Catheters

Revision date:  January 3, 2006

Catheters are small rubber or plastic tubes that can be inserted through the urethra into the bladder. Catheters are a sure-fire way to empty the bladder. Both men and women can use catheters. Paruretics who use catheters perform what is known as clean-intermittent-catheterization (CIC). That means the catheters are inserted as needed, on an intermittent basis. It also means the catheters don't need to be sterile. They just need to be thoroughly clean.

The use of catheters to empty the bladder is easy, quick, discreet, and should not be painful.

There is some risk of infection, especially in women, but your physician can appropriately deal with this risk.

Catheters are easily carried in a woman's purse, a man's pants pocket, or carry-on luggage. They are easily stored in desk drawers and automobile glove compartments or consoles. Many users place them within a zip-lock bag, along with a packet of K-Y Jelly and a disposable hand wipe.

Most catheters must be lubricated with K-Y jelly before insertion. NEVER use Vaseline or any lubricant other than K-Y Jelly or an equivalent. There are catheters that do not need lubrication. The brand name is LoFric. These seem to be popular in Europe and the UK. They are available in the USA too. The decision about which type to use is always a matter of personal choice.

Catheters are available in a number of different styles, sizes, and materials. Anyone who decides to try them will need to do some experimenting to find which kind works best. It is a very individual choice.

Common materials for catheters are rubber, silicone, PVC plastic, or Teflon. You may find one material to be more comfortable than another. Persons with latex allergy need to avoid rubber catheters.

The inserted end of catheters is manufactured with different shapes. We recommend against the use of catheters with tapered tips, but these might be appropriate for some people.

Some catheters have a slight bend near the tip. These are called Coude catheters. Many men prefer the Coude shape, but one must be careful to keep the proper orientation of the catheter tip while inserting it.

While it is possible to obtain catheters and learn to use catheters without medical supervision, there are serious risks involved without proper training and instruction in their use. IPA strongly advises everyone to get a physician's approval and instruction in catheter use before trying them. Once you’ve been trained, you can safely and confidently use a catheter if it’s needed to drain your bladder in an emergency situation, or for providing a urine sample during a drug test.

Catheters can be purchased at medical supply stores, some drug stores, and through on-line mail-order medical supply companies. Usually, no prescription is needed. The prescription requirements seem to vary throughout the country. We recommend that people who use catheters obtain a note of authorization from their physician, and keep this note with them at all times.  

There are also external catheters available that don't need to be inserted into the urethra. They require that you can control the urinary muscles in order to drain your bladder.  They have a rubber sleeve that fits over the penis, a collection bag, and a system of valves and drain tubing to connect up to the bag.  There is a product for women available from the same company.  They can be worn discreetly and a number of people have reported they can be useful.  These are available without prescription in medical supply stores, and there is a product available through the web called the Stadium Pal (Stadium Gal for women.)  For those who can use these devices, they may be very helpful. If considering this option, remember that security personnel might give you a pat-down search for hidden objects and you may need to explain about the external catheter. This will be very likely if there are any metal parts in the catheter or collection bag.

Catheter FAQ

1) Where can I buy them? Try a medical supply store in your community, or use a search engine to find a medical supply store on line. From time to time people will post a URL on the IPA bulletin board. Also, your physician can help you locate a supply store.

2) Do women need special instructions?  Yes.  See our page on Catheter tips for women for more information.  

3) How much do they cost? It varies. Reusable rubber catheters run between about $7.00 and $12.00. Remember, they can be cleaned and reused many times. Disposable catheters usually cost about $2-$3.00 per catheter. They are usually sold in cartons of 30, but some supply stores will sell them individually. Some people wash and reuse disposable catheters.

4) How long does it take to empty my bladder with a catheter? This depends on the diameter of the catheter and how much urine needs to be expelled. A few seconds to a minute is normative. It takes a minute or less to lubricate a catheter and insert it.

5) How will I know that the catheter has entered my bladder? Urine will start to flow. Once the flow starts you will not be able to stop it until your bladder is completely empty. When the flow stops it is time to remove the catheter.  While extremely unlikely to happen, any kind of catheter, including the really small ones put into blood vessels can be over inserted and become knotted. A urinary catheter should only be inserted to the point that urine is obtained - stop. 

6) How do I clean and sterilize catheters? There are two types of catheters. Disposable catheters are designed for single use. Disposable catheters are packed in sterile packages and are sterile when first taken from their package. Try to avoid touching the lower sterile end of such a catheter.

Reusable catheters do not need to be sterile. It is sufficient to clean them with water and a little soap, then rinse them well with water and again if possible with ordinary rubbing alcohol. Let them dry. If you need to quickly reuse them, rinsing with water is sufficient. Tap water will do nicely. We recommend against using the water available in airplane lavatories or other places where the water is stored in containers.

7) What does it feel like after I have removed the catheter? There may be a slight residual urge that will quickly pass. There might be a slight burning sensation. The first time you urinate after having used a catheter there might be a brief mild burning sensation.

8) Where can I find out more? Ask your doctor and post your questions on the IPA Talk forums.

9) How do I find a doctor who will prescribe catheters? Talk to your primary doctor or call around to various urologists in your community. It seems that about 50% of the urologists will readily agree to teach you how to use catheters and the other 50% will adamantly refuse to help you. So call around before making an appointment. Ask to speak with the nurse. Explain that you will want to be taught how to do intermittent self-catheterization. Ask if the doctor is likely to agree to teach that to you. Do not agree to any expensive tests until you obtain a commitment that you will be taught how to use catheters.

10) How can I convince my doctor to prescribe catheters and teach me how to use them? While it is not possible to predict what any individual doctor might do, we recommend that you go to our Best of Boards section. Search using the word "catheter" or the name "Zgourides". You will find the text of a manuscript by Dr. George Zgourides. Download it, and bring a copy with you to your office appointment. Ask the doctor to read it before he examines you or talks with you about the reason for your visit. It is short, and will only take the doctor a minute or two to read.

11) How much practice does it take? It all depends on you. Some people are more squeamish than others or more sensitive internally. We recommend that you practice at home a few times before going out into situations where you may need the catheter.

12) How often can I use catheters? Most people use them infrequently, as an emergency aid when they cannot find a place where they can empty their bladder. Usually, catheters might be used once or twice during a trip, visit, or event. It is OK to use them more regularly. But, most paruretics don't find that necessary.

13) What about infections? Yes, there is an infection risk. But, there are things you can do to reduce your risk. Men can use a disposable iodine wipe on the glans penis before inserting the catheter, wear disposable sterile gloves, or apply over-the-counter betadine. Or, clean and wipe with any common antiseptic. Drink plenty of fluids at the first opportunity after using a catheter, when you know you will be able to safely use a toilet. Drink acidic fruit juices and especially cranberry juice. Empty your bladder frequently. Perhaps take cranberry pills that are sold over the counter.

There is an over-the-counter medicine that may help. It contains an active ingredient called methenamine. We advise against using this because our bodies convert the active ingredient to formaldehyde, which is a known carcinogen. Nevertheless, be aware that this is available and may be helpful for an emergency. Prescription versions of this drug are also available. One prescription form is called "mandelamine," another is called "methenamine hippurate." Neither should be used simultaneously with any of the sulfa-type antimicrobials.

Some physicians will give you sulfa (Bactrim or equivalent) tablets or other antibiotics. You may be instructed to take them if you have symptoms of an infection or to take them routinely each time you use a catheter. There is a great deal of variation in how physicians approach this issue. Discuss how to deal with infections with your personal physician. Know what to do beforehand.

14) What can I do to relieve internal irritation? This is a rare problem that either goes away quickly or may be a symptom of infection if it persists. There are some over the counter medicines containing phenazopyridine that tinge your urine a red color and provide a mild anesthetic effect. Most people will not need this. Phenazopyridine is also helpful for relieving the symptoms of an infection. It does not treat the infection.

15) Where can I learn more? Read our Best of Boards and post your questions to our IPA Talk forum. Many readers use catheters and will gladly answer your questions.

16) Will using a catheter be damaging to my recovery? Some believe that any action that allows a person with paruresis to avoid urinating in a public restroom will harm their efforts at recovering. But, IPA has not established that catheter use is indeed harmful. There is no clear answer at this time. Others have found that having a catheter with them provides an extra measure of security and a reduction in anxiety, because they know there will always be a way to drain the bladder if they encounter a situation that is beyond their ability to cope.

As of this writing, it is IPA’s opinion that catheter use can be helpful as long as the person does not become dependent on the catheter. In other words, it should be used only on an occasional basis, and only after other methods have failed to work (such as trying to reduce anxiety, trying different restrooms, etc.) Catheter use is also valuable if a person needs to produce a urine sample for a drug test and cannot risk being accused of drug use because they cannot provide the sample.

Catheter use is not a substitute for a recovery program that includes support groups, graduated exposure therapy, and cognitive/behavioral therapy. As a person works on a recovery program the need for a catheter should decrease over time. If you find yourself using a catheter more often, it is likely acting as a crutch and you should seek professional help from a psychologist on confronting that dependency.