Establishing sound catheter routines

Establishing good catheter routines

Avoid leaks, reduce the risk of complications, and be able to do more. The key is sticking to your intermittent self-catheterisation (ISC) schedule and ensuring great hygiene.

 

Why catheter routines are important

Why catheter routines are important

Inspiration for fitting catheterisations into your daily life Why catheter routines are important
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Why catheter routines are important

Emptying your bladder with a catheter can give you the freedom to get on with activities that are important to you. The key is finding a way to make emptying your bladder with a catheter a part of your daily routine. Here is some advice that other catheter users have found useful when they had to find their way of fitting catheterisation into their daily lives.

Use a chart or set an alarm to remember

At first, many people like to use a chart or diary, which can be good visual cues when implementing a new routine. Charts are also helpful if your nurse wants you to keep track of the amount of urine you pass. Other suggestions might be to set a watch or a phone alarm. 
Using intermittent self-catheterisation (ISC) is the preferred treatment when you are not able to empty your bladder normally – this avoids residual urine in the bladder, which can lead to infections or complications.

Catheterise 4-6 times or as prescribed by your doctor or nurse

This is the number of times that nurses and doctors recommend you to do ISC (if you are not able to urinate normally e.g. due to chronic urinary retention).
If you are completely dependent on catheters to empty your bladder and catheterise less than prescribed by your doctor or nurse you may experience:

Leakage:

Leakage might occur because your bladder essentially gives in to the urine volume exceeding the bladder capacity. Consider catheterising more frequently to avoid the bladder pressure from building up. 
 

Urinary tract infection:

If you do not empty your bladder often or don’t empty it completely, the urine can become stale. Bacteria in the urine will multiply, which may lead to an infection of your bladder or urinary tract. 

Potential damage to your kidneys:

The increased pressure on your bladder can create a backflow of urine to your kidneys, which can lead to an infection or long-term damage to your kidneys.

If you are catheterising more than 6 times per day and still have problems with urine leakage, you should consult your doctor.

Measure the amount of urine you pass

Make sure your bladder is fully emptied every time you catheterise. Urine left in the bladder can cause infections. Every once in a while, measure the amount of urine you empty. It should be no more than around 400 ml. If you empty more than 400 ml, ask your doctor if you should perhaps catheterise more often.

Go out – but still remember to empty your bladder

Keeping your catheterisation routine is just as important when you are out as it is when you are at home. Plan your day ahead, so your catheterisation fits in with your other activities. When is it convenient for you to catheterise? Before going to the cinema? During the intermission of a play? 

But always remember to empty your bladder completely regardless of where you are.

To make sure urine is removed from the base of your bladder, you need to remove the catheter slowly and pause if more urine is flowing out.

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Useful hygiene tips for catheterising

Useful hygiene tips for catheterising

Useful hygiene tips for catheterising Maintaining good catheterisation hygiene is vital – here’s how you do it Useful hygiene tips for catheterising
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Useful hygiene tips for catheterising

"I always carry baby wipes with me to clean myself. I prefer those to toilet paper. I always wash my hands before and after catheterising. I feel like clean hands are key to maintaining a healthy bladder." - Samantha

 

Even though using a single use catheter reduces the likelihood of infection compared to indwelling catheters, it is still essential that you maintain good hygiene.

Wash your hands

Soap and water is fine, and an antibacterial hand gel can be used instead if you are somewhere where water is not available.

Cleanse genital area

This should be done from front to back. Mild soap and water is all that is required. Dry with a clean pad or towel. Do not touch anything else apart from your catheter after you washed your hands – and only touch the body parts that are meant to be touched to perform catheterisation.

What if I’m in a public toilet? 

If you need to touch anything after you wash your hands – such as the door handle or the hand rims if you’re in a wheel chair – it’s important to use hand-sanitising gel or wash your hands again.

How often should I discard my catheter?

According to international guidelines it is recommended to use a new sterile catheter for each time you perform intermittent catheterisation. The reason is to obtain good bladder health and prevent urinary tract infections.

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What is a bladder infection

What is a urinary tract infection (UTI)?

Learn what causes UTI What is a UTI?
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What is a UTI?

In most people, urine is normally sterile (free from germs or bacteria) and the presence of bacteria in the urinary tract does not necessarily cause a urinary tract infection. If, however, the bacteria grow and multiply to a certain level, they may cause an infection of the urinary tract and needs to be treated. Anyone can get a urinary tract infection (UTI), but they’re more common in women than men due to the short female urethra (the channel through which urine is passed).

An infection can be thought of as a group of symptoms caused by bacteria entering an area of your body that they should not be in. Urinary infections are caused by bacteria entering your bladder, which most commonly enter your bladder through the urethra. The bacteria multiply in your bladder, either floating in the urine or attached to the bladder wall. As your bladder and kidneys are connected, bacteria in the bladder can also invade your kidneys.


If your body’s immune system fails to clear the bacteria from your body, treatment with antibiotics is probably needed. If you have bladder issues already, you’re more at risk of getting UTI.

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How do I know if I have a UTI?

How do I know if I have a UTI?

If you have some of these symptoms you might have an infection How do I know if I have a UTI?
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How do I know if I have a UTI?

If you have bladder problems, you are at risk of developing urinary tract infection. It is important that you recognise the different symptoms of UTI, as untreated UTI can be harmful to your bladder and kidneys.
But be aware of other symptoms, which are more subtle and therefore harder to recognise as UTI-symptoms.

Symptoms that may be related to UTI:

  • Pain or discomfort when passing urine
  • An urge to pass urine frequently
  • Cloudy and strongly smelling urine (unrelated to foods that can cause urine odour)
  • Blood in the urine 
  • Unexpected leakage
  • Fever/sweating or chills
  • Pain in the bladder (above pubic bone area)
  • Pain in the kidney area (lower back area)

How to check if you have a urinary tract infection (UTI)

Your physician may perform a quick urine test which can give a rough indication of whether or not bacteria are present. To determine whether you do have a UTI, your doctor will check with a urine culture and may also want to take a blood test in order to assess other factors. If you suffer from recurring UTIs your doctor may want to have you see a urologist for further testing.

How do I prevent UTI?

There are a number of precautions to prevent urinary tract infections. Read more about how to prevent UTI here.

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Trying to avoid UTIs

Trying to avoid UTIs

Follow this advice and minimize your risk of urinary tract infections (UTI) Trying to avoid UTIs
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Trying to avoid UTIs

"When you’re using catheterisation, you have to have good personal hygiene and that just means washing my hands before I start. I use wipes or I try to at least have some time when I've had a shower, that makes it easier and quicker, because I don't have to go through as many steps." - Vicki

 

There are a number of precautions that might help you prevent recurring urinary tract infections.

Get enough fluids

Everyone needs daily fluids to maintain their health. Drinking 6–8 glasses of fluids each day is the usual recommended amount, but it is not for everyone. You should first consult with your healthcare provider to determine the amount that is best for you based on your individual medical condition(s). Beverages containing caffeine (such as soft drinks, coffee, tea and some energy drinks) and artificial sweeteners are known bladder irritants and may need to be kept to a minimum.

Why?
Drinking lots of water dilutes the urine and flushes bacteria out of the bladder. If you regularly empty your bladder as directed by your healthcare professional, you may remove urine with potential bacteria each time you catheterise. Make sure you drain the bladder completely each time.

Maintain a good personal hygiene

Always wash your hands thoroughly – especially before you use your intermittent catheter. Also, carefully clean around the urethral opening before inserting the catheter.

Why?
Bacteria from improper hand washing, or bacteria near the urethral opening, can be introduced into the urinary tract when using a catheter.

Regularly empty your bladder completely as prescribed by your healthcare professional.

Maintaining your catheterisation schedule may help in the prevention of urinary tract infections.

Why?
Staying on a regular schedule and emptying your bladder completely with intermittent catheterisation, reduces the amount of urine sitting in the bladder and the time that urine is left to sit stagnant in your bladder. Each time you catheterise you remove urine in the bladder along with any bacteria that may be present.  

Use a sterile catheter every time

Use a new, sterile, well-lubricated (hydrophilic-coated or pre-lubricated) catheter every time you catheterise, in order to reduce friction as you insert and remove your catheter. You may also want to discuss the amount of catheters you are allowed each month with your GP or prescriber.

Why?
A well-lubricated, (hydrophilic coated or pre-lubricated) catheter may make the process more comfortable and may lessen the friction during insertion and withdrawal of the catheter.

Tip: Every once in a while, measure the amount of urine you empty. The goal is to keep the catheterised urine at a volume (400ml) which avoids overstretching the bladder and prevents leaking. If you empty more than this amount, ask your healthcare professional if you need to use intermittent catheterisation more often.

Other advice:

Maintain a good bowel regime and avoid constipation.

Some people may benefit from drinking cranberry juice or taking cranberry extract tablets, but there is no clear proof of efficacy. Always ask your healthcare professional before you take any supplements to make sure it doesn’t interact with any of your existing medications.

If you have recurring infections, drink fluids as you have been directed, but try to eliminate known bladder irritants such as caffeinated drinks (coffee, soft drinks and energy drinks) as well as artificial sweeteners to see if it helps, as these items can cause irritation to the urethra.

If you – despite all these precautions – still suffer from frequent UTIs, talk to your doctor.

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Special advice for women on UTIs

Special advice for women on UTIs

Women have a higher risk of UTI. Read our advice for good routines. Special advice for women on UTIs
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Special advice for women on UTIs

Besides drinking adequate fluids, regularly emptying the bladder and maintaining a good personal hygiene, women need to include some extra routines to reduce the risk of getting urinary tract infection.

Precautions when you have sex

During intercourse your genital area will always be introduced to bacteria – either from yourself or from your partner. Follow these rules before, during and after sex to limit the amount of bacteria:

Before sex:

Empty your bladder as a full bladder gives better conditions for bacteria to settle down and grow.

During sex:

If you feel dry during intercourse use a water-soluble gel (lubricant) to help reduce friction and stress of the tissue, which can lead to infection. Diaphragms and spermicides can also cause irritation, which can lead to infections. If you have frequent UTIs talk to your doctor about another form of birth control.

After sex:

Empty your bladder immediately after having sex, even if there is only a small amount of urine in your bladder. This will flush out potential bacteria. Drink 2–3 glasses of water and urinate when you have the urge to do so. The goal is to have a good steady stream of urine to flush any bacteria from the bladder.

Avoid fragrance down there

Don’t use sprays, deodorants, powders or heavily scented soap on the genital area. Some laundry detergents, bleaches and fabric softeners leave residue in your underwear. Use unscented products instead.

Why?
Perfume or other fragranced chemicals can irritate your skin or cause allergic reactions.

Wear cotton and loose-fitting clothes.

Wear cotton underwear and loose-fitting clothes, so air can keep the area around the urethra dry. Tight-fitting jeans and nylon underwear are not good, because they can trap moisture and help bacteria grow.

Other good advice:

  • Change sanitary pads and tampons frequently during menstruation
  • Be careful how you wipe yourself – always wipe from front to back, so that the bacteria from your anal area is not pushed into the urethra.
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Tips on catheter schedules

Tips on catheter schedules

It is important to catheterise regularly to keep healthy and avoid leakage. These habits should be part of your routine. Tips on catheter schedules
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Tips on catheter schedules

You should catheterise 4-6 times a day or as often as prescribed by your doctor or nurse. The best way to remember to catheterise is to get into a habit that fits in with your life. As a quick reminder, here are some things that may help you perfect and stick to your routine:

Link your catheterisation routine to your regular daily activities, for example, brushing teeth and mealtimes

Use reminder ‘aids’ like alarms (on watch or phone) and notes.

Drink at least 1.5–2 litres of fluid per day and do not decrease it.

Keep catheters and accessories handy. Read more about packing a ‘smart kit’.

If you forget, catheterise as soon as you remember.

Consult your doctor or nurse if you have any questions or doubt.

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make bladder management easier

ISC and optimal bladder management

There are many things you can do to make bladder management easier and improve your bladder health. Get inspiration here. ISC and optimal bladder management
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ISC and optimal bladder management

Using intermittent catheterisation is the preferred treatment when you are not able to empty your bladder normally. Besides catheterising 4-6 times a day, you should consider the following options for bladder management:

If you are not completely dependent on catheters there are ways to exercise the bladder:

Pelvic floor exercises

Pelvic floor exercises or kegels are designed to strengthen the pelvic floor muscles to help reduce urinary incontinence. Pelvic floor exercises are equally relevant for women and men. Do it when you are waiting in line, when you watch TV, read a book, in the shower or whenever you can fit it into your daily life. You will need to do the exercises daily and it may take up to several months before you see a significant improvement. You can get different apps for your smartphone, which can help you remember or make it more fun to do the exercise.

Bladder retraining

Some people are able to retrain the bladder to help reduce urinary incontinence, by aiming to gradually stretch the bladder so that it can hold larger volumes of urine. Scheduling bathroom visits and delaying urination could be part of that technique. Ask your nurse or doctor if bladder retraining is relevant for you. Bladder retraining can be combined with using a bladder diary. You can download a diary here or create your own.

Lifestyle changes

Timing fluid intake at certain times can also be helpful so the need to urinate is more convenient and doesn’t coincide with going out or sleeping at night, but still keep in mind that you need to drink around 1.5–2 litres of fluid a day.

Medication

Drugs are prescribed for all types of bladder issues. Talk with your doctor regarding the use of medication.

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Keep a bladder diary

Keep a bladder diary

By keeping a bladder diary you can uncover the scale of your bladder issues Keep a bladder diary
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Keep a bladder diary

Do you have to go more often than usual? Are leakages keeping you from going out? Is your treatment actually working? Be able to see things more clearly and discover patterns to your issues. The bladder diary is a great tool to document your habits before talking about bladder control with your nurse or doctor.

Download a free bladder diary template here

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how much fluids should you drink

How much should you drink?

Why is it important to keep drinking when you have issues emptying your bladder? How much should you drink?
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How much should you drink?

When you have bladder issues, you might feel less encouraged to drink a lot of water, because you feel that this increases your problem. On the contrary not drinking enough can make your symptoms worse. Instead you should time your intake as well as your bathroom visits to gain better control.

Drinking lots of fluid can help flush bacteria out. Water is best but fruit juices can count for some of your fluid needs. Most people should drink 1.5–2 litres of water per day – unless your doctor says otherwise.

Tip: Fill one or more bottles or jugs with the recommended amount of water and store them in the fridge. Then the water is kept nice and cold and you know that once you have emptied them you have reached your daily amount.

When you travel or do sports you might want to drink less, because you are afraid of leakage or don’t want to catheterise at inappropriate times.

If you travel in a hot climate or sweat during physical exercise you risk dehydrating if you don't drink adequately. Not drinking adequately can also result in constipation, which also can affect your bladder health.

When you’ve got urinary tract infection (UTI)

Increase the amount of water you drink when you’ve got a UTI. Fluids perform two jobs: they help flush bacteria out of your bladder, and thin (dilute) your urine. Urine is made of waste products from your body. Concentrated, dark urine is more irritant and is sometimes more painful to pass when you have a bladder infection. Diluted urine is lighter in colour and usually doesn’t burn as much.

Avoid caffeinated drinks like coffee, tea or fizzy drinks. Caffeine can irritate your bladder even more when you have an infection.

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Coming to terms with a new routine

Coming to terms with a new routine

Take charge of your catheterisation and regain control over your bladder Coming to terms with a new routine
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Coming to terms with a new routine

How often do your bladder issues interfere in your daily life? Probably much more than you want them to. Once you have mastered the technique and routine of intermittent catheterisation it will have a positive impact on your life and your feeling of independence.

Still, it is perfectly normal to have worries and doubts during the different stages of changing to a new bladder management routine. If this applies to you, here is some advice that may be useful when you are starting up catheterising:

Phase 1. Receiving the news:

When you are first introduced to intermittent self-catheterisation (ISC), you might feel overwhelmed. Maybe you feel it’s too early for you to be introduced to catheterisation. Perhaps you are still struggling with coming to terms with your situation. It is important that you feel that ISC is your own decision, that you are well-informed by your doctor or nurse about what is going to happen, and that you are given the time to get used to the thought. 

Phase 2. Being taught how to do it:

We would normally feel very intimidated by the thought of a ‘stranger’ watching or touching our private parts. It is important that you receive proper instruction by your nurse and that your need for privacy is respected. If you feel that the demonstration was insufficient, don’t hesitate to get the steps repeated. If possible, ask to be taught at home. 

Trying it at home for the first time:

If you become uncertain when back at home, don’t be afraid to ask for more help. ISC is not just a walk in a park. You might need to try a couple of times before you feel confident that you can do it on your own. You might also be afraid of inserting the catheter yourself without any assistance. Knowing your own body is key to understand where the catheter goes. If you haven’t really examined that part of your body, it might seem a bit awkward at first.  

-If you are a man, just looking at the catheter tube may be unnerving as the tube is quite long – and perhaps the thought can make you afraid of damaging something inside you.
It might put your mind at ease to watch a short animation about the male anatomy to see where the bladder sits in your body and how the catheter gets there.
If you are a woman you might find it difficult to find the urethral opening. Try out different positions if possible and use a hand-held mirror.

Finally into the routine and now facing new challenges:

When you need to get back to work or want to travel, your bladder management routine might be challenged by a changed schedule and a new environment (for example public bathrooms) – and you might even need another type of catheter, which is more compact or includes a urine bag. It’s important that you continue your IC routine and do not skip catheterisations, even though your feeling of security and privacy is not the same. Planning ahead will help with this.

The future

If catheterisation is something you will have to do for the rest of your life, it is important to come to terms with it. But remember, as opposed to other bladder management solutions, you only use a few minutes catheterising 4-6 times a day – the remaining time you can live your life without having to think about your bladder. Be sure to re-assess the type of catheter you are using occasionally, so you continue to have the most optimal product according to your needs and lifestyle.

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