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Catheterisation—clean intermittent catheterisation

Introduction

A normal bladder fills with urine and when it is nearly full it sends impulses to the brain which in turn lets you "feel" that your bladder is getting full and that you need to pass urine. As your bladder becomes fuller, the feeling that you need to pass urine becomes stronger and more urgent. When you pass urine the bladder empties itself completely or almost completely.

What problem do I have with my bladder?

The tests we have been doing show that your bladder is not working properly. Your bladder:

Please note the appropriate options

  • will not empty at all
  • does not let you feel that it is filling or is full
  • does not empty itself well enough and leaves a lot of urine left behind (residual volume)
  • sensation is weak so that the feeling of your bladder filling or being full is not as strong as it should be.

Why has this happened to me and will it get better?

We are not sure of the exact reason but it has something to do with your pregnancy or childbirth. For most women their bladder recovers its normal function within a few days after the birth of their baby, but for some women it may take up to a month. Only rarely does the problem persist.

What is Clean Intermittent Catheterisation?

Clean Intermittent Catherisation (CIC) is the best way for you to help your bladder recover.

We will teach you to pass a small catheter into your bladder so that it becomes completely empty every time you pass urine. By doing this you are giving your bladder "physiotherapy" because you are allowing it to fill up and then become completely empty just as it would generally do. This has been shown to be the safest and fastest way of getting your bladder to recover and start working normally again.

It is called Clean Intermittent Catheterisation because you will use the same catheters over and over again but we will show you how to keep them clean—the catheter does not need to be sterile. We will ask you to catheterise, either, when you feel the need to pass urine and have passed as much as you can or, every few hours even if you don't feel that you need to pass urine—this is the intermittent part.

Are there likely to be any problems using CIC?

There is over 50 years of experience with this approach and there have not been any reports of significant problems. Most people learn to do it very quickly and don't have any problems. You may, occasionally, get a urinary tract infection from doing this although doing CIC is more likely to protect you from an infection, which can occur if your bladder is not emptying itself properly. Even though the catheters are only "clean" it is very unusual for people to get an infection.

How do I do CIC?

We will teach you how to do CIC easily and comfortably. The basic steps are as follows:

  • If you are able to pass any urine then you do that first.
  • After you have passed as much urine as you comfortably can or, if you can't pass any at all then we will ask you to do CIC.
  • If you are at home hold a jug under the catheter so you can measure how much urine comes out of the catheter—this is called the residual urine. Note the amount and the time—we will give you a chart to record this information.
  • It is very important to make sure that you have completely emptied your bladder before taking the catheter out (we will show you how best to do this).

How often do I need to catheterise?

  • You should do it every time you feel the need to pass urine and have passed as much as you can.
  • If you don't feel the need to pass urine then you should try to do so about every four hours and even if nothing comes out do CIC.
  • We usually suggest that you don't need to do CIC through the night but you should definitely do it first thing in the morning and last thing at night before you go to bed.

Do I have to stay at home while I am doing CIC?

No, you should try to do all the things you would do normally and would like to do. You can do CIC anywhere there is a toilet, especially once you have become confident doing it at home.

When can I stop doing CIC?

We will ask you to keep in touch with the Mater Continence Service who will be available to advise about your progress and help make the decision to stop CIC which is why we ask you to keep a record of the residual volumes. Usually we will suggest you stop CIC when your residual urine volume is consistently less than 100 ml (about three tablespoons).

How do I look after the catheter?

The catheter will be a size 12F female disposable catheter, but, as we explained before you will not throw the catheter away after each use. You will alternate two catheters, one on one day and the second one on the next day, for a period of two weeks. After that you throw both catheters away and start with two new ones.

To clean the catheter, wash it under cold running water for about 20 to 30 seconds—this gets rid of most nasty bacteria. Then put it in a clean ziplock plastic bag. Use the same catheter and the same bag for 24 hours then throw the bag away—use a new bag each 24 hours. At the end of the day dry the catheter you used that day by putting a pin into a wall or cupboard (or somewhere convenient) and hang the catheter from its eye for the next day—this allows the catheter to dry out and that kills most of the nasty bacteria.

What can go wrong and what should I do?

Usually, the more often you do CIC the more confident and comfortable you become. Problems you may experience include the following:

  • You might not be able to find the opening of your urethra. If this happens you should call us for help and advice as soon as possible.
  • No urine comes out—the catheter is either not in far enough or in the wrong place; usually the vagina. First, try to push the catheter in further and if nothing happens try to find the opening of the urethra again.
  • As you finish passing urine and try to remove the catheter it hurts—this usually happens because the bladder lining is sucked into the eye of the catheter. You can stop this by putting your finger over the outside end of the catheter just as it finishes dripping (and/or call us for advice).
  • You might see some blood on the catheter or in the urine—if this happens more than once, please call us on the next working day.
  • Rarely, you might think that you have a urinary tract infection—a burning sensation when passing urine, smelly urine, pain in the lower abdomen, fever and sometimes sweats and shivering. If you experience any of these symptoms seek medical help as soon as possible. You should either see your general practitioner or go to Mater Hospital Brisbane's Emergency Department. Usually, you will require antibiotics and the infection will settle down quickly.

We would also ask you to contact the Mater Continence Service on the next working day, or, if this happens during a working day, call us and we can arrange for you to be seen as quickly as possible.

Getting help—Mater Continence Service, Mater Adult Hospital

Although you will have been discharged from Mater Mothers' Hospital your ongoing care will be provided by the Mater Continence Service (Mater Hospital Brisbane), or, if you are a private patient, by your obstetrician unless you have been advised otherwise.

The clinicians at the Mater Continence Service will be advised by your midwife or obstetrician that you are being discharged on CIC and one of our clinicians will keep in contact with you by phone to see how you are going and to offer you any help that you need.

If you do not hear from us within three days of your discharge please call us on 07 3163 3490 so that we can keep in contact with you.

The Mater Continence Service is available Monday to Friday between 8 am and 4 pm. If we are not available to answer your call and the issue/problem is not urgent please leave a message and we will call you back on the next working day.

This information is provided by

Mater Continence Service, Department of Urology and Continence
Mater Hospital Brisbane
Ph 07 3163 3490

© 2013 Mater Misericordiae Ltd. ACN 096 708 922.

Mater acknowledges consumer consultation in the development of this patient information.
Mater Doc Num: Hosp-011-02714
Last modified 27/11/2015.
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