About the author
Jasmine King is a urology nurse specialising in benign urological conditions. She has a special interest in Ketamine and it’s effects on the bladder.
Ketamine’s impact on bladder health
An unexpected crisis is unfolding in urology clinics nationwide as more young adults grapple with bladder issues tied to their recreational Ketamine use.
Ketamine has increased in popularity since the rave scene of the 1990s when it earned the party drug nickname. It gives users a quick high, is relatively cheap, and easy to get hold of. It can be injected, snorted, smoked or swallowed, and is a Class B drug.
Users report a ‘floating, out-of-body’ experience, but the effects are often short-lived as tolerance to the drug quickly develops. This forces users to seek larger and more frequent doses before they can experience the same effects. It also has the reputation of being a ‘safe drug’ because the side effects aren’t widely known.
Ketamine Bladder
The symptoms younger people are presenting with include nausea and vomiting, palpitations, dizziness and gastrointestinal, bladder and liver problems.
The trouble is that these symptoms of recreational drug use are not always recognised by healthcare professionals. They can often be misinterpreted as an infection or interstitial cystitis.
Such patients are frequently treated with numerous courses of antibiotics before being referred to urology specialists. All the while, their continued use of ever larger doses of Ketamine means that, at some point, they cross a threshold and cause themselves significant and irreversible damage. We don’t currently know whether it’s the duration of use, or dosage, that is causing the problem.
Ketamine is excreted via the bladder, where it sits, and is toxic to the surrounding cells and the muscle wall. This causes it to become fibrosed over time, shrinking the organ down.
Once that’s happened, it can’t regrow, so that’s why we have to do major surgery, because patients just don’t have the capacity to hold urine. The bladder simply stops working as a muscle, so they become incontinent.
Life becomes increasingly difficult for patients with Ketamine Bladder who describe needing to rush to the toilet all the time; as often as every 10 minutes for some. They report feeling that their bladder never feels empty, and they’re experiencing pelvic and loin pain, among other symptoms.
Key aspect of management
Many patients presenting with Ketamine Bladder are in their early 20s and have been taking the drug since they were teenagers. If symptoms are spotted early enough, then the extensive damage can often be avoided. But the most important course of action is to stop taking the drug as quickly as possible to protect the upper tract, kidneys and ureters.
We can’t do anything medically if people won’t give Ketamine up, so we refer them to the Bristol Drugs Project for help. Once they’ve stopped, then they can start offering treatment. If it progresses too far, then all we have to offer is major surgery – cystectomies and urostomies, as well as ureteric implantation if their ureters are affected.
Psychological support
Patients in Bristol are supported by a multi-disciplinary team comprising a urologist, nurse, pain specialist, toxicologists and drug support workers.
They are also trying to bring a clinical psychologist on board who can support patients to process what it will be like wearing a bag for the rest of their lives. Such news is going to distressing for many young patients as they realise that this is going to be life-long. It’s not what they’re expecting – they didn’t know, when they started taking Ketamine so young, that it would affect their bladder.
Psychological support is particularly important as younger patients are less likely to want to talk to others; they’re just too embarrassed, and they’re not sure that life will ever be the same again.
Raising awareness
Raising awareness is high on the Bristol team’s agenda. Health care professionals need to be more aware that Ketamine Bladder is a problem, and to talk to patients about their drug use in a way which is non-judgemental.
Younger people too need to be made aware about the dangers of Ketamine and the potential long-term impact, just as they grow into adulthood and prepare for the lives ahead of them.
- Jasmine recently shared her valuable insight into Ketamine Bladder at our World Ostomy Day webinar. You can see the recording in our video library here.