What is urinary retention?

There are two types:

Acute urinary retention: this is a sudden inability to pass urine – it is very painful as the bladder becomes increasingly distended. You should go straight to a doctor (preferably a urologist) to have your bladder drained.

Chronic (long-term) urinary retention: happens gradually over months or years and you may be unaware that it is happening. You may develop symptoms such as having to pass urine frequently, straining to pass urine, intermittent stream and never feeling you have emptied completely.

• In order to pass urine, your bladder must contract and the opening (sphincter muscle around the urethra) must relax. If either of these does not happen urine cannot easily leave the bladder. Sometimes both problems are combined e.g. in Multiple Sclerosis.

• Urinary retention is more common in men when it is most commonly due to enlargement of the prostate gland compressing the urethra and blocking the exit from the bladder.

• Urinary retention in women is relatively uncommon. It can occur after surgery or childbirth or be related to prolapse.

How is it managed?

Treatment of urinary retention involves dealing with the cause. For example, removal of an enlarged prostate or other blockage. While treatment is taking effect or if treatment fails, it is important to ensure that the bladder can drain properly. This is done using a catheter.

There are two methods:

Indwelling catheterisation: the catheter is secured in the bladder and connected to a drainage bag or catheter valve for continual drainage.

Intermittent catheterisation (IC): the catheter is inserted and removed periodically. You may be taught to do this yourself (or have a helper do it) when it is called Intermittent Self-Catheterisation (ISC). See below for further information.

Intermittent Catheterisation

What is intermittent catheterisation (IC)?

• It is a procedure whereby a catheter is passed into the bladder to drain urine and then is immediately removed. The catheter is usually passed through the urethra, but other catheterisable channels such as a mitrofanoff diversion or cystostomy button can be used. The urine can be drained directly into the toilet/urinal, or a drainage bag designed to connect to the funnel-end of catheter or into another receptacle.

• Intermittent catheterisation is used to treat urinary retention which occurs when the bladder is unable to expel urine.

• Many adults and children do self-catheterisation. How often you do it depends on the ability of your bladder to empty urine itself and will be decided by you and your doctor or nurse.

• Some people are unable to self-catheterise in which case a helper (family member) can be taught to do it.

• Intermittent catheterisation can be done in the short-term (e.g. while you are waiting for an operation) or in the long-term (e.g. if you have a spinal injury).

Click on intermittent catheters for information about various intermittent catheters and accessories.

Would intermittent catheterisation be suitable for me?

• If you have problems emptying your bladder, your health care professional may well suggest IC.

• IC is usually the preferred way of managing urinary retention. If it is suitable for you, it means that you can avoid having a permanent indwelling catheter.

• Whenever you need to pass urine during the day, you visit the toilet to catheterise. Some people like this as they feel it is more ‘normal’ and allows freedom from using permanent devices. However it is a personal choice and you may try it and find that it is not suitable for you.

People with a wide range of physical difficulties (including blindness, tremor and reduced sensation in the perineal area) can do IC ¹ However, it is much more likely to be successful if:

• You have a positive attitude towards doing the procedure – doing IC can be very daunting but research has shown that good information, teaching and communication can help new IC users get used to the procedure and manage it long-term if required ²

• You have fairly good use of your hands - catheterisation can be fiddly. Various catheter accessories are available to help if you have limited use of your hands or have difficulty opening your legs.

• You have complex needs – although people with neurological or other physical disabilities can learn to do IC successfully, it may take longer and need more sessions ³ Good advice from your HCP regarding the catherisation aids and accessories that are available is important.

• You have a good memory – you need to be able to do IC according to the regime agreed between you and your health care professional. This may be a few times a week or several times a day. It is important that you do not forget. If your bladder becomes overfull you may experience bladder leakage and in the long-term this build up of urine can cause damage to your kidneys.

There is some research evidence to suggest that people with spinal cord injury who only catheterise once a day may have a higher rate of infections than those who catheterise more frequently ⁴⁵

Is intermittent catheterisation a sterile procedure?

Intermittent catheterisation can either be a:

• Sterile procedure - this is necessary in hospital or a care home, or if the catheterisation is being done by a HCP who has contact with several patients.

• Clean procedure - people catheterising themselves generally follow a clean procedure. A clean procedure may also be used for catheterisation by a helper who only looks after you e.g. a family member . A ‘clean procedure’ simply means that you wash your hands and follow usual basic hygiene procedures before, during and after catheterisation.

You may hear different terms for intermittent catheterisations depending on which of these techniques is used:

• Clean intermittent catheterisation (CIC) – a clean procedure done by an informal helper e.g. family member

• Clean intermittent self-catheterisation (CISC) – if you are using a clean procedure to catheterise yourself.

Is one type of catheter or technique, any better than another?

• At present it is not really known if the different catheter types (coated or uncoated); specific technique (sterile or clean), or method used (single use or re-use of catheters), is better than any other for all clinical situations ⁶ More research is needed in this area.

• There is some research evidence to suggest that hydrophilic-coated catheters may be preferable for comfort and cause less damage to the urethra compared to non-coated catheters in men with spinal cord injuries ⁷ Again, more research evidence is needed.

Are there any risks associated with intermittent catheterisation?

Although IC is a relatively safe procedure, there are some associated risks that you should be aware of:

• Urinary tract infection

As with all methods of catheterisation, you are at risk of developing a urinary tract infection as you are introducing something into the bladder. However this risk is less with intermittent catheterisation than with an indwelling catheter ⁸⁹¹⁰

• Urethral damage

Some urethral damage and bleeding (haematuria ) can be common when you start IC but lasting effects are limited ¹¹ Some research studies have found that haematuria can continue to occur in up to 30% of people doing IC long-term ¹² You should discuss any bleeding with your health care professional.

• False passages

Urethral damage is more of a risk for men and false passages can occur, which can make subsequent IC more difficult. Research evidence suggests that the best way to avoid this occurring is to have good education (of both users and professionals), use of an appropriate catheter material, good catheterisation technique and to avoid letting the bladder become overfull ¹¹

Treatment for false passages in people with a spinal cord injury of six weeks use of an indwelling catheter and five days of antibiotics, has been reported to be effective ¹³

• Bladder stones

Formation of bladder stones has been found to be associated with long-term use of CIC in a number of studies ¹⁴

How to get help

• If you suspect you have either type of urinary retention, you should speak to your doctor.

• Both types of catheterisation will be done under the guidance of your doctor / nurse. Click on Catheters for more information about catheters and accessories.

Hear about the real life experiences of people who use catheters