Establishing good catheter routines

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.

"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

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.

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.

"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

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.

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.

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

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.

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.