Intermittent Self-Catheterization (ISC) is a method used to empty the bladder when a person cannot urinate naturally or completely. This process involves temporarily inserting a thin, hollow tube, known as a catheter, into the bladder through the urethra to allow urine to drain out. ISC is a safe technique for managing incomplete bladder emptying, preventing complications such as urinary tract infections (UTIs) and potential kidney damage. Proper technique, often called clean intermittent catheterization, is necessary to minimize the risk of introducing bacteria. This guide is for informational purposes only and must supplement personalized instruction from a healthcare professional.
Preparation and Necessary Supplies
Gathering the correct materials ensures the procedure is clean and helps prevent infection. The most important item is the intermittent catheter, which your healthcare provider prescribes based on size, length, and tip type. Catheters may feature a straight tip or a coudé tip, which has a slight bend that helps navigate anatomical challenges like an enlarged prostate.
Many modern catheters are hydrophilic, meaning they have a special coating that becomes slick when activated by water or saline, eliminating the need for separate lubricant. If using a non-hydrophilic catheter, sterile, water-soluble lubricating jelly is required to reduce friction and trauma during insertion. You will also need antiseptic wipes or mild soap and water for cleaning the genital area, and a receptacle to collect the urine. Strict hand hygiene is the first step, requiring a thorough wash with soap and water before touching the supplies.
Step-by-Step Procedure for Insertion
The procedure begins with finding a comfortable position that allows easy access to the urethral opening. For men, standing or sitting is suitable. Women often find it easier to sit on the toilet, stand with one foot raised, or use a mirror initially to visualize the meatus. Once positioned, the next step involves cleaning the urethral meatus to reduce bacteria near the insertion site.
Cleaning the Urethral Meatus
For men, hold the penis in an upright position (60 to 75 degrees) to straighten the natural curves of the urethra. If uncircumcised, retract the foreskin. Clean the meatus with a circular motion, moving outward with an antiseptic wipe or soapy cloth.
For women, separate the labia to expose the urethral opening, which is located just above the vaginal opening. Clean the area by wiping gently from front to back, using a fresh section of the cloth or wipe for each pass.
With the catheter prepared (pre-lubricated or coated with gel), hold it a few inches from the tip and gently advance it into the urethra. Insertion should be slow and steady, using gentle but firm pressure. Resistance may sometimes be felt, especially in men as the catheter passes the sphincter.
Men typically insert the catheter 6 to 8 inches, or almost its entire length, until the tip reaches the bladder. Women have a shorter urethra and only need to insert the catheter about 3 inches, or until urine begins to flow.
Once urine starts to flow, advance the catheter another inch or two to ensure the tip is fully within the bladder. Allow the bladder to empty completely; this may be assisted by leaning forward or applying gentle pressure to the lower abdomen.
When the flow slows to a stop, remove the catheter slowly and gently. If urine flow restarts during removal, stop and wait for the flow to cease again before continuing withdrawal.
Post-Catheterization Care and Hygiene
After the catheter is removed, focus on sanitation and proper equipment management. Single-use catheters and their packaging must be disposed of correctly, typically by placing them into a plastic bag and then into household waste. This prevents the spread of bacteria and maintains a clean environment.
If a reusable catheter is prescribed, clean it immediately after use to prevent bacterial growth. Wash the catheter with mild soap and water, rinse thoroughly, and allow it to air dry completely before storing it in a clean container or bag.
Monitoring urine output is an ongoing measure; keep a record of the volume, color, and any unusual characteristics of the drained urine. Observing the urine for changes, such as increased cloudiness or a strong odor, can provide an early indication of a potential issue.
Recognizing and Addressing Common Issues
Encountering issues during the process can be concerning, but many common problems are addressed with simple adjustments. Difficulty inserting the catheter, often felt as resistance, may occur where the urethra naturally narrows or due to a temporary muscle spasm. If resistance is met, relaxing the pelvic floor muscles, changing the angle of the penis slightly (for men), or taking deep breaths can help the catheter pass smoothly with continued gentle pressure. Never force the catheter, as this can cause trauma to the urethra.
Minor discomfort or a small spot of blood on the catheter tip after removal can occur, especially when first beginning the practice, and usually signals slight urethral irritation. Ensuring sufficient lubrication and slow insertion and removal minimizes this friction. If the catheter will not drain, the tip may not be fully in the bladder, or the drainage holes may be blocked by lubricant or debris. This blockage can sometimes be cleared by coughing or waiting a moment.
Certain signs require immediate medical attention, as they may indicate a serious complication such as a urinary tract infection or significant trauma. These warning signs include:
- A persistent fever or chills.
- Cloudy or foul-smelling urine.
- Persistent or heavy bleeding in the urine.
- The inability to insert the catheter after several attempts or the inability to remove a catheter once inserted.
Persistent leakage of urine between catheterizations may signal that the bladder is not emptying completely and requires a review of technique or catheter schedule.