Intermittent self-catheterization (ISC) is a medical technique that allows individuals to empty their bladder using a thin, flexible tube called a catheter. This procedure is commonly prescribed for chronic urinary retention—the inability to completely empty the bladder—or for managing overflow incontinence. ISC is considered a safe and effective long-term solution when performed correctly, helping to protect the bladder and kidneys from damage caused by retained urine. A healthcare provider will always provide personalized training and determine the necessary schedule for optimal bladder management. Learning this skill offers greater independence and helps prevent complications like recurrent infections.
Essential Preparation and Required Supplies
Gathering the necessary supplies and maintaining meticulous hygiene are the most important preventative steps. Required items include the prescribed intermittent catheter, a water-soluble lubricating jelly (if the catheter is not pre-lubricated), a receptacle like a toilet or a collection container, and mild soap and water or antiseptic wipes for cleansing.
Start by thoroughly washing your hands with soap and water for at least 20 seconds to minimize bacteria transfer. Next, the genital area must be cleaned to reduce the microbial load near the urethral opening. For those using a non-lubricated catheter, apply the water-based lubricant to the tip and the first few inches. Hydrophilic catheters are pre-coated and only require activation with water.
Detailed Step-by-Step Procedure
The procedure involves three distinct phases: insertion, drainage, and removal, with slight differences based on anatomy. Finding a comfortable position, such as sitting on the toilet or standing over it, is helpful before starting. The catheter should be handled by the funnel end to keep the insertion tip sterile.
Male Self-Catheterization
Hold the penis at an angle between 60 and 75 degrees, pointing it toward the abdomen to straighten the natural curve of the urethra. Gently clean the head of the penis, retracting the foreskin if uncircumcised. With a slow, steady motion, insert the lubricated tip into the urethral opening.
Advance the catheter approximately six to eight inches until urine begins to flow. The entire length of the catheter may need to be inserted up to the funnel end to ensure it reaches the bladder. Keep the catheter in place until the flow stops completely. After removal, return the foreskin to its normal position.
Female Self-Catheterization
Position yourself comfortably, such as sitting on the toilet or squatting over it, and use a mirror initially to help locate the urethral opening. The urethra is the small opening located above the vaginal opening. Use one hand to gently separate the labia.
Cleanse the area around the urethral opening with a front-to-back motion. Insert the lubricated catheter tip gently into the urethra, pushing it about three inches (eight centimeters) until urine begins to flow. Advance the catheter another inch to ensure it is fully positioned within the bladder. Allow the bladder to empty completely before slowly withdrawing the catheter.
Recognizing and Preventing Complications
The most frequent complication is a urinary tract infection (UTI), which occurs when bacteria are introduced into the bladder. Proper hand and genital hygiene, along with maintaining a consistent catheterization schedule, are the primary methods for preventing UTIs. Regular catheterization helps prevent the bladder from overfilling, which encourages bacterial growth.
Recognizing the early signs of a UTI is important for prompt treatment. Symptoms can include a burning sensation during catheterization, cloudy or foul-smelling urine, and increased frequency or urgency to urinate. More severe symptoms, such as fever, chills, or pain in the lower back or abdomen, suggest a worsening infection.
Contact a healthcare provider immediately if you notice blood in the urine beyond minor spotting, or if you are unable to insert the catheter. An inability to pass the catheter when the bladder feels full and uncomfortable requires immediate medical attention. Persistent pain during catheter insertion or the absence of urine for six to eight hours also requires professional evaluation.
Addressing Common Insertion Difficulties
Resistance may be felt during insertion, particularly in men where the sphincter muscle or prostate can create a slight obstruction. Never force the catheter if resistance is encountered, as this can cause urethral trauma. Instead, stop advancing the catheter, take a few deep breaths, or cough to help relax the muscle.
A brief pause often allows the catheter to pass smoothly when gentle pressure is reapplied. If the catheter still will not pass, remove it and try again with a new, well-lubricated catheter after a short time. For men who frequently encounter resistance, a Coudé-tip catheter with a slightly curved end may be a more suitable option.
For women, mistaking the vaginal opening for the smaller urethral opening is a common difficulty. If the catheter is accidentally inserted into the vagina, it must be removed and discarded, and a new, sterile catheter should be used for correct insertion. If urine does not drain after correct insertion, try repositioning slightly or gently coughing to help initiate flow.