Intermittent self catheterization for patients with urinary incontinence or difficulty emptying the bladder.

Urinary incontinence, difficulty voiding and recurrent urinary tract infections are common in general practice. In patients with multiple sclerosis, spina bifida, intervertebral disc lesions, spinal injuries or tumours, the symptoms may be associated with a high residual volume of urine owing to a neuropathic bladder. Similar complaints may occur in elderly people or in women with gynaecological problems owing to atonic urinary retention. Provided that a significant residual volume of urine is found on abdominal examination, ultrasound, x-ray or catheterization, both groups of patients may be helped by intermittent self catheterization. Intermittent self catheterization is a safe and simple technique. By catheterizing themselves between four and six times daily patients can gain control over their bladders. Abandoning indwelling catheters or bulky external appliances does much for a patient's morale and self esteem. In addition, since the bladder is being drained effectively, urinary tract infections cease to be a problem and the kidneys are safeguarded. Severe disability is not a contraindication since patients in wheelchairs have mastered the technique despite paraplegia, an anaesthetic perineum, spinal deformity, intention tremor, mental handicap, old age or blindness. Patients should be referred to urologists for a trial of intermittent self catheterization. If unsuccessful or unacceptable it can be abandoned with no long term consequences. If it is effective the benefits may be considerable.