What’s the problem?
Intermittent self-catheterisation (ISC) is an alternative to having a urinary catheter in place all the time. Some people need to perform it on a long-term basis, others only for a short period depending on the reason the bladder does not empty naturally. It involves sliding a catheter in, draining the bladder then removing it. Pre-lubricated, single use catheters are used.
ISC has a far lower risk of infection compared to indwelling catheters so should be considered in preference to an indwelling catheter (National Institute for Health & Clinical Excellence, 2010).
The less time a catheter is in the body = less risk of infection!
The advantages are:
- Improves self- management of condition & independence
- More comfortable
- Improved body image
- Enables “normal” sexual activity
- Reduces risks of indwelling catheter associated complications such as stone formation, urethral erosion and CAUTI (catheter associated UTI).
ISC provides a way of emptying the bladder regularly but also enables the person to pass urine normally. Some women can pass urine but do not empty their bladder completely when they do whereas others cannot pass urine at all. The frequency a person should perform ISC varies accordingly. Firstly, it depends on your urinary symptoms. If you can pass urine (void) but do not empty your bladder it is important to check how much urine is left behind after you have voided. You do this by performing ISC straight after voiding and measuring the amount that drains.
You can then be guided by the information in our image that accompanies this article (Ref: Naish. W 2003 Professional Nurse).
- Unable to void/pass urine – ISC 4-5 times per day. Try to keep the volumes to around 500-600mls (a “normal bladder capacity”)
- Residual volume more than 500mls – ISC 3 times per day
- Residue volume 300mls – 500mls – ISC twice daily (morning and evening)
- Residue volume 150mls – 300mls – ISC once daily
- If less than 150mls for 3 catheterisations stop ISC and review.
A lot of women struggle with performing ISC so let’s see if we can help!
Refer to the diagram in our female ISC booklet to familiarise yourself with your anatomy.
“Not one catheter fits all”. Firstly, you will be guided by your health care professional regarding what sized catheters to use. You may be asked to use a larger diameter catheter such as a size 14ch or 16ch if you have a narrowed urethra. Using this size will provide regular dilatation. For women who just need to drain their bladder usually a size 10ch or 12ch catheter is recommended. Men normally use a size 12ch or 14ch catheter (16ch or 18ch for dilatation). Male catheters are also much longer.
If you register with a home delivery company, you can ask for samples of various catheters to try. You may find some easier to use or more comfortable than others. Catheter lubrication and comfort varies considerably! If you obtain your catheters from your local pharmacy this will not be possible as they can only provide what is prescribed by your GP. As long as it is the recommended size you can use any product. There are also some catheters with integrated drainage bags if needed.
Always wash before performing ISC and try not to touch any part of the catheter being inserted. Wet wipes are delivered with each order when obtaining your supply via a home delivery company. If you miss the target and insert it into the vagina throw it away and use a new catheter to try again. DO NOT TRY AGAIN WITH THE SAME CATHETER.
Positions to try!
Some women can perform ISC by feel alone and do not need to use a mirror. If that’s you – great you can sit on a toilet.
If you need to use a mirror it gets more tricky. A lot of women perform ISC standing and “straddling” the toilet or with one leg up in the toilet seat. Adopting this way enables you to balance a mirror on the toilet seat, leaving you with both hands free to part the labia and insert the catheter. If you are unable to stand for that long, or in that position you can try using the mirror to locate the urethra then place a finger next to the urethra, put the mirror down, sit on the toilet then insert the catheter next to your finger and into the urethra.
Alternatively, you may find it easier to use a catheter with a drainage bag. Using these you can perform ISC laying on the bed or sitting on the front edge of a toilet (or chair) with the mirror placed on the floor.
- Always hold the catheter with your thumb on the top and fingers under it. When you insert it aim it straight up not slanting backwords.
- Try a variety of catheters to see which is easier to use and more comfortable. Make sure you drink an adequate volume of fluids to help prevent infections. See the table below for recommended fluid intakes