A-Z Intermittent Self-Catheterisation (ISC)

What is Intermittent Self-Catheterisation (ISC)? 

Self-catheterisation means that you put a soft catheter in your own urethra by yourself to empty your bladder. You’ll be taught exactly how to do this by your healthcare professional either in hospital, at your local clinic or in the comfort of your own home. Don’t be scared to ask about being taught at home if you feel more comfortable with it. If you can’t insert a catheter yourself, this procedure can be done by a healthcare professional or someone who knows how to.

How does ISC work? 

Once you know what you’re doing, you’ll insert the catheter into the bladder at certain intervals throughout the day or when you feel the need to go to the toilet. Sometimes, it will also be necessary that you get up once or twice in the night to catheterise, but normally you shouldn’t if you catheterise before going to sleep. Once all the urine has drained out of your bladder, the catheter can be removed, and ou’re all done. Bear in mind, that all self-catheterisation catheters in the UK are made for single-use only and should be thrown away after use. Make sure to not reuse the same catheter twice as this increases the risk of infection drastically! 

Some people will need to catheterise six times a day, others only once. There isn’t really a one rule for all kind of situation when it comes to frequency. But don’t worry, your healthcare professional will help you work out what works best for you. At the start of your ISC journey, your healthcare professional might ask you to measure your urine and keep a chart of how much you pass each time. This is to make sure you’re catheterising often enough but not too often. 

Who can and can’t use an ISC? 

As with everything, ISC isn’t for everyone so it’s really important that you’re first step is to speak with your healthcare professional about it. To be able to use ISC as a way of catheterisation, it’s necessary that you’re cognitively well and that your dexterity is good enough to catheterise yourself. That’s why, in many cases, ISC may not be suitable for people with Arthritis or Alzheimer’s. However, there are times when family or carers are taught how to perform ISC by a healthcare professional when the person can’t themselves.

How to use an ISC catheter

This guide should be used alongside the instructions for use supplied by the product you’re using. You should always speak to your healthcare professional for advice before using the catheter.

You might feel uncomfortable the first few times you use an ISC catheter. Your best course of action is to stay calm, take a few deep breaths and move as slowly as you can. Remember you should always make sure that you have a spare catheter in case the catheter is dropped before it is inserted. Here is a step-by-step guide that will get you started:

For Women:

1. Wash your hands well with soap and water.
2. Gently clean the genital area with soap and water and then wash your hands again. Be careful not to touch anything else other than your catheter once you have washed.
3. Part the labia with one hand and using your dominant hand insert the catheter into your urethra until it enters the bladder. You may find that using a mirror to help locate your urethra is helpful while you are getting used to this procedure.
4. When urine starts to flow, the catheter can be attached to a urine bag or drained directly into a toilet or jug. When the urine flow stops, retract the catheter by 2-3cm.
5. If urine flow starts again wait for it to stop, retract the catheter for another 1-2cm to drain the rest of the urine.
6. When the bladder is completely empty, slowly, and gently remove the catheter. If you have any doubts, check the instructions for use.
7. Dispose of the used catheter and any other used items in a disposal bag and place in the general household rubbish.
8. Wash your hands well with soap and water.

For men:

1. Wash your hands well with soap and water.
2. Gently clean the genital area with soap and water and then wash your hands again. Be careful not to touch anything else other than your catheter once you have washed.
3. Pull back your foreskin (if you have one) and hold your penis firmly up towards your stomach with one hand.
4. Insert your catheter with your dominant hand and be careful not to touch any part of the catheter that is to enter the bladder.
5. When urine starts to flow, the catheter can be attached to a urine bag or drained directly into a toilet or jug. When the urine flow stops, retract the catheter by 2-3cm.
6. If urine flow starts again wait for it to stop, retract the catheter for another 1-2cm to drain the rest of the urine.
7. When the bladder is completely empty, slowly and gently remove the catheter. If you have any doubts, check the instructions for use.
8. Dispose of the used catheter and any other used items in a disposal bag and place in the general household rubbish.
9. Wash your hands well with soap and water.

Although the procedure of self-catheterisation itself is safe, complications can occur. Some pain and blood may occur especially in the beginning due to irritation of the mucous membrane of the urethra. If symptoms persist, consult a healthcare professional.

What makes ISC so much better? 

ISC is generally seen as the golden standard in the world of catheterisation – and that’s for multiple reasons: 

• It reduces the risk of urinary infections and urine flowing back into the kidneys.
• It increases independence.
• It allows the bladder to recover and regain the ability to empty by itself.
• It’s more convenient in relation to movement and sexual intercourse.
• It reduces any risks associated with long-term catheters (e.g. urethral trauma, encrustation).
• It empties the bladder completely each time you use your catheter which stops a build-up of old urine and prevents urinary infections.

How to get into a routine with ISC 

Routines are an easy way to keep track of your ISC but they’re obviously not for everyone. So, if you’re not a routine kind of person, then that’s not a problem either. Just make sure that you can find a way that works for you and speak to your healthcare professional about it. 

In the long run, the best way to get into a routine is to link your catheterisation to daily activities like brushing your teeth or mealtimes. Look at how your bladder would usually function. When would you usually nip to the loo? You might go for a wee first thing in the morning, then again mid-morning, before or after lunch, once in the afternoon, before or after dinner, and then just before you hop into bed. If that is what your usual pee routine would look like, then try and catheterise according to it. It should become second nature in no time! 

It’s also very important that you get into a routine where you have your catheter supplies handy at any point – no matter where you go. It might be worth getting yourself a little washbag that you can throw in your bag. This way, you always have your catheter and accessories handy when you need them. 

And last but not least, don’t panic if you forget to catheterise. It happens to everyone at some point, and it is not the end of the world - at least not if it only happens once in a blue moon! Just take a deep breath, grab everything you need and go catheterise as soon as you remember.

How long will I need to catheterise for?

How long you will need to catheterise for depends on the reason for needing an ISC catheter in the first place. For example, if you need a self-catheter following surgery, the bladder will normally return to normal function after one to two weeks. You should speak to your healthcare professional for guidance on how long you will need to catheterise for, as it varies from person to person.

READ: Finding the right ISC size for you

How often should I catheterise?

Some people will need to catheterise six times a day, others only once. As you can see, this isn’t really a one rule for all kind of situation when it comes to frequency. But don’t worry, your healthcare professional will help you find out what works best for you. At the start of your ISC journey, your healthcare professional might ask you to measure your urine and keep a chart of how much you pass each time. This is to make sure you’re catheterising enough. 

Can you still have sex whilst using an intermittent self-catheter?

Yes, you should be able to still have sex, performing ISC shouldn’t affect your sex life.

What if I see blood whilst self-catheterising?

It is quite common to see a few drops of blood every now and again whilst self-catheterising, it can be caused by the catheter itself and is usually only temporary. However, if the bleeding is continuous and not going away, please seek medical advice from a healthcare professional.

References

1. https://www.gloshospitals.nhs.uk/your-visit/patient-information-leaflets/intermittent-self-catheterisation-isc-adults/

2. https://mft.nhs.uk/app/uploads/sites/4/2018/04/CISC-August-2017.pdf