We get it: The idea of clean intermittent catheterization (also known as CIC or self-catheterization) can make people squirm. Our goal with this article is to answer common questions and hopefully provide some reassurance that, with practice and good technique, most people can learn how to self-catheterize.

We've asked one of our physician assistants, Bradley Hunt, to help out with this blog post. You'll find his answers below.

As with all content on the GBU blog, the following is meant to be educational, not medical advice. Always talk to a physician about your unique health care needs.

For someone who's never heard of it before, how would you explain clean intermittent catheterization (CIC)?

BRADLEY HUNT: 

CIC is a process by which we train an individual to pass a small sterile catheter into their own urethra, thereby draining urine from the bladder. It is fundamentally the same process that we would perform for people; however by training them to do it themselves improves their freedom and quality of life.

OK, let's address the two biggest questions: Is self-catheterization painful, and is it hard to learn?

BRADLEY HUNT:

As with most things in medicine, the answer is not so black-and-white. To the question of pain, the answer is different for many people. There certainly are some people who report pain/discomfort during self-catheterization, while others say they barely feel anything at all. In my opinion, the general response from individuals trying self-catheterization for the first or second time is that it is not nearly as bad as expected. To the question of difficulty, again, the answer depends. For men, self-catheterization is generally very easy since the urethra is external and mobile. For women, where direct visualization of the urethra is not possible, a mirror must be used, which creates challenges in correctly identifying the urethra while simultaneously keeping the catheter clean.

What would you say to someone who feels overwhelmed or scared about having to do this on their own?

BRADLEY HUNT:

When someone feels overwhelmed by self-catheterization, I often remind them that Rome was not built in a day. I often tell an anecdote of when I was a child learning to put contacts into my eyes. It took me 45 minutes to get a contact lens onto my eyeball, and it came with great pain and frustration as I repeatedly poked myself in the eye. Now, many years later, placing contacts is second nature and offers no challenge. Self-catheterization is just like any other skill; once it is learned and repeated, it becomes second nature. With persistence, anybody can accomplish this.

How long does it usually take for someone to get comfortable with the process?

BRADLEY HUNT:

The initial learning curve is certainly a couple of weeks to months. However, after successfully performing straight catheterization only a couple of times, you would feel confident in your ability to perform this regularly.

What advice do you give to patients to help them feel more confident doing CIC at home or in public restrooms?

BRADLEY HUNT:

Regardless of where one performs self-catheterization, one should try to maintain a clean technique. Washing hands prior to the procedure helps to minimize the risk of infection. Each catheter is prepackaged and sterilized. So long as the catheter touches only you and is not the surrounding environment, there should be no concerns about increased risk of UTI at a public restroom.

How important is cleanliness, and what simple steps can people take to stay safe and avoid infections?

BRADLEY HUNT:

Infections will happen, unfortunately. We are covered in bacteria, and no matter what we do, we inevitably will introduce some degree of bacteria into the bladder during a catheterization. There are crucial steps you can take to limit the risk of infections. We typically recommend cleaning your hands and the urethral opening (if possible) with soap and water prior to catheterization. Being sure to stay hydrated always helps to keep the bladder flushed, and is also recommended.

What supplies or tools make the process easier for patients?

BRADLEY HUNT:

Catheters come prelubricated and individually wrapped for ease of use. They are meant to be used once and then discarded to thereby reduce the likelihood of infection. Some people like to use gloves during this process, though it is not absolutely necessary. For women, a mirror is often useful to help visualize the urethra. Some people will perform straight catheterization into a urinal or other container rather than directly into the toilet.

Are there different types of catheters, and how do patients know which is right for them?

BRADLEY HUNT:

Yes, there are certainly different types of catheters. Men will commonly need to utilize a "coudé" catheter, which has a specialized tip to help bypass the prostate. Women will use a much shorter catheter since their urethra is generally much shorter. Additionally, other subtypes of catheters may be appropriate for her given scenario. Often, the provider would recommend whichever type of catheter they suspect would be a good fit. Samples of catheters are often provided by either the urology department or the catheter supplier so that other options can be trialed.

How does the GBU team support patients learning how to do CIC for the first time?

BRADLEY HUNT:

We always start by teaching patients how to perform straight catheterization in the office with direct supervision. We guide them through the first placement and answer their questions as they arise. There are also a multitude of resources for people who perform straight catheterization online. Specifically, I often point my patients towards YouTube to watch videos (often animated) on appropriate technique so they can be reminded once they get home. If there are further concerns, patients are encouraged to reach out to the office. We can have multiple training sessions with some of our excellent medical assistants who are well-versed in the subject.

If there's one thing you wish everyone reading this understood about CIC, what would it be?

BRADLEY HUNT:

Clean intermittent catheterization improves your quality of life and reduces the risk of infection when compared to a chronic indwelling catheter. There are certainly scenarios that arise where someone would be unable to perform CIC; however, many people are simply too afraid to attempt it. The one thing everyone should understand is that the potential benefit far outweighs the risk of discomfort during the learning process and everyone should try it if they are able to do so. 

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