Question to Trudy

I had botox for overactive bladder. I am now retaining urine, a side effect I was told only occurred in 1 in 100 patients. I have had a Foley catheter for 5 weeks. They say the botox could take up to 6 mos. to wear off so I am being encouraged (feels more like forced) to learn to self-cath. I tried it on two occasions and failed to find the proper location. I can’t figure out how to hold a mirror and hold my labia open with only my left hand. I am terrified of the whole process so my right hand is very shaky as well. I had a panic attack on the last try. They reluctantly replaced the Foley and I know I will be expected to try again at my next appointment in a week. I want to flat out refuse to self-cath. It scares me and I feel humiliated by the whole thing. If this is supposed to be a short term problem, I don’t see why we need to push (no pun intended) the self-cath if I am so stressed out about it. I am a 62 yr. old woman and I feel like a 2 yr. old. Am I being reasonable to refuse the self-cath if a Foley can be used instead?

Trudy’s Reply

I want to point two things out to you. Neither a mirror or holding the labia apart really helps a women use an Intermittent Catheter.

Our body is built to work with us, not against us.  This is why in all cultures, women squat to pee. On the toilet we squat, too. If you don’t hold your labia to pee then you will not need to hold your labia when you cath.   When we sit on the toilet and spread our legs the labia naturally opens.  When you see pictures of women needing to hold their labia while inserting an intermittent catheter I guarantee you that it was thought up by a person that has not thought it through.  When you urinate, the flow of urine is unobstructed. I rest my case

The use of a mirror is unnecessary, truly.  I wish women were not trained this way. Trust me, you can find parts of your body by touch. I am sure a male  thought this up because the thought of never seeing ones private parts is incomprehensible to them.

 When you get ready to insert an intermittent catheter:

  1. Wash your hands really well.
  2. Sit on the toilet with your legs spread or squat if you do not have a toilet.
  3. As you put your catheter near your labia, put your ring finger near your your upper leg (by your labia).  Use the same spot every time.  In the beginning, this will act as a marker. (Your urethra is between your clitoris and your vaginal opening).
  4. Gently probe the area for your urethra. I use the same finger, my ring finger to guide the catheter to my urethra. (For me it is off to the side a bit because of stitches which were the result of the use of forceps during the birth of a ten-pound baby).
  5. Gently probe the area and insert the catheter.
  6. You will find it, I promise.

I understand that there is a lot of stress the first time few times you do this.  It is hard. I used to sweat buckets the first few times. But, rest easy, it will become second nature. I also ended up being a bit sore, initially, because I probed a bit too hard, in the beginning.

Advanced Advice

If you sit in the same position on the toilet, the area around your urethral opening will be in the same place every time.   Remember, if you end up going on a hike or need to use a porta-potty, the spot you need to find will be shifted; fear not, you will find it.  That is why I suggest that after you get comfortable with the same old, position, shift yourself so you do not fret the first time you venture out.

TIP: When I am camping and do not have access to clean water, I pack condoms to put over my ring finger as a barrier, because they are sterile and my hands are not.


I also want to add a note about botox.  Some women with an overactive bladder find great relief with botox.

I am sorry that you are diagnosed with a underactive bladder (UAB), for even a short while.  It is what I have as well, although I will probably always have UAB.  The good news for you is that now you understand what is going on. There are many, not as lucky as we are who have a sluggish bladder and suffer symptoms, but do not know that their difficult symptoms stem from a broken bladder. You are one step ahead of them. You’re proactive and taking care of your problem.

In the book I wrote with Julia Parker MS MILS there is so much more about catheters, including Foley Catheters that you might like to read.  This sample below is offered as an encouragement to stay the course and embrace your new life with intermittent catheters.

From the book “Beyond Embarrassment”

Knowledge Nugget

Advantages of Clean Intermittent Catheterization

Sterile intermittent catheterization was developed in 1947, and, by 1966, a long- term study concluded that this method is state of the art in the management of Neurogenic Bladder. The advantages of clean intermittent catheterization (CIC), which is regarded as the most effective way to aid in bladder-emptying disorders, include a lower risk of urinary tract infections (UTI), urosepsis, and renal damage, besides providing autonomy and mobility. [8,9,10] Prior to the availability of sterile intermittent catheterization, renal failure was one of the most frequent causes of death in spinal-cord injury patients, besides the abnormal backflow of urine back up into the ureters from the bladder (vesico-ureteral reflux). (Pressure within the kidney itself can severely damage it and prevent normal function.) Because urethral catheters are the most frequent cause of UTIs in hospitalized patients, [11] it is important to adopt a system that reduces that risk. Sterile intermittent catheterization, when used long term, reduces renal scarring and bladder calculi (stones), [12] which are common in bladders containing stagnant urine.

Please keep in touch and let us know how you are doing!

References and Notes

8 Spinu, A , et al. “Intermittent catheterization in the management of post spinal cord injury (SCI) neurogenic bladder using new hydrophilic, with lubrication in close circuit devices—our own preliminary results,” J. Medicine and Life 5, no 1 (2012): 21-28

The use of Clean Intermittent Catheterization is so well accepted in some parts of the world that they are provided for free by the health agencies of many countries They are viewed as an application of the concept of the inseparability of biomedical and social aspects in human functioning, based on the system established by the World Health Organization in 2001, the International Classi cation of Functioning, Disabilities and Health (ICFCH) For example, since 2008, the Romanian National Assurance House (the Health Plan of Romania) has fully supported the unlimited use of four closed-circuit hydrophilic catheters per day for patients diagnosed with Neurogenic Bladder

9 De Ridder DJMK, Everaert K, Garcia Fernandez L, et al. Intermittent catheterization with hydophilic-coated catheters reduces the risk of clinical urinary tract infections in spinal-cord injured patients: a prospective, randomized, parallel comparative trial Europ Urology 2005 48: 991-995

10 Vapnek JM, Maynard FM, Kim J , “A prospective randomized trial of the LoFric hydrophilic-coated catheter versus conventional plastic catheter for clean intermittent catheterization,” Journal of Urology 169 (2003): 994-998

11 Tenke P, Jackel M, Nagy E Prevention and treatment of catheter-associated infections: myth or reality? EAU Update Ser 2 (2004): 106-115

12 Donnellan SM, Bolton DM “The impact of contemporary bladder management technique on struvite calculi associated with spinal cord injury ” BJU International 1999 84(3): 280-285