Being in a wheelchair does in no way mean you have to stop playing sport. In fact, the list of wheelchair sports is growing more and more each year, and with the success of the Paralympic and Invictus games, their popularity is booming.
Whether you want to play basketball, maybe try your hand at weightlifting, or just fancy a dip the pool, there are certain considerations you need to make if you’re a catheter user — adhering to proper catheter practices chief among them.
It’s wise to discuss your exercise and sports plans with your doctor and physiotherapist, or biokineticist, so you can play whichever sport you choose comfortably and safely. With that in mind, here’s what you need to know regarding safe catheter usage for wheelchair sports.
Bladder care and sport
Before attempting any sporting activity, all catheter users should ensure that their bladder is emptied before they start playing. When you start playing, monitor your exertion levels just so you’re aware of any signs of complications such as autonomic dysreflexia — a condition that may lead to uncontrollable levels of hypertension in patients with spinal cord injury; something your doctor will discuss with you1.
Those with indwelling catheters should ensure that the catheter is patent, correctly positioned, and safely secured while they participate in sport. After sport, you’re advised to bathe or shower, as following good hygienic practices prevents many complications of catheter use such as infections. Most importantly, bladder care involves proper hydration and avoiding constipation, so it is important to ensure that your fluid intake is sufficient and your diet is healthy.
There are a number of potential pitfalls for catheter users when playing wheelchair sports. However, each is easily remedied and prevented, and this troubleshooting guide will provide you with the information you need. The catheter will not go in (for those catheterising intermittently)
If you are having difficulty inserting the catheter, do not force it. You can try again after a short while, but if you are uncomfortable or your bladder is full, you should visit an emergency department for assistance. If you are unsuccessful in emptying your bladder before playing sport, it is better that you cancel your game and solve the problem — playing sport with a full bladder increases the risk of complications such as urinary tract diseases.
The catheter is not draining urine (for those catheterising intermittently)
If you believe you have inserted the catheter correctly, but you do not see any urine coming through the catheter, then check the position. Women who intermittently self-catheterise should ensure that they have not accidentally inserted the catheter into the vagina, for example.
If this mistake is made, remember to use a clean catheter when you try again, as inserting a catheter that has been in the vagina increases your chance of a bladder infection. Occasionally, the holes in the catheter can become temporarily blocked by lubricant. If you suspect this may be the case, wait a little while for the lubricant to dissolve and try to cough a couple of times to get the urine flowing. If these solutions do not work, it is best for you to speak to a medical professional.
There is no urine in the collection bag (for those with an indwelling catheter)
If you have an indwelling catheter and notice that no urine is draining into the bag, again you need to check the position. The bag should always be below the level of your bladder to allow urine to flow out, and to avoid it flowing in the opposite direction back into the bladder.
Check that the bag is not pulling the catheter down, and check the tube for kinks or compression which may be causing the problem. Securing the tube and catheter bag with tape or straps is advised during sport to prevent problems related to position and kinks, however be careful to not clamp the catheter down when doing this as it can lead to the bladder becoming overly full. Catheters may also be blocked by air or debris, and if you suspect an internal blockage then you should seek medical attention straight away.
There is a leak or there is bypassing of urine (for those with an indwelling catheter)
Some people who have an indwelling catheter can experience leaks, which may become more apparent when playing sport due its physical nature and constant movement. Urine may leak from the urethra, and in the case of a suprapubic catheter, urine may also leak around the cystostomy wound. Most leakage issues can be solved by simply ensuring the catheter is in the correct position and that there are no blockages or tube kinks. If the problem persists, however, discuss it with your doctor, who may suggest a catheter of a different size.
The catheter has fallen out or been expelled (for those with an indwelling catheter)
If you use an indwelling catheter, and notice that the catheter has been expelled from the body, attention should be sought from a healthcare professional to determine the underlying cause. This is especially true when playing sport as if the catheter has been expelled due to an impact, a common occurrence in wheelchair sports such as basketball, and your doctor will be able to go through some short term solutions with you such as bodyworn pads and urosheaths.
The skin around the cystostomy site is red or inflamed (for those with an indwelling suprapubic catheter)
This problem may be due to skin irritation or infection, and it is advisable to visit your doctor who will test for infection and prescribe treatment if necessary. When playing sport, a great way of preventing this problem is just to make sure you have the appropriate underwear and clothing for the sport you are playing.
Urine is cloudy or smells bad (for all catheter users)
Anyone using a catheter, regardless of whether it is intermittent or indwelling, should be cognisant of the nature of their urine, and know the signs and symptoms of urinary tract infections (UTI) to look out for2 . If you suspect you have a UTI, you should consult your doctor.
There is blood in the urine (for all catheter users)
Infection or trauma, such as a physical impact when playing sport, may lead to blood in the urine (haematuria). Bladder stones and cancer may also cause haematuria, but these conditions do not occur commonly3. Regardless, it is advisable to report haematuria to your doctor.
Boosting in sport
Although banned by the International Paralympic Committee in 1994, there’s nothing really stopping amateurs in wheelchair sports from boosting their performance levels. Boosting is a method of naturally inducing autonomic dysreflexia in order to increase blood pressure — resulting in improved physical performance. This is done through painful stimulus in the lower part of the body, and methods include clamping down your catheter in order to overfill your bladder. As mentioned above, this really is not advised as an overfilled bladder may lead to a UTI.
We encourage you to get playing wheelchair sports safely as they not only provide you with the exercise you need to maintain an overall healthy wellbeing, they’re also great for social interaction with people who have gone through, or are going through, what you have yourself. Being able to share advice with others through sport can be an amazing step to living a perfectly normal and happy life.
If you need any more advice on safe catheter usage when playing sport, do let us know and we’ll put you in touch with a Bard nurse. They’ll be more than happy to lend their support and expert advice. Alternatively, check out our Learn section for more information.
1 Dolbow DR. Exercise following spinal cord injury: physiology to therapy. Journal of Neurorestoratology. 2015 Dec;3:133139.
2 "Catheter related UTI: MedlinePlus Medical Encyclopedia." (2006). Accessed: May 16th 2016
< https://www.nlm.nih.gov/medlineplus/ency/article/000483.htm >
3 "Catheter problem solving guide NHS Lothian." (2015). Accessed: May 16th 2016