Please see below for answers to our frequently asked questions:

What is Intermittent Self Catheterisation (ISC)?

Intermittent catheterisation, either by yourself or your carer, is a clean technique.  It involves the insertion of a small catheter into the bladder at regular intervals.  This allows you to drain the urine from your bladder if you are unable to void naturally. The catheter is then removed leaving you free to go about your daily life.

ISC is not a new technique; it has been around for many years

  • Egyptians used reeds which drained into urns
  • Romans used lead pipes
  • Victorians used silver and lead catheters

The clean technique/Clean Intermittent Catheterisation (CIC)

CIC was pioneered by Lapides & his colleagues in the early 1970s. It refers to the clean technique (routine hand washing and drying, good hygiene standards) transforming ISC into a safe and simple technique.

What are the Advantages of ISC?

  • Patient gains independence, retaining and improving their quality of life
  • Easy to learn
  • Urinary tract infections are reduced
  • Patient is in control of their own bladder
  • Normal sexual relationships are not affected
  • No incontinence; no smells
  • Significant protection from upper tract reflux (avoiding kidney failure)
  • No longer the need for a permanent in-dwelling catheter, therefore preventing problems such as bladder neck damage and erosion of the meatus

Please see answers to commonly asked questions below:

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What is Bladder Augmentation?

Bladder Augmentation is a surgical procedure which enlarges the bladder. It is performed for people who have otherwise untreatable urinary incontinence (leakage) or bladder conditions that may damage kidney function.  When a bladder is too small, this can put stress on either the kidneys or the urethra, and can often cause incontinence of urine.

The surgical procedure consists of a section of the bowel being removed from its origin. The top of the bladder is opened up and the section of bowel is placed over the opening. This procedure will sometimes be carried out in conjunction with another procedure such as a Mitrofanoff, otherwise known as a continent urinary diversion, should the person be unable to empty their bladder as a result of the surgery, or be unable to perform Intermittent Self Catheterisation / Clean Self Catheterisation via the urethra. 

Managing Bladder Augmentation

woman-managing-bladder-augmentationThe outcome of a Bladder Augmentation is designed to allow those undergoing surgery to remain continent, prevent the pressure of urine in the bladder and / or prevent further problems to the kidneys. However if Intermittent Self Catheterisation (ISC) / Clean Intermittent Self Catheterisation (CIC) is necessary, this should help the person to gain control of their bladder and improve their quality of life. Alternatives to this surgery may include Bladder Botox injections and anticholinergic medications.

What is Bladder Botox?

Botulism toxin has become a popular form of treatment for overactive bladders. When other medications cannot control a bladder enough, Bladder Botox may be used. Bladder Botox is a less invasive treatment which is injected into the nerve endings and can be used in the bladder, urethra or both. Botox will be inserted by means of a cystoscopy (camera via the urethra). Bladder Botox blocks the nerve endings that usually react to the bladder filling up which in turn stops the nerve signals entering the nervous system and this stops the bladder from contracting.

How effective is Bladder Botox?

Many people can see positive results to treatment within just seven days, and the results of Bladder Botox can last up to six months without any further treatments. Those who find the treatment successful may also find that the bladder does not react enough to the urine within, which may cause further issues such as Urinary Retention and residual urine. This can be resolved by the use of Intermittent Self Catheterisation (ISC). Bladder Botox can help people manage their bladder, prevent urine pressure from building up, and therefore delay the return of the bladder over-activity or incontinence.

What is Bladder Cancer?

Bladder Cancer is where the growth of abnormal tissue, known as a tumour, develops in the bladder lining.  In some cases, the tumour spreads into the surrounding muscles.  The main causes of Bladder Cancer are chemical exposure (often in the work setting) and smoking. Bladder Cancer is diagnosed by a biopsy which is taken from the growth of cells during a cystoscopy. The diagnosis will determine the type of malignant tumour and the appropriate treatment necessary. Chemotherapy, radiotherapy or surgery may be required to treat Bladder Cancer. The consultant may consider there to be a possibility of saving the bladder by removing all, or the majority of the tumour, by means of surgical intervention. It is sometime necessary to arrange an urgent operation to remove the bladder and to create a stoma (Urostomy) or a neobladder (bladder made from bowel tissue). This will be the case if it is thought that the cancer is too aggressive and may risk the tumour spreading to other parts of the body.

Managing Bladder Cancer

managing-bladder-cancerIf a bladder is removed and a neobladder is made, the patient will need to perform Intermittent Self Catheterisation (ISC) / Clean Intermittent Catheterisation (CIC) via the urethra.  Alternatively, the patient may be advised to have a Mitrofanoff procedure otherwise known as a continent urinary diversion, as a way of emptying the bladder if the urethra needs removing as well. A Mitrofanoff requires ISC/CIC to be performed approximately four to six times a day. Every person who is diagnosed with cancer is different and therefore the treatment is determined on the type of tumour found and the best possible outcome available for that individual.

What is an Enlarged Prostate?

Benign Prostatic Hyperplasia (Prostate Enlargement) is a common condition particularly in older men. It is thought that at least 60% of older men have some degree of Prostate Enlargement. Many men worry that an enlarged prostate gland indicates Prostate Cancer however this is not always the case. The prostate is located between the bladder and the penis and when this is enlarged it can put pressure on both the urethra and bladder. This can make it difficult to pass urine effectively without leaving a residue of urine within the bladder and can sometimes cause complete urinary retention. This can also increase the risk of Urinary Tract Infections (UTIs), which if untreated, can cause problems.

Managing an Enlarged Prostate

managing-an-enlarged-prostateTreatment for Enlarged Prostate can include simple lifestyle changes such as avoiding stimulants like alcohol and caffeine. There are medications available to help manage the symptoms but if the enlargement is too severe then surgery may be required. If the bladder is retaining urine, Intermittent Self Catheterisation (ISC) / Clean Intermittent Catheterisation (CIC) may be a successful option to void urine from the bladder. This in turn will reduce the risk of urinary tract infections and reduce the added pressure on the bladder from retaining too much urine. An Enlarged Prostate is not a serious condition and can usually be managed well however if the symptoms become difficult to control, they can have an adverse effect on lifestyle and an impact on one’s quality of life.

What is Multiple Sclerosis?

Multiple Sclerosis (MS) is a neurological condition which means that if affects your nerves.  It's caused when your immune system isn't working properly. MS affects different people in different ways. In any one person, the symptoms can vary from day to day.  There are a range of possible symptoms.  Bladder problems are common in MS but there is usually something that can be done to help. There are two main types of bladder disorder that can occur in MS. The most common is a problem with storage, and the other is a problem with emptying. It is not known why some people get one and not the other, or why some people experience both.

Managing Multiple Sclerosis

woman-with-multiple-sclerosis

The most effective solution for incomplete bladder emptying is often intermittent self-catheterisation (ISC) / clean self-catheterisation (CIC) which can assist in alleviating the symptoms. ISC allows the bladder to void the urine; the process does not hurt.  There may be a feeling of pressure when the catheter goes into the bladder or sometimes it may be a little bit difficult to pass the catheter. If trouble occurs with inserting the catheter, then taking a few minutes to have a break and trying again may help.

Once control of the bladder has been established through ISC, self confidence and dignity can be restored.

What is Post-operative Urinary Retention?

Post-operative Urinary Retention can occur for a number of reasons. There is an increased risk of retention in operations which are performed within the pelvic region or spinal region.  This may include spinal surgery, gynaecological surgery and prostate surgery. It is thought that the anaesthetic used during surgery is the main cause for Post-operative Urinary Retention, especially in anaesthetics used in the spinal region (Epidurals). This is due to the anaesthetic blocking the nerve signals between the brain and the bladder which would usually tell the brain when the bladder needs to be emptied. Post-operative Urinary Retention can often block the signals in the urethral sphincter muscle which as a result will not relax, and allow one to pass urine when necessary.

Managing Urinary Retention

post-operative-urinary-retentionDepending on how long the Urinary Retention lasts, which is different for all, will determine whether intervention may or may not be required. Sometimes a long term catheter will be placed in the urethra for a few days whilst the effect of the surgery and anaesthetic recedes which also reduces the risk of the bladder becoming damaged from the Post-operative Urinary Retention. If the Urinary Retention persists it may be necessary for a Healthcare Professional to teach Intermittent Self Catheterisation (ISC) / Clean Intermittent Catheterisation (CIC). It is often difficult to trace the route of this retention, and to know how long it will take the bladder to fully recover. In some cases ISC is a lifelong commitment which will necessitate changes to one's lifestyle.

The Prostate

The Prostate is a small gland the size of a walnut that produces the clear fluid found in semen. The prostate gland is wrapped around the top of the urethra and sits below the bladder and above the penis. Common symptoms of Prostate Cancer include difficulty passing urine, pain whilst urinating, overactive bladder and blood or semen in the urine. Most enlargements of the prostate are not cancerous (benign) and are easily treated however it is important to spot the signs quickly as they could be linked to Prostate Cancer.

Cancer of the prostate is more common in older men and can progress slowly without any symptoms. This is why it is important for men over the age of 60 to have a routine check for enlarged prostate. This is a simple test that involves the doctor inserting a finger into the rectum to feel for any lumps that could suggest an enlarged prostate.

Treatment of Prostate Cancer

treatment-of-prostate-cancerThe treatment of Prostate Cancer will depend on the type of malignant tumour involved and whether it is contained within the prostate or the cancer has spread outside the prostate. Treatment methods may include surgery, chemotherapy, radiotherapy and hormone therapy. Hormone therapy is an option.  It works by lowering the testosterone levels in the body which in turn can reduce the growth of the tumour, sometimes shrinking it so the symptoms disappear completely. Due to the enlargement of the prostate, Intermittent Self Catheterisation (ISC) / Clean Intermittent Catheterisation (CIC) may be taught, or a long-term catheter may be used to help the bladder empty completely. 

What is Spina Bifida?

Spina Bifida is a congenital condition where there is a gap or fault with the vertebrae. There are three degrees of severity which can occur during pregnancy these being: spina bifida occulta, spina bifida cystica with meningocele, and spina bifida cystica with myelomeningocele. Spina bifida cystica with meningocele and spina bifida cystica with myelomeningocele are the two types of spinda bifida which result in the spinal cord to bulge out and cause bladder and bowel problems.

Managing Spina Bifida

managing-spina-bifidaWhen managing bladder problems for someone with spina bifida one soon learns how to recognise urinary tract infections which in turn will help in protecting the kidney function. There are several ways to help with urinary incontinence, one of which is intermittent self-catheterisation (ISC) / clean self-catheterisation (CIC).

Sometimes surgical intervention is necessary and a Mitrofanoff (continent urinary diversion) is required. ISC does not hurt, but there may be a feeling of pressure when the catheter goes into the bladder or sometimes it may be a little bit difficult to pass the catheter. If trouble occurs with inserting the catheter, often taking a few minutes to have a break and try again may help.

When an older child becomes more independent it is important for them to be able to learn how and when to manage their bladder. ISC encourages them to gain control of their bladder problems and therefore will help to increase their confidence and maintain their dignity.

What is Urinary Retention?

Urinary Retention is a complication in which you are unable to pass urine, caused by many other conditions or complaints. It can be caused by nerve dysfunction, urinary tract infections, stricture disease, spinal disorders and certain medications.

Acute urinary retention is a medical emergency and requires urgent medical attention. This can often leave someone with over one litre of urine in their bladder which can put pressure onto the kidneys and cause renal failure. If you feel unable to pass urine it is important to seek medical advice as soon as possible. Often there will be various tests to undergo which help identify a cause for bladder retention these include: bladder scan, an ultrasound of the kidneys and bladder, urodynamics and cystoscopies.

Managing Urinary Retention

managing-urinary-retentionChronic urinary retention is a period of prolonged incapability to pass urine. This can be a lifelong condition for many and is managed by either intermittent self-catheterisation (ISC) / clean intermittent cathetersation (CIC) or a urostomy stoma.  ISC is often taught to people as this is a less invasive option rather than a permanent catheter. If neither of these options are beneficial or surgical intervention is required for long term options this may involve a urostomy (stoma) or a Mitrofanoff (urinary continent diversion).