Getting Bladder Care Right – Thoughts from a Nurse Practitioner

Joke Beekman has worked with spinal cord injury patients for over 30 years. Read what she has to say about bladder management, intermittent self-catheterisation, intermittent catheters, and more.

Learn how Joke helps her SCI patients manage their bladders effectively, so they can live their lives to the fullest.

Working in spinal cord injury rehabilitation you realise the importance of good bladder care
I’ve seen research – and I’ve also heard it direct from my patients – that bladder issues are a bigger challenge for people with spinal cord injuries (SCI) than using a wheelchair. SCI patients have a lot of things to deal with, so if bladder management isn’t one of them, that’s great. Getting bladder care right is so important for their quality of life.

Intermittent self-catheterisation is the best option
Intermittent self-catheterisation (ISC)  is the gold standard for bladder management. ISC is the emptying of the bladder at repeated intervals with a single-use catheter. SCI patients are much less likely to get a urinary tract infection (UTI)  when using an intermittent catheter versus an indwelling catheter (i.e., one that remains in the bladder continuously). In addition, the risk of getting bladder stones is lower.

And then there’s the lifestyle aspect. Who doesn’t want to have an active, fulfilling life? If you have a spinal cord injury and get a lot of UTIs or you’re leaking urine, that impacts your ability to do the things you want to do. If you learn to perform ISC, quite soon it becomes a normal part of your daily routine, like brushing your teeth or caring for your skin. And it will give you much more freedom, independence, and control.

Years ago, bladder care meant bladder training
When I started my career over 30 years ago, most of my work was bladder related. Back then, very few patients used catheters. Bladder management was all about bladder training – which meant SCI patients actually had to physically hit their abdomen until the urination reflex started, then their bladder would drain. Unfortunately, this same reflex could happen if they simply bent forward while seated in their wheelchair. Basically, patients were constrained by their bladders. They’d have to sit on large incontinence sheets or wear large absorbent pads – so it was hard to go out and do anything.

Thankfully, bladder care began to change. It became clear that bladder training wasn’t the best bladder management method – and not only because of the inconvenience and mess. It also allowed pressure to build up in the bladder, which can cause problems. If urine flows back from the bladder to the kidneys this can eventually result in kidney failure.

The intermittent catheter products we use
The standard products we use are the Hollister VaPro™ No Touch Intermittent Catheters. We did a non-scientific test in our unit, collaborating with patients and nurses, and these catheters came out best in terms of being user-friendly. And the protective tip and sleeve mean you don’t even need to use sterile gloves when performing ISC, which is a big plus. The VaPro catheters are easy to use and there’s much less chance of cross-contamination or germs. On a ward where a lot of people are catheterising every few hours, that’s a real risk.

Typically, we start with a 12 Charriere (i.e., diameter size) intermittent catheter, which works for most people. We also choose one that has an integrated collection bag or is connected easily to a bag. Depending on the person’s lifestyle, they may prefer a compact size catheter – for example, if they travel often. Women tend to prefer the compact-sized catheters too, for convenience and discretion. It’s always about patient choice though – everyone should choose the catheter that works best for them.

ISC challenges are different for men versus women
My patients nowadays tend have incomplete spinal cord injuries. And if they aren’t fully paralysed, they may feel the catheter being inserted. Although men can find their urethra easily, some find catheter insertion uncomfortable, or fear they will find it so. I tell them that it’s more comfortable if they catheterise themselves versus someone else doing it. They also can use a lidocaine gel to reduce sensitivity.

For most of our female patients, discomfort isn’t the issue; it’s that ISC is more challenging to do. Some women must undress completely to perform ISC, some have to be lying down on a bed, and some need to use a mirror to see their urethra. All of this makes the process more difficult if they’re at work, or out and about. Female SCI patients who can move their upper body (e.g., paraplegics) can usually perform ISC on the toilet, as they can transfer there quite easily.

Everyone is different. One patient of mine, a woman who’s about 75 with a high body mass index (BMI), is catheterised by her husband. He’s been doing it for her for 10 years now!

ISC can also be more challenging as you get older
I have 80+ year-old male patients who can do ISC themselves, but for some females the same age it can be difficult. It’s not the actual catheterisation process that is challenging; it’s transferring themselves to the toilet, because they may have lost upper body strength. Men and younger people have an easier time transferring themselves to the toilet every four hours or so to do ISC.

Get ISC right, and keep going
Dealing with the bladder is one of many things in life that changes after a spinal cord injury. For that reason, it may be easier for SCI patients to do ISC, versus people for whom a urological problem is their only health issue. If you do perform ISC, be sure to stick with it – if you don’t, you may become incontinent or develop bladder issues.

ISC isn’t just bladder management, it’s lifestyle management
ISC has completely changed the way we work with our SCI patients. It gives them so much freedom and independence. They can go out, and they can do what they want. They’re in control of their bladder.

If you are considering ISC, ask your healthcare provider questions about the catheterisation process and about catheter options. Learn about all of the intermittent catheters that are available to you, so you can make the right choice. With a little help and information, you can find the catheter that works for you and allows you to live your life the way you want to.

Joke Beekman, RN, CNS, M-ANP, is a highly experienced nurse practitioner specialising in spinal cord injuries at Sintmaartenskliniek in Nimsegen hospital, in the Netherlands. Over her 30+ year career, Joke has seen the treatments and products for bladder care improve immeasurably. Joke has done numerous presentations and educational activities on a local, national, and international level to share her extensive knowledge and best practices with other healthcare professionals. Always straight-talking and modest, Joke says, “It feels strange to be told I’m a specialist; I’m just doing my job.”

People who provided testimonials received compensation from Hollister Incorporated. The testimonials, statements, and opinions presented are applicable to the people depicted. These testimonials are representative of their experience, but the exact results and experience will be unique and individual to each person.