What is intermittent self-catheterization?

Intermittent self-catheterization (ISC) means a patient passing a thin, hollow soft catheter himself into his bladder to drain urine.

Need for ISC

The bladder is a hollow organ that stores urine until we get the urge to pass urine.The kidneys produce urine which passes down the ureters & stores into the bladder. The bladder capacity is 400-450 ml. Usually at this capacity one gets a strong desire to pass urine. The detrusor muscle of the urinary bladder contracts at this point to empty the bladder. Urine travels from the bladder down the urethra where it is emptied in a toilet.

Indications for intermittent self-catheterization

• Neurogenic bladder

• Hypocontractile or acontractile detrusor

• Secondary myogenic decompensation ( post long standing obstruction)

• Spinal cord injury

• Surgery on the spine

• DSD – detrusor sphincter dyssynergia

• Caliberation post Optical internal urethrotomy (OIU) for stricture urethra or post bladder neck incision (BNI) for bladder neck stenosis etc

The reasons for ISC could vary from caliberation i.e. checking the caliber of the urethra to emptying the bladder for large residues of urine.

Intermittent self-catheterization is a safe and effective method of completely emptying the bladder at regular intervals. Self-catheterization is done as advised by your urologist, usually every 3 to 4 hours. Do not ever stop self-catheterization on your own.

Benefits of ISC

Less risk of urinary infections than keeping the patient on chronic catheterization thus allowing better quality of life

Risks of ISC

ISC is less dangerous than leaving residual urine to collect in the bladder. It is safe for both children and adults. People feel apprehensive about doing ISC initially as it involves a lifestyle change but ISC is not painful if done properly because there are no nerve endings in the urethra. It might be uncomfortable at first but this is usually due to anxiety. While doing ISC one must try to relax by taking deep breathes from mouth. One should never push the catheter in case of resistance, lest one ends upinjurying the urethra. The bladder will not puncture as it’s wall is quiet thick, catheters are soft & flexible and bend inside the bladder.

It takes practice getting the catheter into the bladder, especially in females as they find it difficult to bend & visualize the urethral orifice. With support from our catheter adviser, most people can learn.

How to clean your catheter

• Always wash hands before and after procedure.

• Wash catheter after use in warm soapy water.

• Run tap water through the catheter. Place the catheter on a clean towel to air dry.

• Alternating catheters is a good idea.

• Replace your catheter in a clean container.

• Catheters should be discarded when they begin to lose their flexibility, or become brittle or discolored. Usually change the catheters by 7 days.

Equipment

• Catheter size — 14 French or the size specified by your urologist .

• A container to carry the catheter.

• Cotton balls moistened with soap and water.

• Water soluble lubricant/ Lignocaine Jelly

• Do not use mineral oil or petroleum lubricant.

Procedure

• Prepare equipment.

• Wash hands with soap and water.

• Stand, sit or lie down, whichever is easier for you.

• Remove catheter from clean container.

• Lubricate the catheter end that will be going into the urethra.

Note: Lubricant must be water-soluble.

Male ISC

Wash your hands with soap and water.

Wash genitals or use a wet wipe.

Choose a comfortable position, either standing or sitting. If you are not over a toilet, have a container ready into which you can drain the urine.

Gently pull back the foreskin (if present), hold the penis up towards your stomach and guide catheter into the urethra, taking care not to touch the part of the catheter entering your body. Once you have passed one half length of the catheter through external meatus, lower the penis and slide the catheter the rest of the way into the bladder until urine flows. Drain the urine into toilet or container.When urine stops flowing, slowly and smoothly withdraw catheter. Be careful, as more urine might drain on removal. To completely remove the catheter pinch off the end and pull it out. This will prevent urine from flowing back into the bladder.

Gently pull the foreskin back into position. Wash your hands. Check for any unusual odor and/or cloudy hazy urine. Be aware of any changes that need to be reported to your urologist.

Female ISC

Wash your hands with soap and water. Wash genitals or use a wet wipe. Choose a comfortable position: squatting, sitting on toilet, standing with one foot on toilet seat or lying down with your knees bent. If you are not over a toilet, have a container ready into which you can drain the urine. With one hand, spread the labia (lips at the entrance to the vagina) apart and find the urethral opening above the vagina. Use a mirror initially. With practice you should be able to find the urethral opening by touch. Cleanse the urethral opening using downward strokes, front to back, with a cotton ball soaked with soap and water.

Gently insert catheter into the urethra in and upward and backward direction approximately 5 cm, until urine flows, taking care not to touch the part of the catheter entering your body. Drain the urine into the toilet or a container. When urine stops flowing, slowly and smoothly withdraw catheter. Stop each time more urine drains. To completely remove the catheter pinch off the end and pull it out. This will prevent urine from flowing back into the bladder.Wash your hands. Check for any unusual odor and/or cloudy hazy urine. Be aware of any changes that need to be reported to your urologist.

Remember

• Catheterize regularly, every 3 to 4 hours to keep urine volumes low or as advised by us at Urofort.

• Do not skip a catheterization for any reason.

• Always wash your hands before and after the procedure.

• Fluid intake is directly related to urine output and the frequency of catheterization.

• If the catheter is accidentally dropped and cannot be washed properly, it may be wiped off to remove any possible grit and then used to catheterize. (It is better to keep a stock of 3-4 catheters everytime by your side as back up for such contingencies).

• It is more important to empty your bladder.

• You are more likely to get an infection from a full bladder than an unwashed catheter.

Problems

If you have trouble inserting the catheter, try to relax, take a warm bath and try again. If you have trouble removing the catheter, try to relax, leave it for a few minutes and try again. Coughing helps. Do not ever use force. If above maneuvers do not work, contact your urologist.

Contact us if you have any of the following:

• Fever

• Nausea

• Pain in the back

• Cloudy urine

• Bad smelling urine.

• Blood in urine

• Sudden pain or bleeding when inserting the catheter

• Inability to urinate or presence of abdominal distention

• Absence of urine for 6 to 8 hours

• People with spinal cord injuries should contact hospital emergency, if they have a severe pounding headache (this may indicate unresolved autonomic dysreflexia) and immediately catheterize themselves to empty their bladder.

In case of any of the conditions mentioned above contact our Urology Helpline at (+91-9560398928). You can also get an appointment at Urofort (+91-9910103545) or at our hospital with Dr Manav Suryavanshi by Urology Coordinator (+91-9560398967) as per your convenience.

For More Information

Meet us at

Medanta Kidney & Urology Institute

Medanta – The Medicity

Sector 38, Gurgaon, Haryana – 122001, India

For appointment Call+91-9910103545

Email – info@urofort.com

Web address – www.manavsuryavanshi.com