Intermittent self-catheterisation (ISC) is the practice of regularly inserting and removing a urinary catheter throughout the day in order to empty your bladder. It’s a popular method, and has been shown to be superior to having a permanent indwelling catheter as it can result in more independence, an improved quality of life, and a reduced risk of complications¹. Nevertheless, complications such as seeing blood in your urine (hematuria) can still happen, so it’s important that you understand why they happen, how to react, and, ultimately, how to prevent them.
What causes blood to appear?
Urinary tract infections (UTIs) occur commonly in catheter users, and most people will experience at least one UTI within the first five years of catheterisation². Remember, the urinary tract is normally sterile and protected from germs in the environment, so any type of catheterisation can compromise this. Furthermore, it’s important to understand that bacteria multiply in urine that is left in the bladder — meaning that not catheterising often enough to fully empty your bladder can increase the risk of infection.
Symptoms of a UTI may include fever, a feeling that you need to catheterise urgently or more frequently, and urine that is pungent — potentially containing mucus, particles, and blood as well. Trauma to the urethra is another fairly common complication of ISC which can cause blood in the urine. Other complications of ISC include bladder stones and bladder cancer, which can both result in bloodstained urine — these complications are rare though.
Hematuria is commonly seen in the early stages of ISC. However, should you see blood after self-catheterising for a long time, then you should go and see your doctor as it could be a UTI or a result of trauma. Additionally, bladder stones can become more common in people who have been performing ISC for a while. This can be due to pubic hair being introduced to the bladder, for example. Therefore it’s important to maintain proper catheter usage techniques and appropriate hygiene levels in order to minimise these risks.
How to react if you see blood
Seeing blood in your urine may be scary, and trouble with insertion or removal of a catheter can be distressing — but it’s a common symptom, and very easily treated. Understanding how it can come about though, is the first step to being able to prevent it from happening.
Firstly, blood in the catheter may be a sign of infection or trauma. Noticing blood in your urine should prompt you to assess yourself for any other signs and symptoms of a UTI, which should be reported to your doctor. Accidentally damaging the lining of the urethra upon catheter insertion or removal may cause bleeding, too. So if you are battling to insert or remove the catheter, stop and try again after a short while; if you still have difficulties, you should consult with your doctor or nurse. It is advisable that you promptly seek medical attention if bleeding is heavy or if you notice blood clots³.
Educating yourself on bladder care overall, adhering to your prescribed catheter routine, being hygienic, and following proper catheter techniques are the most important ways to avoid complications such as hematuria. Most people who self-catheterise intermittently do so 46 times per day, for example. The frequency at which you catheterise is also very important in preventing UTIs, one of the most prominent causes of hematuria, since the regimen is designed to minimise stagnation of urine in the bladder. The volume of urine should be measured after each catheterisation, and should not exceed 400500ml. For the same reason, make sure you have completely emptied your bladder every time you catheterise: inadequate emptying can allow bugs to grow in the residual volume of urine left behind, potentially causing an infection.
It may be useful for you to use Credé’s method to ensure adequate voiding — where you place pressure on your abdomen just above your pubic bone. In addition to the frequency and completeness of bladder emptying, pay attention to your hydration. If you are not drinking enough fluids, your risk for infection is higher. Conversely, excessive fluid intake can also be problematic due to large volumes of urine in the bladder.
Perfecting your technique and using a sufficient amount of lubricant upon insertion can also really help to prevent trauma to the urethra — any problems with technique or equipment should be resolved quickly with your attending healthcare professional4.
What about nutrition?
Cranberry juice, lactobacillus (a ‘good bug’ found in yoghurt), and vitamin C have been shown to reduce bacterial growth in the bladder5. If you have a history of recurrent UTI’s, you may wish to discuss these preventative measures with your doctor. However, the use of antibiotics to prevent UTIs is generally not recommended, as this can lead to growth of bacteria that are resistant to antibiotics.
Hematuria is particularly common in the initial stages of learning how to catheterise, but should not persist. Yet, being prepared for ISC complications and understanding what causes them, you can make every effort to prevent them from occurring, and react calmly and appropriately to any potential ISC problems you may face. Additionally, awareness of potential complications also guides you in knowing what to look out for when catheterising, too.
For more information on how you can treat and prevent common ISC problems such as hematuria, just let us know and we will put you in touch with a Bard nurse for a chat. You can also check out our Learn section for more information on hematuria.
1 Igawa, Yasuhiko, Jean‐Jacques Wyndaele, and Osamu Nishizawa. "Catheterization: possible complications and their prevention and treatment." International Journal of Urology 15.6 (2008): 481-485.
2 Wyndaele, JJ. "Complications of intermittent catheterization: their prevention and treatment."
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3 Bennett, Elisabeth. "Intermittent selfcatheterisation and the female patient." Nursing standard 17.7 (2002): 37-42.
4 Seth, Jai H, Collette Haslam, and Jalesh N Panicker.
"Ensuring patient adherence to clean intermittent selfcatheterization." Patient Preference & Adherence 8 (2014).
5 Newman, Diane K, and Margaret M Willson.
"Review of intermittent catheterization and current best practices." Urologic nursing 31.1 (2011): 12.