- There are many reasons the bladder may not empty during urination:
- Recent pelvic surgery is a very common reason.
- Different medical or neurologic problems can contribute to this, including bladder prolapse.
- The bladder muscle may not function effectively to push out all the urine.
- Tight pelvic floor muscles can prevent urine emptying.
- Urinary tract infections (UTI) and bladder stones may interfere with the bladder’s normal function.
- Failure to fully empty the bladder can result in accidental leakage of urine, infections, or damage to the bladder wall.
ISC involves placing a small tube (catheter) in the bladder to empty the urine. You do this process periodically—sometimes several times a day. By keeping to your schedule, you can reduce leakage, infections and protect your bladder.
LEARN THE TERMS
Intermittent self-catheterization (ISC): Performing catheterization on yourself a few times a day to drain the urine from the bladder.
Catheterization: The process of placing a small plastic tube (catheter) into the bladder to drain the urine
Catheter: A plastic tube temporarily placed to drain urine from your bladder.
Constipation: Having a bowel movement fewer than three times a week, along with straining to produce a hard bowel movement.
Your doctor or nurse will train you on the ISC process. Some women are advised to try to urinate normally and then use a catheter to drain any remaining urine. Other women need to perform ISC to drain all of their urine because they cannot urinate at all.
Most women perform ISC about every 4 to 6 hours and again before going to sleep. How often you need to empty your bladder depends on how much you drink. If you use a diuretic (water pill), you will need to ISC more often. Drinking more fluids will not help your bladder empty better–you will just need to catheterize more often. You will also be taught to log how much urine comes out through the catheter. Based on this information, your doctor or nurse may adjust your catheterization schedule.
There is a small risk of urinary tract infections (UTI) associated with self-catheterization. Stay aware of how you feel and contact your medical provider if you are tired or not feeling well. Symptoms of a UTI include:
• Fever and chills.
• Pain or burning when you urinate or catheterize.
• Pain in your back.
• Cloudy or bad-smelling urine.
• Blood in the urine.
Your bowel habits can affect the ISC process. Constipation can make it harder to completely empty your bladder. There are lifestyle changes and treatments that can help you overcome bowel problems.
Everyone’s urine has some bacteria in it. ISC can increase the levels of bacteria. Cleaning your hands and equipment carefully is important in preventing infections. Most women can safely reuse catheters. Find a place at home to keep your supplies and equipment safe and clean. When you travel, keep the supplies with you in a carry-on bag.
You’ll need to record everything you drink as well as the amount of urine that comes out through the catheter. Figure out if you want to use a paper log or an “app” for this part of the process. Above is a sample of the types of information you’ll need to record.
SIX-STEP ISC PROCESS
STEP 1: WASH YOUR HANDS. It is very, very important to WASH YOUR HANDS to help avoid infection. Wash your hands with soap and water for two full minutes, or use a hand sanitizer.
STEP 2: GET SET UP
Gather your supplies:
• Disposable catheters and the storage container with a lid.
• Container for measuring urine.
• Sterile lubricant.
• Toilet paper or wipes.
• Hand mirror.
TEP 3: GET IN POSITION
Whether standing or sitting, get in a comfortable position. If you are just learning to perform ISC, a hand mirror to help see the urethral opening. Take a few deep breaths and relax your pelvic floor. With wet toilet paper or wipes, wipe from front to back in the genital area one time. Then immediately wash your hands again.
STEP 4: CATHETERIZE
Pick up the catheter without touching the end that goes into your bladder, then dip the tip into the sterile lubricant. Next, open your labia with one hand and gently insert the catheter into the urethra until urine comes out. If you have difficulty, do not force the catheter in. Take a moment, take a few deep breaths and try to relax. Then try again. Changing the angle that you are inserting it may be helpful. These things can help relax the pelvic muscles and let the catheter slide in smoothly.
Once the catheter is in, let the urine flow naturally. Do not press down with your abdominal muscles. When the urine stops flowing, slowly remove the catheter. Use the toilet paper to dry yourself and wash your hands.
STEP 5: CLEAN UP
Taking the time to clean up ensures the safe handling of your catheterizing equipment. DO NOT let others touch the catheter or its storage container to reduce the risk of infection.
Wash the catheter with warm, soapy water, then check to see if the “eye” of the catheter on the tip is blocked. Next, rinse the soap off the catheter with clean, running water, followed by shaking it to remove excess water. Store the catheter in a clean container with a tight lid. Once per week, you will also need to take the time to clean the storage container. Use warm soapy water and dry the container thoroughly before placing the catheter back in it.
You can clean catheters and use each one for 2 to 4 weeks. However, if you have an infection, use a new catheter each time you perform ISC. Also, if the catheter is damaged or dirty, DO NOT wait to change it out. Take out a new one immediately. Call your doctor’s office if you need more supplies.
When to Call Your Doctor’s Office
Contact the doctor’s office if you are having problems performing ISC or experience pain or bleeding. A small amount of blood is OK, but it should not be a lot. Let the doctor know if you think you have a UTI as you may need an antibiotic. Check-in as directed over the phone to verify the amount you should be urinating. Some women will be able to stop catheterizing once the bladder resumes emptying on its own, such as after surgery.
1. ISC Is a safe and effective way to empty the bladder that most women can learn.
2. Most women perform ISC about every six hours after trying to urinate and before going to sleep.
3. Contact the medical provider’s office if you have any concerns about your technique. Also, call the medical provider If you notice signs that might indicate UTI.