- Your doctor has recommended clean intermittent self catheterization (CIC) to help you empty your bladder
- Urine is produced by the kidneys and carried to the bladder where it is stored
- When emptying is appropriate, the bladder outlet control muscle (sphincter) normally relaxes while the bladder muscle contracts to expel the urine through the urethra (“urine passage”)
- Sometimes, the bladder may not empty completely or at all, usually because of obstruction of its outlet (e.g. enlargement of the prostate) or weakening of the bladder muscle
- The bladder must then be emptied through a plastic or rubber tube, a catheter, passed through the urethra
- In some cases, a catheter may be left in place, draining urine continuously into a collection bag
- After several weeks, this may lead to urinary infection and stone formation, as well as the discomfort of having a catheter in the urethra and the inconvenience of carrying a urine collection bag
- For many men with incomplete bladder emptying, it is possible to learn to inset and remove a catheter themselves (CIC), decreasing the risk of infection and minimizing discomfort with little inconvenience
- A clear plastic or soft rubber catheter, size 12,14 or 16 french
- Water soluble lubricant (e.g. KY Jelly TM, Muko TM, etc.) do not use
- petroleum jelly (e.g. Vaseline TM,) or mineral oil
- Soapy wash cloth, disposable towelettes or unscented diaper wipes
- Clean, dry towel
- Urine collection container, if desired
- Catheters storage container (e.g. zip-lock bag)
Self - Catheterization Technique
Proper “clean”technique (no disinfectant or gloves required) will usually prevent infection without the need for absolute sterility. Catheterization may be performed in any clean washroom; counter space within reach is useful.
- assemble the necessary supplies and have them close at hand
- If possible, try to avoid straining.
- Wash your hands thoroughly with soap and water, then, rinse and dry. It is best to keep your finger nails short and clean.
- Get into a comfortable position; you may catheterize yourself standing, sitting in front of or on a toilet or propped up in bed.
- Retract the foreskin, if you are not circumcised. Wash the head of the penis with soap and water, then rinse with water and dry. A damp towelette can be used as an alternative
- Generously lubricate about 8 cm (three inches) of the catheter tip with water soluble lubricant.
- With your non-dominant hand (I.e. left hand for right handed men), grasp the penis just behind its head and pull it gently and slightly upward to straighten the urethra.
- Using your dominant hand, slowly inset the catheter in the urethra until urine begins to flow (about 5cm or two inches). it is important to breath slowly and relax your muscles. Advance the catheter another 3 cm (about one inch) to ensure that the tip is well in to the bladder.
- Using your dominant hand, slowly insert the catheter into the urethra until urine begins to flow. There may be slight resistance at the level of the sphincter and prostate. It is important to breath slowly and relax your muscles. Advance the catheter another 3 cm (about one inch) to ensure that the tip is well in to the bladder.
- Drain urine into a container or directly into the toilet. Gentle straining may help bladder emptying. Take note of the amount of urine obtained.
- When urine stops flowing, withdraw the catheter slowly. Urine may flow irregularly as additional pockets are drained.
- You may wish to wipe the penis opening with tissue paper and then replace the foreskin in its usual position.
- Clean and store your catheter before washing your hands again.
Your doctor or nurse will tell you how often you need to catheterize. The frequency of bladder emptying depends on the volume and type of fluid consumed and the bladder storage capacity. Restricting your evening fluid consumption may prevent the need to empty during the night.
Often, a sensation of bladder fullness will tell you when you need to increase the frequency of catheterize. Most men who empty only with a catheter will self-catheterize four or five times daily, about every four to six hours when the bladder contains 400 to 500ml (13-17 oz) of urine.
If you obtain volumes greater than 600ml, (20 oz) you will need to increase the frequency of catheterization. When you drain less than 200ml (7 oz) at a time, you may catheterize less often if you are voiding as well. If you are not sure whether the bladder is full, catheterize. Soon you will learn to recognize a full bladder reliably in time, you will develop a regular schedules. A record of times and volumes obtained will help your doctor fine tune your schedule.
Volume by Catheter
You need not restrict any of your usual activities, including sexual activity. If may be best to empty the bladder before engaging in sex. Bowel function should not be affected and you should be able to take all of your usual medication.
Generally, a catheter can be reused and cleaned for about a week unless it becomes rough, cracked or damaged. Inexpensive replacement catheters may be purchased from your medical supply store or pharmacy. Keep two or three catheters on hand at all times.
Immediately after using a catheter, wash it with warm, soapy water and rinse it thoroughly, inside and out. Liquid hand or dish soap is effective and safe. Allow the catheter to air dry on a clean surface or towel. Store it in a dry, paper towel or clean plastic bag.
- Pain or resistance with the passage of a catheter may indicate that you are not using enough lubricant. Occasionally, it may be a sign of scar formation in the urine passage way.
- Blood on the catheter or in the urine suggests the possibility of injury to the urethra,
- prostate or bladder. Concern arises when bleeding is continuous, frequent or heavy.
- Cloudy, foul-smelling urine, painful urination, fever (over 38.5oC or 101oF). chills or
- abnormal sweating may indicate infection
- If you are unable to insert the catheter after several attempts, you should go immediately to your hospital emergency room. Please contact your doctor or urology nurse if you have any of these problems.
CIC is a safe and effective way of emptying the bladder when necessary. With practice, your ease of catheterization will improve, usually within a few weeks. Most men will find that quality of life is minimally affected and often improved with CIC.
DR. GRIFFIN .M
MBBS, MS (Gen Surgery), M.Ch(Urology)
Consultant Urologist, Andrologist & Kidney Transplant Surgeon
MBBS, MS, Mch (Urology)