Intermittent self-catheterization (ISC) is a method of emptying the bladder by temporarily inserting a thin, hollow tube, called a catheter, through the urethra. This procedure is typically necessary when conditions such as a spinal cord injury, certain neurological disorders, or urinary retention prevent the bladder from emptying completely on its own. ISC allows a person to drain urine at regular intervals throughout the day, which helps maintain bladder health and prevents complications like urinary tract infections or potential damage to the kidneys. While this article serves as a general guide, a healthcare professional must teach the specific technique and schedule tailored to individual needs.
Essential Supplies and Preparation
Before beginning the catheterization process, gathering all necessary items ensures a smooth and hygienic procedure. The prescribed catheter is the most important tool. Catheters can be non-coated, pre-lubricated, or hydrophilic; the latter two are designed to be slippery upon contact with water or are ready to use directly from the package. If a non-coated catheter is used, a sterile, water-based lubricating jelly is required to coat the tip and the first several inches of the tube to minimize friction. Petroleum-based products should never be used as they can damage the catheter material and irritate the urethra.
Thorough hand hygiene is the first and most important preparatory step to reduce the risk of introducing bacteria into the urinary system. Hands should be washed with soap and water for at least 20 seconds, or an alcohol-based hand sanitizer can be used if a sink is unavailable. Once hands are clean, all supplies, including antiseptic wipes or soap and water for cleaning the meatus, should be placed within easy reach. A collection container or a toilet must also be accessible to receive the draining urine.
The final step involves cleansing the area around the urethral opening, also known as the meatus. This cleaning should be done with mild soap and water or an antiseptic towelette, wiping from front to back to prevent contamination from the rectal area. For uncircumcised males, the foreskin must be retracted before cleaning the tip of the penis. Maintaining this clean field minimizes the introduction of germs during insertion.
Step-by-Step Guide to Self-Catheterization
Male Catheterization Technique
The male technique begins with finding a comfortable position, which may involve sitting on the toilet, standing in front of it, or sitting in a wheelchair. The penis should be held gently but firmly, aiming it upward toward the abdomen at an angle of approximately 90 degrees. This positioning straightens the urethra’s natural curve, helping the catheter pass through the urethra without encountering unnecessary resistance.
The lubricated catheter tip is then inserted slowly and gently into the meatus. Insertion continues with steady, non-forceful pressure until urine begins to flow, indicating the catheter has reached the bladder. At this point, the angle of the penis should be lowered toward the floor to facilitate drainage into the toilet or collection container. The catheter is typically advanced another one to two inches after the initial flow begins to ensure both drainage eyes on the tip are fully inside the bladder.
The catheter must be held in place until the flow of urine completely stops, which may require gently bearing down or changing position slightly to ensure full bladder emptying. Once the bladder is empty, the catheter is removed slowly and gently. Some find it helpful to pinch the catheter just before complete removal to prevent any residual urine inside the tube from leaking out.
Female Catheterization Technique
For females, finding a position that allows for easy access and visibility of the urethral opening is important, such as sitting on the toilet, standing with one foot on a stool, or lying down with knees bent. Using a mirror can be particularly helpful, especially during the initial stages of learning, to accurately locate the meatus, which is situated just above the vaginal opening. The labia are parted using the index and middle fingers of the non-dominant hand to expose the urinary opening.
The lubricated catheter is then inserted into the meatus with the dominant hand. It is important to avoid accidentally inserting the catheter into the vagina; if this happens, the catheter must be discarded, and a new, clean one used for the correct insertion attempt. The catheter is advanced slowly until urine begins to flow, indicating entry into the bladder.
Once urine flow is established, the catheter is advanced approximately half an inch to one inch further to confirm the drainage holes are fully within the bladder cavity. The bladder must be allowed to drain completely, which may be assisted by gentle pressure on the lower abdomen or by shifting position. After the urine stops flowing, the catheter is withdrawn slowly and smoothly.
Recognizing and Addressing Complications
The most common complication associated with intermittent self-catheterization is a urinary tract infection (UTI), which occurs when bacteria enter the urinary system. Symptoms of a UTI can include a burning sensation during urination, cloudy or foul-smelling urine, and an increased urgency or frequency to empty the bladder. Systemic signs like fever, chills, or pain in the lower back may indicate a more serious infection and require immediate medical attention.
Difficulty inserting the catheter is a common procedural challenge that can be caused by muscle spasm or temporary blockage. If resistance is felt, a person should never force the catheter, as this can cause urethral trauma, including the formation of a false passage. Instead, taking a deep breath and relaxing the pelvic floor muscles, or slightly adjusting the angle of the catheter, may allow for a gentle insertion. If multiple attempts fail and the bladder remains full, stop the procedure and contact a healthcare provider.
Minor issues like slight bleeding or discomfort are not uncommon, particularly when first starting ISC or if the catheter is not adequately lubricated. Small amounts of blood on the catheter are usually not concerning unless the urine itself appears red or pink, or if the bleeding is heavy or persistent. Any instance of persistent pain, inability to pass urine after several attempts, or the appearance of fever or large amounts of blood warrants a call to the healthcare provider for guidance and possible intervention.