age) and he's hoping the Tamsolosin will help regulate the flow. He said if not there is a small op he can do. He also arranged a scan which he's having on Friday, blood tests he had today plus PSA and we're seeing him again on Tuesday.

Can't begin to tell you how much better we feel and thank you to you all for taking the trouble to reply. It really really helped.

That's really good you feel more reassured now. X

So relieved to hear this
I took Contiflo before and it really helped