How painful is it to be have a catheter inserted into your bladder?

[Carpe Diem]

Any suggestions for a young girl who has to undergo this procedure? Anyone have experience with a voiding cysto urethra gram? I know I am not spelling this correctly.

 

Thanks.

 

Oppss sorry about the error in the title.

[Barb_]

Any suggestions for a young girl who has to undergo this procedure? Anyone have experience with a voiding cysto urethra gram? I know I am not spelling this correctly.

 

Thanks.

 

Will they do a local to numb the area first? I remember it being exceedingly painful, but I'd just given birth to a 10lb baby and the area was too traumatized to pee 24 hours later. So I may not be the best person to ask. How old is she?

 

Barb

[GraceinMD]

I've never seen one done without local anesthesia (usually a gel in the urethra, although I'm not positive that this is what would be done for young children; Dr. Alice, are you here?).

 

Here's a blurb from a site:

Voiding Cystourethrogram (VCUG). A VCUG involves putting dye into the bladder and then watching with continuous X-rays to see where the dye goes. Doctors typically order a VCUG when they are concerned about urinary reflux, which can sometimes lead to kidney damage later. A catheter is inserted through the urethra, into the bladder, which can be uncomfortable and scary for a child, but usually is not painful. The bladder is then filled with contrast material that is put in through the catheter. Images are taken while the bladder is filling and then while the child is urinating, to see where the dye and the urine go.

[summer]

It is not painful, but will likely be scarey for her. Just make sure the person doing it has tons of experience. When I sign consents when we arrive, I always cross off the part where it gives the consent for students to work on a child or observe. Then I have to remind them I did not give consent when they come in. An inexperienced person can potentially cause pain. But that has been rare, but I also do not allow students to work on me or my children..students, residents, or interns.

[KidsHappen]

I have IC. I remember having one done as a small child (3-4) and while I can't remember if that one was painful I do remember it being tramatic. Based on my experience I personally wouldn't consent to it unless the child was in pain, everything else had been done and it was absolutely neccesary.

[swellmomma]

Make sure you have someone well trained inserting it. The one I had done for my c-section it was a nursing student, she made so many mistakes so the precept did it, without changing the catheter or adding more gel it was so painful having a dry catheter inserted and it caused me to have bladder problems for a few months after until it healed. Any I had after that I made sure they did AFTER I had an epi in place and they could not leave it in.

 

I would ask about a local being applied, and if you think your child will be upset and it is a must have perhaps the dr can prescribe something like valium or something to calm her and keep her realxed because I know the tenser you are the more it hurts.

[Mom24bz1g]

I wouldn't do one on a young girl without sedation. It is a conscious sedation because they need her to void at the end. However, Versed is used so the memory is usually gone.

 

My 4yo will be having another VCUG this August. Her urologist will not agree to have them done without sedation because of the mental trauma.

 

S hasn't had one done since she was an infant. I didn't know what was happening nor did I know that one could use sedation. The woman did a horrible job inserting the cath and S was bleeding when she finished. I did stop her once I realized that it was going so horribly (I was at S's head). The woman got her supervisor and they eventually managed to cath her.

 

If the same thing happened this time, I would stop the whole procedure and walk out. It's so difficult though because she really needs the tests done.

 

Now, I ALWAYS ask for the Child Life Specialist and Supervisor. I call ahead to make sure they know that, for a reason the urologist can't determine, they have a hard time cath'ing S. I let them know that I want the most experienced person to help us so could they pretty please put that on their schedule. :001_smile: For S, I will now also insist on a woman.

 

There is a Yahoo group on kidney reflux. The most popular test for this is a VCUG so you could get lots of info regarding the test if you joined the group.

 

I hope it goes well for your dd.

 

Michele

[RoughCollie]

I had a zillion of them when I was a kid. The catheter hurt going in, but now I can have a catheter put in with no pain at all. I think all the nerve cells were killed off or something.

 

When I was a child, the worst part for me was afterwards -- it was very painful to urinate at first (this got better over time and disappeared after the first day).

 

It was a humiliating procedure and I always dreaded it.

 

When my DS had kidney stones when he was 2, he was in terrible pain. During the few days before his surgery, the doctor prescribed a pain medication that he said was specifically used for urethra and ureter pain, and it worked. I can't remember the name of it, but your doctor should know what it is.

 

RC

 

Any suggestions for a young girl who has to undergo this procedure? Anyone have experience with a voiding cysto urethra gram? I know I am not spelling this correctly.

 

Thanks.

 

Oppss sorry about the error in the title.

[Mama Bear]

she had the magical cocktail of Ketamine and Versed. If any of my children were ever to need a VCUG in the future, they would have that same combo, or general anesthesia, or I'd be dead. I would never under any circumstances (except life or death) consider that procedure without enormous pain meds plus the handy-dandy "forgetting" meds.

 

This speaks to good touch-bad touch and a whole lot of other things, IMO. So there's my two cents.

 

Best of luck.

[keptwoman]

DD has had 2 and I have had a couple as a child too.

DDs first one was when she was only 3 months old, and I think it was worse for us than for her. I have to take DHs word for it, as I was so traumatised by mine at age 5 that I spent the whole time outside crying while she had it done. He said she didn't like being restrained and cried a little when her bladder was really full, but was really fine within 5 minutes.

It wasn't so bad when she was 2 1/2 either, the meds made her almost drunk, and giggly and you can be sure I made sure she had the forgetting meds because I still remember the trauma from mine at 5 years old. I actually found being with her that time as rather cathartic for me, I felt better about mine after seeing hers.

For me the memory is not so much the pain, it's the humiliation of having it put in and having to pee on the table, not fun.

In the end it's a necessary thing, and the forgetting meds make it much better I think. DD had forgotten within a very short time, couldn't even remember going to the hospital to have it, DH mentioned something that night and she just looked blank at him.

Also, like someone else said, make sure the person who is doing it is very experienced in dealing with and cathing children.

[Carpe Diem]

She is almost 10 years old. She is mortified but seems to be getting use to the idea. She says she is mostly embarrassed. She wants to wear a mask over her face so the people won't ever recognize her.

 

They will put on a numbing cream. When I aksed about giving her something to knock her out a bit they stated they don't do that because she has to be awake to stand up and pee.

 

She has had at least 10 UTIs, closer to 15. At first we realized it was from bubble baths. Cut those out and they stopped for awhile. Then she had a bit more. She doesn't drink enough water/liquid and it is a battle at our house to get her to do so. We suspect her UTIs are due to constipation, which according to the ped is a cause of UTIs.

 

Our ped wasn't even really aware of her UTIs because we always had to go to the walk in clinic. When I brought it up at her last physical he sort of dismissed them saying they probably weren't real cases of UTI. But he did refer us to hae an ultrasound done of her bladder/kidneys which turned out normal. That was in Dec. Now she has had a UTI each month for the last 3 months in a row. They have been horribly painful even 3 days after the abx is started.

 

I asked if it could be the same UTI that never really was knocked out by the antibiotics. He said no.

 

He talked to the urologist and said she absolutely had to have a VCUG. I questioned him about the necessity and said I knew she was constipated. He stated that even if we treated the constipation and she wasn't having UTIs she could still be having reflux. Then he did the scare thing by saying he had one girl who had a few UTIs and nobody ever thought much about it and she really had reflux and ended up with kidney failure.

 

She just finished antibiotics for her last UTI and is on another antibiotic until the test can be completed.

 

I looked online about the reflux condition and it didn't sound like her because it said kids with this will have difficulty being potty trained and often are failure to thrive.

 

Should we still go ahead with the test? Insisting on versed? What could be some other obscure causes for UTIs. She does the proper wiping routine. Wears cotton undies.

 

Thank you so much for your input & time.

[Julie in CA]

I would be *running* to get a second opinion on this, and when looking for a doc to give the second opinion, I'd only see one that would consider using the meds that the other ladies here have suggested, should they deem the procedure really necessary.

[ChristusG]

I've had 3 catheters....two while I had an epi right befor giving birth, so I didnt feel those. And one without any numbing.

 

I wouldnt say that it hurt.....but you need to just be able to relax and breathe. It didnt hurt though....it was a tad bit uncomfortable. However, once it was in, I dont think you are supposed to be able to feel it, but I did. That was the most uncomfortable part for me....being able to feel it in there.

[RoughCollie]

I had one of the first surgeries for reflux (bilateral reimplantation of the ureters), when I was 10 years old.

 

It is important to have the VCUG to rule out reflux. I now have 2 kidneys which, in combination, do the work of one. In my case, even though I spent weeks in the hospital every year and underwent a zillion VCUGs and other tests (some under anesthesia), the doctors waited too long to do the surgery and they didn't know even half of what they know now in the 1960s.

 

Potty training and failure to thrive issues were not present in my case.

 

Personally, I wouldn't fool around with something like this. All 4 of my children had VCUGs when they were very young because the condition that causes the problem is inherited by up to 2/3 of the children of parents who had it. One of them had it and he underwent surgery when he was in first grade, and he *never* had a UTI.

 

RC

[JumpedIntoTheDeepEndFirst]

Ok-My DD and I have been through this procedure more times than I can count in the last 5 years. (DD ages 5-10) I think we are well into double digits. She has never had any anesthesia, maybe some numbing cream. In our experience the worst part is having to urinate at the end of the proceedure.

 

Here is my advice-bring wipes or something that will make her feel comfortable cleaning up after the procedure. You should have the option to wear a hospital gown but might want a change of clothes just in case.

 

Now-after having discussed this with the docs, nurses, radiology techs etc. several times-the most important part of this procedure going well is the attitude of the parent(s). Your acceptance and positive attitude as well as courage and comforting presence are very important. The more calm you can be the better the procedure will go. If your DD is of a scientific bent the docs etc will be happy to explain, show her the photos they are taking etc. I think that preparation is half the battle, what will happen, why is it important to have this test, how can DD better prepare herself. I have always put on the lead vest and stayed in the room to support her.

 

Is the procedure important? Yes, we had no idea our daughter had reflux. In fact her reflux was very serious. The UTIs and their symptoms were all we had to go by. DD also had various kidney tests and ultrasounds as well. Typically the ultrasounds were done at about the same time. I do recommend a consultation with a pediatric urologist, I learned the hard way that there is a difference. Also, be sure to discuss the effects and risks of sedation. Sedation for children is always a touchy issue.

 

In no way do I wish to belittle the amount of discomfort involved (both physical and mental) in the procedure. It is difficult but can be completed successfully (sometimes with a little ice cream afterwards). I wish you and your daughter the best!

[lynn]

I had a couple during labor and surgery and I honestly don't remember any pain associated or discomfort for that matter.

[mcconnellboys]

I find it to be the most aggrevating thing in the world, but lots of folks are more tolerant than me....

[Alice]

I think you've gotten great advice. Probably the advice of Moms who have been there done that is better than mine (I'm a pediatrician and have put plenty of catheters in but never been through it with a child of my own.)

 

It sounds to me like she definitely needs the VCUG. That number of UTI's definitely raises concern for relux. Reflux can certaily lead to more serious complications if untreated. It certainly may be constipation but with the number she has had, I think you have to do the VCUG to be sure of what you are dealing with.

 

As far as the procedure itself I know here the hospital will give the kids anesthesia although my patients have told me they have to fight for it. I'm not sure why they would need to have her stand up to pee, but it's been a long time since I've actually seen one of these done and I admit I don't remember all the details. They might be able to give her something like Versed that is short acting while they place the catheter and then will wear off quickly. Once it's in it shouldn't be as painful, I've had a catheter myself after C-sections and it's uncomfortable but not painful. The discomfort with urinating afterwards is probably something that can't be completly avoided. The Versed or other short acting anesthetic would be more for her if she is very very scared or anxious than it will truly relieve pain. If she isn't particularly anxious or scared you probably can do it with the kind of techniques offered by the poster above (all good thoughts).

 

I don't know where you are but you will probably find that only a children's hospital is going to be willing or able to do any kind of sedation. There are plenty of radiology centers and outpatient hospitals here that see kids but that aren't equipped to do anesthesia or sedation. The children's hospital can do it because they are so busy they don't always make it easily accessible if it's more "optional" like this. I know I have had several patients who were told "we don't do anesthesia" for the VCUG and then the parents insisted or I called or the urologist called and then they did it. Also, sedation does have it's own set of side effects and so should only be done by someone experienced like an anesthesiologist. Hope that helps.

[Holly IN]

I didn't have the procedure but I did have a catheter inserted with NO numbing agents. It was so painful. I was spitting hairs at the dr that ordered it, after I was wheeled to the ultrasound room. The tech said what in the world.... She asked me who ordered this to be done to me. I said the ER dr. She pulled it out immediatly and said this was uncalled for. Afterwards I told them I want to be released and will go to my dr's office instead. I chewed the ER dr out and said I will never go to that hospital or any of the dr's again. I haven't to this day. :D

 

It is painful. I am sorry to say that. Make sure that she gets numbed up. Are you sure this is the way to do it? Are there any test they can do first to rule out other things?

 

Holly

[Holly IN]

I had a couple during labor and surgery and I honestly don't remember any pain associated or discomfort for that matter.

 

Remember you had an epidural. That makes a big difference. I had C-sections so they gave me epiduals before they put it in. I do not feel it all.

 

When they do it with no numbing agents....it is very painful as I stated in my post above.

[jenn&charles]

I had this done as a child - at least I believe this is what it was - (when I was about 6) and honestly it is a very traumatic memory.

When I was around 10 I had an IVP done and I don't remember why (because I don't think an IVP requires one) but they mentioned a catheter and I about flipped. They would have had to sit on me after peeling me off of the ceiling. Thankfully I didn't have to get one at that time. I NEVER want a catheter as an adult because of what I went through.

 

It hurt A LOT, I was embarrassed, the staff didn't explain what they were doing as they were doing it, I felt like my bladder was going to burst, etc.

Thinking back it would have helped a lot to have a numbing agent applied. It would have also helped to have the staff explain everything as they went along.

The best thing you can do as a mom is be really positive and never leave her side. Find something they will let you bring to distract her like a nintendo DS or music w/headphones or something. I'm not sure if she can have them around when they do the x-rays, but maybe for part of it or while you are waiting it will be ok. She's 10, but I'd bring a teddy bear or something too for her to squeeze, if she gets uncomfortable. If they had something like that back then, it would have helped get my mind off of things.

Insist on having an experienced person!! I can remember to this day the staff talking about how neither one had ever put a catheter in a child.

Best of luck to you both and I'll be praying for her for her procedure to be as comfortable as it can be.

[KidsHappen]

She is almost 10 years old. She is mortified but seems to be getting use to the idea. She says she is mostly embarrassed. She wants to wear a mask over her face so the people won't ever recognize her.

 

They will put on a numbing cream. When I aksed about giving her something to knock her out a bit they stated they don't do that because she has to be awake to stand up and pee.

 

She has had at least 10 UTIs, closer to 15. At first we realized it was from bubble baths. Cut those out and they stopped for awhile. Then she had a bit more. She doesn't drink enough water/liquid and it is a battle at our house to get her to do so. We suspect her UTIs are due to constipation, which according to the ped is a cause of UTIs.

 

Our ped wasn't even really aware of her UTIs because we always had to go to the walk in clinic. When I brought it up at her last physical he sort of dismissed them saying they probably weren't real cases of UTI. But he did refer us to hae an ultrasound done of her bladder/kidneys which turned out normal. That was in Dec. Now she has had a UTI each month for the last 3 months in a row. They have been horribly painful even 3 days after the abx is started.

 

I asked if it could be the same UTI that never really was knocked out by the antibiotics. He said no.

 

He talked to the urologist and said she absolutely had to have a VCUG. I questioned him about the necessity and said I knew she was constipated. He stated that even if we treated the constipation and she wasn't having UTIs she could still be having reflux. Then he did the scare thing by saying he had one girl who had a few UTIs and nobody ever thought much about it and she really had reflux and ended up with kidney failure.

 

She just finished antibiotics for her last UTI and is on another antibiotic until the test can be completed.

 

I looked online about the reflux condition and it didn't sound like her because it said kids with this will have difficulty being potty trained and often are failure to thrive.

 

Should we still go ahead with the test? Insisting on versed? What could be some other obscure causes for UTIs. She does the proper wiping routine. Wears cotton undies.

 

Thank you so much for your input & time.

 

Your second post here has me a bit concerned. I would definitely be getting a second opinion.

 

First, are these verified bacterial UTIs with a culture? Or are they just presumed to be UTIs based on symptoms? That really does make a difference. It sounds like it could be IC (Interstitial cystitis) which is actually much more common (not obscure at all) than reflux. Please look this up before going through this potentially painful procedure. If she does have IC then the procedure would be even more painful and would really require sedation. Here are a few sites to get you started:

 

http://www.ichelp.org/

 

http://www.ic-network.com/

 

 

I would be happy to answer any questions about this that you may have.

[Mamagistra]

(((Carpe Diem)))...I hope your dd is feeling better soon.

[Mom24bz1g]

They fill the bladder with a dye solution. When it is full they will have her pee on the table. The X-rays are taken while she is urinating. Reflux will only show up when urinating. They take different types of X-rays during this time, but I know for a fact that she will be lying down.

 

I would still insist on Versed and a pain reliever. I was told when I take dd in that they will try to talk us out of a conscious sedation because of the risks, etc. I do get all that, but dd is already traumatized. You do have to get a doctor to order the conscious sedation beforehand.

 

If I was your dd's age I know that would be absolutely humiliating for me. I do think there are a small percentage of people that medical procedures, etc. don't seem to affect them much, but for me it sure would and for my dd it does.

 

It is good to remember that you know your daughter best and you are her best advocate. I am very honest with my dd about what is going to occur. I have found that works best.

 

I do have a positive attitude, but do NOT minimize her feelings whether it is hurt, humiliation or just plain scared. I have found that for my dd she needs to see what is being done to her. It helps her process her feelings. Whereas my ds needs me to distract him and talk nonstop until whatever is over with.

 

Maybe your dd would like a light blanket to cover her face with. Maybe you could get under the blanket (at her head) and talk to her or sing or something. I usually try to think ahead of time what I am going to talk nonstop to ds about. Think of a few different things because it can be difficult keeping a conversation going. Call ahead and see if she can listen to an ipod or if there is a TV/DVD in the room. They will be as accomodating as they can be.

 

Blessings and prayers your way as you work through this.

 

Michele

[JumpedIntoTheDeepEndFirst]

Sorry it didn't show up-the quotes below are from Mom24bz1g...

The X-rays are taken while she is urinating. Reflux will only show up when urinating.

 

Actually, reflux typically only shows up while urinating. It can ocassionally show up by filling the bladder to capacity. It is for this reason that you need to urinate while they are taking the pictures. Typically the radiologist watches it on a live photo feed similar to TV and snaps photos from the picture. (Sorry I don't know the technical terms.) The diagnosis comes from both the still photos as well as what they can observe. Your DD will not be subject to x-rays during the entire procedure and once they think they have filled her bladder they will use her verbal responses/physical sensations to gauge when to start the pictures. I have often wondered if they could put a bedpan under the cathetar rather then just pads under the patient. I think that would certainly be worth asking about... Also-be sure DD understands that the people involved (med staff) have all seen these type of procedures before. They know what will happen and understand that everything is happening to make the test run properly. They are not going to be upset by the procedure or anything that DD is required to do-they are there to help her.

 

Maybe your dd would like a light blanket to cover her face with. Maybe you could get under the blanket (at her head) and talk to her or sing or something. I usually try to think ahead of time what I am going to talk nonstop to ds about. Think of a few different things because it can be difficult keeping a conversation going. Call ahead and see if she can listen to an ipod or if there is a TV/DVD in the room. They will be as accomodating as they can be.

 

Michele

 

Michele has some great ideas here! I would practice relaxation techniques such as deep breathing or positive mental images (ie sitting in a beautiful garden) as well. The entire staff did their best to distract DD-we even helped the radiologist plan his vacation once. Books and magazines work well too. Even me just reading to the kids can help as a distraction.

 

As my DD has gotten older I try to let her be more in charge of the situation. If she has questions they get asked first, we let her answer her medical history as much as possible etc. And I insist that the medical team listen to her and answer her if they don't respond initially.

 

Hang in there-we wish you all the best!

[keptwoman]

I would still insist on Versed and a pain reliever. I was told when I take dd in that they will try to talk us out of a conscious sedation because of the risks, etc. I do get all that, but dd is already traumatized. You do have to get a doctor to order the conscious sedation beforehand.

 

If I was your dd's age I know that would be absolutely humiliating for me. I do think there are a small percentage of people that medical procedures, etc. don't seem to affect them much, but for me it sure would and for my dd it does.

 

Like Michele, having had one and remembered it, I'm pretty staunch on the need for meds.

 

If it was my DD (and likely in the years to come it will be, more than once as she has bilateral Grade 3 reflux which needs to be reassessed periodically) I would absolutely insist on meds and not accept a no.

 

But also having suffered kidney damage from long term undiagnosed reflux, there is no way I'd be not getting the procedure. Yes, it's horrible, but kidney damage has the potential to be much much worse. I had the bi-lateral reimplantation and I've been fortunate that the damage has healed itself, but even with healed damage I have potential health problems as I get older.

 

The other thing you could do in the meantime is when she gets a UTI next, and gets antibiotics and gets the urine tested, check with the doctor a few days later to make sure that the abx are appropriate for the particular bug she has. Also as much as possible I would use your urologist or family doctor rather than the urgent clinic because you really need consistent treatment from someone who knows your childs history. I had scripts on hand for DD from the doctor, so at the first sign of infection I would get the script fill and drop a urine sample off to the lab, this meant the doctor was kept well informed and I didn't have to go to urgent care or wait until normal business hours to get on to treating her infection.

 

And yes, it is possible to have (I cant remember the official term) a minor long term UTI simmering under the surface and cropping up occasionally but not being completely gotten rid of by the antibiotics. So sometimes a different or longer term antibiotics are needed to get rid of it (lucky me, still very susceptable to UTIs) If the recurrent infections continue it is possible (not ideal obviously, but possible) to have daily low dose antibiotics to prevent infection. I was on them for 12 years.

[Carpe Diem]

I've read through them several times and have done more research. I've looked at the links KidsHappen provided regarding IC.

 

I found out that our hospital will not do conscious sedation due to two children coding. We would have to go the route of having her completely put under which we wouldn't want to do.

 

I called a well known children's hospital at a neighboring state. For her age there they would also NOT use conscious sedation.

 

I've put a call into my dd's uncle who is an MD. Hopefully he can talk to any urologist friend he might have to determine if this is definately the right course to take.

 

We've talked this morning to a friend whose daughter has had numerous uncomfortable tests completed for advice on how they've coped and she gave me some good suggestions in line with what has been suggested here by you smart people.

 

I called one of my family members who really was NOT helpful and really minimized the whole thing saying my dd was basically in a woman's body and that she needs to get into the real word. :eek:NOT. I was surprised and couldn't help myself when I told her she should avoid working in peds.

 

The one suggestion that I have from the nurse at our peds office that gives me the most comfort for right now is to give my daughter benedryl to help her relax/feel drowsy. We are going to try some tonight to be sure it makes her have that result and not the opposite.

 

Thank you for everyone who replied with your experiences, wisdom and well wishes. Please say prayers for my dd on Friday morning.

 

If there are any other suggestions or ideas please let me know. I will pm you KidsHappen to get more info on IC.

 

Thanks again.

[Mamagistra]

Thank you for everyone who replied with your experiences, wisdom and well wishes. Please say prayers for my dd on Friday morning.

 

Praying now for wisdom, comfort, and mercy for you and dd tomorrow. :grouphug:

[keptwoman]

I get a little confused with time zone differences, but I'm thinking it's friday there. So I hope it all went well today.

[Mamagistra]

How did everything go? Hope your dd is having a restful evening. :001_smile:

[TracyR]

Hope all went well . You had gotten well saged advice . My daughter was born with renal issues ( along with others ) and she has grade 2/3 reflux in her good kidney and her right kidney at birth was functioning at 25% which its down to 20% right now , and she has a severly dialated ureter. Why I have no idea at this point but i'm switching doctors because the one we're seeing now isn't investigating why .

 

Anyways the VCUG is not a pleasant test . My daughter has had two of them. Our hospital doesn't do conscious sedation unfortunatley . So this is not something we look forward .

 

I have had a cather in when I had my youngest and it does sting a bit going in but once its in there is no pain whatsoever after that . Anyways you can see on the xray wether they have reflux or not . If you see stuff going up then that's not a good sign , its a sign of reflux . You want stuff to go down :>)

[Barb_]

Bumping for news.

[Mamagistra]

Update here. :001_smile: