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Author: Alison Bardsley, Continence Adviser and Services Manager, Witney Community Hospital
Intermittent self-catheterisation (ISC) is a means of treating people with bladder emptying problems, reducing the risk of infection and greatly improving the lives of many people. In spite of undertaking ISC some people find that they are prone to recurrent Urinary Tract Infections (UTIs), with women more prone than men. This article provides some hints and advice to help you.
What is Urinary Tract Infection (UTI)?
A UTI is an infection anywhere in the urinary tract, which includes the organs that collect and store urine and release it from your body (the kidneys, ureters, bladder and urethra).
Bacteria are often present in urine with no symptoms, but there is not always a need to treat unless you develop flu-like symptoms. Most infections arise from bacteria travelling up the urethra (the bladder opening) into the bladder, (however it is worth remembering that we are immune to our own bacteria and that infection through the blood stream is rare). Large volumes of static urine within the bladder can allow bacteria to colonise.
Urinary tract infection is usually prevented through the bladder providing a ‘washing out’ mechanism by normal emptying. If bacteria enters the urethra, subsequent efficient voiding expels the bacteria.
For people undertaking ISC this ‘washing out’ does not take place, allowing bacteria to enter and remain in the bladder. Female anatomy can make it difficult for some women to undertake self catheterisation and sometimes a UTI can be caused by a woman trying to locate the correct orifice and transferring bacteria from the bowel. The most common cause of UTI is Escherichia coli (E coli) that originates from the bowel. Sexual intercourse is often linked with UTI and some studies have indicated a link with spermicidal agents and diaphragms.
What are the symptoms of a UTI?
Frequency – desire to pass urine more often than usual, although you may find that you pass only small volumes.
Urgency – urgent desire to void, you may feel that you will lose control.
Pain – a burning sensation in the urethra (the opening from the bladder) when passing urine. Pain in the lower abdomen or the back. Fever and a feeling of being generally unwell.
Cloudy urine or blood in the urine. It is not uncommon for patients starting to perform ISC to experience a small amount of bleeding, either in the urine or at the tip of the catheter. However bleeding is not normal if a person has been catheterising for some time.
Tips for preventing UTI
For those carrying out ISC, avoid having excessive volumes of urine within the bladder as this can cause infection. Frequency of catheterisations is very individual and dependent on each persons needs.
A useful guide is to try to empty your bladder every 4 hours and keep your residual urine less than 500mls.
It is advisable to drink plenty of fluids every day (around 2000 – 2500mls or 3 – 4 pints).
Hand washing may not always be possible, so carrying alcohol hand rubs or wipes may be useful. There is little evidence that washing the genital area before each catheterisation is necessary and washing this area once a day with mild soap and water is usually all that is required.
Excessive washing can damage the body’s natural defence area and can make the skin sore. People who are prone to infections may find it helpful to wash the genital are after a bowel motion. Extra washing may be required for women during menstruation.
Women should aim to void (or catheterise) within 10-15 minutes following sexual intercourse to expel any bacteria.
Using tampons rather than pads will help to prevent contamination during menstruation.
When travelling it is advisable to carry catheters that have their own water source to avoid using local water supplies.
After using the toilet, always wipe from front to back, especially after a bowel movement.
Wear cotton underwear and loose fitting clothes so that air can keep the area dry. Avoid tight fitting jeans and nylon underwear, which trap moisture and can help bacteria grow.
If you think you have an infection
Start to drink more water (drink a glass as often as possible).
Take some tablets that you would use for a headache e.g. aspirin or paracetamol. This will help to reduce any fever or temperature.
Try to rest and keep warm, a hot water bottle is often useful.
Take a specimen of urine to your doctor and arrange to have it tested as soon as possible.
Although urinary tract infections are not generally life threatening, they can cause considerable distress. The nature of conditions and illnesses that require people to undertake
Intermittent Self Catheterisation means that a UTI can cause hospitalisation. If conservative and preventative measures are unsuccessful a prophylactic (preventative) course of antibiotics may be prescribed by your GP. Your continence advisor, Urology nurse or community nurse can help you with individual advice concerning catheterisation and to enable you to carry out catheterisation wherever you may need to.
If you do not have the name of a Urology nurse or continence advisor in your area and would like to get in touch with one, please phone The Continence Foundation for information on: 0845 345 0165 (9.30am to 1pm).
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