A-Z

Living with a urinary catheter

What is intermittent self catheterisation (ISC) and why is it used?

There are two main types of catheter:

  • intermittent catheter, where the catheter is temporarily inserted into the bladder and removed once the bladder is empty
  • indwelling catheter, where the catheter stays in place for many days or weeks

Intermittent catheterisation is a technique used to empty the bladder at regular intervals, varying from several times a day to once a week, depending on fluid intake, how quickly remaining (residual) urine increases in the bladder, and whether any urine is passed urethrally (the tube that leads from the bladder through which urine passes). Residual urine is the volume of urine left in the bladder immediately after someone has been to the toilet. Incomplete bladder emptying can lead to incontinence, urgency, frequency and recurrent infections. The catheter is temporarily inserted and removed once the bladder is empty. A person’s partner or a nurse may pass the catheter but many people master the technique themselves. Intermittent catheterisation is almost always done through the urethra (the tube through which urine passes). Occasionally it is done through the abdominal wall, called a Mitrofanoff (see 'Using a Mitrofanoff for intermittent self catheterisation').

 

A consultant talks about the history of intermittent self catheterisation.

A consultant talks about the history of intermittent self catheterisation.

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Intermittent catheterisation is now considered to be the gold standard for emptying the bladder. It’s an interesting history here, because Everard Home in 1806 actually advocated intermittent catheterisation and during the 19th century men would carry their catheters around in their top hats and in their walking sticks. 
 
And it went out of fashion for many years, until it was brought back by Lapides, an American urologist in 1972. He pointed out that intermittent self-catheterisation could be performed quite safely. And this completely transformed the care of young children with spina bifida. Many of those children were undergoing quite major surgery because of the problems they had with bladder emptying.
 

But nowadays they go to school with a catheter in their pocket and they just perform intermittent self-catheterisation. And they’re able to empty the bladder completely and they manage this without experiencing serious infections in most cases. That is rare.  

The catheter is removed after the flow of urine is stopped. Unlike the indwelling Foley catheter, intermittent catheters have no balloon on the tip so cannot stay in place unaided. Urine will flow out of the bladder and through the catheter, and can then be guided into the toilet. It should be painless but some people experience pain or discomfort at times.

Studies suggest that clean intermittent catheterisation is the safest method of emptying the bladder because this method has the lowest potential for urological complications (Weld and Dmochowski 2000; Wyndaele 2012). The consultant we interviewed is convinced that the intermittent catheter is the best type. He called it ‘the gold standard’ because the bladder can be emptied completely, reducing the risk of infection, which is common when people use an indwelling catheter.  

 

A consultant shows an example of an intermittent catheter. He describes patients who might...

A consultant shows an example of an intermittent catheter. He describes patients who might...

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This is an intermittent catheter and it is coated with a lubricious surface so that if you just pour a little water into the package, it wets the surface of the catheter and that makes it very slippery. And you just then can take the catheter, and this can be passed into the urethra and the bladder drained.

 
Are there different sorts of intermittent catheter?
 
There are but it just consists of a straight catheter in fact.
 
Would there be different sizes?
 
Yes, oh yes. There would be different sizes from quite narrow ones. The gauge of the catheter is measured by what we call the French gauge, that’s the circumference of the catheter in millimetres.
 
Is it possible to cause any damage passing the catheter?
 
Yes, yes. Passing a catheter in a male patient of course can cause problems because the male urethra is about 18 centimetres, whereas the female urethra is about 4 centimetres. And the male urethra is at risk when a catheter is passed because it can damage the surface and cause an abrasion of the lining.
 
But do most people manage it alright without any damage?
 
As long as they’ve been well trained how to perform intermittent self-catheterisation. That is the really important point. And continence advisors are well experienced at teaching people how to perform intermittent self-catheterisation.
 
Some women develop problems with bladder emptying following childbirth, and have difficulties emptying the bladder completely, and they can be taught intermittent self-catheterisation.
 
Patients who have neurological conditions too, multiple sclerosis for example, spinal injuries, many of these patients are performing intermittent self-catheterisation now.

Some catheters are ‘self-lubricated’- after it is soaked in water for a short time it becomes slippery enough to insert. With others, a lubricating jelly is used to ease insertion. Most catheters nowadays are ‘single use’, but some people still use the same catheter more than once, storing it in a clean place when not in use. Based on current research it is not possible to state that one type of catheter used for intermittent self catheterisation (ISC) or one technique or strategy is better than another (Moore, Fader and Getliffe 2007). 

Peter was diagnosed with multiple sclerosis in 1993. From about 2003 he had problems with incontinence so started intermittent self catheterisation.

 

Peter removes an intermittent catheter from a sterile packet and holds it up for people to see.

Peter removes an intermittent catheter from a sterile packet and holds it up for people to see.

Age at interview: 66
Sex: Male
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This particular catheter is called SpeediCath, and it’s my size, size 12. You can get different varieties.

Can you hold it up? [He holds up the catheter and takes it out of its holder]  

Yes, you can get different varieties, different sizes and mine is size 12 and that’s how you peel and separate the top before removing the catheter, that’s the catheter edge, and you can see the lubrication there. And the lubrication is easy, you don’t have to worry about lubricating and it’s clean, it’s sterile.

Do you still have to use any gel or not?

No.

No.

No that was only on the second time. The lady did it the first time, the nurse did it the first time, and I did it the second time when I was at home, to start me off on the routine. And yes I did feel a little bit faint because it was an unusual sensation shall we say, yeah.

Carol used intermittent catheterisation on several different occasions because of problems brought on by bladder endometriosis.

 

Carol shows what a ‘SpeediCath’ catheter looks like. It’s as easy to use as a tampon. She also...

Carol shows what a ‘SpeediCath’ catheter looks like. It’s as easy to use as a tampon. She also...

Age at interview: 39
Sex: Female
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This is a sort of standard size, what this is called, “SpeediCath” 
 
SpeediCath? 
 
SpeediCath, and this one, it’s got like, you can stick it [the outer cover or package] to the toilet door so if you are using a public toilet, you can stick it to the toilet door. You don’t have to add water to these products and there are some that you do have to. This is lubricated so you just literally take it out, it’s lubricated, and make sure that you don’t touch the tube. And then with your other hand you have to pull up slightly to put it in the right position, and insert it. 
 
And I have to say this is so easy. As a woman I think gosh this is as easy as putting in a tampon. It really is that simple. And obviously you have to wash your hands before you do it. But it’s so quick and easy. But the product makes all the difference. This one’s very good. And then you just dispose of it. 
 
The other products that I was going to show at the same time is that this is practically the same thing, but it’s a compact one and it’s got a much smaller tube. And these ones are really good for travelling around with so I use these ones at home and, if I ever need to do this self-catheterisation when I’m out, I’ve got some compact products. And then you just dispose of it and no one would ever really know. 
 
So you just sit over the loo when you’re doing that? 
 
You just sit over the loo, and I think in the early days it’s useful to have a mirror, but actually you just get used to where it is. It’s strange but it does become second nature really. It’s very easy, very easy. 

 

References:
Moore K, Fader M, Getliffe K. (2007) Long-term bladder management by intermittent catheterisation in adults and children. Cochrane database systematic review  October 17; 4: CD006008
 
Weld K. &Dmochowski R. (2000) Effect of bladder management on urological complications in spinal cord injured patients. The Journal of Urology163, 768-772

Wyndaele J. et al. (2012) Clean intermittent catheterization and urinary tract infection: review and guide for future research. BJUI110; E910-E917


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Last reviewed October 2018.
Last updated October 2018.
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