Intermittent self-catheterisation (ISC): being taught how to do it

Intermittent self catheterisation (ISC) is usually taught by a nurse. It is not a sterile technique but should be a clean one, so it is very important to have good hygiene standards. It is also important that people receive plenty of information before learning how to do it. Good communication skills can facilitate the learning experience. The head of a local continence service explained everything very clearly before she showed Peter how to pass a catheter.

The nurse showed Peter all the products that were available for ISC. She talked about hygiene and explained the process with the help of a leaflet.

Age at interview 66

Gender Male

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What about searching for information? Did you always have plenty of information about catheters from the beginning? Or would you have liked more?

No, no, no. I did [have information] from the beginning because I’d gone to the head of the continence service for the health authority that I was in, she was able to a) show me b) to show me the products that were available, to demonstrate how to use them; to talk about hygiene; to see how hygiene fitted in before and after and how you would dispose of the product etcetera. So shed taken me through the whole process and also shed explained to me with a leaflet as well, showing me the penis, okay, and showing me a catheter and where it goes and how it goes through the urethra and into the bladder. And she told me about that yes occasionally you could get spasm where the bladder won’t open to allow the catheter through but you know it will eventually relax and you’ll be able to pass it in.

So all that information was really helpful?

Yes very much so yeah.

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Initially Peter felt a little faint when he tried to do ISC because he said it was ‘an unusual sensation’, but he soon got used to it.

Peter recalls the first time he was shown how to do ISC. He found ISC very helpful because it allowed him to fully drain his bladder.

Age at interview 66

Gender Male

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I said yes, cos I was willing to give anything a try so she [the nurse] said, Well can you come and see me in a days’ time? So I turned up to see her and she said she was going to, she showed me the catheter. It wasn’t one that was self-lubricated. You had to put it into the sink, so we went through the process of cleaning of hands, the process etcetera, so we were keeping infection, as much infection out as possible.

By putting it in the sink you mean lubricate it with water?

Yes with water, I mean to fill the whole container with water from a tap, that’s right. And then we got to sort of hold that up so that it was in the container for about ten or twenty seconds so it became lubricated before insertion. But as I’d not had it before, not tried it before and it was not a self-lubricating one, she said I’d got some numbing gel that I’m able to sort of insert into your penis beforehand. So yes this is a little bit messy but then I found that you could have that numbing gel first, and then insert the catheter and it’s surprisingly, the length of the catheter, most of the length, 90% of the length goes through your urethra, is that the right term? And of course it’s not until you get to the last 5, 10% that it enters your bladder and will start to drain. Then of course I was finding that, well that helped tremendously because I was able to fully drain my bladder whereas before I’d go to the toilet, and then think that I’d finished and when I got back out of the toilet, walking back I’d find that I wanted to go again.

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It is important that the person teaching ISC takes a friendly and relaxed approach to reduce embarrassment and anxiety. Betty was aged 63 when she first learnt how to do ISC. She said she was taught by a wonderful nurse.

Betty recalls how she learnt ISC. The nurse was kind and very understanding.

Age at interview 93

Gender Female

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Would you mind telling me a little bit about how she [the continence advisor] taught you?

Well we spent quite a bit of time on the bed and she showed me how to insert it [the catheter] into the right place, and she also told me to do lots of drinking.

Did she help you? Did she use a mirror to show you where to put it?

Yes she did. Yes, that was one of the things that was a bit horrifying. But I got used to that. And gradually I, it didn’t take me very long, I think it was two weeks she came, and then I was able to do it myself. And first of all it seemed to intrude upon my life, but then I got so used to it, it didn’t. I just planned the hours out myself.

So right from the beginning she came two or three times a day did you say?

Yes.

And you said to start with you found it a bit horrifying.

Yes, because I had never looked at myself there.

No.

One doesn’t really.

No.

And then to have a mirror and see ones self like that is not easy.

No.

But I got used to, I got used to it and well I didn’t need to do it [use a mirror] anymore after a fortnight. I was able to, she said I was able now, then to carry on myself, and I found that I did very well. I didn’t have any mishaps of any kind.

For any nurses who might be watching this, what would, what was the important thing about her, the way she taught you?

She was a very kind nurse, very understanding. And gentle. And she didn’t, how I can I put it? She didn’t tell me what to do, she suggested that I did so and so.

Oh that’s good.

And I liked that. I don’t like being told what to do. And I was in touch with her for some time but I lost touch afterwards. Too many years have gone by. But I, I’ve never forgotten her. She was a very special nurse, very.

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Peter explains how the nurse put him at his ease when she taught him how to self catheterise.

Age at interview 66

Gender Male

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Firstly the lady who was in charge of the continence clinic at one of the hospitals that I looked after, with fire training, she was very, very good. She started me on the road of catheterisation. She started me on saying Look this is what I’d do for my job so, she says, Don’t feel embarrassed, she says, You’re no different to anybody else. And she says, Just accept it for what it is. And she says, Once you’ve accepted it in your mind then I think that’s the way to move on. You know you accept it for what it does for you, for how it improves your life, okay and it does improve your life.

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Some of the women we spoke to found doing ISC difficult at first. Jade, for example, said she didn’t know if she was inserting the catheter in the right place. With practice though, ‘you could do it with your eyes closed.’ Jade was diagnosed with Fowler’s Syndrome when she was 13. Fowler’s Syndrome is the commonest cause of urinary retention in young women. The problem is caused by the sphincter’s failure to relax to allow urine to be passed normally. The urethral sphincter is the muscle that keeps people continent. Jade had a urethral catheter, a suprapubic catheter and now uses an intermittent catheter.

Jade got stressed the first time she tried to catheterise. The catheter is in a saline solution…

Age at interview 22

Gender Female

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I couldn’t do it [self-catheterise]. So then I got really stressed and I thought, Right, I’ll have a day’s break and then, so I can calm down and then go back to it. And then the first time I tried after the break, I did it perfect. And I’ve been able to do it ever since.

What was the most difficult thing? Locating the urethra?

Yes, yes, I just couldn’t find. I don’t know, yes, I just couldn’t find it I think or, and you didn’t know if it was in the right place or the right hole. But when you, it is true, when you carry on doing it you just, you could do it with your eyes closed. You know exactly what to do. And so then I went back to hospital probably about two weeks after that, and I had to, the nurse asked me to self-catheterise in front of her, so that she knew that I was doing it correctly and things. And I said, Yes. So I did it and she was happy with it.

Every time I self-catheterise, I’ll go to the bathroom. I’ll wash my hands, and then I’ll get my catheter. I’ll squeeze the water out, which is inside the catheter, which is like a saline solution that will clean it all and make it easier to pass.

And then I’ll put the catheter in and drain it out, put the catheter back in the wrapper, chuck it in the bin and wash my hands. And then carry on with my normal day.

So are you sitting over the loo as you do that?

Yes, well, I stand up, and then sit down when it’s in. But I’ve now got it down to a fine art, so it will take me as long as any other person to go to the toilet. I’m that quick at it now.

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Jennifer, who was also diagnosed with Fowler’s Syndrome, had many urinary tract infections (UTIs) and, at the age of 19, found she could not pass urine. At first she tried self catheterisation and then a urethral catheter.

ISC was a scary prospect at first and hard to do. Being taught how to do it properly and shown…

Age at interview 26

Gender Female

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What was it like doing self-catheterisation?

It was quite a scary prospect at first. I didn’t have the best experience because I was only taught by ward staff. Later on down the line I was properly taught by a urology nurse specialist using a mirror. She gave me different catheters, different sizes of catheters which were a lot easier, and she got me into a proper regime of when to self-catheterise. So about six months later I’d got into a proper regime and I found it okay.

Was that every so many hours? When you say a regime?

Every four hours, but not during the night

And you used a new sterile catheter each time?

A new sterile catheter each time, yeah and I used to have various sizes. I’d have small compact ones which I used to carry around when I was out, which they weren’t the most comfortable catheters, but they were the easiest because they were all self-contained. They had all the water inside them, so it was a lot easier than a longer one. The bigger ones I had that you had to add water to. They really wouldn’t fit in a normal sized handbag so

Why do you need the water if they’re not going to stay in?

Because the water acts, it activates the coating on the catheter, a gel which makes them slide in and out more.

Oh okay.

So if you don’t have, if they’re not coated they dry and you really struggle to get them in. So all catheters are coated. Some of them come in their own coating most of the ones now, as time’s gone on, all generally are all sitting in a solution. But you still can get the odd ones on the market I think that aren’t.

So that’s what you meant when you said they come with water, a solution?

They come with water, they come in solution. Some of them are in like a bag that you squeeze, and it goes into the catheter. Some of the catheters sit in the solution, they’re all really different each ones that you get, but yeah, it’s just finding the right one.

Once you find the right one for you, as I said I had like two, ideally I would have just used the bigger one all the time, cos it was a softer one, it didn’t hurt as much but practically wise it wasn’t the best for carrying round. You can’t just go into a public toilet and open a tap and fill it up with tap water, so it wasn’t really the best thing.

So that’s why I used two, which I always thought was quite, you know it was quite a handy way of dealing with my bladder when I was out. And just have something so small it was so small that you could put it, you know if you didn’t want to take a bag you could just put it in a pocket, could put it in a camera case.

You could put it, I used to, when we used to go away on holiday, instead of carrying a handbag I’d carry my camera case and it just had a zip on the top and it would just slot in and no one would know any different.

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Carol was diagnosed with endometriosis in 2003. This had invaded her bladder and bowel. After several operations she had a urethral catheter, once for four months because of a perforated bladder. Sometimes she has to self catheterise because she has urinary retention.

Carol’s bladder function is erratic. She finds a lubricated catheter easiest to use. Finding out…

Age at interview 39

Gender Female

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I have found that my bladder function is erratic, so sometimes I don’t have much sensation. I can’t always tell when my bladder is full. Sometimes it just doesn’t work very well, and at other times it’s completely fine. So I do find sometimes I need to use intermittent self-catheters.

Is that because you can’t pass urine?

Yeah. And so that urinary retention does make me worry because when I’ve had that before, it’s been when it’s perforated and I’m in pain and I can no longer urinate. So it’s very quick and easy to use the intermittent self-catheters, but I have found that knowledge of the products isn’t widespread amongst, well for example the consultants or perhaps even used in the hospitals.

And I know a very good gynaecology nurse specialist who gave me a product which is lubricated, and that is so easy to use. it’s just finding the hole, the urethra to put it in.

Who taught you how to do it?

A nurse taught me on the ward, but I’ve been seen in a private hospital and the downside of that is you don’t have access to urology nurse specialists that you do on the NHS. So she was more of a general nurse and I found her very unhelpful and I hadn’t showered, and I want, she wouldn’t let me shower because she didn’t have time and I felt that, I had some loss of dignity when she taught me how to do that. And it was unnecessary really because, and again she used an un-lubricated product which is much harder to use. And it’s such a small thing, and perhaps again it comes down to money.

So you found the best products yourself really?

Yeah, from a friend of mine who I know through doing work for Endometriosis UK. She showed me the products and she’s a gynaecology nurse specialist on the NHS. And I found it quite shocking actually that they’re more up to date on products than in the private sector, where they perhaps don’t look at this. But it depends where you have your care as to what products you are given.

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In 2007 Faye became ill and found it impossible to pass urine. She used intermittent catheterisation until 2009 and then had an indwelling urethral catheter for a while. She now has a suprapubic catheter but hasn’t yet got a diagnosis.

Faye didn’t want to be taught ISC by a male nurse. She found it hard to catheterise because of…

Age at interview 29

Gender Female

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I was seen by an urologist, and from then they decided that I ought to be doing intermittent myself. But I found that too difficult with my other problems with my knees and whatever, so the district nurses were coming out twice a day to do it.

So you went into hospital and they started any more investigations at that point?

No.

And who tried to show you how to do the intermittent catheterisation?

Nobody. I was just left, I was given a box by the continence nurse at the hospital and I was just left.

She didn’t show you what to do?

No. It was a he. And no he didn’t. I didn’t want him to.

It was a man?

Yeah.

You didn’t want him, no I can understand that. But did you not have the option of seeing a woman?

No, they said they was too busy.

Oh dear. So what happened then?

Well I did it a couple of times, it was painful but I still did it.

You managed it?

Yeah. And then I came home. It lasted maybe about a week before the continence nurses, the local team got in touch from there they put proper support in place.

You said that you found it very difficult to practice intermittent catheterisation because you have other problems. Can you say anything about what made it difficult for you? You said you’ve got problems with your knee.

Yeah, just bending, getting in place.

So did you manage it at all? The intermittent catheterisation?

I managed it maybe once a day. I just drank the bare minimal to get by, so I wouldn’t have to keep doing it. After that the continence nurse got in touch, the local one. And she put support in place for district nurses to come and see to me every day, it became twice a day, and then,

So they came twice a day, and they were passing a catheter for you?

Yeah. And that was all well and good, only not very good for my dignity.

And then how many years did that go on for?

That went on maybe about a year. And that stopped cos I was going up to Scotland to see my brother and then I asked them to put in an indwelling catheter.

Was that a urethral one?

Yeah.

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Sometimes people find it impossible to self catheterise. Sharon started having urinary problems after a difficult forceps delivery. She found it hard to pass urine and had urine infections. Later, when she found it impossible to pass urine, she had to have a suprapubic catheter inserted, which she has had ever since.

The nurse tried to show Sharon how to self-catheterise but neither of them could get the catheter…

Age at interview 52

Gender Female

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I was under the hospital again and they wanted to teach me to self-catheterise. So I had to go in for a few hours and they would show me how to do it and everything. Anyway, I couldn’t do it and I’d come over all funny and everything. And the nurse put me up on a bed and said she would try and do it, but she couldn’t get one in. And they even got a paediatric catheter and that wouldn’t even go in.

And I’d had enough by then. I said No, leave me alone. I’ve had enough, don’t want to know. And that’s when I sort of carried on coping on my own again [sometimes she needed to pass urine very frequently and passing urine sometimes took five to ten minutes].

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Advantages of an indwelling catheter

Urinary catheterisation is a medical procedure used to drain and collect urine from the bladder. A urinary catheter might be used long term: to treat...