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 an urologist) to have your bladder drained.
Chronic (long-term) urinary retention: this 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 and is most commonly due to enlargement of the prostate gland compressing the urethra and blocking the exit from the bladder.
• Urinary retention is less common in women. It can occur after surgery or childbirth or be related to prolapse.
How is urinary retention 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 left in place in the bladder and connected to a drainage bag or catheter valve for continual drainage. There is more information about indwelling catheterisation here.
• Intermittent catheterisation: the catheter is inserted and removed periodically. You may be taught to do this yourself, or have a helper do it.
Intermittent catheterisation
Intermittent catheterisation is used by many people to manage urinary retention – that is, they have problems emptying their bladder fully or at all.
It is a procedure in which a catheter is passed into the bladder to drain urine and then is removed once drainage has stopped.
Many people successfully use intermittent catheterisation to manage urinary retention both in the short-term (for example, while waiting for an operation) and the long-term (for example, following a spinal injury). Using intermittent catheterization for to empty their bladder means they can avoid the need for an indwelling catheter.
Would intermittent catheterisation be suitable for me?
If you have problems emptying your bladder, your health care professional may well suggest intermittent catheterisation.
Many people prefer intermittent catheterisation because it gives them more control and seems more “normal” than having an indwelling catheter. Whenever they need to empty their bladder, they visit the toilet to catheterise. However it is a personal choice and you may try it and find that it is not suitable for you.
Intermittent catheterisation should only be done after a thorough assessment and training in the procedure by a healthcare professional. Reference: Maki 2001 For some people with neurological or physical disabilities, learning to perform intermittent catheterisation may take longer and more training sessions may be needed than usual. Reference: Vahter 2008
How often you catheterise each day is a decision to be made jointly with your health care professional. This varies from person to person and depends upon clinical considerations such as how ineffective the bladder is at draining in the normal way as well as lifestyle considerations.
Although intermittent catheters can be used by people with a wide range of physical difficulties (including impaired vision, tremor and reduced sensation Reference: Fowler 1998), success is more likely if:
• You have a positive attitude towards the procedure – starting intermittent catheterisation can be very daunting but research has shown that good information together with thorough teaching and good communication with your health care professional can help you to adapt to intermittent catheterisation successfully both when you are new to it and in the long-term. Reference: Logan 2008
• You have reasonably good hand control – opening packaging, lubrication and inserting the catheter can be difficult for some people, although there are some products that can help.
• You have a good memory as regular catheterisation at the correct time is important. You must catheterise 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.
Some people are unable to self-catheterise in which case a helper such as a family member can be taught to do it.
Although in intermittent catheterisation the catheter is usually passed through the urethra, other catheterisable channels such as a mitrofanoff diversion or cystostomy button can be used.
Are any risks associated with intermittent catheterisation?
Intermittent catheterization is usually the preferred way of managing urinary retention and avoids many problems associated with indwelling catheterisation. Although a relatively safe procedure, there are some associated risks to be aware of:
Urinary tract infection - As with all methods of catheterisation, there is a risk of developing a urinary tract infection as a ‘foreign body’ is being introduced into the bladder. This risk may be less with intermittent catheterisation than with an indwelling catheter, but there is no evidence from trials that proves this to be true. Reference: Jamison 2013, Shekelle 1999, Johansson 2002, Turi 2006
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. Reference: Woodbury 2008, De Ridder 2005
Urethral damage - Some urethral damage and bleeding (haematuria ) canoccur when commencing intermittent catheterisation but lasting effects are limited. Reference: Wyndaele 2002 Some research studies have found that haematuria can continue to occur in up to 30% of people doing intermittent catheterisation long-term. Reference: Perrouin-Verbe 1995 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 intermittent catheterisation more difficult. Research evidence suggests that the best way to avoid this occurring is to ensure catheter users and healthcare professionals are well informed about intermittent catheterisation, use of an appropriate catheter, good catheterisation technique and to avoid allowing the bladder to become overfull. Reference: Wyndaele 2002
Treatments for false passages in people with a spinal cord injury that have been reported to be effective in very small studies include six weeks use of an indwelling catheter and five days of antibiotics, and, for people who do not want an indwelling catheter, placement of a prostatic stent for three to six months. Reference: Michielsen 1999, Gökalp 2003
Bladder stones - Formation of bladder stones has been found to be associated with long-term use of intermittent and indwelling catheterisation. Reference: Chen 2001
Both types of catheterisation will be done under the guidance of your doctor or nurse. For more information about catheters and accessories click here.
Hear about the real life experiences of people who use catheters