Intermittent Self-Catheterization

A Step by Step Guide

for
Men and Women

©1986 – 2005
St. Joseph’s Healthcare Hamilton
Hamilton, Ontario

Contributors:
Jennifer Skelly
Paula Eyles
Linda Hilts
Jane Worral
Linda Campbell
Janice North

Artwork by:
Elizabeth McMahon
Terra Nicolle

Inside this book…

Some words in this book ...…………………………………………………. 1
What is Intermittent Catheterization? ..................................................... 2
Why do Intermittent Catheterization?
When to catheterize
Helpful hints
Record book …………………………………………………………………. 3
Eating and drinking ………………………………………………………….. 4
Medications …………………………………………………………………... 5
Where to get the equipment ……………………………………………….. 6
Looking after the equipment
Steps to follow if female ……………………………………………………. 7
Positions for females …………………………………………………….. 10
Steps to follow if male ………………………………………………………. 11
Positions for males ……………………………………………………….. 15
What to do when there is a problem ………………………………………. 16
Going out or travelling ………………………………………………………. 17
When you have questions or concerns …………………………………… 18
Some words in this book . . .

Bladder: the part of the body that holds urine

Catheter: a narrow, plastic tube that helps urine flow from the bladder to
outside the body

Overdistended: a word used to describe the bladder when there is more

than a normal amount of urine in it and you are not able to void. A more
than normal amount is over 500 mls or 2 cups.

Perineum: the part of the body between the scrotum and the rectum in a
man, and the pubic bone and the rectum in a woman.

Urethra: a smooth passage that goes from your bladder to the outside of
your body through which you pass urine. The catheter is put into the
urethra to go to the bladder to let the urine out.

Void: a word used to describe when you try to empty your bladder by
passing urine through the urethra. The bladder has a small amount of urine
left in it after voiding. This is called residual.

Kidneys

Bladder
(holds urine)
Urethra Perineum
Perineum

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What is Intermittent Catheterization (IC)?

Intermittent Catheterization is sometimes called IC. A thin tube, called a

catheter, is put into the urethra each time you need to empty your bladder.

Why do Intermittent Catheterization?

Some people have bladders that cannot hold all of their urine.
Some people are not able to empty their bladders completely.
Intermittent catheterization is done to:
• keep you dry
• prevent infection in your bladder
• keep your bladder and kidneys healthy

When to catheterize

This depends on how much fluid you drink. Most people need to
catheterize every 4 to 6 hours when they are awake.

Helpful hints...

• You should drink between 1,500 to 2,000 mls a

day. This is 6 to 8 large glasses of fluid a day.

• Each time you catheterize, the amount of urine

needs to be between 400 to 600 mls.

• Avoid becoming overdistended.

This means that you have too much
urine in your bladder. Pick times during
the day that will drain the right amount
of urine so your bladder does not get
overdistended.

The signs of being overdistended are:

• feeling restless
• sweating
• chills
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 • headache
• looking flushed or pale
• cold fingers, toes, arms or legs
• the lower part of your abdomen looks bloated

If you have any of these feelings, you need to catheterize as soon as you
can. You may then need to adjust the times you catheterize and the
amount of fluid you drink so your bladder does not become overdistended.

When you can, try to void before you catheterize. The urine left in your
bladder after you void is called residual urine. If you have 200 mls or less
when you catheterize after you void, you can increase the time between
catheterizations.

As voiding improves, the amount of residual urine will decrease. If the

amount of residual urine stays below 100 mls, you may be able to stop
doing intermittent catheterization.

Remember . . .

Be sure to check with your health care professional before you stop
catheterizing.

Record Book

Use this chart as a sample to make your own record book. This will help
you adjust your catheterization times.

Date Time Fluids I drank Amount I voided Amount I

on my own catheterized

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Eating and drinking

• You do not need to follow a special

diet unless advised by your doctor.
• You need to drink 6 to 8 large
glasses of fluid each day.
• Change your drinks during the day. For example, drink water, apple or
cranberry juice and decaffeinated tea, coffee and pop.
• Avoid caffeine. Caffeine makes you feel the need to void more often and
right away. Caffeine is in coffee, tea, colas, Mountain Dew® and
chocolate. It is best to check product labels.
• Have something to drink with your meals.
• Drink between meals as well.

Remember . . .

• Drink 2 glasses of cranberry juice or the equivalent cranberry capsules

each day. This helps keep the amount of e coli bacteria in your bladder
low and reduces the chance of bladder infection.

Medications

There are 3 reasons why you may need medication:

• to help you empty your bladder
• to reduce bladder spasms
• to treat an urinary tract infection if you get one

Take medication exactly as your doctor orders it.

Do not stop taking any of these medications

without talking to your doctor first.

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Medication to help empty your bladder

Medication such as Urecholine® or Duvoid® can help empty your bladder by

improving the muscle tone of your bladder.

• Take this medication 3 times a day with your meals.

• Allow 2 hours between the time you take this medication and the time
you catheterize.

• Try to void before you catheterize each time.

Here are some examples:

• If you take your medication at 8:00 in the morning, void and catheterize
at 10:00 in the morning.

• If you take your medication at 12:00 noon, void and catheterize at 2:00
in the afternoon.

• If you take your medication at 4:00 in the afternoon, void and catheterize
at 6:00 in the evening.

Medication to reduce bladder spasm

Ditropan® or Probanthine® helps reduce spasms in the bladder. This

medication can make your mouth dry but you need
to keep on taking it.

You may also become constipated if

you take this medication. Eat foods
high in fibre to prevent constipation.
High fibre foods include whole grain
products, bran, fruit and vegetables.

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Medication to treat urinary tract infections

You will need to take antibiotic medication to clear up a urinary tract

infection.

Let your doctor know about any side effects you have while taking this
medication. Make sure you know what to do if you get any side effects from
the medication.

Increase the amount of fluid you drink when you have a urinary tract
infection. This helps to flush the infection out of the kidneys and bladder.
When you increase your fluids, you may need to increase the number of
times you catheterize.

Where to get the equipment

• You can purchase equipment from medical supply stores and some
drug stores.

• Some insurance plans cover the cost of equipment.

Looking after the equipment

It is important to clean and care for the catheters to help prevent urinary
tract infections.

All catheters should be washed well with soap and

water after each use.

• Wash the catheter by hand using Sunlight® liquid

detergent under warm running water. Soap and
rub the catheter for 10 seconds, then rinse well.
• Place the catheter on a clean cloth to air dry.
When the catheter is dry, put it in a clean dry container for the next use.
• Catheters that are not being used again should be thrown away.
• Plastic catheters that are being used again should be thrown away when
the plastic looks cloudy. This is about once a week.
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Steps to follow if female

Getting Started

Get your equipment ready:

You will need:

the size and type of catheter your health care provider recommends

a clean, dry container to store your catheter in. This could be a zip-lock
style bag or toiletry bag.

soap and water

washcloth or non-scented throw away wipes

tube or packages of water-soluble lubricant

such as Lubrifax® or K-Y Gel®

toilet-top plastic measuring container if you sit on the toilet

bedpan if you catheterize lying down

Step 1

• Make sure you can reach your supplies while you catheterize.

• Arrange your clothing so it is out of your way.

• Put the toilet-top plastic measuring container in your toilet

if you use one.

• If you are able, try to void before you catheterize.

• If you voided, measure the amount of urine in the

container.

• Empty the container into the toilet.

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• Flush the toilet.

• Rinse the container with warm water.

• Put the container back in the toilet. This will catch the catheter if you
drop it.

Step 2

• Wash your hands with soap and water.

• Rinse your catheter with warm water.

• Lubricate about 5 centimetres or 2 inches at

the tip of the catheter.

• Place the catheter on a clean surface within

reach.

Step 3

• Wash your perineum with soap and water.

Be sure to:
• separate your labia
• wash from front to back only
• use non-scented soap or throw away wipes

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Step 4

• Get into a position that is best for you.

• Separate your labia.

• Slowly put the catheter about 3 inches or 8

centimetres into your urethra.

• When urine begins to flow, push the

catheter in about 1 more inch or 3
centimetres.

• Allow all of the urine to drain from your bladder.

• Push down with your abdominal muscles to help empty your bladder.

Step 5

• When the urine stops flowing, gently and slowly take the catheter out of
your urethra.

• If the urine begins to flow again as you are removing the catheter, stop
pulling it out and wait for the urine to stop flowing. Then slowly pull the
catheter out.

• Using toilet paper, wipe from front to back only.

• Measure the amount of urine in the container.

• Empty the container into the toilet.

• Flush the toilet.

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Step 6

• Rinse the container with warm water.

• Wash your catheter with soap and water.

• Wash your hands.

• Let the catheter air dry.

• When dry, put the catheter in the bag.

• Clean up your work area.

Step 7

In your book, record:

• the amount you voided
• the amount you catheterized

Positions for females

You can use these positions:

Sitting forwards on a toilet, wheelchair, chair or side of a bed.

Sitting backwards on the toilet with a mirror between the lid and the seat.

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Sitting on a toilet facing forward with a mirror on a low stool.

Standing beside the toilet with one foot resting on the toilet rim.

Lying in bed with:

• pillows behind your neck and back
• legs bent
• ankles touching each other
• knees apart

Put a make-up mirror with lights or a magnifying mirror on the bed to look
into.

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Steps to follow if male

Getting Ready

You will need:

the size and type of catheter your health care

provider recommends

a clean, dry container to store your catheter in.

This could be a zip-lock style bag or toiletry bag

soap and water

washcloth or non-scented throw away wipes

tube or packages of water-soluble lubricant such as Lubrifax® or K-Y

Gel®

toilet-top plastic measuring container if you sit on the toilet

bedpan if you catheterize lying down

Step 1

• Make sure you can reach your equipment while you catheterize.

• Arrange your clothing so it is out of the way.

• Put the toilet-top plastic measuring container on the toilet

if you use one.

• If you are able, try to void before you catheterize.

• If you voided, measure the amount of urine in the container.

• Empty the container into the toilet.

• Flush the toilet.

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• Rinse the container with warm water.

• Put the container back on the toilet. This will catch the catheter if you
drop it.

Step 2

• Wash your hands with soap and water.

• Rinse the catheter with warm water.

• Lubricate 15 centimetres or 6 inches of the

catheter. Put the catheter on a clean surface
within reach.

Step 3

• Get into the position that is best for you.

• Hold your penis in one hand and wash it well

with soap and water using a circular motion.
Move from the tip of your penis to the base.

• Men who are not circumcised should pull the

foreskin back and wash well with soap and water.

Step 4

• Hold your penis at a 60° to 75° angle.

• Slowly put the catheter in your urethra until urine

begins to flow. This will be at about 20 to 25
centimetres or 6 to 8 inches. Sometimes the
catheter is hard to push just before it goes into the
bladder. This is normal. Use gentle but firm
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 pressure on the catheter until it passes this point and the urine begins to
flow.

• When the urine flows, push the catheter in about 2 centimetres or 1 inch
more.

• Relax and let all the urine drain from your bladder.

• Push down with your abdominal muscles to help empty your bladder.

Step 5

• When the urine flow stops, gently and slowly remove the catheter. If the
urine begins to flow as you are taking out the catheter, stop and wait for
the urine to flow to stop. Then slowly pull the catheter out.

• Using toilet paper, wipe the lubricant off your penis. If you are not
circumcised, pull your foreskin forward.

• Measure the amount of urine in the container.

• Empty the container in the toilet.

• Flush the toilet.

Step 6

• Rinse the container with warm water.

• Wash your catheter with soap and water.

• Wash your hands.

• Let the catheter air dry.

• When dry, put the catheter in the bag.

• Clean up your work area.

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Step 7

In your book, record:

• the amount you voided
• the amount you catheterized

Positions for males

You can use these positions:

Sitting on a toilet, wheelchair, chair, or side of a bed:

Lying in bed with:

• pillows behind your neck and back
• feet apart
• knees apart

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What to do when there is a problem

What you see or feel Why this happens What you do

When you cannot push Sometimes the catheter Try to relax.

the catheter along your is harder to insert just
Apply gentle and firm
urethra, it is called before it enters the pressure until the
meeting resistance. bladder. catheter passes further
This is normal and can and urine begins to flow.
be caused by bladder Men can try changing
spasm. the angle of the penis
during insertion from 60°
up to 75°. This often
helps the catheter pass
smoothly.
You cannot remove the This could be caused by Wait 5 to 10 minutes.
catheter when you finish a spasm in your bladder. Try to relax. Try to
catheterizing. remove it after you have
relaxed. If you still
cannot remove it,
contact your health care
provider.
If you find that you often
have trouble removing
the catheter, talk to your
health care provider.

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You feel or see the signs Contact your health care
of a urinary tract provider. You may need
infection: to take a urine sample to
the lab for testing. If you
• high fever not caused
have a urinary tract
by a sore throat, cold
infection, you will be
or flu
given medication to treat
• pain or burning when it.
you void or
Increase your fluid
catheterize
intake and adjust your
• blood in your urine catheterizations.
• voiding more often
than your normal
such as every hour or
less
• cannot wait to void or
you feel you have to
void right away
• foul smelling or
cloudy urine
• wetting yourself more
often than usual

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Going out or travelling

You need to make a travel kit up and take it with you.

The amount of equipment you take depends on how
long you will be away. For example, if you go away for
the day, you can carry your equipment in a zip-lock
style bag, toiletry bag, purse or small bag. If you will be
away longer, you may need to carry your equipment in
a shopping bag, back-pack, gym bag or suitcase.

Your travel kit should include:

A supply of catheters in separate plastic bags

The amount depends on how long you will be away.

a bag to store the catheter in

non-scented, throw away wipes

water-soluble lubricant - take 1 package for each

time you will catheterize.

When you have questions or concerns…

Contact a member of you health care team.

This may be:
• Your family doctor
• Nurse Continence Advisor

PD 1488 Rev 2005

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