Learning
How your body works
Understanding how your body works will help to make it clearer exactly what you are doing with your catheter – and where it’s going
The production and storage of urine
The kidneys [1] are located just within the bottom of the ribcage on the right and left sides of the back. One of the primary functions of the kidneys is to excrete waste products from the biochemical processes that occur in the body. The kidneys are continually flushed with blood, from which they filter the salts and other chemical substances to be excreted. They also draw water out of the blood - and together, water, salts and other chemical substances constitute urine. The urine trickles from the two kidneys through the ducts called ureters [2] down to the bladder [3] where it collects.
When empty, the bladder is like a flat balloon or sac that expands gently as urine flows into it. Urine is produced continuously but mainly during waking hours. Once the bladder contains approximately 200-250 ml, most people will have an urge to empty it, but can wait, without any problems, until it contains 500 ml. The bladder is kept closed by a circular muscle valve (sphincter) [4] at the base of the bladder.
Urinating
The base of the bladder [1] has an opening, which is closed by a circular muscle valve (sphincter). When this valve relaxes, it opens and the bladder contracts and urine passes out through a tube called the urethra [2]. It is your brain that controls the nerves that tell the valve to the bladder to open. A man’s urethra is 15 to 30 cm long and is S-shaped. It runs from the bladder through the prostate [3] to the tip of the penis [4]. The urethra is very flexible. The narrowest and stiffer part of the urethra is at the tip of the penis where the diameter is approximately 6-7 mm wide, corresponding to a catheter size 18 to 21. In About catheters you can read more about catheter sizes.
When catheterising, the natural S-shape of the urethra can be changed into a U-shape by holding the penis upwards away from the body at an angle of 60 to 70 degrees. This U-shape of the urethra will ease the insertion of the catheter and will also reduce the risk of damaging the urethra.
Depending on your fluid intake, diet and medication, most people will empty their bladder 4-7 times a day. You will notice that the less you drink, the darker the colour of the urine will be. This is because drinking less means there is less fluid available for excretion of waste products in the kidneys. A darker colour of your urine means waste products in the urine are more concentrated. Make sure that you drink enough fluids to keep your urine a pale yellow. Please note that certain things you have been eating or drinking may also discolour the urine.
Intermittent catheterisation
There are many reasons why some men cannot urinate voluntarily and may require intermittent self-catheterisation. Your condition may be temporary or it could be that you are coming to terms with a permanent need for carrying out intermittent self-catheterisation. This can be caused by damage to the nerve supply to your bladder, an enlarged prostate, the result of an operation or a condition you were born with. Whatever the reason, urine must not be left in the bladder because, if it remains there for too long, it can become stale and cause infection. There are also other important reasons why the bladder must be emptied completely at a regular basis.
Why do intermittent catheterisation?
Why do intermittent catheterisation?
In most cases using an intermittent catheter will enable you to regain control of your bladder, rather than your bladder controlling you and your life, contributing to an improved quality of life for you and your relatives.
If you cannot empty your bladder completely, urine remains which can become stale and cause an infection of the bladder and/or kidneys as bacteria will grow and multiply. An infection might irritate the bladder so it won’t keep closed thus causing leakage/ involuntary emptying of the bladder (incontinence). Intermittent catheterisation can help:
- Reduce the risk of bladder infections
- Reduce the risk of kidney infections
- Reduce pain and general discomfort associated with infections (fatigue, rise in body temperature, pain and cloudy and offensive-smelling urine)
- Reduce the need for medications for treating infections (antibiotics)
- Reduce incontinence episodes
- Reduce psychological, social and physical restrictions associated with incontinence
If you cannot pass urine at all, it will accumulate in your bladder and try to escape back to the kidneys where it potentially causes a decreased function or even damage to the kidneys. Over time overfilling of the bladder can also cause the bladder to become slack like a worn out rubber band. In such cases the bladder wall might fold into pockets that complicate a complete emptying of the bladder. Intermittent catheterisation can help:
- Reduce the risk of developing a slack bladder
- Reduce the risk of kidney damage
- Reduce pain and general discomfort associated with damage of the kidneys
- Reduce psychological, social and physical restrictions associated with pain and discomfort caused by kidney damage
If you are not able to control the emptying of your bladder and you experience episodes of incontinence, intermittent catheterisation can put you in control by:
- Reducing wetting accidents
- Avoiding or reducing the use of pads, etc. and avoid the use of permanent urine drainage devices
- Reducing skin problems related to the use of pads
- Reducing psychological, social and physical restrictions associated with incontinence or permanent urine drainage devices
How does intermittent catheterisation work?
Intermittent catheterisation is an artificial way of emptying your bladder. It means that periodically a hollow plastic tube (a catheter) is inserted into the urethra. The catheter is inserted at the tip of the penis, past the prostate, past the sphincter muscle and into the bladder. The catheter has two drainage eyes at the end and because it is hollow, urine will flow through it and the bladder will empty. Once the drainage is complete you can remove the catheter again. Take your time to ensure that the bladder is emptied completely. Remove the catheter slowly to drain urine left at the very bottom of the bladder. Intermittent catheterisation must be done at regular intervals and is easiest if you keep to a set schedule each day.
Intermittent catheterisation is appropriate for males of all ages and is a relatively simple technique, but of course, it will take some time for you to learn how to catheterise yourself. The location of the urethra at the tip of the penis is generally easy and usually the procedure is associated with a minimum of discomfort. The catheterisation procedure must always be carried out under guidance from a healthcare professional and information on these pages is only intended as follow-up to the advice you have already been given.
About catheters
Historically, intermittent catheterisation was known to the ancient Egyptians who made catheters from reeds. The early Greeks used hollow metal tubes while the oldest preserved catheter was made out of bronze and was found in Pompeii. Catheters have also been made from wax, horn, intestines, horsehairs, metal and PVC. The invention of polyurethane has resulted in a significant advance in the development of modern catheters for intermittent catheterisation. Polyurethane catheters are more convenient than those of natural origin and do not contain phthalates present in PVC catheters.
Catheters for intermittent catheterisation come in different lengths and they have a small funnel at the end to be held by the hand. The funnel can be connected to a collecting bag, e.g. if you need to use the catheter away from the toilet.
The diameter of a catheter is measured in Charrière (CH) or French (FR). 3 Charrière corresponds to 1 millimetre. The lower the Charrière, the smaller the diameter. The higher the Charrière, the faster the catheter will drain the bladder. It is important to use a Charrière size big enough so that you will not have to spend excessive time in the toilet compared to your usual routines. However, the smallest size of catheter that will drain the urine at an acceptable speed should be used. Catheters range from 5 to 20 Charrière with 12 and 14 being the most common for adults.
Some people might experience difficulties in passing the catheter through the narrow passages of the urethra, e.g. through the prostate or the sphincter muscle to the bladder. In such cases, catheters have been developed with greater rigidity or with special shaped tips to aid the catheter through. Your healthcare professional might also advise you to choose a catheter that is one size bigger to help insertion. This is because the tip of a bigger size catheter might be easier to push through a narrow passage.
Most catheters for intermittent catheterisation are ready to use and are disposable. They come with a sterile, lubricating coating which aids insertion and minimises resistance, so it is gentle on the urethra. Some catheters require immersion in water for 30 seconds to activate the coating before insertion in the urethra. If you use tap water that is filtered, make sure to clean the filter of the tap regularly.
Re-usable, plain uncoated catheters are available but rarely used. Uncoated catheters must be lubricated before insertion into the urethra and should be washed and dried after use.
How to use a regular catheter
1. Wash your hands with soap and water and dry them. Use soap with a neutral pH value to avoid irritation of the sensitive skin around the genitals. Wet wipes may be used as an alternative when hand-washing facilities are unavailable. Disinfecting your hands may be done in addition to washing your hands.
2. Open the upper end of the peel pouch indicated by the arrow 5 cm (2 in). You can hang the peel pouch by using the adhesive spot, or rest it in the sink. Stand next to the toilet and make sure you have a suitable container to hand. If you have poor manual dexterity you might find the opening ring helpful. Attach the adhesive spot to the sink and pull the adhesive ring towards yourself and then downwards to open the peel pouch.
3. If there is a possibility you might be able to urinate, always try before you use a catheter. Gently pull the foreskin back and wash the head of the penis with water. In order to remove any bacteria that might be present at the opening to the urethra, you should wash in a circular motion starting at the urethra and working outward.
4. Hold your penis pointing upwards and close to your stomach to ensure that the urethra is regular. Holding your penis upwards will ease the insertion of the catheter as the natural S-shape of the urethra is changed into a U-shape. Be careful not to squeeze your penis as this may obstruct the passage of the catheter during insertion into the urethra .
5. Remove the catheter from the packaging. You will notice that the first 5cm is lubricant-free so it is easier for you to hold. Make sure that the catheter does not touch anything before you enter it in the urethra. Touching the sink or your clothes for example will contaminate the catheter and can potentially cause infection.
6. Provide a gentle pressure to the head of your penis in order to open up the urethra. Slowly and gently insert the catheter into your urethra as you have been instructed until it reaches your bladder. It is normal that you may feel a slight resistance from the sphincter so be gentle, but it is safe to continue. Continue to insert the catheter until the urine starts to flow and continue for a few centimetres further. If you put your finger over the funnel end of the catheter before the flow starts, this will avoid spillage. Remove your finger to drain.
7. When the flow stops, move a little and straighten yourself up to make sure that the bladder is completely empty. Then slowly remove the catheter. If you use a regular catheter without a special tip it is recommended that you slowly rotate the catheter as you withdraw it and stop each time more urine drains out. This is to ensure complete emptying of the bladder.
8. Dispose of the catheter properly and put it in your household rubbish. Do NOT flush it down the toilet. If you have used gloves throw these away as well. Wash your hands again and the process is complete. Disinfecting your hands may be done in addition to washing your hands.
How to use SpeediCath Control
1. Wash your hands with soap and water and dry them. Use soap with a neutral pH value to avoid irritation of the sensitive skin around the genitals. Wet wipes may be used as an alternative when hand-washing facilities are unavailable. Disinfecting your hands might be preferred as an alternative to washing your hands.
2. Open the upper end of the peel pouch indicated by the arrow 5 cm (2 in). You can hang the peel pouch by using the adhesive spot or rest it in the sink. Stand next to the toilet and make sure you have a suitable container to hand. If you have poor manual dexterity you might find the opening ring helpful. Attach the adhesive spot to the sink and pull the adhesive ring towards yourself and then downwards to open the peel pouch.
3. If there is a possibility you might be able to urinate, always try before you use a catheter. Gently pull the foreskin back and wash the head of the penis with water. In order to remove any bacteria that might be present at the opening to the urethra, you should wash in a circular motion starting at the urethra and working outward.
4. Hold your penis pointing upwards and close to your stomach to ensure that the urethra is straight. Holding your penis upwards will ease the insertion of the catheter as the natural S-shape of the urethra is changed into a U-shape. Be careful not to squeeze your penis as this may obstruct the passage of the catheter during insertion into the urethra.
5. Remove the catheter from the packaging. You will notice that the first 5cm is lubricant-free so it is easier for you to hold. Make sure that the catheter does not touch anything before you enter it in the urethra. Touching the sink or your clothes for example will contaminate the catheter and can potentially cause infection.
6. Provide a gentle pressure to the head of your penis in order to open up the urethra. Slowly and gently insert the catheter into your urethra as you have been instructed until it reaches your bladder. It is normal to feel a slight resistance from the sphincter so be gentle, but it is safe to continue. Continue to insert the catheter until the urine starts to flow and continue for a few centimetres further. Depending on the length of your urethra, you might need to insert the wider part of the catheter as well before the urine starts to flow. This will not harm the urethra as it is flexible and has a larger diameter than the wide part of the catheter.
7.When the flow stops, move a little and straighten yourself up to make sure that the bladder is completely empty. Then slowly remove the catheter. If you use a regular catheter without a special tip it is recommended that you slowly rotate the catheter as you withdraw it, and stop each time more urine drains out. This is to ensure complete emptying of the bladder.
8. Dispose of the catheter properly and put it in your household rubbish. Do NOT flush it down the toilet. If you have used gloves throw these away as well. Wash your hands again and the process is complete. Disinfecting your hands may be done in addition to washing your hands.
Tips and tricks
You can either stand or sit when inserting a catheter yourself. Many men prefer to stand. But if you decide to sit, you might choose to sit on a chair in front of the toilet or close to it.
Inspect the catheter before using it. If the catheter or the packaging is damaged, do not use it. Make sure that the catheter does not touch anything before you insert it. Touching the sink or your clothes could contaminate it and potentially introduce infection.
At first you might feel anxious about inserting a catheter into your urethra. You might not be able to find the opening of the urethra or the catheter might fall out again once you have first inserted it. It is quite usual to meet these challenges in the beginning. Please remember that thousands of people of all ages catheterise themselves every day and have learned this technique as confidently as you will.
If you feel unwell at the thought of inserting the catheter in the urethra, there might be a risk that you will feel dizzy when you do the catheterisation. To prevent fainting and hurting yourself, you might want to sit down to perform the catheterisation until you have familiarised yourself with the procedure. Apply a gentle pressure to the head of your penis in order to open up the opening to the urethra.
To help insertion of the catheter, it is important to relax. This is especially so for the first few times you carry out intermittent catheterisation as anxiety causes contraction of the penis or the sphincter muscle and influences the manual dexterity. Taking a hot shower or doing some relaxing exercises prior to the catheterisation might help you to feel more relaxed. Coughing a few times might also help.
If for some reason you have poor manual dexterity, you might benefit from using a catheter specially designed for better control when inserting the catheter into the bladder.
If you are having troubles with spillage once the urine starts to flow, consider whether you would benefit from catheterising in a different position. If you put your finger over the funnel end of the catheter before the flow starts, this will avoid spillage. Remove your finger to allow flow. You might also want to connect the catheter to a collecting bag or to use SpeediCath Complete, a catheter that is integrated with a collecting bag.
If you are sitting in a wheelchair during catheterisation, do keep your underwear in place, e.g. using a pantler. A pantler is a device especially developed to keep your clothes in place. You can also use a coat hanger for the same purpose – sitting on the arms of the hanger and using the hook for holding the underwear. To avoid wetting your clothes make sure you place a drape under your penis. For hygienic reasons the drape must then be disposed.
