A man in a rollercoaster cart being chased by another cart with a bladder inside it. The track winds up and down.

The Truth About Suprapubic Catheters

Warning: this is a story about a man and his pee.

I've done everything possible to avoid a suprapubic catheter (SPC). To me, it meant "a freaking tube coming out of my belly," and that's all I needed to know.

A tube. Would be coming. Out of my belly. No thank you.

Losing my punch

Infant boys are known to squirt a parent in the eye during a diaper change. Teenagers can pee their name in the snow. I heard of a guy who proposed to his girlfriend that way.

Many years ago, my pee stream began to lose its punch, thanks to MS. I mentioned this to my neurologist, who referred me to a urologist, who gave me a pill that supercharged my stream. Cool.

As is typical with MS, the improvement was temporary. Over the next few years, my pee stream went from supercharged, to normal, to wimpy again. We added a second type of pill to the mix, just to keep things flowing. The side effects were unpleasant, but I didn't feel I had a choice.

The elephant in the bathroom

When I became a full-time wheelchair user, I stopped peeing directly into the toilet. From my wheelchair sitting position, I would fill up a little container and empty its contents into the toilet. Of course, this option is unavailable to about half of the world population.

Penis envy is supposed to be some deep Freudian construct about how girls reject their mothers and gravitate toward their fathers, but I suspect true penis envy is about a man's (undeserved) ability to aim his pee in any damn direction he pleases.

The demise of my bladder

My bladder management strategy sufficed until two problems cropped up. First, my bladder took on neurogenic characteristics. Everything would be sailing along copacetic, and then my brain would get the signal from my bladder that it was time to go, and a clock would start ticking. I would have about 30 seconds to react. Tick, tick, tick. I could usually override the urge if I had to, but it was unpleasant and probably unhealthy.

Second, my hands stopped working. Fortunately, my wife also stopped working — or at least she worked from home for the duration of the pandemic. As her return to in-person school counseling approached a few weeks ago, we had to make a decision. I accepted the inevitable and scheduled surgery to install my shiny new suprapubic catheter. FML.

Suprapubic catheter surgery

On the morning of my procedure, I enjoyed my ceremonial last pee before I would join the ranks of the incontinent who must endure tubes and bags and holes in their bodies, not to mention the indignity of it all. When I awoke from surgery, there it was, my very own SPC, as advertised. I awaited the inevitable pain in my gut from the incision and associated tunneling into my bladder. It never came. I'm several weeks out now and still waiting for the pain.

I worried about managing a storage bag on my belly, thigh, or calf — each location had its shortcomings. But we realized if I was going to be in a wheelchair all day, why not attach the bag to the wheelchair? We did, and it's inconspicuous and only needs attention two or three times a day.

Silver linings

I stopped taking all those damn pee pills, and I don't miss them one bit.

More broadly, my new plumbing system has advantages over the stock systems we are equipped with at birth. Unlike healthy people, I'm no longer burdened by the incessant need to stop what I'm doing every few hours, find a toilet, and spend time attending to my bladder. Imagine a life without that nuisance. Why do people put up with it? When will everyone want an SPC? It ranks high in my list of MS silver linings, along with handicapped parking and preferred stadium seating.

Don't be jealous; it's unbecoming.

Too much? Consider granting me this indulgence. After all, I have a freaking tube coming out of my belly.

The truth about SPCs: Pros and cons

It's still early. I haven't been through the process of a routine catheter change-out yet. I haven't had a urinary tract infection either, although it's inevitable because we have created this new interface between the outside world and my inside world, a weak spot that invading bacteria will one day exploit. I haven't had the drain hose catch on some mechanical portion of my fancy wheelchair and rip the whole works apart, spilling its "contents" all over the place.

All that aside, the truth about SPC's is that they can be life-changing, in a good way. The emptying of my bladder, a function no less vital to my existence than the circulation of blood through my body, no longer dominates my life. It's as automatic as the beating of my heart.

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