Your browser is no longer supported

For the best possible experience using our website we recommend you upgrade to a newer version or another browser.

Your browser appears to have cookies disabled. For the best experience of this website, please enable cookies in your browser

We'll assume we have your consent to use cookies, for example so you won't need to log in each time you visit our site.
Learn more

Reasons for intermittent catheterisation

  • Comment

Consultant nurse Daphne Colpman explains the function of the bladder and when it becomes necessary for intermittent catheterisation.

The bladder

The bladder has two functions: storing urine once it has been made by the kidneys, and eliminating it when convenient. It is a hollow muscular sack that expands as it fills with urine. It has a muscular wall, called the detrusor muscle, which is relaxed during filling. As it fills, sphincter muscles at the neck of the bladder are contracted to prevent urine leakage. During filling, stretch receptors within its wall send messages to the brain’s central cortex and inhibitory messages are usually sent back to the detrusor muscle, delaying micturition.

When it is convenient to void, the urethral sphincter and pelvic floor relax and the detrusor muscle contracts, resulting in bladder emptying (Beynon and Nicholls, 2004). Fig 1 shows the cycle of bladder filling and emptying.

Reasons for intermittent catheterisation

Intermittent catheterisation (IC) was originally used to manage bladder emptying problems. It was popularised by Lapides, who taught patients with long standing urine retention due to neurological disease to self catheterise using a clean technique (Lapides et al, 1972). It can be performed by a patient’s spouse, carer or health professional, or by patients themselves (intermittent self catheterisation, ISC).

Indications for IC are varied and include:

  • Failure of the bladder outlet to open sufficiently to allow the passage of urine through it: this commonly occurs in men, as a result of prostatic enlargement, but can also be secondary to strictures within the urethra or following surgery for stress urinary incontinence;
  • Detrusor hypocontractility/failure: this occurs when the bladder fails to contract enough to expel urine. This can be a result of damage to the innervation of the bladder, such as in diabetic neuropathy, or following damage to the bladder wall secondary to over distension, which can occur with urine retention;
  • Procedures/drugs affecting the contractility of the detrusor: Botox may be injected into the bladder wall to treat urge incontinence. About 20% of people who are undergoing this procedure may subsequently not be able to empty their bladder completely (Flynn et al, 2009). Patients who plan to have Botox are usually taught to perform ISC. Other procedures, such as cystoplasty, can also lead to retention as well as drug therapies such as high dose antipsychotic medication;
  • Instilling drugs: some people may be taught ISC to instil drugs directly into the bladder - for example, using dimethyl sulfoxide (RIMSO-50) to treat interstitial cystitis (Slack et al, 2008);
  • Managing urethral stricture: if a stricture occurs within the urethra it may be surgically dilated or incised (urethrotomy). To help prevent recurrence the patient may be taught to pass a large (18Ch) catheter.

Author Daphne Colpman, MSc, BSc, RGN, is consultant nurse, Epsom and St Helier Trust

  • Comment

Have your say

You must sign in to make a comment

Please remember that the submission of any material is governed by our Terms and Conditions and by submitting material you confirm your agreement to these Terms and Conditions. Links may be included in your comments but HTML is not permitted.