Self-Catheterisation: Steps & Important Safety Tips to Remember

Learning to self-catheterise can feel like a lot to take in at first. There are new supplies to become familiar with, hygiene steps to remember and a technique to learn. But with proper training and practice, intermittent self-catheterisation can become a familiar part of your everyday bladder-management routine. 

In this guide, we'll walk through the important safety steps to remember when performing intermittent self-catheterisation, from preparing your supplies and maintaining good hygiene to inserting and removing the catheter carefully, recognising possible signs of infection and knowing when to ask for help. 

Disclaimer: This article is intended as a general safety guide only. Self-catheterisation should first be taught by an appropriately qualified healthcare professional, who can recommend the correct catheter, technique and schedule for your individual needs. Always follow the instructions provided by your healthcare team.

1. Before you start: Make sure you have the right catheter

Safe self-catheterisation starts before you even open the catheter. Using the right type and size of catheter for your individual needs is important for comfortable and effective bladder emptying, and this choice should be made with guidance from your healthcare professional.

Intermittent catheters aren't all the same. They can differ in their diameter, length, tip design and lubrication or coating, and the most appropriate option will depend on factors such as your anatomy, bladder-management needs, dexterity and the technique you've been taught.

Some of the main differences you may come across include:

• Catheter size (Fr/Ch): Catheter diameter is commonly measured using the French (Fr) or Charrière (Ch) scale. A higher number indicates a larger diameter. Using a larger catheter isn't necessarily better—your healthcare professional should recommend an appropriate size that allows effective drainage while minimising unnecessary discomfort or trauma.

• Catheter length: Catheters are available in different lengths, including options designed for male, female and paediatric anatomy. Your healthcare professional can advise which length is appropriate for you.

• Catheter tip: Many intermittent catheters have a straight, rounded tip, often referred to as a Nelaton tip. Other designs, such as Coudé or Tiemann tips, may be recommended when navigating the urethra is more difficult. These shouldn't be selected simply because insertion has become difficult—speak with your healthcare professional first.

• Coated or uncoated: Some catheters have a hydrophilic coating or come pre-lubricated and ready to use, while others may require a separate lubricant. Always follow the instructions for your particular catheter.

• Standard or compact designs: Compact catheters can offer greater portability and discretion when you're away from home, but suitability still depends on your individual needs.

Before each catheterisation, it's also worth taking a moment to check the catheter packaging. Make sure you're using the correct product and size, check that the packaging is intact, and don't use a catheter past its expiry date. If a sterile single-use catheter package is damaged, already open or otherwise compromised, use a new catheter instead.

2. Prepare everything before you begin

Before washing your hands and starting self-catheterisation, take a moment to gather everything you'll need and have it within easy reach. Preparing your supplies beforehand means you won't have to stop midway through the process to open cupboards, search through drawers or touch other surfaces unnecessarily.

Exactly what you'll need will depend on the catheter you use and the technique recommended by your healthcare professional, but this may include:

• Your prescribed intermittent catheter

• Lubricant, if your catheter requires it

• Soap and clean water for handwashing

• Any cleansing supplies recommended by your healthcare professional

• A toilet or suitable urine collection container, depending on where you're catheterising

• A disposal bag or appropriate waste bin for used single-use supplies

• A mirror, if you use one to help locate the urethral opening

Check that your catheter packaging is sealed and undamaged before you begin, but don't open it until you're ready to use it. If you're using a catheter that requires activation, lubrication or another preparation step, follow the manufacturer's instructions for that specific product.

It's also worth preparing the space itself. Make sure you have enough room to position yourself comfortably and safely, and keep your catheter and other clean supplies away from potentially contaminated surfaces such as the toilet, floor or sink.

3. Wash and dry your hands properly

Good hand hygiene is one of the most important safety steps when self-catheterising. Your hands can carry microorganisms that may be transferred to the catheter or the area around the urethra, potentially increasing the risk of urinary tract infection (UTI). 

A few simple habits can help:

• Wash your hands immediately before catheterisation, rather than earlier in your bathroom routine.

• Dry them thoroughly using a clean towel or disposable paper towel where available.

• Use disposable gloves if recommended or preferred, especially if you're assisting someone else with catheterisation. 

• Avoid unnecessarily touching the part of the catheter that will enter your body.

What if you're away from home?

Self-catheterisation may sometimes need to be performed in a public bathroom or somewhere without convenient access to your usual facilities. Planning ahead can make maintaining good hand hygiene easier.

Where clean running water and soap are available, handwashing should be your first option. If they're not readily available, an alcohol-based hand sanitiser may be useful for hand hygiene, provided your hands aren't visibly dirty or soiled.

4. Keep the catheter clean

Once you've washed and dried your hands, the next priority is keeping the catheter as clean as possible before and during insertion. Even with clean hands, the catheter can pick up microorganisms if it comes into contact with surrounding surfaces. 

While preparing and handling your catheter:

• Avoid touching the section of the catheter that will enter the urethra wherever possible.

• Don't allow the catheter to touch the toilet, sink, floor, clothing or other potentially contaminated surfaces.

• Use any handling sleeve or no-touch grip provided with the catheter as instructed by the manufacturer.

• Apply lubricant as instructed if you're using a catheter that requires separate lubrication.

• Don't place an unpackaged catheter down on a surface while you prepare something else.

If a sterile single-use catheter is accidentally dropped or the part intended for insertion touches a potentially contaminated surface, don't simply wipe it off and continue using it. Use a new catheter where possible.

5. Position yourself comfortably

Finding a position that feels comfortable, stable and gives you adequate access to the urethral opening can make self-catheterisation easier. There isn't one position that's right for everyone—the best approach can depend on your anatomy, mobility, balance, dexterity and the technique you've been taught by your healthcare professional.

Some people may find it easier to catheterise while:

• Sitting on or standing in front of the toilet

• Sitting on the edge of a bed or chair

• Standing with one leg raised and supported, where appropriate and safe

• Lying or reclining, particularly when mobility makes other positions difficult

The positions used can also differ between people with male and female anatomy. For example, some women may use a mirror to help locate the urethral opening, particularly while they're first learning the technique. Your continence nurse or other healthcare professional can help you find a position that works best for your body and circumstances.

Whichever position you use, try not to rush. Make sure you're balanced and properly supported before beginning, especially if you're standing or have limited mobility. You should also be able to reach your catheter and other prepared supplies without having to change position unnecessarily.

💡Tip: If positioning is consistently difficult because of reduced mobility, dexterity or balance, speak with your healthcare professional rather than struggling through the process. They may be able to suggest a different position, technique or equipment that makes self-catheterisation easier and safer for you.

6. Never force the catheter

If the catheter doesn't pass easily, don't try to overcome the resistance by pushing harder. Forcing a catheter can irritate or injure the urethra and may cause pain, bleeding or other complications.

Some resistance or difficulty can occur for different reasons. Your positioning may need adjusting, the muscles around the urinary sphincter may be tense, or there may be an anatomical or medical reason that makes insertion more difficult. Whatever the cause, significant or unexpected resistance shouldn't simply be pushed through.

If you're having difficulty:

• Stop rather than applying additional force.

• Try to relax and avoid rushing, as tension can make catheterisation more difficult.

• Check your positioning and follow the technique you've been taught by your healthcare professional.

• Don't repeatedly attempt insertion if it's causing pain, bleeding or increasing resistance.

• Don't change to a different catheter size or tip on your own in an attempt to overcome the problem.

• Contact your healthcare professional if difficulty inserting the catheter persists or becomes a recurring problem.

7. Pay attention to pain and bleeding

Self-catheterisation shouldn't involve significant pain. When you're first learning, you may notice some unfamiliar sensations or mild discomfort as the catheter passes through the urethra, but pain that is severe, persistent or different from what you normally experience shouldn't simply be ignored.

Occasionally, minor irritation of the urethra can also result in a small amount of blood on the catheter or in the urine, particularly if catheterisation has been difficult.

Pay attention to changes such as:

• New or increasing pain during insertion or removal

• Pain that continues after catheterisation

• Repeated bleeding during or after catheterisation

• A noticeable or increasing amount of blood in your urine

• Bleeding accompanied by difficulty inserting the catheter

• New lower abdominal, pelvic or urinary discomfort

• Pain or bleeding that is becoming more frequent over time

It's also useful to become familiar with what's normal for you. If you've been self-catheterising comfortably and suddenly begin experiencing pain, bleeding or difficulty that wasn't there before, speak with your healthcare professional so the change can be assessed.

8. Allow the bladder to empty before removing the catheter

Once the catheter has reached the bladder and urine begins to flow, give your bladder enough time to drain before removing the catheter. Removing it too soon may mean that some urine remains in the bladder.

You'll usually notice that the initial stream of urine gradually slows and eventually stops as the bladder empties. If your healthcare professional has asked you to measure or record your urine output, do so according to the instructions they've provided.

Consistently large or unusually small volumes may help your healthcare professional determine whether your catheterisation schedule or bladder-management plan needs reviewing.

9. Remove the catheter slowly and gently

Follow the removal technique demonstrated by your healthcare professional. In general, the catheter should be withdrawn slowly and smoothly, allowing any remaining urine to drain as you remove it.

Keep these safety points in mind:

• Remove the catheter slowly rather than pulling it out quickly.

• Continue to follow the technique you've been taught, including any instructions for allowing remaining urine to drain during removal.

• Don't tug or pull forcefully if the catheter doesn't come out as expected.

• Stop if you experience significant pain or unusual resistance.

• Pay attention to unexpected bleeding on the catheter or in your urine.

• Don't repeatedly move the catheter backwards and forwards in an attempt to overcome resistance.

If the catheter feels stuck or you're unable to remove it normally, don't try to force it out. Remain calm and contact your healthcare professional for advice. If you're unable to access your usual healthcare provider and the catheter cannot be removed, seek appropriate medical assistance.

Once the catheter has been removed, check that it appears intact and dispose of or handle it according to the manufacturer's instructions and the guidance you've been given. Wash and dry your hands afterwards.

10. Watch for possible signs of a UTI

Urinary tract infections (UTIs) are a potential complication of intermittent self-catheterisation. Because a catheter passes through the urethra and into the bladder, good hygiene and correct catheterisation technique are important for reducing the risk of introducing bacteria into the urinary tract. 

Possible signs and symptoms of a UTI can include:

• Burning, stinging or pain in the urinary tract

• New or worsening lower abdominal or bladder discomfort

• Needing to urinate more frequently or urgently, if you also urinate normally between catheterisations

• Cloudy urine

• Blood in the urine

• A noticeable change in urine odour

• Fever or chills

• Feeling unusually tired or generally unwell

• Pain in the back or side, particularly around the kidney area

However, cloudy or strong-smelling urine on its own doesn't necessarily mean you have a UTI. Urine can change in appearance or smell for several reasons, including hydration, foods and medicines. That's why it's important to consider other symptoms and seek professional assessment rather than diagnosing or treating a UTI yourself.

Read related article: What Are the Different Types of Urinary Tract Infections (UTIs)?

If you develop symptoms that could indicate a UTI, contact your healthcare professional for advice. They may recommend a urine test or other assessment before determining whether treatment is necessary.

Quick self-catheterisation safety checklist

Once you've been properly trained by your healthcare professional, following a consistent routine each time you self-catheterise can make it easier to remember the important hygiene and safety steps.

Use this quick checklist as a general refresher alongside the individual instructions you've been given.

Before you begin

• Use the correct catheter type, size and length recommended for you.

• Check the packaging is sealed, intact and within its expiry date.

• Gather everything you need before starting, including lubricant if required and a suitable urine collection container if you use one.

• Prepare a comfortable, stable position that gives you adequate access without needing to rush or strain.

• Wash and dry your hands thoroughly immediately before handling your catheter.

During catheterisation

• Keep the catheter clean and avoid touching the section that will enter the urethra wherever possible.

• Don't allow the catheter to touch potentially contaminated surfaces such as the toilet, floor or sink.

• Follow the insertion technique taught by your healthcare professional.

• Never force the catheter if you encounter significant or unexpected resistance.

• Stop and pay attention to unusual pain or bleeding rather than trying to push through it.

• Allow your bladder enough time to empty according to the technique you've been taught.

After catheterisation

• Remove the catheter slowly and gently rather than pulling or rushing.

• Dispose of or handle the catheter according to its instructions for use and the advice you've been given.

• Wash and dry your hands again once you've finished.

• Record your urine output if your healthcare professional has asked you to monitor it.

• Pay attention to anything that's different from your normal routine, such as increasing difficulty, pain, bleeding or possible symptoms of a UTI.

Making safety part of your self-catheterisation routine

Self-catheterisation may involve several steps to remember, particularly when you're first learning. With appropriate training and practice, however, these steps can become part of a familiar everyday bladder-management routine. 

The important thing is not to become so familiar with the process that the basic safety principles are overlooked. Preparing your supplies before you begin, washing your hands, keeping the catheter clean, using gentle technique and allowing your bladder to empty properly are all simple but important parts of the process.

It's equally important to pay attention when something changes. Self-catheterisation that suddenly becomes more difficult or painful, recurrent bleeding, possible symptoms of infection or an inability to empty your bladder shouldn't simply be accepted as part of the routine. Knowing when to stop and seek professional advice is just as important as knowing how to perform the procedure itself.

Above all, remember that self-catheterisation is individual to you. Your catheter type and size, technique and catheterisation schedule should be based on the advice and training provided by your healthcare professional.

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