Display Patient Information Leaflets

Date issued: October 2024  

For review: October 2026

Ref: C-594/AC/Colorectal/Clean Intermittent Self-Catheterisation for Adults

PDF: Clean Intermittent Self-Catheterisation for Adults.pdf [pdf] 469KB

How the urinary system works?         

The kidneys filter waste products and water from the blood (this is urine). The urine passes from the kidneys into the bladder via 2 small tubes called ureters. There is also a tube that extends from the bladder to the outside through which urine is passed. This is called the urethra.             

The bladder should comfortably hold 250ml to 350ml of urine. When the bladder is full a message is relayed to the brain to warn the bladder to empty. The brain tells the bladder to hold until a convenient location is found. When an appropriate place is reached another message is sent from the brain, which stimulates the bladder muscle to squeeze and the urethral opening to relax. This allows the urine to be expelled and the bladder to be emptied. Any interruption in this message system or blockage in the urinary tract may result in the bladder being unable to empty fully. If this is the case, then CISC may be recommended.  

What is Clean Intermittent Self-Catheterisation (CISC)? 

• CISC is a simple and safe way of emptying your bladder.

• A small soft tube (called a catheter) is passed into the bladder through the urethra, which allows the urine to drain.

• When the bladder has been emptied the catheter is removed and thrown away.

• With practice this will only takes a few minutes.

• CISC is an alternative to a permanent long-term catheter .

Why CISC?

There are lots of reasons why someone may be unable to fully empty their bladder and need to use a catheter. These may include:

• Poor bladder tone (weak bladder muscle)

• Bladder hypertrophy (over stretched muscle)

• Urethral obstruction

• Neurological conditions

• Pelvic surgery

Benefits of CISC

We hope that CISC will improve your confidence and quality of life. Other benefits include:

• The risk of kidney damage will be reduced.

• You can choose when you want to empty your bladder allowing you more control.

• Urinary tract infections are often reduced.

• The feeling of quickly needing to pass urine may be less.

• Visits to the toilet, particularly during the night will be reduced.

• It can prevent or reduce the overflow incontinence.

• Avoids the need for a permanent catheter which can increase the risk of urinary tract infections.

• It is often more comfortable than a permanent catheter.

• Natural voids can be encouraged between ISC.

• The build-up of old urine in the bladder that can cause infections is removed.

Risks and side effects of CISC

Performing CISC for many years has very few complications, however there are a few risks and side effects from doing so.

• Urinary Tract Infection (UTI) - this is usually less than the risk of infection associated with the bladder not emptying. However, they are still possible, and you may need antibiotics from your GP.

• A small amount of blood spotting on catheter removal. If the bleeding is heavy, persist or has clots, contact your nurse for advice. If you are taking blood thinning medication, the risk of this may be higher.

• Discomfort - performing CISC should not be painful, it may at first feel unusual, but this should improve with practice and time.

Frequently asked questions         

Q. Will the procedure be painful?

No. Some people experience slight stinging and a feeling of wanting to pass water. This is perfectly normal and will pass as you become used to the procedure. People are surprised how painless the procedure can be. 

Q. What if I develop an infection?

You may develop an infection when you first start CISC. This is usually because you have not emptied your bladder completely for some time. It does not mean you have done anything wrong. Symptoms of a urine infection include cloudy urine, pain or tenderness in the lower part of your tummy or kidney area, feeling unwell (hot and feverish), or having blood in the urine. If you suspect that you have an infection, contact your GP who will consider if you need antibiotic treatment.

Q. How long will I need to perform CISC?

The answer to this depends on the reason why you are performing CISC.

Q. How often will I need to perform catheterisation?

Generally, the larger the amount of urine left in the bladder the greater the frequency of catheterisation. Some people perform CISC once daily while others may perform CISC up to 6 times a day. People are usually able to decide the frequency for themselves as they begin to understand their bladder function. Your continence nurse will advise you initially. Do not be afraid to ask!

Q. How will I obtain the catheters?

Your GP or healthcare practitioner will write a prescription. You can collect your catheters from your local chemist or many of the catheter companies offer a free prescription collection and delivery service.

Q. Are there different types of catheters available?

Yes. The recommended catheter is a single use type which has a slippery coating. Different brands have slightly different coatings. There are a variety of catheters which come prepared for use. Your nurse will discuss which catheters are best for you.

Q. What if I travel or go on holiday?

Performing CISC should not restrict your travel or holiday choices, you just need to be organised. Make sure that you order enough catheters for the length of your trip and make sure you can get to them while travelling. A GP/doctor’s letter may be helpful if you are travelling abroad, so as to avoid any difficulties with Customs. Some delivery companies will offer supplies to be delivered to your holiday destination.

Q. Can I still have sex?

Yes. Performing CISC should not affect your sex life. 

Q. What equipment do I need?

Catheters, hand wipes or soap and water and something to drain urine into if you are not using the toilet. Some catheters have drainage bags attached for use if toilet access is difficult. A rubbish bag is always useful to dispose of the equipment after use. 

Steps to CISC for women

CISC is known as a clean procedure. Positions for the procedure are an individual choice, you may prefer to stand, lie or sit. 

Before you start using CISC, it is helpful if you examine your genitals with a mirror to locate the urethral opening. The urethral opening can be found between the clitoris and vagina. If it is difficult to see the urethra, gently draw your genital folds of skin (labia) forward and upwards with your fingers. It may be possible to feel the urethral opening like a small, raised mound.

1. Try and pass urine in the toilet before CISC if possible.

2. Wash your genital area with soap and water, from front to back.

3. Wash your hands thoroughly. Hand wipes are useful if you are using public toilets.

4. Prepare the catheter as per the manufacturer’s instructions. Place in a position of easy access near the toilet or along with a jug or catheter bag to drain urine in to. Open the genital folds of skin (labia) with your thumb and forefinger to expose the urethra.

5. Hold the catheter in the area advised from the manufacturer’s instruction, this may be different in differing catheters. You should not touch the exposed catheter as this will introduce bacteria to your bladder. Use your dominant (preferred) hand.

6. Once you have located the urethral opening, insert the catheter, aiming upwards until urine drains out of the catheter.

7. If the catheter enters your vagina by mistake, just remove it and start again with a new catheter; this will not cause any harm.

8. When the catheter is within your bladder you will see urine draining from the drainage port of the catheter. When the urine stops draining, you are safe to slowly remove the catheter. Please use a pause and drain technique approximately 3 times on removal, this will ensure the base of the bladder is drained before complete removal.

9. Dispose of the catheter in a sealed plastic bag and place in the dustbin. When you are managing to empty your bladder on a regular basis, you will be asked to measure the urine drained for a period. Your continence nurse will use the measurements to advise you on an CISC regime. Once you have settled into this regime there will be no need to measure the urine routinely.

Steps to CISC for men

CISC is known as a clean procedure. Positions for the procedure are an individual choice, you may prefer to stand or sit. Try and pass urine in the toilet before CISC if possible.

1. Clean your genital area with soapy water.

2. Wash your hands with warm soapy water thoroughly. Hand wipes are useful if you are using public toilets.

3. Prepare the catheter as per the manufacturer’s instructions. Place in a position of easy access near the toilet.

4. Retract the foreskin (if present) and gently pull the penis into an upright position facing you so you can see the opening of the urethra.

5. Insert the catheter into the urethral opening. The catheter should insert easily with gentle pressure. Remember the urethra is about 20 cm in length, so you will probably need to insert most of the catheter. You will feel some resistance as the catheter passes through the pelvic floor and prostate. At this point, coughing or trying to pass urine can help. Urine will drain as you enter the bladder. While you are performing the procedure you may feel the sensation to pass urine.

6. When the catheter is within your bladder you will see urine draining from the drainage port of the catheter. When the urine stops draining, you are safe to slowly remove the catheter. Please use a pause and drain technique approximately 3 times on removal, as this will ensure the base of the bladder is drained before complete removal. Dispose of the catheter in a sealed plastic bag and place in the dustbin.

7. Wash your hands. When you are successfully managing to empty your bladder on a regular basis you will be asked to measure the urine drained for a period. Your continence nurse will use the measurements to advise you on an appropriate CISC regime. Once you have settled into this regime there will be no need to measure the urine routinely.

Troubleshooting: Common problems

There is blood in my urine when I use a catheter

A small amount of blood when you first start to catheterise is perfectly normal. This will improve after the first week or so. If there is a large volume of blood loss, please contact your GP for advice. If this happens after you have been catheterising for some time, take a urine sample to your GP’s surgery for testing to rule out an infection.

It stings when I pass urine

You may have a urine infection. Take a urine sample to your GP’s surgery for testing.

I experience a stinging sensation when I catheterise

This is a common sensation when you first perform CISC. If this continues it may be worth trying a different brand of catheter. Discuss this with your continence nurse.

I am unable to remove the catheter when I have previously had no problem

Do not worry; sometimes this can happen. Try to relax; a warm bath can be helpful. If you are still unable to perform CISC please contact your healthcare professional or GP.

No urine drains out of the catheter

• Your catheter may not be in your urethral opening for a woman.

• You may be experiencing a bladder spasm (contraction).

• The bladder may be empty. Try again later, if there is still no drainage contact your healthcare professional or GP.

I can’t get the catheter out

Try to relax; you are most likely experiencing a bladder spasm. Coughing while you try to remove the catheter can help. A warm bath can also be helpful. If this does not resolve, contact your healthcare professional or GP. Medication to relax the bladder may be given to prevent this from happening again. Never force the catheter or cut the catheter.

Frequency of performing CISC

There may be variations to how often you are asked to perform CISC and your nurse will discuss this with you.

Follow up

When you start CISC at home, either your nurse or a member of the Secure Start team will contact you over the telephone. They will want to know how often you are catheterising and how much you are draining, how you are managing with the catheterisation and whether you have any concerns.

You will be registered with Fittleworth, a home delivery service. They will deliver the catheters to your home and will require a repeat prescription from your GP. This can be arranged between the home delivery company and your GP on instruction from your nurse specialist. Your consent will be required for the home delivery and follow up from Secure Start which will be explained to you in more detail at your appointment. 

Further information

Functional Urology Nurse Specialists, Chestnut Unit, 01752 430081.

Monday to Friday 8:30am to 5pm

Useful websites

British Association of Urological Surgeons

Bladder and bowel community

Useful videos

How to perform catheterisation with VaPro catheters | Hollister - YouTube

Infyna Chic Intermittent Catheter Educational Videos | Hollister UK