GP Stories - Blocked Catheter

 Doing a weekly ward round at a nursing home is interesting that you get to see people in their home and you get to see them very regularly. You tend to remember the patients a lot better and generally build a better relationship because of it. Because of that, you can tend to talk to the residents a lot less formally than you may do a regular patient.

I had a elderly man who had a long term catheter whom i was seeing regularly for his skin ailments on his legs. The catheter was due to him not being able to pass urine freely, so it wasn't going anywhere. It normally was getting changed 6-7 weeks by the district nurses but more recently it was needed to be changed several times a week. The nurses at the home had an idea what was causing it however they felt they couldn't broach it with the patient. Every day after lunch, the patient was given 'alone' time with himself and his iPad and then following that, the nurses noticed cloudy sediment within the tubing and bag of the catheter, and invariably the catheter would need to be changed soon after. They tried flushing the tube with normal saline but even then it would still block. Some of the nursing home staff wondered if they should restrict his alone time, but I told them that was not right and he is entitled to his privacy, even if it blocks up his catheter. 

None of the nursing staff could bring themselves to explain their thoughts when the patient asked why it kept blocking so he asked for me to try explain it.

Next nursing home round, the head nurse and I came to see him at the bedside. He asked 

"Why does my catheter keep blocking? They are changing it every few days when it used to least several weeks? Its very inconvenient let alone quite uncomfortable every time!" 

"So.... there are a few reasons why a catheter may block, infections, sediment, stones. In your case, I believe some extra fluid is getting in the tube and blocking it." 

I let him consider that and was hoping he would get it and move on. Sadly he persisted. 

"I don't get it, how is extra fluid getting into the tube?"

"You know the time the nurses give you alone, it seems the extra fluid comes after those times..." Letting it trail off into awkward silence. He looked at me puzzled.

I asked the nurse to leave the room.

"Your ejaculate is blocking the tube." is the medical translation of what I told the man, I just used more lay-person language. He got the jist of what I was saying when I put into terms he could understand. He said he'd try alert the nurses as soon as he was done with his alone time, but would accept the frequent catheter changes if need be.

It's interesting that blocked catheters are invariably an issue that we learn about, but this particular (likely common) cause is never really mentioned in the textbooks. Maybe there is a medical term for it that I don't know about it, if there is, please enlighten us, I would be interested.