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Urology nurse Paula Muter has spent over 20 years helping people with spinal cord injuries learn to perform intermittent self-catheterization (ISC) – and gain freedom and independence.
I relish working with spinal cord injury (SCI) patients
I love this specialty! It’s so different from any other experience in a healthcare setting. It doesn’t feel over-medicalized and there’s so much emphasis on rehabilitation. And because people can be in rehab for up to a year, you really get to know them, their families, and their children.
So much has changed since I started my nursing training in the 1980s
When I was a junior nurse, all SCI patients were fitted with an indwelling catheter (one that remains in the bladder continuously) as a standard practice. Today, each patient is assessed individually, and their thoughts and feelings are taken into consideration when it comes to bladder management. Things have changed, and continence care products have developed so much. Intermittent self-catheterization (ISC) is now the gold standard.
Specialization has been great for me – and great for my patients
With experience not only does your clinical knowledge improve, but also the way you interact with your patients. You get better at reading people and their personality types, and at making them feel comfortable – even during a short appointment. If they’re relaxed, they can share their fears and concerns with you, and you can address them. Once their head is in the right place, everything else gets easier.
I’ve known some of the patients in my clinic for 20 years now. One 17-year-old who came to me after a skiing accident now has his own family!
When it comes to ISC, the patient leads the way
Once you’ve gotten to know the person that comes into your clinic and have given them the information that’s appropriate for them, they are in charge. I like to make sure that the patient feels that they are leading the decision-making process. I tell them that this particular intermittent catheter that I’m showing them is just one of many, and that there are several options available.
When I explain ISC, I give them information about how it works physically and practically, about protecting themselves from germs, about preventing problems – but I leave the choice of whether or not to do it up to them. I’m the clinician, but it’s their body. If your patient is at the forefront of their own care, it really takes the heat out of every decision.
Fear and taboo are the biggest roadblocks to ISC
When it comes to learning ISC, it’s a bit like taking off an adhesive bandage in slow motion – the anticipation is the worst bit. Psychology probably isn’t considered enough when teaching ISC and I do think there’s a lot of hidden fear.
People have worries: Could I damage myself? What if I put it up the wrong hole? Women say to me, “What if I put the catheter in my vagina?” I say, “So what? You’d put a tampon in there, right?” Men say to me, “Where is all that tubing going to go?” when they see the length of the catheter. I help them realise how far their bladder is from their penis.
Since the whole topic of continence care is a bit “down there” it can be awkward to discuss. I try to help my patients feel comfortable talking about it.
Getting down to basics
It’s not easy to discuss ISC in general terms as it’s so complex, but I try to speak about it in plain language and keep things simple as possible.
For the vast majority of my patients, their first attempt to do ISC goes well and they can’t believe it happens so quickly. It’s typically easier for men because they can see where the catheter is going. The idea of putting a tube into their penis can be mentally difficult, but it’s physically easier – especially if you give them tips on how to feed the tubing in and how to take it out. They can do it with their eyes closed!
With female patients – who can find ISC more challenging because of the location of their urethra – I talk them through exactly what’s going to happen. I try not to over-medicalize it, since they may be doing this procedure for the rest of their lives. I don’t ask them to lie on a bed or use a mirror to look between their legs. I say, try doing it by touch, let’s see if you can put it in. Wash your hands, wipe yourself, separate your labia with two fingers, insert the catheter, and if it gets into your bladder, you’ll pee.
There are only two options for insertion – the vagina and the urethra. If it goes in the vagina, it doesn’t matter. Just have another go at it. And when you do it right, there you are – the whole ISC process just takes two minutes! I also tell all my patients that everything we talk about will be written down. When they get home they’ll have a letter detailing the step-by-step ISC process, and they will also have a brochure with all the information they need to know.
Matching the patient with the right intermittent catheter
I’d say female wheelchair users tend to prefer intermittent catheters that are a little stiffer. If the catheter is too floppy or flimsy ISC doesn’t always work. Patients choosing a catheter based on its environmental impact is becoming more common too. Most of my female patients want a discreet catheter, and they also like nice colours. So, when I lay out a few on the table for them to look at, they often go for the smaller, pastel coloured ones – like the Infyna Chic™ Intermittent Catheter. Psychologically, all of these product features make a difference to them – they’ll feel better about using the catheter. It’s not just a medical decision.
If I could change one thing
The quality and discretion of intermittent catheter products have hugely improved and that makes a big difference. One thing I’d love us to work on is getting ISC education into the training for all healthcare professionals – not just nurses, but also physical and occupational therapists, for example. I’d like to get continence care discussed everywhere.
If I had one message to share with people considering ISC
That’s simple: there’s nothing to be frightened about. I can say that with confidence as I’ve helped hundreds and hundreds of people learn ISC over the years. I have piles of letters from patients on how ISC has changed their lives for the better. It’s made them feel free and independent, it’s improved their sex lives, and it’s helped them do the things they want to do without anxiety about emptying their bladder.
There is light at the end of the tunnel.
Paula Muter, RGN, BA, is a clinical nurse specialist in the Neuro-Rehabilitation Centre at Sheffield Teaching Hospitals in the UK. She currently works with the urology team, providing clinical expertise to patients with spinal cord injuries.
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