What is it?
A simple and safe procedure of inserting a well lubricated clean tube known as a catheter along the urethra (drainage channel), and into your bladder. This allows you to drain urine from your bladder at regular intervals.
Why is it done?
This procedure is most often called for in patients who, either temporarily or long term, have the inability to completely empty their bladder of urine. By intermittently inserting this soft drainage tube into the urethra to empty the bladder you will prevent the bladder muscle becoming damaged, and prevent your urine flowing back up to the kidneys.
How often will I need to perform this?
The amount of times it is necessary to drain the bladder varies from person to person. It can depend on how well your bladder empties and how much urine is left behind (residual urine). Your doctor will advise you about your individual plan.
Will I get an infection?
Intermittent self catheterisation is performed using a clean but non sterile technique. Bacteria may still enter the urine, this is called bacteruria, which is different from a urinary tract infection. A urinary tract infection is where the bacteria multiply and infect the bladder wall or even the kidneys, which can cause pain and fever. By regularly catheterising and emptying the bladder completely you will reduce the risk of developing a urinary tract infection. However there is still a small risk. If there is a need for the periodic use of antibiotics to help prevent an infection, Your doctor will advise you accordingly.
Why not leave the catheter in there?
Placing a permanent indwelling catheter can increase the risk of more serious infections and can cause scarring of the urethra (bladder drainage tube). They can be uncomfortable to wear and generally have a drainage bag attached. Intermittent self catheterisation is the preferred method for emptying the bladder. If your bladder is able to return to complete emptying, intermittent catheterisation is a more successful technique for promoting the normal bladder filling and emptying cycle. It is more effective than an indwelling catheter or ongoing poor bladder emptying. Intermittent catheterisation does not interfere with sexual activity.
Where should I perform the catheterisation?
You can decide on the most suitable place to catheterise yourself. Many people do it on the toilet while others do it in the privacy of their bedroom.
I’m not sure if I can do this?
It is quite natural to initially be concerned that you “will not be able to do it” however, after reading over the instructions and after assistance and instruction by our trained staff in the performance of this procedure you will become quite skilled at self catheterising safely and easily. A wide range of people of all ages from around the world intermittently self catheterise their bladder every day.
Where do I get my supplies from?
Catheters and lubricating jelly are often available at well stocked pharmacies or medical supply wholesalers. Call ahead to make sure the supplies you require are in stock. Supplies can be obtained in person, by telephone, fax, email or even ordered over the internet. Some examples of local suppliers are found under Catheters, Pads and Continence Aids.
What equipment will I need?
Clinic nurse to enter details after assessment
Lubricating jelly should be used liberally and must always be water based. Never use a petroleum based lubricant such as Vaseline. One of the most commonly used water based lubricants is KY jelly.
Women may find a mirror helpful, especially to begin with
Cottonwool balls, wipes or towelettes. Soap and water
Unperfumed soap is less likely to cause skin irritation
You may be asked to measure how much urine you pass before catheterising, then measure the urine drained with the catheter.
A zip-lock bag or travel toothbrush container is adequate to store your equipment
Okay, how do I do it?
• Wash your hands well with soap and water
• Lay out and prepare your equipment on a clean dry surface
• If instructed to do so, try to pass urine first (if you are keeping a diary, you may need to measure this urine)
• Intermittent catheterisation can be performed in several positions either, standing, sitting, squatting or lying down.
• Position yourself on the toilet seat, wheelchair, or bed, whatever position provides the most comfort. Some people sit on the toilet and lean back, while others are more at ease squatting or standing with one leg on the toilet or bath.
• Place a collection container between your legs if you are using one
• Remove catheter from packaging. Do not handle the end that enters the bladder.
• Lubricate the catheter, if necessary, from the tip extending back about 2-3 inches or 5- 7.5cms. (some catheters are self lubricating)
• Spread the labia apart with the second and fourth fingers of your left hand if you are right handed, (or right hand if you are left handed)
• Cleanse the urethral opening using a downward stroke, front to back, with a cotton ball soaked with soap and water, or cleansing wipes.
• You may use a mirror to locate the urethral opening at first, but it is recommended you learn to catheterise without the mirror, by feel. This means you will need to carry less equipment with you and therefore be more independent
• The urethra is located just in front of the vagina. A finger located at the opening to the vagina can act as a guide so that you insert the catheter just in front of this.
• With the catheter in your right hand (or non dominant hand) insert the catheter gently into the urethra upwards and backwards, approximately 2 inches or 5cms until urine flows.
• Advance the catheter another one inch or 2.5cms
• Empty the bladder completely
• Slowly rotate and begin to withdraw the catheter. Stop each time more urine drains.
• When you are sure the bladder is empty, gently remove the catheter.
• If you are lying down you can pinch off the end of the catheter to prevent leaking from the catheter tip as the catheter is withdrawn.
• If you have been requested to, measure your output and note the amount of urine before discarding it.
• Wash your hands well. Use a soapy lather to wash the catheter. Rinse it well.
• If using a disposable catheter place in a plastic bag for disposal
• Manufacturers recommend catheters for single use only, however if you choose to reuse your catheter cleanliness is very important
• Run tap water through the catheter then allow it to air dry on a paper towel
• Store it in a clean container where it can be easily located for its next use. Always carry a catheter and lubricant with you when you are away from home
• An option to cleaning after each use is to soak the catheter in a solution of 1 part vinegar to 3 parts tap water, to dissolve urine crystals which may have formed on the catheter. The solution needs to be freshly mixed each time
• A catheter should be discarded after one week or when it begins to lose flexibility or becomesrough or discoloured, whichever occurs first.
Signs of urine infection include a frequent and urgent need to pass urine or pain or burning when passing urine. The urine may look cloudy instead of clear, or have blood in it. It may also have an offensive smell. Other signs of infection could be a general feeling of being unwell, headaches and having a temperature. If you suspect you have a urine infection, you should arrange for a urine test and you may be given antibiotic medication to treat this. Remember to drink plenty of fluids- at least 6-8 glasses of non caffeine drinks per day. (If you have a heart condition please discuss fluid intake with your doctor first.)
Do not stop catheterizing. It is better to drain the infected urine from your bladder than to leave it there.
It is not uncommon when you start to perform self catheterisation to see a small amount of blood either in the urine or on the end of the catheter. This should normally stop within a few days. You should contact a doctor if the bleeding is heavy or doesn’t resolve within 2-3 days, if there are blood clots in the urine, or if the urine looks like red wine.
Pain or Soreness
Intermittent self catheterisation should not be painful and most people have minimal discomfort when performing this procedure. It is not uncommon to experience some pain or discomfort the first few times, sometimes a local anaesthetic of lubricating gel may help. eg. lignocaine gel. Occasionally discomfort and resistance are due to a tightening of the pelvic floor muscles around the urethra. It may help to relax and give a little cough as you insert the catheter. Pain can also be a sign of infection, if pain persists and or there is bleeding when you take the catheter out, seek medical advice.
A urethral stricture is a narrowing of the urethra caused by a scar. Self catheterisation may contribute to these in the long term but generally only if there has been a traumatic insertion. Self catheterization can also be used in the treatment of strictures to prevent them from recurring. If you experience pain, resistance and bleeding when trying to insert your catheter you should not proceed and contact your doctor.
Avoid constipation by drinking 6-8 glasses of water daily and include fruit and vegetables in your daily diet. Being constipated can make it difficult for the urine to drain from the bladder, if you need help with managing constipation please let your nurse or doctor know.
If you are traveling abroad and are in doubt about the quality of the water in the country you are visiting, it is recommended you use bottled water for washing yourself and your catheter. Remember to take enough supplies of catheters and any other equipment you need. These are best taken in your hand luggage incase your suitcase is mislaid.
Version: V3, July 2017