Intermittent catheterization (ISC) is a procedure used to drain urine from the bladder several times a day. It involves inserting a thin, flexible tube into the urethra to empty the bladder completely, and then immediately removing it. This method is necessary for individuals who experience urinary retention, such as those with neurogenic bladder dysfunction resulting from spinal cord injuries or multiple sclerosis, or temporary retention after certain surgeries. Regularly draining the bladder prevents complications like urinary tract infections (UTIs), kidney damage, and bladder over-distention. Before attempting ISC, you must receive comprehensive training from a healthcare professional who will determine the correct technique and specific supplies for your needs.
Preparation and Supplies Checklist
Gathering the correct equipment ensures a successful and hygienic procedure. The central item is the intermittent catheter, which comes in different types. Straight catheters are the most common, while coudé tip catheters feature a slightly curved end, often used by men with an enlarged prostate to navigate the urethra more easily. You will also require an appropriate lubricant. Hydrophilic catheters are pre-coated and activated by water to create a slippery surface. Non-hydrophilic catheters require a sterile, water-soluble lubricating jelly applied to the tip and the first few inches of the tube. For hygiene, use gentle soap and water or an antiseptic wipe, such as a BZK towelette, to clean the genital area before insertion. Finally, a container or the toilet must be available to collect the drained urine, and you should wash your hands thoroughly with soap and water before beginning the process.
Performing Intermittent Self-Catheterization
Once supplies are ready, find a comfortable position, such as sitting on the toilet, standing, or placing one foot on a stable surface. Begin by cleaning the urethral opening to minimize the risk of introducing bacteria. For males, hold the penis upright (60 to 75 degrees) to straighten the urethra’s natural curves. Uncircumcised men must retract the foreskin before cleaning the tip. For females, gently separate the labia to expose the urethral opening, which is located just above the vaginal opening.
Using gentle, firm pressure, slowly insert the lubricated catheter tip into the urethra. Males insert the catheter approximately 6 to 8 inches until urine begins to flow. Females have a much shorter urethra, requiring insertion of only 1 to 3 inches before drainage starts. If you encounter resistance, never force the catheter. Instead, take a few deep breaths, cough gently, or slightly change your position to help relax the urinary sphincter muscle.
Once urine flow starts, gently advance the catheter another inch or two to ensure the tip is fully inside the bladder. Hold the catheter in place until the flow of urine completely stops, indicating the bladder is empty. You may press lightly on the lower abdomen or lean forward to encourage final drainage. After the bladder is emptied, remove the catheter slowly and gently in a smooth, continuous motion. If urine begins to flow again as you withdraw, stop and wait for the drainage to cease before continuing removal.
Maintaining Hygiene and Recognizing Issues
Proper hygiene after catheterization is essential to maintain urinary tract health. Disposable catheters, the most common type, should be discarded immediately after a single use. If you use a reusable catheter, it must be thoroughly cleaned with soap and water, rinsed, air-dried, and stored in a clean container until the next use. Self-catheterization carries a risk of complications like UTIs, so monitor for signs requiring medical attention. Call a healthcare provider if you experience:
- Fever, chills, or severe, persistent pain during the procedure.
- Urine that is cloudy or has a foul odor.
- Heavy or non-stopping blood in the urine.
- Repeated inability to insert the catheter after several attempts.
- New or increased leakage between catheterization times.