Reference
Intermittent self-catheterisation, without the jargon.
Usually shortened to ISC: emptying the bladder several times a day with a single-use catheter instead of waiting for it to do so itself. It sounds drastic, but for many people it is what gives everyday life back.
What this page does not cover: how to do it. The technique is learned properly once, from a continence nurse, in rehab, or at a urology practice — with instruction, practice and feedback. A website cannot replace that, and trying would do harm.
Why catheterise at all?
When the nerve connection between bladder and spinal cord is disrupted — after a spinal cord injury, with multiple sclerosis, with spina bifida — the bladder no longer runs through its usual cycle of filling and emptying. Two things go wrong: urine is left behind, and pressure inside the bladder rises.
Together these are the real problem, and it concerns the kidneys rather than the bladder. Under pressure, urine can be pushed back up the ureters. Residual urine is also a good breeding ground for bacteria. Over years this can turn into kidney damage — gradually, without much warning.
ISC breaks that chain: the bladder is emptied regularly, before pressure builds. That is why professional bodies regard it as the first-choice method for neurogenic bladder dysfunction — ahead of an indwelling catheter, which over time brings more infections and more complications.
Reference
How often, how much.
These figures are guides for adults. What applies to you is set by your care team, depending on bladder capacity, pressures, and what works in your daily life.
| Measure | Usual range | What matters |
|---|---|---|
| Catheterisations per day | 4–6 times | Less often means larger volumes and more pressure; more often is hard to sustain |
| Volume per catheterisation | below 400–500 ml | The single most important figure. If it is regularly exceeded, the interval must shorten |
| Fluid intake per day | 1,5–2 l | Drinking less to catheterise less often is the most common and most harmful mistake |
| Catheter size | 12–14 Ch | Given in Charrière. Set individually, not chosen by yourself |
| At night | usually 0–1 times | Depends on evening fluid intake and on how much urine is produced overnight |
The rule behind it: the clock does not decide, the volume does. Anyone regularly draining well over 500 ml is catheterising too rarely — even if the schedule was kept. That is exactly what a diary is for.
What insurance covers (Germany)
In Germany single-use catheters count as medical aids and are covered by statutory health insurance where indicated. A prescription is needed, usually from urology. Supplies then arrive monthly through a medical supply house or homecare provider, in the quantity matching the prescribed rhythm.
There is a statutory co-payment of ten per cent, capped per month. People with a chronic condition can apply for exemption — almost always worth doing, through an application to the insurer.
Worth knowing: you get to choose the product. If a catheter does not fit or glides badly, that is not something to put up with — ask for a different brand. Most manufacturers send samples.
Bacteria in the urine are not automatically an infection
Almost everyone who catheterises has bacteria in their urine. On its own that is not an infection and is generally not treated with antibiotics — it is called asymptomatic bacteriuria. Treatment follows when symptoms appear: fever, flank pain, suddenly cloudy or strong-smelling urine, new leakage between catheterisations, or, with a spinal cord injury, increased spasticity.
The distinction is not pedantry. Every unnecessary course of antibiotics raises the chance that fewer of them work during the next real infection.
When there is no waiting
Much about ISC can wait for the next appointment. These signs cannot:
- Fever with flank or back pain
- Blood in the urine that does not stop shortly
- The catheter will not pass and the bladder is full
- No urine despite a clearly full bladder
- Chills or feeling distinctly unwell
- With a spinal cord injury at or above roughly T6: pounding headache, sweating and flushing above the level of injury — signs of autonomic dysreflexia
Autonomic dysreflexia is an emergency, and a full bladder is its most common trigger. Sit upright, loosen tight clothing, empty the bladder, get medical help.
Why writing it down helps
With ISC the volume decides whether the rhythm is right — and you only see it if you note it down. Two weeks of times and millilitres show whether the intervals fit, whether too little is drunk in the evening, and whether the night is a problem. That is the basis on which an interval can sensibly be changed at all.
On paper the bladder diary template does the job — it has its own catheter column. Across weeks it gets tedious, and that is what Bladder & Bowel Manager is for: reminder timers on your own interval, entries in two seconds, totals calculated for you, and a PDF report for the next appointment. Everything stays on your device.