What is Catheterization?
Catheterization requires the insertion of a thin tube called a catheter into your urethra to drain urine collected in your bladder. There are a variety of types of catheters and its important you discuss with your health care provider which is the best type for you.
Since you usually need to empty your bladder a few times a day you will have to catheterize at varying times or intermittently throughout the day.
Why Self Catheterize At Home?
Your doctor may recommend that you insert a catheter at home (called intermittent self-catheterization) if you have: 1
- Urinary retention (inability to drain urine from your bladder normally)
- Urinary incontinence (inability to control the release of urine from your bladder)
- A medical condition such as multiple sclerosis or a spinal cord injury that prevents you from emptying your bladder
- Temporary urinary retention during recovery from surgery.
Reducing the Risk of Injury
For many people, intermittent self-catheterization is managed with little difficulty, pain, or injury. However, catheterization does have its risks since you have to catheterize a few times a day. It is common to have urethral bleeding, urethritis, or inflammation of the urethral opening from frequent catheter insertion. Other more serious events can occur resulting in urethral injury and pain.8 Therefore, it is important to get instruction from your doctor or nurse and have meetings with them if you are having any difficulties. Proper techniques with the right catheter and lubrication can help avoid the risk of injury and pain. It is a good idea to familiarize yourself with the procedure and the anatomy involved.2
Basic Anatomy Of The Urethra
The urethra is like a tube which transports urine from the bladder to exit outside the body.
The urethra in men and women is not open inside like a hose; nice and smooth. Instead, there are flattened folds inside that expand to open the urethra only when you urinate.3 Normally the urethra is closed. See Figure 3, which shows a cross-section view of a closed urethra. Note all the folds in the lining that could be damaged when putting a catheter inside.
The tissue lining the urethra is sensitive, rich in nerves and blood vessels and not very stretchable.4 Pain when catheterizing is caused by the stretching of the urethra when the catheter enters the urethra, and the friction it creates as the catheter contacts the lining of the urethra as it moves along the urethra towards the bladder.4
Is There A Difference Between The Male And Female Urethra?
The male urethra is approximately 15 to 25 cm long and follows a path that curves around the prostrate before it enters the bladder. This makes catheter insertion a little more difficult and makes it easier to cause injury when trying to push the catheter into the bladder.5
The female urethra is shorter (approximately 3-4 cm) and is mostly in a straight line to the bladder.6
Use of a lubricating jelly or lubricating jelly with an anesthetic, an ingredient that numbs an area from pain, can minimize the pain and reduce the risk of injury when catheterizing.2,7
Benefits Of Instillation With A Lubricant
To put lubricating gel directly into the urethra is called instilling the gel or instillation.
There are two common lubrication methods to help put a catheter into the urethra:
1. Coat the outside of a catheter with lubrication before inserting into a urethra.
Coating only the outside or tip of the catheter with a lubricant may not be enough to protect the urethra from injury. This is because much of the lubricant is often pushed off the outside of the catheter as the catheter is pushed into the urethra. This means less lubricant is going into the urethra to protect the lining of the urethra.1
Once the catheter is inserted into the urethra, the portion of the urethra in front of the catheter is still closed. This means that the catheter must force the urethra to open. This results in an increased risk of pain from stretching the urethra with the catheter or injury from friction caused by the catheter and contact with the lining.4
2. Instilling lubrication directly into the urethra before inserting the catheter.
Putting lubrication into the urethra before inserting the catheter reduces the risk of injury to the delicate lining of the urethra.2,3 By putting the lubricant directly into the urethra it is possible to get a more even coating of the lining of the urethra with lubricant. Now the urethra which is normally closed, is gently opened by the lubricating gel and kept open in front of the catheter. This makes a lubricated path for the catheter to follow and reduces the risk of pain and injury.2,6
How is Intermittent Self-Catheterization Performed?2
Supplies You Need
Before you self-catheterize you should have the necessary supplies at hand:
A water-soluble catheter lubricant (such as Cathejell®);
Cleaning aids, such as a soapy washcloth, disposable towelettes (alcohol wipes), or unscented diaper wipes, to clean around the urethra;
A clean dry towel to dry the urethral area; and
- A plastic bag or container to dispose of your towelettes and catheter in
Re-using catheters is not recommended due to the risk of causing an infection, however, if you have to reuse a catheter, wash it immediately with warm soapy water (liquid hand soap or dish soap), rinsing it thoroughly, inside and out. Then allow it to air dry on a clean surface or towel. You can store it wrapped in a paper towel or in a clean plastic bag such as a resealable food bag.9
Steps to Follow When Performing Intermittent Self-Catherization (ISC) at Home2
This is a basic outline of how to do intermittent self-catheterization when using a syringe of Cathejellmaintain your pressure on the syringe to keep it compressed and then remove it from the urethra. sterile lubricant. You should get training instruction from your doctor or nurse about the process before trying it yourself.
- First, wash your hands with soap and water, and dry them.
- Prepare your catheterizing materials for use, taking care to keep them clean and sterile.
- Position yourself sitting on a toilet or facing the toilet, whichever you prefer. In males, if uncircumcised, pull back the foreskin and in females spread your labial lips, then wash around the urethral opening with a clean cloth, soap, and warm water.
- Once that is done, apply a drop of Cathejell® to the urethral opening, to enable the smooth and rounded cone of the Cathejell® syringe to be easily inserted in the urethra. Then, inject Cathejell® slowly into the urethra. The injection of Cathejell® opens and expands the urethra, enabling the catheter to be inserted easier than would be the case if the lubricant were simply applied to the catheter.
- When the syringe seems to be fully compressed, maintain your pressure on the syringe to keep it compressed and then remove it from the urethra.
- To allow the anaesthetic to take full effect you should wait 5 minutes following instillation of Cathejell® before inserting the catheter. However, it is still okay to proceed before that time if you do not have the time to do so. You just will not get the full benefit of the anesthetic during the insertion of the catheter.
- Once the anaesthetic has taken effect, you insert the catheter into the urethra carefully pushing it up to the bladder. It is a good idea to try to stay still and relax your pelvic area while inserting the catheter as this makes it easier to insert the catheter.
- When urine starts draining from the catheter, it indicates that the tip of the catheter has reached the bladder. Make sure that you have the end of the catheter drain into the toilet or a container to catch the urine.
- Once the urine has stopped coming out of the catheter, slowly remove the catheter, stopping anytime more urine begins to drain from the catheter. Uncircumcised males should replace the foreskin back over the tip of the penis.
- Dispose of any disposable materials such as cleaning wipes, catheter, and catheter packaging, clean your genital area and wash your hands.
How Often Should Self-Catheterization Be Done? 2,9
The need for intermittent self-catheterization may be short and temporary, or rather long-term. The frequency to empty your bladder depends on the volume and type of fluid you drank and how much your bladder can hold. This usually ranges from once per day to every 4-6 hours throughout the day.
If possible, try to urinate first, to see if you can get any urine out normally; then use the catheter if you do not feel your bladder was fully emptied. It is a good idea is to record how much urine is coming out for the first few times, by catching the urine in a measuring cup. Measure the amount you urinated without using a catheter, record the amount, and dump the urine out. Then insert the catheter and catch the urine that comes out, measure it, record it, and dump it.
The measured amount of urine that came out of the catheter (after you urinated some volume) will guide how often you should catheterize. If less than 100-200 mL came out of the catheter 2 or 3 times in a row, you should probably wait longer between catheterizations. Try spacing your catheterizations apart long enough to keep the volume coming out of the catheter each time between 200 – 500 mL. This will give you an idea of how often you need to catheterize. Keeping a record of the time and frequency you catheterized at and how much urine came out each time will help you to set a schedule to catheterize by.
Ask your healthcare professional for advice if you still have questions about how often you should self-catheterize.
Things To Look Out For 2,9:
There is always a risk of injury or a urinary tract infection with catheterization. Possible symptoms that may appear include:
- Pain or unusual resistance to the insertion of the catheter: this may mean you are not using enough lubricant or may be a possible sign of a stricture or scarring of the urethra.
- Blood in the urine or on the catheter: you may see mild urethral bleeding during or right after catheterization within the first week or two after catheterization; this can be normal and not necessarily a sign of an injury. However, frequent or heavy urethral bleeding is unusual and requires medical attention.
- Painful urination, cloudy or bad smelling urine, fever (temperature of 38°C/100.4°F or higher), or chills: these may indicate an infection and requires medical attention.
- If you can’t insert the catheter after several attempts: this may require immediate medical attention.
Please report to and seek for advice of your healthcare provider if you noticed any of the above (or other) symptoms) or go to the nearest hospital emergency room if immediate support is required.
Why use Cathejell for Self Catheterization?
To make the self-catheterization process easier, you should use a sterile lubricating gel. Cathejell is a sterile lubricating gel in an accordion syringe with an anesthetic (an ingredient that numbs an area from pain), which is injected into your urethra before putting the catheter into the urethra, to reduce the risk of pain and injury to the urethra.
Practice Makes It Easier
Intermittent self-catheterization is a safe and effective way of emptying the bladder when you can’t empty it normally. After a few weeks of self-catheterization you will find yourself more at ease with the procedure, your catheterization technique will improve, and it will become easier to do it. Most individuals find that self-catheterization has minimal effect on their daily living activities and will often feel improvement in their quality of life compared to when urinating was difficult.
- Cravens DD, Zweig S. Urinary catheter management. Am Fam Physician. 2000 Jan 15;61(2):369-76. PMID: 10670503. https://www.aafp.org/afp/2000/0115/p369.html
- Clean Intermittent Urethral Catheterization in Adults, Canadian Best Practice Recommendations for Nurses, April 2020, Urology Nurses of Canada, https://unc.org/wp-content/uploads/2020/05/Clean-Intermittent-Urethral-Catheterization-Adults-for-Nurses-BPR-May2020-1.pdf
- Wilson M. Catheter lubrication and fixation: interventions. Br J Nurs. 2013 May 23-Jun 12;22(10):566, 568-9. doi: 10.12968/bjon.2013.22.10.566. PMID: 23752454.
- Tzortzis V, Gravas S, Melekos MM, de la Rosette JJ. Intraurethral lubricants: a critical literature review and recommendations. J Endourol. 2009 May;23(5):821-6. DOI: 10.1089/end.2008.0650. PMID: 19397430.
- Male Urethra anatomy – Noah Schenkman Medscape, June 29, 2016, https://emedicine.medscape.com/article/1972482-overview#:~:text=The%20male%20urethra%20originates%20at,(see%20the%20image%20below).
- Female Urethra anatomy – Noah Schenkman, Medscape, June 27, 2016, https://emedicine.medscape.com/article/1972504-overview#a2
- Aygin D, Usta E, The effect of lubricants used in indwelling bladder catheterization through urethra on procedure-related pain: a literature review, Int J Clin Exp Med 2017;10(2):1995-2005, www.ijcem.com
- Uro Today, Diane Newman, Intermittent Catheters – complications – published URO-TODAY online – Mar 3, 2020.
- CUA website, patient pamphlet on Clean Intermittent self-catheterization for men/women https://www.cua.org/sites/default/files/Flipbooks/PIB/PIB01_en/mobile/index.html