Trouble-shooting for Freedom

Two experts and a whole lot of cathing and irrigation questions answered.

Starting self-catheterisation or bowel irrigation can feel like the world just got a lot harder. It doesn’t have to. Bev Collins, clinical excellence manager at Wellspect HealthCare UK, and Annie Craig, national clinical and product educator at Mediplast Australia, are specialist nurses who’ve helped hundreds of people live a full life with continence support.

“Getting into an established routine is everything,” says Bev. And here’s what else she and Annie want you to know.

Starting out with self-catheterisation can feel daunting. Where do you even begin?

Bev Collins: It can be intimidating – and it’s okay to acknowledge that. But it’s also something that can be learned, and what we’d like to offer is some reassurance that, actually, this can fit into your daily life. Take the advice of your healthcare professional who’s doing the teaching, because it can be a bit of a minefield.

Annie Craig: Having too many catheters to choose from, initially, can be overwhelming. Starting off by trialling just one or two and really working out what fits you best is a great place to begin.

What if we’ve only been shown how to self-cath while lying down?

BC: When people are initially taught – particularly women – they’re very often taught on a bed or a couch, which can limit how you learn. One of the biggest barriers is being able to locate the urethra, but that doesn’t have to be done lying down. That’s just a starting point.

The really important thing is that transition – getting on to the toilet, a chair, a commode or even doing it from a wheelchair. A mirror can help in a sitting position.

And touch is also a great way of learning, building that muscle memory so you know exactly where you need to be. It’s amazing how quickly the light bulb comes on and it becomes natural to do.

I support a woman who was taught on the bed and lived her life that way for a very long time – always having to race back to her hotel room on holidays. We’ve now taught her to sit on the toilet and do it. That freedom is everything.

AC: It’s almost like contact lenses – trying to put them in to start with is always a bit difficult. But once you get the routine and once you know how to do it, it does get a lot easier over time.

What actually makes the difference when we’re out in the world and need to cath?

AC: The overall design of a catheter can make such a huge difference. Hydrophilic catheters, like the LoFric™ range, are activated by fluid to create a silky surface. That helps reduce discomfort and supports a gentler insertion and removal process.

For women with reduced hand and wrist function, the LoFric Elle™ has a unique L-shaped handle. It’s pre-lubricated, really easy to insert and gives you that extra dexterity and line of sight to the urethra.

For men, the LoFric Origo™ has an insertion grip that helps you guide the catheter without touching the catheter surface, so you’re inserting it under clean conditions. The coating also helps protect the urethra from infection and strictures.

Some of the best positioning tips we’ve picked up have actually come from the people we support. I work with a woman with multiple sclerosis who was really struggling to get enough separation to insert the catheter. We tried placing a physio ball between her upper thighs – just enough to hold them apart – and it made all the difference.

BC: And I have a patient who puts one leg up on a small stool, stands and leans over it, places a mirror on the toilet seat to locate her urethra, then moves it aside when the urine starts to flow. She can do that in any toilet, anywhere. And when you’re out and about, just a small bit of preparation goes a long way.

Make sure you’ve got your supplies, some hand wipes or hand gel – you never quite know what you’re going to get when you walk into a public bathroom. Do consider using a disabled toilet if you need more space – not all disabilities are visible, and it’s absolutely okay.

AC: If you’re somewhere you really can’t control the toilet situation – on a plane, at a concert, the footy, a nightclub – an all-in-one intermittent catheter with a bag attached is a game-changer. It’s the same process as usual but instead of going into the toilet, it goes into a bag that can be tied off and discarded. And it’s still completely discreet.

What if we’re self-cathing but still have accidents overnight?

AC: Continue doing that last catheter before bedtime – keeping to a good routine is key. Initially, it can help to keep a chart of how many times you’ve cathed throughout the day. And think about what the accident actually is – is it that you can’t get to the toilet in time? Having an all-in-one catheter on the bedside table can really help.

If you have reduced mobility and don’t have an all-in-one catheter, having something similar to a urine bottle to catheterise into may be a good solution overnight.

BC: Also consider whether the bowels are affected – a full bowel puts pressure on the bladder when you’re lying down, and the bladder and bowel are very closely situated anatomically. Sorting the bowel routine can actually help with overnight bladder accidents too. And think about fluids – maybe you’ve had a bit more alcohol than usual. Caffeinated drinks can be a mild irritant to the bladder. It’s worth looking at the whole picture.

Let’s talk bowels. Who is irrigation actually for?

BC: Transanal irrigation can be used for people who’ve got constipation or faecal incontinence. Within the neurogenic group – spinal cord injury, multiple sclerosis, Parkinson’s, spina bifida, diabetes, post-stroke – the bowel transit can be anything up to double the normal 30 to 36 hours. The longer the faeces is in the large bowel, the harder it gets, because that’s where all the reabsorption of fluid takes place. Dry poo means constipation – and that means bloating, discomfort and distension.

When somebody uses high-volume irrigation, the water goes in high enough to stimulate peristalsis – that natural wave-like contraction that moves everything along. It causes a stretch, stimulates the natural peristalsis and starts to put water back into the stool to soften it. So by the time it gets to the rectum, it’s actually in a state that’s easier to pass – and all of that just using water, not medication.

What if we just can’t get comfortable with it?

AC: Starting with something like the Navina Mini system with an extension tube and a cone can be a little bit easier – just to get yourself into that routine inserting the cone, instilling the water and allowing time for the water to release. Then you can work your way up to a rectal catheter where you can inflate the balloon and be completely hands-free to focus on irrigating. It’s about taking things really slowly and having really achievable goals.

It’s also important to discuss the volume of water you will need to irrigate with your healthcare provider, as this will help tailor the therapy to you and achieve the best outcomes.

BC: Set the expectation at the beginning – this is not a magic wand, and you need to work at it. The majority of people can take up to 12 weeks to establish a routine, and that’s okay. Those first seven to 10 days, just concentrate on learning the equipment.

AC: And don’t try to do it all by yourself. If you’re worried about how your bathroom setup will work, call us. We can go through where to position everything – could you hang it here, could you put it on a table? People send me photos of their bathrooms and we work it out together like we’re building a Sims house! This sets them up in the best position for the irrigation process.

How do we get past the psychological block of sticking something up our bottom?

BC: Sometimes we just give somebody the cones or catheters to take home and gently try inserting on their own first, before we add the water. It shouldn’t be painful – it might feel slightly strange, but not painful.

The key is that bowels love habits. Over that ten to 12-week period, people start to find their own way. By week four or five, they might find that every other day all they’re getting back is clear water, so they don’t need to do it daily. People start to learn that for themselves.

How do we know when we’re done?

AC: Twenty to 30 minutes is usually a good routine. This factors in time for the setup and getting yourself into a comfortable position. A gentle abdominal massage while you’re sitting can help facilitate movement.

Make sure you’re in a comfortable position and not straining. And stay hydrated – sometimes you can absorb the water, so hydration matters. Doing it after a meal also helps.

BC: The actual instillation is just a couple of minutes – it’s waiting for the peristalsis to do its work. And remember, the more water you put in, the more you have to wait to come out. Stick to the volumes your healthcare professional has set for you.

What if it stops working – or just stops working as well?

BC: This is not uncommon and you’re not doing anything wrong. We literally strip it right back to the beginning – start with a lower volume, then build back up again. Sometimes the bowel just needs that kickstart.

It may also be that someone has come off all their laxatives, so we might need to reintroduce one briefly just to get bowel stimulation going again. And then you’ll find it kickstarts and you can start the journey again.

Any travel tips for using catheters or bowel irrigation systems on the go?

AC: Plan ahead and pack more than you think you need, just in case one drops on the floor or you misplace any. Keep supplies in your carry-on in case your checked bag is delayed. Get a letter from your clinician describing what’s in your medical bag – this can be really useful to provide to airline staff or at security checkpoints.

If you’re on a high-volume system like the Navina Classic, the Navina Mini at 185ml is perfect for travel – it’s a simple bulb you can take away and top up to reach higher volumes. The travel pack just looks like a toiletry bag, so everything stays discreet.

BC: Contact your airline or cruise line – you’re entitled to a free medical bag for your equipment. You may need a travel certificate, which is just a signed letter confirming you have medical products. Keep that bag strictly medical – I’ve learned that lesson the hard way travelling with sports teams!

When it all clicks, what changes?

BC: These products allow people to have independence and freedom. We talk about making a real difference every day – and that’s ultimately why I do this job. It shouldn’t be, “oh, that person there uses a catheter”. It should just be a very natural thing, so people can get on and lead a very ‘normal’ life.

AC: Yes, this builds independence for people – and they can also empower others. They can be the person that gets someone else saying, “I heard this from someone who’s doing it and it changed my life”.

This article was made in partnership with Mediplast Australia. You can access support from their clinical team at shop.mediplast.com.au. In Australia, Mediplast represents the globally trusted continence range by Wellspect HealthCare – the unique hydrophilic urinary catheter range LoFric™, and the convenient Navina systems for bladder and bowel management respectively.

Always follow the advice of your healthcare professional before making any changes to your catheter or bowel management routine. Product suitability varies from person to person – your clinical team is best placed to guide you.