Diane Newman: Welcome. I'm Diane Newman. I'm a nurse practitioner and I specialize in the area of urology and pelvic floor dysfunction for over 35 years. I'm proud to tell you that I am the Editor of the Bladder Health Center on UroToday.com. And I have sections within that center on catheterization and bladder management for those individuals who can't empty their bladder. We have a resource center on indwelling urinary catheters, intermittent catheterization and a new one on external catheters.

What I'd like to present now is information and problems that we see in individuals who have longterm, indwelling, urinary catheters. These problems can occur with a transurethral catheter, which means a catheter that goes through the urethra or a suprapubic catheter, which goes directly into the bladder above the suprapubic bone. These are problems that many nurses and physicians deal with in these longterm patients. You'll see these patients in urology offices, in-home care, and in nursing homes.

This is about those patients where you are going to remove that Foley catheter, which is an indwelling urinary catheter, another name is a Foley catheter, and you find that you cannot deflate the balloon. What do you do? You'd be surprised how common this problem is and there are many reasons why. And I tried to put together on this presentation the problem and what action you can do to try to get that balloon to deflate.

It could be that the deflation channel is blocked. So you want to try to remove that blockage or dislodge that debris. What we have learned is that encrustations, crystallization, occur around the balloon and actually may block it or harden it. So you want to dislodge that debris and you can do that by putting in a few more drops of sterile water into the inflation channel of the balloon. I would not do more than one to two MLS. Do it with a sterile syringe and do it with sterile water and that might basically clear up that area.

You also may want to consider the fact that it could be a faulty valve or syringe. As you try to withdraw that fluid from the balloon, it could be the syringe isn't working. So go get a new syringe and try that and just do it very slowly. A lot of times, just to deflate that balloon, I will just let that syringe in place and the pressure from the balloon will actually push the water back into that syringe. You can insert the needle of a sterile 10cc syringe into the balloon drainage channel, just above the inflation valve. And sometimes if that valve is faulty, you can withdraw the water gently from that channel of the balloon.

One of the most common causes of why that balloon does not deflate is constipation or fecal impaction. I did home visits in a county in Philadelphia for 15 years in the 90s and I saw a lot of fecal impaction. I saw a lot of homebound individuals who had an indwelling urinary catheter. And sometimes what happens is literally the hard stool, that impaction, pushes on the balloon, pushes on the catheter and basically you cannot deflate the balloon. And what I've taught patients and what I've had to do is basically disimpact that individual as far as get rid of the stool and then usually the balloon will deflate.

Now say you have that patient where there's nothing you can do, well hopefully you are practicing where you have a policy that offers a procedure or a policy as far as what to do with that balloon that does not deflate. I do not recommend that you cut the inflation valve off. Also, you do not want to push too much water in that inflation valve because it can burst the balloon and you can leave fragments in the bladder and the urethra. So you don't want to burst it by over-inflating it.

What I have suggested is, again, you contact a urology referral or possibly that person may have to go to the emergency room to have further interventions as far as deflating the balloon. But what I find is that these other actions do work and I know that most nurses who are dealing with patients long term with indwelling urinary catheters find that they can, with these different maneuvers, get that balloon to deflate.