Intermittent self-catheterization (ISC) is a common and safe procedure involving the temporary insertion of a thin, flexible tube (catheter) into the bladder through the urethra to drain urine. This process is typically taught by a medical professional and is performed multiple times daily by individuals who have difficulty emptying their bladder naturally. Performing ISC correctly helps manage bladder health and prevents complications like kidney damage or urinary tract infections. This guide provides clear instructions for individuals who have been medically instructed to self-catheterize.
Preparation and Necessary Supplies
Gathering all required items and establishing a comfortable position are the first steps. You will need the specific size and type of intermittent catheter prescribed by your healthcare provider, such as a straight catheter or a hydrophilic (pre-lubricated) version. If using a non-hydrophilic catheter, use a sterile, water-soluble lubricating jelly for smooth insertion; petroleum-based products must not be used.
Other necessary supplies include cleansing wipes, mild soap and water, or cotton balls for hygiene. You will also need a method for collecting urine, though many people drain directly into the toilet. Proper hand hygiene is paramount: thoroughly wash your hands with soap and water for at least 20 seconds immediately before touching any supplies.
Finding a comfortable and stable position makes the process easier. Common positions include sitting on the toilet and leaning back, standing with one foot elevated, or lying down with knees bent. Practicing in a consistent position helps develop muscle memory and reduces anxiety.
Step-by-Step Guide to Insertion and Drainage
The first step is locating the urethral opening, situated between the clitoris and the vaginal opening. Initially, a small mirror can help visualize the area, but the goal is to perform the procedure by touch. To expose the area, gently separate the labia with your non-dominant hand and pull slightly upward.
Next, cleanse the area around the urethral opening using an antiseptic wipe or mild soap and water, wiping from front to back to avoid introducing bacteria. If using a standard catheter, apply water-soluble lubricant to the tip and the first one to two inches of the tube. Hydrophilic catheters are pre-coated and ready for use.
With the labia separated, gently insert the lubricated tip into the urethral opening, holding the tube approximately one inch from the tip. Use a steady, slow motion to slide the catheter forward until urine begins to flow, indicating the tip has entered the bladder. Insertion is typically about three inches before drainage starts.
Once urine flows, advance the catheter another half inch to one inch to ensure it is well inside the bladder. Hold the catheter securely and allow the bladder to drain completely, which may be helped by coughing or applying light pressure to the lower abdomen. Once the flow stops, slowly begin to withdraw the catheter.
As you remove the catheter, pause briefly if you notice a second trickle of urine, then continue the slow, gentle removal. If using a non-hydrophilic catheter, you may pinch the end closed during removal to prevent dripping. After removal, dispose of the single-use catheter and wash your hands again.
Maintaining Hygiene and Preventing Infection
Preventing Urinary Tract Infections (UTIs) requires diligent hygiene. Thorough handwashing before and after every catheterization is the most important defense against introducing bacteria. Consistently cleansing the genital area from front to back before insertion also prevents contamination.
It is highly recommended to use a new, single-use catheter for each procedure to maintain the lowest risk of infection. Single-use catheters should be discarded immediately and never reused, as home cleaning significantly increases the risk of bacterial contamination. If you use a reusable catheter, follow a specific cleaning protocol, typically involving washing with warm, soapy water, rinsing, and air-drying completely before storage.
Following the prescribed catheterization schedule, typically four to six times a day, ensures the bladder is emptied regularly. Allowing the bladder to become over-distended by waiting too long increases the risk of infection and potential bladder wall damage. If you experience symptoms such as burning, cloudy or foul-smelling urine, fever, or lower back pain, contact your healthcare provider immediately for a potential UTI.
Troubleshooting Common Difficulties
Dealing with Resistance
If the catheter meets resistance during insertion, never force it. Resistance is often caused by a temporary muscle spasm in the urethra. Stop, take a few deep breaths to relax the pelvic floor muscles, and then try again with gentle, steady pressure or by slightly rotating the catheter.
Locating the Urethral Opening
Difficulty locating the urethral opening is a common initial challenge, as the opening is small and easily confused with the vagina. Using a mirror can help reinforce the location, or try changing your position, such as elevating one leg, to better visualize the area. Placing a finger just inside the vaginal opening can act as a landmark, ensuring the catheter is directed to the opening above it.
Post-Catheterization Issues
Seeing a small amount of blood on the catheter tip occasionally may occur due to minor irritation of the urethral lining, but persistent bleeding requires contacting a physician. Pain during insertion may indicate the catheter size is too large or lubrication is insufficient; ensure you use a generous amount of water-based jelly. If urine leakage occurs immediately after removal, the bladder may not have fully drained, so ensure you advance the catheter slightly after the initial flow begins.