Can urinary catheters lead to incontinence. How often do catheterized hospital patients experience complications. What are the main types of urinary catheters and their uses. How to properly care for a urinary catheter. What are the potential risks and problems associated with catheter use.

Understanding Urinary Catheters: Types and Applications

Urinary catheters are flexible tubes designed to empty the bladder and collect urine in a drainage bag. These medical devices are typically inserted by healthcare professionals and can be crucial for patients facing urinary difficulties. There are two primary types of urinary catheters:

• Intermittent catheters: Temporarily inserted and removed once the bladder is empty
• Indwelling catheters: Remain in place for extended periods, secured by an inflated balloon in the bladder

While indwelling catheters offer convenience, they pose a higher risk of complications, particularly infections. The insertion process can be uncomfortable, often requiring the use of anaesthetic gel to minimize discomfort.

When Are Urinary Catheters Used?

Urinary catheters serve various medical purposes, including:

• Draining urine in cases of urethral obstruction
• Assisting urination for those with bladder weakness or nerve damage
• Emptying the bladder during childbirth with epidural anesthesia
• Facilitating bladder drainage before, during, or after certain surgeries
• Delivering medication directly into the bladder
• Managing severe urinary incontinence when other treatments have failed

The Prevalence of Catheter-Related Complications in Hospital Settings

Recent studies have revealed a concerning trend: more than half of catheterized hospital patients experience complications. This high rate underscores the importance of proper catheter management and highlights the potential risks associated with their use.

Why do so many patients face catheter-related issues? Several factors contribute to this problem:

• Prolonged catheter use
• Improper insertion techniques
• Inadequate maintenance and care
• Patient susceptibility to infections
• Underlying health conditions

Navigating the Risks: Potential Problems with Urinary Catheters

While urinary catheters are essential medical tools, they come with inherent risks. Understanding these potential complications is crucial for both healthcare providers and patients.

Urinary Tract Infections (UTIs)

The most common complication associated with urinary catheters is the development of urinary tract infections. These infections can affect the urethra, bladder, or, in severe cases, the kidneys. UTIs typically require antibiotic treatment and can lead to more serious health issues if left unaddressed.

Are long-term catheters more likely to cause UTIs? Yes, the risk of infection increases with the duration of catheter use. This heightened risk emphasizes the importance of using catheters only when necessary and for the shortest time possible.

Bladder Spasms and Discomfort

Many catheterized patients experience bladder spasms, which can feel similar to stomach cramps. These spasms can be uncomfortable and may lead to urine leakage around the catheter.

Catheter Leakage and Blockage

Improper catheter placement or maintenance can result in urine leakage, which may cause skin irritation and increase the risk of infection. Catheter blockage is another potential issue, often caused by debris or blood clots, which can lead to urinary retention and discomfort.

Urethral Damage

Long-term catheter use or improper insertion techniques can cause damage to the urethra. This damage may lead to scarring, strictures, or even more severe complications requiring surgical intervention.

The Link Between Catheters and Incontinence: Unraveling the Connection

A common question among patients and healthcare providers is: Can a catheter cause incontinence? While catheters are often used to manage incontinence, in some cases, they may contribute to or exacerbate the condition.

How might catheters lead to incontinence? Several mechanisms can be at play:

• Bladder muscle weakness: Prolonged catheter use may cause the bladder muscles to weaken, potentially leading to difficulty controlling urination once the catheter is removed.
• Urethral irritation: Catheter-induced irritation or damage to the urethra can affect its ability to close properly, resulting in urine leakage.
• Altered bladder sensitivity: Extended catheterization may interfere with normal bladder sensations, making it challenging for patients to recognize when they need to urinate.
• Psychological factors: Some patients may develop anxiety or fear related to urination after catheter removal, potentially leading to functional incontinence.

It’s important to note that while these risks exist, proper catheter management and timely removal can significantly reduce the likelihood of catheter-induced incontinence.

Catheter Care: Best Practices for Minimizing Complications

Proper catheter care is essential for reducing the risk of complications and ensuring patient comfort. Healthcare providers and patients should adhere to the following best practices:

1. Maintain strict hygiene: Clean hands thoroughly before handling the catheter or drainage system.
2. Keep the catheter secure: Ensure the catheter is properly taped or secured to prevent movement and potential urethral damage.
3. Monitor urine output: Regularly check urine color, volume, and clarity to detect potential issues early.
4. Empty the drainage bag regularly: Don’t allow the bag to become overly full, as this can increase the risk of infection.
5. Stay hydrated: Adequate fluid intake helps flush the bladder and reduce the risk of infections.
6. Perform regular catheter changes: Follow healthcare provider recommendations for catheter replacement to minimize infection risk.
7. Watch for signs of complications: Be alert for symptoms such as fever, pain, or changes in urine appearance, and seek medical attention promptly if concerns arise.

Living with a Urinary Catheter: Adapting to a New Normal

For patients requiring long-term catheterization, adapting to life with a urinary catheter can present challenges. However, with proper guidance and support, most individuals can maintain a relatively normal lifestyle.

Everyday Activities with a Catheter

Can patients with catheters engage in regular activities? In most cases, yes. Catheterized individuals can typically:

• Work in most occupations
• Exercise and participate in sports (including swimming)
• Engage in sexual activities (with proper precautions)
• Travel (with appropriate planning)

The key to maintaining an active lifestyle is proper catheter management and open communication with healthcare providers about any concerns or limitations.

Emotional and Psychological Considerations

Living with a catheter can have emotional and psychological impacts. Patients may experience:

• Body image concerns
• Anxiety about potential leaks or odors
• Frustration with the need for ongoing medical management
• Changes in intimate relationships

Healthcare providers should address these concerns and offer resources for emotional support, including referrals to support groups or counseling services when appropriate.

Alternatives to Long-Term Catheterization: Exploring Options

Given the potential risks associated with long-term catheter use, healthcare providers and patients should explore alternative options when possible. Some alternatives to consider include:

• Intermittent catheterization: This method involves inserting and removing a catheter several times a day, reducing the risk of long-term complications.
• External catheters: For male patients, external catheters (condom catheters) may be a suitable option for managing incontinence without the risks of internal catheterization.
• Bladder training: Behavioral techniques and exercises can help some patients regain bladder control and reduce reliance on catheters.
• Medications: Certain drugs can help manage overactive bladder symptoms or improve bladder emptying, potentially eliminating the need for catheterization.
• Surgical interventions: In some cases, surgical procedures may address underlying urological issues, reducing or eliminating the need for catheter use.

Discussing these alternatives with a healthcare provider can help determine the most appropriate management strategy for each individual patient.

The Future of Catheter Technology: Innovations on the Horizon

As medical technology advances, researchers and engineers are working to develop improved catheter designs and materials to reduce complications and enhance patient comfort. Some promising areas of innovation include:

• Antimicrobial coatings: Catheters with surfaces that inhibit bacterial growth may help reduce the risk of urinary tract infections.
• Smart catheters: Devices equipped with sensors to monitor urine flow, detect blockages, or alert healthcare providers to potential complications.
• Biodegradable materials: Catheters made from materials that naturally break down in the body could reduce the need for removal procedures and minimize tissue damage.
• Improved drainage systems: Enhanced designs that reduce the risk of backflow and contamination.
• Patient-controlled valves: Devices that allow patients to control urine flow, potentially improving quality of life and reducing complications.

These innovations hold promise for improving the safety and efficacy of urinary catheters, potentially reducing the high rate of complications currently observed in hospital settings.

As research continues and new technologies emerge, it’s crucial for healthcare providers to stay informed about the latest developments in catheter design and management. This ongoing education can help ensure that patients receive the most appropriate and least invasive care possible, minimizing risks while effectively addressing urinary issues.

In conclusion, while urinary catheters remain an essential tool in medical care, their use comes with significant risks and potential complications. By understanding these risks, implementing proper care techniques, and exploring alternatives when possible, healthcare providers and patients can work together to minimize catheter-related problems and improve overall outcomes. As technology advances, we can look forward to safer, more comfortable catheter options that may further reduce the incidence of complications and enhance quality of life for those requiring urinary management.

Urinary catheters – NHS

A urinary catheter is a flexible tube used to empty the bladder and collect urine in a drainage bag.

Urinary catheters are usually inserted by a doctor or nurse.

They can either be inserted through the tube that carries urine out of the bladder (urethral catheter) or through a small opening made in your lower tummy (suprapubic catheter).

The catheter usually remains in the bladder, allowing urine to flow through it and into a drainage bag.

When urinary catheters are used

A urinary catheter is usually used when people have difficulty peeing (urinating) naturally. It can also be used to empty the bladder before or after surgery and to help perform certain tests.

Specific reasons a urinary catheter may be used include:

• to allow urine to drain if you have an obstruction in the tube that carries urine out of your bladder (urethra). For example, because of scarring or prostate enlargement
• to allow you to urinate if you have bladder weakness or nerve damage that affects your ability to pee
• to drain your bladder during childbirth if you have an epidural anaesthetic
• to drain your bladder before, during or after some types of surgery
• to deliver medicine directly into the bladder, such as during chemotherapy for bladder cancer
• as a last resort treatment for urinary incontinence when other types of treatment have been unsuccessful

Depending on the type of catheter you have and why it’s being used, the catheter may be removed after a few minutes, hours or days, or it may be needed for the long term.

Types of urinary catheter

There are 2 main types of urinary catheter:

• intermittent catheters – these are temporarily inserted into the bladder and removed once the bladder is empty
• indwelling catheters – these remain in place for many days or weeks, and are held in position by an inflated balloon in the bladder

Many people prefer to use an indwelling catheter because it’s more convenient and avoids the repeated insertions needed with intermittent catheters. However, indwelling catheters are more likely to cause problems such as infections.

Inserting either type of catheter can be uncomfortable, so anaesthetic gel may be used on the area to reduce any pain. You may also experience some discomfort while the catheter is in place, but most people with a long-term catheter get used to this over time.

Read more about the types of urinary catheter.

Looking after your catheter

If you need a long-term urinary catheter, you’ll be given detailed advice about looking after it before you leave hospital.

This will include advice about getting new catheter supplies, reducing the risk of complications such as infections, spotting signs of potential problems, and when you should get medical advice.

You should be able to live a relatively normal life with a urinary catheter. The catheter and bag can be concealed under clothes, and you should be able to do most everyday activities, including working, exercising, swimming and having sex.

Read more about living with a urinary catheter.

Risks and potential problems

The main problems caused by urinary catheters are infections in the urethra, bladder or, less commonly, the kidneys. These types of infection are known as urinary tract infections (UTIs) and usually need to be treated with antibiotics.

You can get a UTI from using either a short-term or a long-term catheter. However, the longer a catheter is used, the greater the risk of infection. This is why it’s important that catheters are inserted correctly, maintained properly, and only used for as long as necessary.

Catheters can also sometimes lead to other problems, such as bladder spasms (similar to stomach cramps), leakages, blockages, and damage to the urethra.

Read more about the risks of urinary catheterisation.

Page last reviewed: 03 February 2023
Next review due: 03 February 2026

The Hidden (And Not-So-Hidden) Dangers Of Treating Incontinence With Urinary Catheters

This is the second in a 3-part series on urinary incontinence in men suffering with benign prostatic hyperplasia. Dr. Richard Roach, of Advanced Urology in Oxford, FL, discusses the challenges of using urinary catheters to treat men with BPH-related incontinence, and the drawbacks of long-term catheterization.  

In my last BHEALTH blog post, we touched on the peculiar, yet common link between BPH and incontinence. Among other topics, we reviewed the progression of BPH disease state, to the point that symptoms begin to manifest themselves through urge and stress incontinence. Likewise, we also discussed the role that urinary catheters play in men who are not good candidates for BPH therapies.

So let’s now take a closer look at this population of men who must rely on urinary catheters to manage BPH-related incontinence symptoms, and examine the shortcomings of long-term catheter use:

Losing the ability to void naturally

The first (and most obvious) drawback of chronic catheter use is losing the ability to urinate at-will. Of course, managing supplies and components can be a hassle, but there are also health concerns associated with preventing your bladder to fill and empty on its own. Chronic catheterization, particularly with an indwelling catheter, can increase the risk for deterioration in overall bladder health, which can lead to a permanent inability to store and drain urine naturally, or even cancer.

Heightened infection risk

Perhaps the most immediate health concern with chronic catheter use is the heightened risk of infection. According to the Centers for Disease Control, more than 500,000 patients each year in the U. S. develop urinary tract infections (UTIs) while in the hospital, and indwelling urinary catheters (commonly known as Foley catheters, which reside inside the bladder for either a short or long period of time) are the leading cause. And the CDC numbers only count UTIs acquired while in the hospital; many others develop infections from long-term indwelling catheter use at home.

Compromises to quality of life

The last, but no less important, drawback of chronic catheter use is the impact on quality of life. Many men are simply unable to perform day-to-day activities inside and outside the home. The embarrassment or inconvenience of a drainage bag is a commonly lamented life-limiter, and some types of catheterization restrict a man’s ability to be sexually active, which can strain relationships.

These challenges represent the key reasons that healthcare professionals around the world are seeking alternatives to long-term catheter use. And though it’s not always feasible to have a catheter removed, it’s important to point out that there are alternatives to long-term catheterization.

The final post in this series will highlight the story of one such patient who stopped using a catheter after several challenge-fraught years, and gained back his ability to urinate when he wanted to – without components or supplies, without infections and (most importantly for him) without any significant compromises to his everyday life.

Read part 3 of this series here.

Dr. Richard Roach attended the University of Wisconsin-Madison Medical School and completed his residency at the University of Wisconsin-Madison Hospital and Clinics. After graduation, Dr. Roach moved to Minocqua, Wisconsin and joined the Marshfield Clinic, where he practiced for the next 26 years. In 2013, he moved to Florida and is currently a partner in Advanced Urology Institute. He is certified by the American Board of Urology. His specialties include plasma vaporization for BPH, treatment of female stress incontinence and penile prosthesis for ED. He is also an expert in laser & laparoscopic surgery.

Urinary incontinence: causes and treatments

How rehabilitation can help with urological problems

The topic of urinary incontinence is considered taboo, many are ashamed of the problem and put off visiting a doctor. At the same time, incontinence negatively affects important aspects of life – from the emotional state to the ability to leave the house and travel.

There are various causes of incontinence, such as post-surgery stress, stroke, spinal cord injury, and other nervous system disorders. In this text, we will analyze in detail the causes of incontinence, as well as effective methods of treatment and rehabilitation.

Causes and risk factors for urinary incontinence

One of the most common risk factors for urinary incontinence is older age. Women over 60 report daily urinary incontinence in the range of 9% to 39%, men over 65 experience this problem half as often – from 2 to 11%. Urinary incontinence in the elderly is statistically associated with a decrease in strength and overall muscle tone, especially in the pelvic floor muscles.

Regardless of age and gender, the risk of urinary incontinence is increased in people with diabetes and overweight. For young women, childbirth, gynecological and infectious diseases can become an additional risk factor – from 7 to 37% of women aged 20 to 39have been reporting this issue for years.

Urinary incontinence may be due to a stroke. In 32-79% of patients, incontinence occurs upon admission to the hospital and in 25-28% remains at discharge.

Normally, in order to prevent leakage of urine, the sphincters (valve muscles) of the urethra should be closed during the accumulation of urine in the bladder, and the bladder muscle should be relaxed.

When the bladder is full, signals from the bladder are transmitted to the spinal cord and then to the brain, after which the response signals follow the same path, causing the bladder to contract and the sphincters to open. As a result, urine flows out of the bladder.

Frequent urination after a stroke is associated with an overactive bladder muscle, which occurs due to impaired communication between the central nervous system and the bladder. Risk factors for urinary incontinence: paresis (decreased strength in any part of the body), depression, cognitive impairment, age over 75 years, dysphagia (impaired swallowing), loss of visual field and a large area of ​​\u200b\u200bbrain damage (lesion of the cortex and subcortical region) .

“Recently, a patient came to our clinic after a stroke with frequent false urge to urinate and episodes of urinary incontinence day and night,” says Ivan Kolbin, a neurourologist at the Three Sisters Clinic. – Before each physical therapy session, the patient goes to the toilet because he is afraid that involuntary urination will occur during the exercises. At night, a man does not get enough sleep, as he wakes up at least four times because of the desire to go to the toilet. All this greatly affects his quality of life and emotional state. But this is solvable. If you choose the right therapy, then after 2-3 weeks the symptoms will go away or significantly decrease.

The main functions of the bladder – the accumulation and excretion of urine – are also impaired in spinal cord injuries. It is not uncommon for patients with spinal cord injury to stop feeling bladder fullness and the need to urinate. It is also likely that the person will not control the work of the sphincter of the urethra.

“If the patient has damage at the cervical or thoracic level, then frequent urination and urinary incontinence is associated with a spastic bladder that does not hold urine when filled. Although the signals between the bladder and the spinal cord are passing, the signals between the brain and the bladder have disappeared, so the person does not feel the fullness of the bladder and cannot control urination. The bladder muscle and urethral sphincter in this case are hyperactive, in addition, the joint work of these muscles is disrupted, says Ivan Kolbin. – In patients with lesions at the lumbar or sacral level, the situation is the opposite: the tone of the bladder is reduced, there are no contractions, the bladder gradually overflows and incontinence from overflow occurs. Failure to completely empty the bladder can lead to problems. Temporary placement of a urethral catheter is recommended in these patients to avoid overdistension of the bladder and prevent urinary tract and kidney complications.”

Temporary placement of a urethral catheter is recommended for these patients to avoid overdistension of the bladder and complications of the urinary tract and kidneys

a number of other cases.

“Prolonged use of a catheter sometimes causes a nosocomial infection that can contribute to urinary incontinence. Hygiene and regular intermittent catheterizations are important to avoid inflammation of the urinary tract, because the longer urine remains in the bladder, the more likely bacteria will multiply and cause inflammation. It is also important that the bladder is completely emptied and that there is no residual urine left in it, which contributes not only to inflammation, but also to the formation of stones. An indwelling catheter should be changed regularly. During catheterization, it is important not to damage the urethra, as this also creates the prerequisites for inflammation.

Urinary incontinence, in both men and women, can be stressful. Stress incontinence in women is more often associated with birth injuries, hormonal disruptions, and surgeries. In men, stress incontinence in most cases occurs after a prostatectomy (surgery to remove all or part of the prostate for prostate cancer) and after a transurethral resection (surgery for a benign prostate tumor).

Incontinence after prostatectomy is also due to the fact that when the prostate gland is cut off from the urethra, its back wall is partially damaged. The function is restored, as a rule, within 6 months after the operation. The number of patients with persistent urinary incontinence after surgery can reach 11.9%.

Treatment and rehabilitation

Pelvic floor training

Regular exercise is said to make the pelvic floor muscles stronger and stronger. Classes are held under the supervision of a doctor or with a smartphone, which tell the patient when to contract muscles and when to relax. It takes an average of 20 weeks to achieve results.

Kegel exercises help strengthen your pelvic floor muscles. But they are not shown to everyone. For example, in men after a stroke, mostly neurogenic damage occurs, in which drug therapy is sufficient. Muscle tone is more likely to decrease in women, especially with additional risk factors such as childbirth.

Electrical stimulation

This method is effective for men with urinary incontinence after prostatectomy.

Electrical stimulation (ES) activates the pudendal nerve. This causes the pelvic floor muscles to contract and also keeps the urethral sphincter closed and reduces the urge to urinate.

Electrical stimulation can be anal – when a special probe is inserted into the anal canal, as well as percutaneous – when overhead electrodes are placed (for example, on the hamstring or in the sacrum).

Extracorporeal magnetic innervation

This technique is effective in the complex treatment of urinary incontinence and works on the same principle as MRI: a device that is built into the seat of the chair creates a magnetic field. Next to the chair is a power supply unit with which the doctor can adjust the strength of this field. The doctor selects an individual dose of magnetic radiation for the patient, which improves the conduction of the nerve impulse and stimulates the contraction of the pelvic floor muscles. Unlike anal electrical stimulation, this method causes less discomfort for the patient.

General advice for patients with urinary incontinence

It makes sense to consult with your doctor about some aspects of your life. Perhaps he will advise:

• Limit fluid intake, drink in doses (no more than 200 ml of water at a time), drink less after 18:00, and also empty the bladder before bedtime so as not to get up at night and get better sleep.

“These are temporary restrictions,” says Ivan Kolbin. “Once the bladder again accumulates and holds a large portion of urine, you can return to the usual way of life.”

• Avoid excessive consumption of caffeinated, alcoholic and carbonated drinks.

“Caffeine stimulates urination even in patients without neurogenic disorders and stroke. Therefore, it is better for patients with urinary incontinence to limit coffee and, if there is such a need, drink it in the morning. If the patient himself notes the relationship between the intake of caffeinated drinks and incontinence, then it should be completely excluded, ”Ivan Kolbin.

• Do physical exercises to strengthen the muscles of the pelvic floor.

“The intensity of exercise depends on the condition of the patient. In most cases, Kegel exercises are enough to do 30 sets 3 times a day, ”- Ivan Kolbin.

• Watch your weight – Being overweight can put pressure on your bladder and make you want to urinate.

The experience of the Three Sisters clinic in helping people with difficult urination

Patients with urinary incontinence are most often admitted to the Three Sisters Clinic after a stroke and spinal cord injury. In these cases, rehabilitation specialists work with them to strengthen the muscles of the pelvic floor. For example, Kegel exercises are recommended. The doctor supervises the exercises and teaches the patient to do them on their own so that they can continue exercising at home after discharge.

The main goal of rehabilitation is to regain control of urination and urinary retention. It is important that urination is voluntary and the patient, depending on the severity of the violation, has time to get to the toilet or other auxiliary means of rehabilitation.

If a person is holding urine, then the next goal is to increase the intervals between urination and work on control. For example, if an urge appears, the patient needs to learn how to hold urine so as not to interrupt the session and not immediately run to the toilet. The quality of rehabilitation and life in general depends on this.

Physicians also prescribe medication individually:

• Alpha-blockers, which are recommended for men because they help relax the sphincters and the prostate gland. This allows urine to pass freely, and alpha blockers also help reduce the pressure in the bladder that occurs when urine passes.

• In addition to alpha-blockers, botulinum toxin preparations can be used to relax the bladder and sphincters. This method helps to reduce spasticity and hypertonicity of the bladder.

• Anticholinergic drugs are given to people using intermittent catheterization. Anticholinergics relax the bladder and prevent contractions in the bladder muscle fibers that can cause urinary incontinence.

Text author: Polina Fomintseva, medical journalist, graduate of the School of Modern Journalism of the European University in St. Petersburg

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What to do after removing a catheter for prostate surgery

This information will help you know what to do after removing your catheter for prostate surgery.

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What to do after prostate surgery

Control urinary problems

Your bladder and urethra will be weak for 2 days after your catheter is removed. Don’t try to push while urinating or force yourself to urinate. Let the urine come out on its own. Do not strain when emptying your bowels.

Limit your daily fluid intake to 4-6 glasses (8 ounces or 240 ml) of fluid per day. This will help reduce urine leakage. If you are leaking urine, limit the amount of alcohol and caffeine you drink.

Limit fluids after 7:00 pm and empty your bladder before bed. This will help you avoid having to get up at night to urinate.

You may notice blood or blood clots in your urine for several weeks after your catheter is removed. This is because the incisions (surgical cuts) inside your body heal, and the crusts that form on them are excreted in the urine. If you notice blood in your urine, drink more fluids until your urine clears. If there is still blood in the urine after 24 hours, call your surgeon.

Do Kegel exercises

Start Kegel exercises (pelvic floor exercises) 3 days after catheter removal. Discuss with your healthcare provider which exercises are safe for you. For more information, read the resource Pelvic Floor Exercises (Kegel Exercises) for Men.

Take your medication

Finish your antibiotics.

Get your results

Results will be available approximately 10 business days after surgery. Call your doctor for results.

Schedule prostate specific antigen (PSA) blood tests

Do a PSA blood test according to the following schedule:

• 6–8 weeks after surgery;
• 3–6 months after surgery;
• 12 months after the operation.

After 12 months of surgery, have your blood tested for PSA every 6 months. With this frequency, the analysis should be performed within 5 years after surgery.

After 5 years of surgery, have a PSA blood test every 12 months. It is recommended to perform throughout life.

Your doctor may ask you to test your PSA blood more often.
In this case, the nurse will provide you with additional information.

Get your PSA blood tested at MSK if possible. If this is not possible, you can contact the health care center at your place of residence. Ask for the results to be faxed to your doctor at MSK.

Follow your sexual activity plan

Talk to your health care provider about when it is safe for you to resume sexual activity after your procedure.

You can start your erection medication on the evening of the day your catheter is removed. You may need to take one of these medicines daily for up to 1 year after surgery. Discuss with your surgeon how long you will need to take these drugs.

Your doctor or nurse will give you information about your medication schedule. Follow this schedule until your post-op appointment with your surgeon.

The following are options for this schedule:

Bolting dose information

Bolting dose is the maximum dose of the drug. This is most likely the dose needed to achieve an erection (the hardening of the penis needed for intercourse). When you take a loading dose, take it on an empty stomach (on an empty stomach). Drink the medicine about 2 hours before dinner.

The medicine starts working after 30-60 minutes. Its effect will remain in the body for up to 8 hours. At any time during these 8 hours, try to achieve sexual arousal from contact with a partner or from self-stimulation. Write down what happened and tell your doctor about it at your next appointment.

If you haven’t had an erection after 4 weeks of loading dose, call your doctor. He can refer you to our sexual health specialists.

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When to call your surgeon

Call your surgeon immediately if you have:

• there was a strong (very strong) pain in the lower part of the abdominal cavity (belly) when urinating;
• no urination.

These symptoms may indicate that the catheter needs to be reinserted. If you are unable to come to MSK, you can have a catheter placed at your local urologist or at the nearest emergency room.