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Common Cathing Problems (+ How to Fix Them!)

Intermittent catheters can improve your quality of life by giving you more freedom and independence, but adjusting to life with a catheter can come with its own set of challenges. In this article, we’ll go over some common issues you may run into while self-cathing and how you can avoid them. But first —

What is self-catheterization?

Intermittent self-catheterization (ISC), or clean intermittent catheterization (CIC), is the insertion and removal of an intermittent catheter by the user to drain urine from the bladder. 

Compared to alternatives such as indwelling catheters, which are left in the body for extended periods of time, ISC is a great option for draining the bladder as it’s minimally invasive and decreases the risk of infection. Additionally, ISC provides you more freedom as the catheter does not need to be attached to a drainage bag or device at all times.

Common problems with self-catheterization

While there are a lot of advantages to self-cathing, it’s important that you learn the proper way to self-cath. The good news is that, with the right information, self-cathing can be an easy and painless process. Below, you’ll find some common issues that you might run into and some tips on how to avoid each one. While the information below is a good starting place, it’s important to consult a healthcare professional for a complete assessment of your needs before you begin self-cathing.

Urinary tract infections (UTIs)

Many people who self-catheterize experience urinary tract infections (UTIs) due to improper insertion or contamination of the catheter. Therefore, it’s important to be aware of the signs of infection and consult your doctor immediately if you think you may have an infection.

UTI symptoms

— Low belly (bladder) pain or pressure

— Feeling a strong urge to urinate

— Blood on the catheter

— Fever

— Cloudy urine

— Foul-smelling urine

— Change in urine color

— An unusually slow dribble of urine

Tips to avoid UTIs:

1. Stay clean

Successful self-catheterization starts with good hygiene. This means washing your hands before and after self-cathing, cleaning the urethra well (paying special attention to your labia or foreskin), and taking good care of your supplies. When you’re out of the house, make sure to bring extra catheters. If one drops on the floor or touches a non-sterile surface, throw it away and use a new, sterile catheter. Similarly, pay close attention to the packaging of your catheter. If it’s damaged in any way, you’ll want to throw it away and use a new catheter that you know is sterile.

2. Single-use catheters

Most intermittent catheters are single-use, disposable catheters, and help decrease the risk of infection as they are individually wrapped in sterile packaging prior to use. Never reuse a single-use catheter as doing so increases your risk of infection and injury. If you’re using a multi-use catheter, consider switching to catheters that are single-use. If you’re unable to switch, make sure you’re properly cleaning and storing your catheters between uses.

3. Opt for a catheter that requires less handling

The more you need to touch the catheter prior to insertion, the more you’re at risk of developing an infection. Thankfully, there are many intermittent catheters designed to reduce the need to handle your catheter. Some catheters are even non-touch as they are fitted with protection sheaths to protect the catheter. 

There are also different types of lubricants that require varying amounts of handling. Catheters are either non-lubricated, pre-lubricated (coated with a lubricant), or hydrophilic (coated with a substance that will dissolve in water). Almost all people who self-cath need some type of lubrication on their catheter. Manually applying lubricant can increase the risk of infection because you’ll need to touch the catheter more. Consider using a pre-lubricated or hydrophilic catheter, that requires less handling to decrease your risk of infection.

Discomfort

Self-catheterization, especially if you’re new to it, can be uncomfortable. While some discomfort is normal at first, you should be aware of the warning signs that require medical attention and how you can avoid them.

Warning signs requiring medical attention:

— Continued blood in the urine

— Rashes and sores

— Severe pain

— Foul-smelling urine

Tips to avoid discomfort:

1. Change your position

There are various positions to self-catheterize. Many people prefer sitting on a toilet, wheelchair, or at the edge of the bed. Others have found that laying down on a bed slightly propped up with your knees bent works best. Women especially might find it helpful to elevate one leg on a toilet or other object. It can also be helpful for women to use a mirror to better see the urethra when first learning to self catheterize. Try out different positions to see which works best for you.

2. Change your catheter

Contrary to popular belief, there is a right size and orientation to intermittent catheters. Using the wrong size catheter, or inserting it in the wrong way can cause discomfort and trauma. The size of the catheter refers to the diameter of the tube and is measured in French units (Fr). If urine is leaking from around the catheter or draining too slowly, you may be using a catheter that is too small. On the other hand, if you are experiencing pain when inserting your catheter, it may be because your catheter is too large.

Catheters are also available with two types of tips, coude and straight. While straight tip catheters work for most people, coude tip catheters often work better for people with enlarged prostates or other conditions that obstruct the urethra. If you think you may be using the wrong size or tip, consult with your doctor to see if another option would work better for you.

Blood on the tip of the catheter

While blood on the tip of the catheter may occur occasionally, it should not happen all the time. If you continue to see blood on your catheter, consult a doctor.

Blood on the tip of the catheter could be a sign of:

— Infection

— Trauma

— Bladder stones

— Bladder Cancer (rare)

Tips to avoid blood on the catheter:

Catheterize slowly: don’t rush when self-catheterizing, go slow to make sure you’re inserting the catheter properly.

Never force the catheter: your catheter should be able to reach your bladder with minimal resistance. If necessary, remove the catheter and start over.

Difficulty inserting or removing the catheter

Especially when you’re first learning to self-catheterize, it can be difficult to insert and remove the catheter. With practice, you’ll be able to better navigate your body and understand what techniques work best for you. If you continue to experience difficulty, talk to your doctor to make sure you’re using the proper technique and find out if there are any changes that can make self-cathing easier for you.

Tips for inserting a catheter easily:

1. Relax: tension in your body makes it more difficult to catheterize. If you are finding it difficult to insert your catheter, stop and take a deep breath before proceeding, which can help to relax the pelvic floor muscles (the muscles that support the bladder) Some people may find it is easier to do this while laying down the first few times. 

2. Never force the catheter: your catheter should be able to reach your bladder with minimal resistance. If necessary, remove the catheter take a few deep breaths and start over.

Tips for removing the catheter:

1. Relax: tension in your body makes it more difficult to catheterize. If you are finding it difficult to remove your catheter, stop and take a deep breath before gently removing the catheter.

2. Cough: coughing may help release the catheter from your body.

Rotate the catheter: rotating the catheter can make it easier to remove the catheter from your body.

Urethral complications

The lining of the urethra is delicate and prone to damage and complications. If you are experiencing any of the signs below, consult a doctor immediately.

Common urethral complications:

— Urethral strictures: narrowing of the urethra due to repeated trauma.

— Urethritis: inflammation of the urethra.

— False passages: blind ending pockets in the urethra caused by repeated trauma.

Signs of urethral complications:

— Bleeding

— Frequent urinary tract infection

— Difficulty passing a catheter

— Increased urgency 

— Urine stops flowing completely

If you also urinate on your own, you may notice:

— Difficulty urinating

— Pain during urination

— Decreased urine flow

Tips to avoid urethral complications:

1. Proper technique: consult with your doctor to make sure you’re using the right technique to avoid injuring yourself.

2. Catheterize slowly: don’t rush when self-catheterizing, go slow to make sure you’re inserting the catheter properly.

3. Use enough lubricant: not using enough lubricant can increase the amount of friction and trauma within the urethra.

Epididymitis

Some men who self-catheterize experience epididymitis, an inflammation of the epididymis which is the tube behind the testicle that stores sperm. In some cases, it also causes inflammation of a testicle, known as epididymoorchitis.

Signs of epididymitis:

— Pain, swelling, or warmth in the scrotum

— Pain, swelling, or redness of the testicle

— Pain when urinating

— Increased urge to urinate

— Blood in the semen

— Pain in the lower abdomen or pelvis

— Fever

Tips to avoid epididymitis:

1. Proper technique: consult with your doctor to make sure you’re using the right technique to avoid injuring yourself.

2. Catheterize slowly: don’t rush when self-catheterizing, go slow to make sure you’re inserting the catheter properly.

3. Use enough lubricant: not using enough lubricant can increase the amount of friction and trauma caused by the catheter.

4. Use the right catheter tip: coude catheters work better for some men as they are better able to navigate a large prostate and other obstructions of the urethra.

Bladder spasms

Bladder spasms are abnormal contractions of the bladder and can occur when the bladder is irritated by the catheter.

Signs of bladder spasms:

— Increased urge to urinate

— Burning sensation when urinating

— Only being able to pass small amounts of urine at a time

— Pelvic pain

Tips to avoid bladder spasms:

1. Avoid bladder irritants: caffeine, alcohol, and tobacco are known to irritate the bladder and should be avoided when possible.

2. Avoid drinking a lot at once: instead, distribute the amount of liquid you drink evenly throughout the day.

3. Maintain a healthy diet and exercise: eating right and exercising to maintain a healthy weight is also good for the bladder.

Bladder stones

Bladder stones are the formation of concentrated minerals (often calcium) in the bladder and can occur when urine is not fully drained from the bladder. The introduction of pubic hair into the bladder is also a common cause of bladder stones. Note that many of the signs listed below are signs that people who are able to urinate would experience. Those who can’t urinate (i.e. people who use intermittent catheters) won’t experience many of these signs.

Signs of bladder stones:

— Pain during urination

— Difficulty urinating

— Blood when urinating

— Increased urge to urinate

If you also urinate on your own, you may notice:

— Lower abdominal pain

— Cloudy urine

— Change in urine color

Tips to avoid bladder stones:

1. Drain the bladder completely: making sure the bladder is emptied completely will prevent the formation of bladder stones. Consult with your doctor to make sure you are catheterizing properly and practicing good technique. Moving the catheter slightly before removing can help make sure all urine has been eliminated. It is also good to wait a few seconds after the catheter stops draining before removing it. 

2. Stay clean: it’s important to make sure the catheter is clean and sterile before inserting it into the body. If the catheter isn’t clean, bacteria and pubic hair can be introduced into the bladder and cause complications.

Finding the right intermittent catheter

Intermittent catheterization can be an ideal solution for many people who have trouble emptying the bladder naturally . But, it’s essential to learn proper technique since most cathing problems arise from contamination and improper technique. Finding the right catheter to fit your needs can significantly reduce the risk of both.

Better Health carries a wide selection of intermittent catheters that are reimbursable through Medicare or private insurance. If you’re not sure where to start, taking our product selection quiz or requesting free samples can help guide your decisions.

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