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What to Know About Intermittent Catheterization

Medically Reviewed by Dan Brennan, MD on June 11, 2021

Intermittent catheterization is a medical technique used to help empty the bladder. A catheter is passed through a surgical channel in the skin to the bladder, after which the bladder is emptied. 

Why You May Need Intermittent Catheterization?

Intermittent catheterization is used if you have urinary retention — where you find it difficult to empty your bladder on your own. 

Urinary retention is divided into acute and chronic urinary retention, and it can be caused by many factors like inflammation, infection, neurological conditions, pharmacological agents, and physical bladder obstruction.

Infection and inflammatory issues. One of the many inflammatory causes of urinary retention is acute prostatitis — the inflammation of the prostate gland. In this condition, the prostate becomes enlarged and presses against the urethra, blocking it. Acute prostatitis can be caused by various infectious agents, mainly including gram-negative bacteria like E. coli or Proteus species. 

Another inflammatory cause of urinary retention is urethritis — the inflammation of the urethra caused by a urinary tract infection (UTI) or a sexually transmitted infection (STI). A UTI or an STI can cause urethral edema — i.e., swelling — and thus lead to urinary retention. In women, urethral edema can be caused by inflammation of the vagina or vulva — called vulvovaginitis — due to infection. 

Neurological issues. Your urinary function control is mediated by activity between your central nervous system and the somatic nerves of your urinary system. So, any neurological interruption can also cause urinary retention.

For example, people with stroke often suffer from urinary retention because the muscles of their bladder (detrusor) can't respond to stimuli from their nervous system. People with diabetes may also have urinary retention caused by diabetic peripheral neuropathy. Multiple sclerosis and spinal cord trauma or compression may also cause urinary retention. 

Pharmacological issues. Any drug or agent that decreases your bladder's muscle contraction can lead to urinary retention. Many pharmacological drugs like those with anticholinergic properties can cause bladder muscle contraction weakness. 

Other issues. Other causes of urinary retention include trauma, pregnancy, and postoperative complications. Trauma like injury to the urethra, penis, or bladder can also lead to urinary retention. People with pelvic fractures may also have urethral disruption.

Pregnancy-associated urinary retention can be caused by an impacted retroverted uterus — the uterus curves backward and obstructs the urethral opening. Urinary retention can also after a c-section or prolonged labor during delivery.

Postoperative complications that cause urinary retention include opioid use, surgical trauma, or bladder overdistension (where bladder muscles stretch until they get damaged). For example, after surgery of your rectum, many patients show urinary retention often caused by the distension of their abdomen or the dilation of their rectum. 

After identifying the cause of the urinary retention, your doctor will either recommend you to get intermittent catheterization done or prescribe you other medical interventions like using alpha-adrenergic blockers. 

Long-Term Catheterization Versus Intermittent Catheterization

Intermittent catheterization is a short-term process — where the catheter is removed after each usage. In contrast, in a long-term catheterization, there is no need to continuously replace the catheter after each use.

Even though both the techniques have benefits and risks, an indwelling catheter used for long-term catheterization increases your chances of getting infections, namely catheter-associated urinary tract infections (CAUTIs). Nonetheless, intermittent catheterization greatly reduces this risk. 

Catheter Maintenance

Catheterization trauma and CAUTIs are the most common complications of intermittent catheterization, which may lead to dissatisfaction with the results. Scientists have tried to develop more innovative catheter materials that reduce the risk of these complications.

For example, disposable uncoated PVC catheters reduce the chance of infection during catheterization, whereas disposable coated catheters provide lubrication, which increases the ease of insertion. For reusable catheters, an additional cleaning maintenance step is needed to reduce infection risks. These catheters can be cleaned and disinfected using simple soap and water and sterilized via microwaving or boiling. 

WebMD Medical Reference

Sources

SOURCES:

American Family Physician: "Urinary retention in adults: diagnosis and initial management."

Cochrane Database of Systematic Reviews: "Intermittent catheterisation for long-term bladder management. "

Medical Clinics: "Urologic emergencies."

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