Learning a new skill is hard enough, let alone undertaking a medical procedure like self-catheterisation! While practice does bring confidence, there are certainly some common issues that arise for catheter users in the first few weeks. Below we discuss some common challenges that may arise for new catheter users, along with strategies to help set you up for success:
Fear and anxiety – understandably many people feel nervous about causing damage, or not being able to perform the procedure correctly and independently. Please note, a small amount of bleeding can occur when you start out catheterising, but this should settle in time. Ongoing or excessive bleeding may indicate trauma and should be investigated promptly (Bardsley, 2015). If you have difficulty inserting the catheter, remember not to use excessive force as this could cause damage. Have a break and come back to the procedure when you are calm, take your time, and try again. If you cannot get the catheter in you will need to contact your healthcare professional or local health service promptly, as urine cannot be left to build up in the bladder. If you continue to struggle inserting the catheter, or you do not feel confident performing catheterisation on your own, you may need a review to trouble-shoot, including consideration of an alternative catheter and method of insertion.
Learning the technique – there are several different steps in performing catheterisation, while attention also needs to be paid to keeping things as clean as possible. It can take a little while for people to get into their own routine and remember all the steps. If you don’t feel confident in performing the procedure or you can’t remember the order of things, seek help and consider what might be a useful educational tool for you. This could include a simple list of instructions that you keep handy to remind you of the steps of catheterisation as you are performing the technique. It is also important to remember hygiene, keep your environment clean and remember hand hygiene. If infections start to become a regular occurrence, ask your healthcare professional to help review your technique to ensure you are keeping things as clean as possible.
Finding the right position – it can be hard to figure out the most comfortable position to insert the catheter, and this can take a lot of practice. For example, some women may prefer to perform catheterisation in a semi-reclined position rather than on the toilet, especially if they are navigating anatomical changes like pelvic organ prolapse. Meanwhile, men could either sit or stand, depending on what feels more comfortable. Don’t be afraid to try different positions if you are struggling, and ask about helpful accessories such as mirrors, hand grips, penis holders, and portable urinals.
Understanding anatomy –Many people are not aware of their anatomy, while others may have medical conditions which alter their anatomy. These conditions might include menopausal changes, pelvic organ prolapse, or an enlarged prostate. Firstly, engage with educational material to understand how self-catheterisation works. Following this, become well acquainted with your own anatomy (using a mirror can be very helpful for females), so you know where to insert the catheter and at what angle. If your anatomy is a little different, try alternative positions and different techniques. Remember, you may also need to try a few different types of catheters to find which design suits your individual needs. Your healthcare professional should be able to help you on this journey.
*For females, it is easy to insert the catheter into the vagina when you are starting out. If this occurs, start again using a different catheter. Using the same catheter may cause infection (Logan 2017).
Managing pain and discomfort – inserting the catheter can be uncomfortable at first, but this should settle with time. Pain can persist is some cases, especially if there is inflammation or sensitivity in the urethra, which is common in menopausal women (Logan, 2017). Pain on insertion can also occur if you are feeling tense and not fully relaxing the pelvic floor, or you experience bladder spasms in response to the insertion of the catheter. If you are experiencing persistent pain, speak to your healthcare professional about techniques to relax the pelvic floor, and use of medications such as vaginal estrogens for the urethral mucosa (in women) or anticholinergics to reduce bladder spasm (Bardsley, 2015).
Overcoming emotional barriers – people may experience an array of different emotions about catheterising, including embarrassment, frustration, or discouragement during the learning process. They may also be reluctant to leave the house or venture anywhere new where they are not aware of the available toilet facilities. Remember that self-catheterisation enables you to maintain independence and have control over your bladder function (Shaw and Logan, 2013). Catheterisation can be performed anywhere, provided you can do this cleanly. Manufacturers are also producing catheters in small, discrete packaging, which are easy to carry around in bags or pockets without embarrassment. Following use, catheters can be wrapped in their packaging and disposed of in normal household waste, so nobody need know about your bladder management. For more tips and support, there are also various community groups and organisations available through a quick online search.
Self-catheterisation is an intimate procedure, and it is normal to feel anxious when you are starting out. It is important that you feel supported in the learning phase and understand where to get help and advice if you run into any challenges. Asking questions and exploring learning resources, such as this one, will help you to gain knowledge and confidence in performing catheterisation safely into the future.
References
Bardsley, A. 2015. ISC in women following urogynaecologic surgery. British Journal of Nursing (urology supplement). Vol. 20 (18), pp. S6–S13.
Logan, K. 2017. The female experience of ISC with a silicone catheter. British Journal of Nursing. Vol. 26(2), pp. 82–88.
Shaw, C. and Logan, K. 2013. Psychological coping with intermittent self-catheterisation (ISC) in people with spinal injury: a qualitative study. British Journal of Nursing Studie. Vol. 50(10), pp. 1341–50.