Intermittent Self-Catheterisation: How to Make It More Comfortable (What the Research Shows)

Quick answer: Clean intermittent self-catheterisation (CISC) empties the bladder on a schedule to protect the kidneys and reduce infection risk. Comfort comes down to three things: an appropriate catheter for your anatomy, unhurried lubrication and insertion, and a consistent schedule so the bladder never over-fills. Persistent pain or bleeding is not something to push through. Speak to your doctor or continence nurse.

What is intermittent self-catheterisation, and why is it used?

Intermittent catheterisation means passing a thin catheter into the bladder, draining it, then removing the catheter straight away. Nothing is left in place. It is used when the bladder cannot empty on its own, for example after spinal cord injury, in multiple sclerosis, in some prostate conditions, or after certain pelvic surgeries.

The clinical logic is straightforward. Urine that sits in a bladder for long periods raises pressure and gives bacteria time to multiply. Because nothing stays in the urethra between catheterisations, intermittent catheterisation avoids the continuous foreign body that an indwelling catheter presents.

Why do so many people find it uncomfortable at first?

In our experience as wound, ostomy and continence nurses, discomfort usually traces back to a handful of fixable causes rather than to catheterisation itself:

• Not enough lubrication, or lubricant that dries out mid-insertion. Friction against the urethral lining is the single most common source of stinging.
• Rushing. Insertion against a tense pelvic floor hurts. Slow, steady advancement with relaxed breathing is far more comfortable than force.
• A catheter that is the wrong size or style. Larger is not better. The narrowest catheter that drains well is usually the most comfortable.
• Leaving it too long between catheterisations. An over-full bladder is uncomfortable to drain and raises the risk of leakage between sessions.

What is actually being studied about catheter comfort?

Catheter coatings are an active research area, because how a catheter feels in use strongly predicts whether someone keeps doing it. One example is a multi-centre prospective observational study run by ConvaTec, NCT05470751, which followed 72 men who self-catheterise and measured their experience using two validated questionnaires (the ICDQ and the ISC-Q) over a 60-day period. Secondary measures included user confidence about catheter stickiness and the related concern of urethral trauma, plus how consistently participants kept to their catheterisation routine.

An honest note on the evidence: this study is listed as completed (April 2024), but no results have been posted to the registry at the time of writing, and it was an observational cohort rather than a randomised comparison. That means it can describe what users reported, but it cannot on its own prove one catheter design outperforms another. We mention it because it shows what the field is measuring, not because it settles the question.

What actually helps day to day?

• Keep to a schedule rather than waiting for the urge. Your doctor or continence nurse will set the interval based on your bladder volumes. Most routines land somewhere between four and six times a day.
• Wash your hands properly before and after. This is the "clean" in clean intermittent catheterisation, and it matters more than any product.
• Lubricate generously. If you use a hydrophilic catheter, give it the full soaking time the instructions specify. A partly activated coating is a scratchy coating.
• Stop and reset if you meet resistance. Take a breath out, relax the pelvic floor, and try again gently. Never force a catheter.
• Drain fully, then withdraw slowly. Pausing as flow stops lets the last of the urine clear.
• Do not reuse single-use catheters. Follow the manufacturer's instructions on whether a catheter is single-use or reusable.

When should you call your doctor?

Do not wait and see if you notice any of the following:

• Fresh blood on the catheter, or bleeding from the urethra
• Fever, chills, flank or lower back pain, or cloudy strong-smelling urine, which can point to a urinary tract infection
• Inability to pass the catheter, or a catheter that will not come out
• Pain that is getting worse rather than easing as you gain practice
• A sudden drop in the volume you drain, or a sudden increase in leakage between catheterisations

For people with spinal cord injury above T6, a blocked or over-full bladder can also trigger autonomic dysreflexia, which is a medical emergency. If you have been told this applies to you, follow the emergency plan your specialist gave you.

The bottom line

Intermittent catheterisation is a skill, and like any skill it gets markedly easier with practice and the right kit. If it still hurts after the first few weeks, that is a signal to review your catheter choice and technique with a continence nurse, not a sign that you are doing it wrong.

This article is general information, not medical advice. Catheter type, size and catheterisation frequency must be prescribed for your individual condition. Please consult your doctor or continence nurse before changing anything about your routine.

EMIS+ supplies continence and catheter care products to clinics, care homes and families in Singapore. You can browse our range at www.emis.asia.