Symptom Management

Safe Catheterization

By Tracy Walker and Christine Hampton
There are different ways MS can affect the bladder but one of the most serious is urinary retention. The good news is urinary retention can be managed and its serious effects prevented.

Why is urinary retention such a serious problem when many folks don’t even realize they are not emptying their bladder completely? Urinary retention can lead to frequent urinary tract infections that if left untreated can lead to sepsis, hospitalization, and even death. Even when treated quickly, urinary tract infections often cause increased MS symptoms when the immune system is activated to fight infection. Over time, urinary retention can cause high pressures in the kidneys, leading to kidney failure and dialysis. So, treatment is very important, even if you aren’t having these symptoms yet.

Avoiding UTIs

How is urinary retention treated? There are a variety of approaches to help folks empty their bladder fully, including intermittent catheterization or IC. 

When I mention the word “catheterization,” many of my patients have preconceived notions of what this means and oftentimes are convinced they cannot perform catheterizations safely or having to do so would mean not being able to live a normal life. The reality is many people who have this problem are already controlled by having to spend so much time in the restroom or home sick with the effects of recurrent UTIs. Once they start catheterizing they feel so much better and they wish they had done it sooner. 

While not performing catheterization when needed can lead to very serious health risks, there can be risks associated with catheterization if not done correctly. One question I always get is “won’t putting a catheter in cause infection?” The answer is it can, but when done correctly it usually does not. Studies have shown that most bladder infections are caused by the bladder overstretching from retention. 

Therefore, catheterization helps keep the bladder from overdistending and mimics normal bladder function. It is important to wash your hands before and after, use clean technique when performing catheterization, and apply lubricant to protect the tissue leading into the bladder. It is also important to perform catheterizations on schedule – or more frequently if you have additional fluid intake. Your medical team can give you the specific procedures to follow and tell you if there are any additional precautions you need to take

If you are having difficulty performing the catheterizations ask your medical team to refer you to an occupational therapist. Occupational therapists are a great resource for helping patients overcome any obstacles to performing safe catheterizations.

Catheterization challenges

There can be many obstacles that make completing self-intermittent catheterization for individuals with MS frustrating. Some of these obstacles include impaired fine motor coordination or dexterity, weakness, impaired vision, and loss of range of motion or contractures. Fear not, there are many strategies and pieces of equipment that can make it easier.

It is not uncommon for individuals with MS to report having difficulty with their fine motor coordination or their ability to pick up or manipulate small objects in their hands. Decreased fine motor coordination can make it difficult to manipulate the catheter to effectively insert it into such a small target area while remaining clean. There are many catheters out there that require less dexterity than others. Some of these catheters can be used with little to no hand function. Look for catheters that are easy to open and have firmer tubing. Thumb holes on the bag may help you with holding onto the bag. Try out a few types of catheters to determine what works best for you. 

Impaired vision can be another barrier for individuals with MS when completing an IC. It can be helpful to spend time locating your urethral opening before trying to insert the catheter. Mirrors are a great tool to assist with locating this area. You can also work with an occupational therapist or a trusted individual to help locate the opening to the urethra. If you are still having difficulties, try switching positions while seated to see if a different angle will help you locate the urethral opening. The “no touch” method for completing an IC is preferred in order to reduce your risk of contamination and infection.

Lastly, decreased range of motion or contractures can also make catheterization difficult by limiting positioning options. Positioning is one of the most important factors for successful self-catheterization. The position you need to be in to complete an IC greatly varies depending on if you are a male or female. Because of female anatomy, limited range of motion in their lower body can lead to more difficulty in completing an IC. Contractures or decreased range of motion can affect your ability to get into a position to effectively insert the catheter. Stretching daily may help increase or maintain your lower body range of motion. Increased tone and/or spasticity tends to be closely linked to the loss of range of motion and can also negatively affect your ability to maintain an effective position. You may need to speak with your doctor and/or work with your local physical or occupational therapist to help manage the spasticity or increased tone. 

What if you are having trouble inserting the catheter? Start slow. Don’t try completing self-catheterization away from home on your first go. It may be helpful to have a couple of practice runs before you even begin inserting the catheter. This will ensure you have all the necessary supplies and the ideal setup for you. As previously discussed, positioning is key to being successful at self-catheterization wherever you are completing the IC. To start, try completing an IC in bed with your upper body supported against a surface to make the process easier for your first couple tries. This will allow you to not only get into a position with your legs resting open, but will also give you ample surface to set all of your supplies on. If you are still having difficulty reaching the necessary areas, try scooting your hips forward so that you are slouching or sitting on your tail-bone. Once you have mastered the bed, try sitting. This can be in a wheelchair or on the toilet, depending on what is most appropriate for you. If sitting in a wheelchair, try to prop one leg on the outside of the frame of your chair to allow for better positioning.

Adaptive strategies

Once you have successfully completed an IC in the comfort of your home, it’s time to head out into the community. When heading out to work or other places you visit, plan ahead. What space will you have available? What supplies do you need? Try making a “travel IC bag” to ensure that you will always have the necessary bladder supplies when heading out. Make sure you have a couple extra catheters and all the necessary attachments. Some catheters are prelubricated and have the bag already attached whereas others will need to be lubricated and drained into either an attached bag or the toilet. It may be a good idea to bring an extra change of clothes and towels as you are getting more comfortable completing an IC away from home. Other supplies you may want to pack include a small plastic trash bag to place all your trash in after completing an IC and antibacterial hand wipes to make sure you are staying clean and avoiding infections. 

There can be many barriers for completing intermittent catheterization both in the home and the community, but adaptive strategies and equipment can assist with helping you to be successful. Here are some common problems and equipment that may help:

If you are still having difficulty completing the self-catherization, reach out to your local occupational therapist. He or she can help problem solve your specific barriers to find the right equipment and strategies for you to be successful. Managing your bladder can be difficult, but with the right tools and strategies, this challenge can be overcome and improve your quality of life.

What is catheterization?

In urinary catheterization a flexible tube known as a urinary catheter is inserted into the bladder through the urethra. Catheterization allows urine to drain from the bladder for collection. Intermittent catheterization is typically done at home by the patient, after training with a nurse or therapist.

* Tracy Walker is a certified nurse practitioner at the Andrew C. Carlos MS Institute at the Shepherd Center in Atlanta. She is actively involved in the MS community and frequently speaks on MS issues. Most notably, she has spoken on behalf of the MS Consortium of MS Centers.

* Christine Hampton, MSOT, OTR/L, has been with Shepherd Center for more than four years and has worked with patients with spinal cord injuries and multiple sclerosis. She received her Master of Science in occupational therapy from the Medical University of South Carolina and currently enjoys working with individuals with multiple sclerosis in the Eula C. and Andrew C. Carlos Multiple Sclerosis Rehabilitation and Wellness Program as an occupational therapist. She has recently been involved in developing resources for patients and their families to better understand how to manage symptoms of MS, especially if they are unable to access therapy services. She lives in Atlanta with her husband, Ben, and facility dog, Errol. Errol enjoys joining Christine in her therapy sessions to work with her patients.