Anatomy of the urinary system
Urine is the liquid made by the kidneys when they clean and filter the blood. Urine flows from the kidneys, through the ureters, into the bladder. Urine is then stored in the bladder until it is required to empty.
During the usual urination process, the bladder contracts, and the urinary sphincter relaxes, to allow for the passage of urine through the urethra (tube that drains the bladder to the outside).
After the bladder empties, a small amount of urine may remain in the bladder. This is called the post-void residual (PVR). If a person cannot empty their bladder completely, the PVR increases and can contribute to infection, urinary incontinence, and rarely, permanent damage to the bladder and kidneys.
What is intermittent self-catheterisation?
If you can’t empty your bladder on your own, intermittent self-catheterisation (ISC) can be an effective solution. ISC is where you insert a small soft, hollow plastic tube (catheter) into the urethra, past the sphincter into the bladder, to allow urine to drain. It is then immediately removed once the drainage stops. The usual process only takes 3 to 5 minutes once you are proficient.
ISC helps to reduce bladder pressure, prevent a build-up of residual urine, and preserve kidney health. When performed correctly, ISC can also reduce the risk of urinary tract infections (UTIs) and promote continence.
ISC is a common procedure that is used by many people with difficulty passing urine. It is a safe, effective, and simple way to completely empty the bladder. ISC has been shown through various studies to be superior to an indwelling catheter in terms of reducing long-term complications such as UTI, bladder shrinkage, discomfort etc.
ISC is also used for patients with a known history of urethral stricture (scarring and narrowing), to self-dilate the urethra at regular intervals and prevent recurrence of the stricture.
Why do I need to do ISC?
Certain health conditions can make it difficult to empty your bladder. These can include, but are not limited to:
- Bladder outlet obstruction – sometimes caused by benign prostatic hyperplasia, urethral stricture, bladder neck and meatal stenosis.
- Underactive bladder.
- Neurogenic bladder caused by cerebral palsy, stroke, multiple sclerosis (MS), Parkinson’s disease, lumbar disc prolapse, spinal surgery, spina bifida or spinal cord injuries.
- Onabotulinum toxin A (Botox) bladder injection (see anti-spasm bladder injection) for the overactive bladder. This can sometimes impair the ability of the bladder to empty (5% risk), possibly leading to elevated residual volume and the need to self-catheterise. Your Urologist will discuss this with you prior to any such procedure.
- Diabetes related bladder dysfunction.
- Fowler’s syndrome (urinary retention in young women).
What are the benefits of doing ISC?
- Reducing the risk of urinary tract infections and the possible sequelae (e.g., developing multi-resistant infections from long-term use of antibiotics, and kidney scarring).
- Treating overflow incontinence.
- Preventing kidney damage.
- Preventing bladder stones.
- Avoiding long-term indwelling catheterisation.
- Preventing sequelae of chronic abdominal straining during voiding (e.g., haemorrhoids, hernias, vaginal prolapses).
- Treating lower urinary symptoms (e.g., spending a long time per void, waking up multiple times at night, daytime urinary frequency, sensation of bloating due to incomplete bladder emptying).
How do I do ISC?
It is very helpful to get the help of a urology or continence nurse when first starting out to do ISC. The general steps are:
- Cleaning the genital/urethral area at the start.
- Applying lubricant +/- numbing gel in the urethra.
- Opening the catheter package and handling it cleanly.
- Inserting it to drain the bladder.
- Cleaning the genital/urethral area at the end.
- Disposing or cleaning the catheter.
How can a urology or continence nurse consultant help?
He/she can give specific instructions and tips on:
- Choosing the right type of catheter for you (e.g., single-use vs multi-use, lubricated vs non-lubricated, curved-tip vs straight-tip, different size catheters).
- The best position during ISC (e.g., lying down, standing or sitting).
- How to find the urethra (e.g., parting the labia, using a mirror).
- How to relax during insertion of the catheter.
- How to clean and store multi-use catheters.
- How to purchase more catheter supplies.
- How to apply for funding from the government (e.g., SWEP).
How often will I need to self-catheterise?
The frequency of ISC will be determined by your Urologist and adjusted if necessary. This is determined by a combination of factors:
- Your degree of bladder dysfunction (e.g., acontractile vs partially contractile bladder).
- Your persistent symptoms with the current ISC regime (e.g., UTIs, incontinence).
- Bladder diary parameters.
When commencing intermittent catheterisation, you will be asked to complete a bladder diary. The bladder diary records the volume of urine you can void on your own without straining, followed by the post-void residual volume as drained via the catheter. This allows one to calculate the voiding efficiency and adjust the frequency of ISC. For example, if the PVR is often high, more ISC may be needed.
Taking care of yourself at home
It is normal to feel some apprehension about starting ISC. You may be worried about:
- Your ability to physically do the ISC.
- Your ability to cope with doing ISC mentally.
- The degree of discomfort when doing ISC. When done correctly, ISC should not be painful.
- Injuring yourself when doing ISC. With the correct technique and lubrication, the risk of injury is very minimal. Many patients do ISC multiple times a day on a long-term basis without hurting themselves.
- Developing urinary infections. It is somewhat common to get a UTI in the first few months when learning ISC and you may need antibiotic treatment. However, once your technique is good, the overall risk of UTI will decrease significantly. The key is to keep practicing.
- Ongoing costs.
We have an experienced team here at Melbourne Bladder Clinic. Your Urologist and Urology nurse will be able to teach you how to self-catheterise, and offer you support to become confident in managing your catheters at home. This includes information about accessing equipment, financial assistance, and how to deal with common problems that may arise, such as an infection.