Have you ever experienced pain or discomfort using intermittent urinary catheters? The good news is catheters don’t have to be painful or uncomfortable to use. In this article, we’ll go over some common reasons Intermittent catheterization can cause pain and steps you can take to make the process of self-catheterization easier.
Identifying the cause of catheter pain
The first step in reducing catheter discomfort is to identify what type of pain you’re experiencing.
One type of pain is called urethral pain if it occurs in the urethra, which is the thin tube that empties urine from the bladder out through the urethral opening at the end of the penis or above the vagina. Urinary tract infections or irritation from the catheter are common reasons for urethral pain.
Bladder spasms can also cause pain. Bladder spasms might occur because of irritation from the catheter or neurogenic bladder. Bladder spasms can feel like stomach cramps or menstrual cramps.
While catheters can cause pain, they are not the only sources. If you are experiencing pain while urinating, it could be caused by:
- Bladder stones, which are hard masses of minerals in your bladder. They develop when the minerals in concentrated urine crystallize and form stones.
- Prostatitis in men, or inflammation of prostate gland
- Interstitial cystitis, a complex condition identified by chronic inflammation of the bladder’s muscle layers
- Sexually transmitted diseases such as genital herpes, gonorrhea, and chlamydia
If the pain only started when you started catheterizing and only happens during self-catheterizing, it’s probably related to the catheter itself and not one of the above reasons.
Common causes of catheter pain
1) The catheter may be too rigid
Catheter tubes are made from a variety of materials – from very flexible, like rubber and silicone, to very rigid, such as PVC – to achieve different goals. The more rigid the catheter, the easier it is to insert, while a more flexible catheter will be more comfortable to insert.
A rigid catheter makes it possible to maneuver past structural obstacles, such as in the case of urethral strictures or an enlarged prostate. But a rigid catheter may also cause tiny tears and discomfort on insertion, especially for beginners.
As an alternative to rigid catheters, flexible catheters, like the CompactCath or SpeediCath Flex Pro, might help you reduce pain. A flexible catheter will put less pressure on sensitive or inflamed tissue as it passes through the urethra. If your catheter feels too rigid or too soft, ask your medical supplier about available alternatives.
2) The catheter may need more lubrication
The amount of lubrication needed for comfortable insertion varies between individuals. Without lubrication, your catheter could cause friction and small tears in the urethra, which can lead to scarring that causes strictures in the urethra. Strictures are areas where the urethral passage becomes more narrow due to natural tissue formation or trauma.
Increasing the amount of lubrication could help you reduce or eliminate any discomfort you experience.
There are several options for lubricating your catheters, including self-lubricating catheters or catheters that come with a lubrication packet so you can control how much lubricant you use. Lubricants also come in different formulations. Hydrophilic catheters are coated with a special polymer that becomes very slippery when wet. Sterile lubricants, which are bacteriostatic (meaning they stop bacteria from reproducing), can be water-based or silicone-based.
3) The catheter’s eyelets are too rough
If you’ve tried increasing the amount of lubrication and are using a flexible catheter, but are still experiencing pain, your catheter’s eyelets might be to blame.
If you look closely at your catheter’s eyelets (the two holes at the top of the catheter that allow urine to flow through the tube) you might find them to have rough edges. Ouch!
During the manufacturing process, companies use a punch (similar to a paper hole press) to create the eyelets in the catheter. In a perfect world, the punch would leave smooth edges, but the actual result is often rough edges and snags.
Fortunately, all the catheters available from Better Health offer polished eyelets.
4) You may need a coudé catheter
The shape of the tip of your catheter can also affect your level of comfort with self-catheterization. Catheter tips are available in two shapes. A straight tip catheter is just that, it has no curves or bends. A coudé tip catheter (“coudé” is a French word meaning “curved”) has a slight bend near the top. It allows for easy and comfortable insertion by providing a smooth passage around the obstructions in the bladder.
The shape of a typical coudé catheter looks similar to a bendy straw. An alternative type of coudé catheter is an olive tip catheter, which features a rounded or ball-shaped tip with a slight curve.
A straight tip catheter can cause pain if it encounters resistance — such bumps or tight spots — in the urethra. If you’re experiencing urethral strictures or an enlarged prostate, a coudé tip catheter can help by passing around these obstacles more easily.
5) You might be using the wrong size
If you’re using a lubricated catheter but still feel pain or pressure during insertion, you might be using a catheter with a diameter that is too large. Another symptom that could indicate your catheter is the wrong size is feeling pain right before the catheter hits the bladder. This could indicate that the diameter is greater than that of your bladder neck. The solution is simple, just try a smaller size.
Catheter diameter is measured in a unit called “Fr”, pronounced out loud as “French.” One Fr is equal to 0.33 mm. If you look at your catheter’s packaging you’ll see 12 Fr or 14 Fr (or a slightly larger or smaller even number) indicated by the catheter’s brand. Ask your supplier for a smaller size to see if the pain goes away. A smaller size catheter should function exactly the same, except the speed of urine flow should be slightly slower.
6) Your body is still adjusting to intermittent catheters
Quick and painless self-catheterization takes time and practice. If you’re a beginner and catheter use is still new to you, remember that your body needs time to adjust to its new routine.
Be gentle when inserting your catheter. Under normal conditions, the catheter should slide in smoothly. If you’re having challenges, pause, take a few deep breaths to relax the muscles and try again. Using too much force or inserting the catheter too quickly can cause trauma, leading to strictures and false passages. False passages are “dead ends” in the urethra created from scarring or irregularities in the tissue of the lining.
You may occasionally see small amounts of blood in your urine or your drainage bag. The presence of blood in urine is called hematuria and is a normal result of using intermittent catheters. Small tears and bleeding can occur as the catheter tube passes along the lining of the urethra. Blood from the tears then moves out of the body with the urine.
If you continue to experience painful cathing or experience more than a small amount of bleeding, please talk to your doctor before trying any solutions on your own. Above, all, never forcefully insert your catheter if you’re experiencing pain or seeing signs of injury.
7) You may have a latex allergy
If you experience itching or discomfort during insertion or following the use of a catheter, latex may be the culprit. Check to see if your products, including the gloves you’re using, contain latex. Switching to latex-free catheters could be an easy resolution to your discomfort. You also want to make sure your catheters are DEHP and phthalates free.
Other cause for pain while using intermittent catheters
Bladder spasms are sudden contractions of the detrusor muscle in the bladder. Spasms can occur for several reasons. Inserting a catheter can irritate your bladder, causing spontaneous, painful spasms.
Bladder spasms can also be symptoms of neurogenic bladder. Neurogenic bladder occurs when the nerves that control the bladder have been damaged, causing problems with urinary retention or emptying.
In either case, it might be best to seek medical advice from your healthcare provider to determine the cause of the bladder spasms and determine a course for treatment.
Urinary Tract Infections
Urinary tract infections (UTIs) are a common reason for pain inserting or removing intermittent catheters. Catheter-associated urinary tract infections (aka CAUTI) can occur when the catheter is contaminated with bacteria from your hands or around the urethral opening, or from clothing or surrounding surfaces. It is important to practice good hygiene with catheters; wash your hands and wipe the urethral opening before inserting the catheter.
Some symptoms of a UTI are:
- Burning urination
- Pelvic pain
- Pain in upper back and side
Other symptoms of UTIs include cloudy, dark, or foul-smelling urine, a frequent and strong urge to urinate despite low urine volume, fever, chills, and nausea.
If you’re experiencing any of these symptoms, please contact your health provider for treatment. If you have frequent UTIs, ensure your catheterizing process is sterile — always wash your hands, clean the area with an antiseptic wipe, and always use a fresh catheter. There are also supplements, such as cranberry pills, that you can take to help keep your bladder healthy.
How to relieve catheter pain
Good self-care practices can help make the overall experience of self-catheterization more comfortable.
- Practice good hygiene and catheter care. Ensuring you wash your hands properly, wipe the urethral opening with an antiseptic wipe, and use new catheters every time can minimize the chances of introducing bacteria that cause urinary tract infections.
- Check that the catheter you’re using meets your needs. Are you able to insert the catheter with minimal friction and effort? If not, try using a catheter that has a different shape, more flexibility, or a different size. If intermittent catheterization is still uncomfortable or causing you pain, you might want to talk to your doctor. If the urethra or bladder area has had trauma, your doctor might recommend using an indwelling urinary catheter for a short time while the area recovers, then trying intermittent catheterization again .
- The type of lubrication you use has a big impact on self-catheterization. Your body can change the amount of lubrication it needs so try increasing lubrication or switching to a different type of lubricant.
Remember that you don’t have to stick with the first catheter or lubricant you used when you started self-cathing. We encourage you to explore different options until you feel comfortable.
If you’re looking to try out a different type of catheter, Better Health carries a selection of intermittent and external catheters that are reimbursable through insurance. Take our product selection quiz to find the best catheter for you or request free samples through our website.