It’s common for women in the early stages of intermittent self-catheterisation to encounter a number of challenges. These difficulties may relate to a lack of familiarly with your own anatomy, problems that may occur as a result of decreased mobility and sensation, and psychological aspects associated with emotion, fear, and social stigma.
Getting used to the self-catheterisation process may feel intimidating, but when broken down into separate issues and challenges is something you can overcome step by step. We’ve broken down some of these key challenges to help you begin feeling comfortable in yourself again.
Overcoming the physical challenges
If the location of your urethra is a mystery to you, do not despair, you are the same as most women. The urethra is found south of the clitoris and north of the vagina, and your doctor or nurse will explain the anatomy of the area to you. Having a good light source and using a mirror are good initial steps to take to familiarise yourself with your body. This may be unusual at first, as you will be looking at your body in a different way, but with time you will be able to do this comfortably without the need of a mirror.
Gently separate your labia, and lift slightly upwards. If you don’t see anything, do this over the bath or on the bed over a towel and try to urinate while paying attention to where the urine comes out. A trick often used by nurses is to focus on the area, and look for a small movement (sometimes called a ‘wink’) while you cough. These tips can really help you to settle into routine at home, and the whole process is not as complicated as it first sounds. In fact, women who have visual difficulties can easily get familiar with the location of the urethra using touch and identifying landmarks of the genitalia — even blind people have mastered selfcatheterisation1. You will begin to get comfortable with the process relatively quickly.
Perfecting your technique
Difficulties, however, can be found in proper insertion technique; often relating to issues with mobility, sensation, and coordination. Your doctor or nurse will consider these challenges when teaching you, and will be able to advise on the best position for you, such as standing with a leg on the toilet or squatting against a wall, along with any aids or devices that can help you depending on the severity of your disability. Pain can often be caused simply by anxiety, or tension within your body, as well as hypoestrogenised urethral and perineal tissue. Therefore, simple steps such as lubricating the intermittent catheter appropriately can aid you in the insertion process.
Keeping yourself clean is perhaps one of the most important hygiene considerations you can make. Bladder stones, for example, can be caused by the introduction of pubic hair in the bladder, and are common in patients who have been performing intermittent self-catheterization for quite a while — so make sure you are clean shaved before inserting the catheter.
The most common complication of self-catheterisation is a urinary tract infection2, however, and ensuring that you catheterise in a clean and hygienic way, as directed by your doctor, may help to reduce this risk. Learn about the signs of bladder infection and consult your doctor if you have a fever, or pain, or burning when urinating. You will also be instructed on monitoring your urine for blood, sediment, cloudiness, and bad odour.
Don’t be afraid to take your time, and take comfort in the fact that discomfort when inserting or removing the catheter usually lessens with time. However, sharp or severe pain should prompt you to consult with your healthcare professional. As with anything new, the more you practice the more it will become second nature to you — and the more comfortable you will feel.
Tackling the psychological barriers
Emotional and social aspects involved in self-catheterisation can act as very significant barriers to settling into a comfortable routine. Fear, doubt, shame, and frustration are all very normal feelings to have at first. You may also be grappling with the emotions associated with your condition.
From our potty-training days, we were all taught that urinating was something we needed to control and be independent in. To complicate matters, however, there are a number of beliefs and cultural ideas about genitalia. Social stigma or perceptions about your new toilet habits can create anxiety, but know this: nobody around you loves or respects you any less because you use a catheter to urinate.
As we know, most of the physical challenges are simple to address, and complications are uncommon. Understanding why you need to self-catheterise, though, and getting comfortable with the process, should dispel fears and assist you in tackling the initial challenges. Learn to accept help from family and friends, and discuss your feelings in support groups and with the healthcare professionals who care for you.
There are many reasons to persevere through the initial difficulties with intermittent self-catheterisation. Understand that the practice of intermittent self-catheterisation forms a very important part of the management of neurological conditions and spinal cord injuries3. Bladder dysfunction symptoms such as difficulty emptying your bladder, a weak urinary stream, frequency (needing to urinate very often), and urgency (feeling that you need to urinate immediately) are relieved through proper intermittent self-catheterisation techniques. Catheterisation can also prevent serious complications of bladder disorders, including infections of the kidneys and autonomic dysreflexia — a potentially life-threatening condition that is often caused by bladder distention. Furthermore, intermittent catheterisation allows you to avoid the challenges associated with having a permanent indwelling catheter.
Remember, too, that you are not alone. Millions of women and girls worldwide are self-catheterising on a daily basis. These women likely started out with many of the same concerns and challenges as you. Studies have shown that people living with neurological conditions who have accepted intermittent self-catheterisation as normal and incorporated it into their daily routines have an improved quality of life4. While many of the physical and psychological barriers to female self-intermittent catheterisation are very common initially, the vast majority of these problems can be solved.
If you need any more information on self-catheterisation, then please do get in touch and we'll put you through to one of our Bard nurses. Alternatively, you can pop across to our Learn section for more content.
1 Oakeshott, P., & Hunt, G. M. (1992). Intermittent self-catheterizationn for patients with urinary incontinence or difficulty emptying the bladder. The British Journal of General Practice, 42(359), 253–255.
2 Seth JH, Haslam C, Panicker JN. Ensuring patient adherence to clean intermittent selfcatheterization. Patient Prefer Adherence. 2014 Feb 12;8:1918.
3 Pannek J, Blok B, CastroDiaz D, Del Popoplo G, Kramer G, et al. EAU guidelines on neurogenic lower urinary tract dysfunction. European Association of Urology, 2011 update.
4 Shaw C, Logan K, Webber I, Broome L, Samuel S. Effect of clean intermittent selfcatheterization on quality of life: a qualitative study. J Adv Nurs. 2008 Mar;61(6):64150.