How to Safely Perform a Bladder Washout at Home After a Spinal Cord Injury
A bladder washout is a way of gently rinsing mucus, sediment or small pieces of debris out of the bladder through a catheter.
A catheter is a soft tube used to drain urine from the bladder.
Bladder washouts are not needed by everyone with a spinal cord injury. Only perform a washout if your spinal injury team, continence nurse or urologist has:
Recommended it for you
Shown you how to do it
Told you which fluid to use
Told you how much fluid to use
Explained how often to do it
Why might I need a bladder washout?
Your healthcare team may recommend bladder washouts if:
You often have mucus or sediment in your bladder
Mucus makes it difficult to drain your bladder
Your catheter often becomes blocked
You have had bladder enlargement surgery, also called bladder augmentation
Your healthcare team has given you a regular washout plan
During bladder augmentation surgery, a small piece of bowel may be used to make the bladder larger.
The bowel tissue continues to make mucus after the operation. This mucus may block a catheter or contribute to bladder stone formation.[1,2]
Bladder washouts are not usually recommended simply to prevent urine infections. Research has not clearly shown that routine washouts prevent infections or catheter blockages in everyone.[3–5]
Before you start
Only perform a bladder washout if you or your carer have received practical training.
Your instructions will depend on:
The size and capacity of your bladder
Whether you have had bladder surgery
The type of catheter you use
Whether your catheter goes through the urethra or through an opening in the abdomen
Whether you are at risk of autonomic dysreflexia
Whether bladder procedures cause pain or spasms
What equipment will I need?
You may need:
The washout fluid recommended by your healthcare team
A 50 or 60 mL catheter-tip syringe
A clean container
A second container for the returned fluid
A clean towel or waterproof pad
Soap and water or hand sanitiser
Clean gloves if a carer is helping
Your catheter drainage bag, valve or plug
Sterile salt water, called 0.9% sodium chloride or normal saline, is often used.
Some spinal injury services may recommend sterile water or boiled water that has been allowed to cool. Only use the fluid recommended for you.[4]
Do not use:
Homemade salt water
Vinegar
Antiseptic
Chlorhexidine
Antibiotics
Acidic catheter-cleaning solutions
These should only be used if they have been specifically prescribed.[3–5]
How to perform a bladder washout
Step 1: Prepare a clean area
Choose a clean, well-lit place.
Make sure you are sitting or lying safely.
If you use a wheelchair:
Put the brakes on
Make sure you are stable
Place your equipment where you can easily reach it
Check:
The washout fluid is not out of date
The container is not damaged
The fluid is at room temperature
Very cold fluid may cause bladder spasms or trigger autonomic dysreflexia.
Try not to touch:
The tip of the syringe
The end of the catheter
The inside of any catheter connection
Step 2: Wash your hands
Wash your hands with soap and water.
If a carer is helping, they should wear clean gloves. Gloves should be changed if they touch anything unclean.
Step 3: Empty your bladder
Your bladder should usually be empty before starting the washout.
If you use intermittent catheterisation
Intermittent catheterisation means putting a catheter into the bladder several times each day and removing it after the bladder has drained.
Clean the area where the catheter goes in, as you have been taught.
Insert your usual catheter.
Allow all the urine to drain.
Leave the catheter in place for the washout.
If you have a catheter that stays in place
This may be:
A urethral catheter, which passes through the penis or urethra
A suprapubic catheter, which passes through the lower abdomen
Before disconnecting anything:
Check that the tubing is not bent or twisted
Make sure you are not sitting or lying on the tubing
Make sure the urine bag is below the level of your bladder
Check that the catheter valve is open
Empty the bag if it is full
Step 4: Fill the syringe
Draw the amount of washout fluid recommended by your healthcare team into the syringe.
A 50 mL syringe is often used, but your instructions may be different.
Hold the syringe with the tip pointing upwards.
Gently push out any air.
Step 5: Connect the syringe
Gently connect the syringe to the end of the catheter.
Do not touch the connection points.
The syringe should fit securely without needing to be forced.
Step 6: Slowly put the fluid into the bladder
Gently press the syringe plunger.
The fluid should enter the bladder slowly.
Never force the fluid
Stop immediately if:
The fluid is difficult to push in
You feel resistance
You develop pain
Fluid leaks around the catheter
Your leg or abdominal spasms become worse
You develop symptoms of autonomic dysreflexia
The fluid should always be inserted slowly and gently.[4]
Step 7: Gently draw the fluid back out
Slowly pull back on the syringe plunger.
The returned fluid may contain:
Mucus
White or cream-coloured material
Sediment
Small pieces of debris
A small amount of blood staining
Do not pull back hard on the syringe.
Strong suction may pull the bladder lining against the catheter openings. This can cause pain and bleeding.
What should I do if the fluid does not come back?
If the fluid does not return:
Stop putting more fluid into the bladder
Check that the catheter is not bent or twisted
Allow the fluid to drain naturally
Gently change your body position
Reposition the catheter only if you have been shown how
Change the catheter if your healthcare team has taught you to do this
Do not keep adding more fluid.
Adding fluid that cannot drain may overfill the bladder. This may cause pain, bladder damage or autonomic dysreflexia.
Step 8: Repeat the washout as instructed
Empty the returned fluid into a waste container.
Repeat the gentle washout using the amount stated in your personal plan.
Stop when:
You have used the total amount recommended by your healthcare team, or
The returned fluid is reasonably clear of mucus and debris
Some people are told to use several 50 mL portions.
People who have had bladder augmentation may be told to use a larger total amount. This must be based on the size of their bladder and the advice of their surgical team.[2,4,7]
Keep track of:
How much fluid you put in
How much fluid comes back out
The amount coming out should be close to the amount put in.
Step 9: Drain the bladder
When the washout is finished, allow the bladder to drain completely.
If you use intermittent catheterisation
Remove the catheter gently after the fluid has stopped draining.
If you have a catheter that stays in place
Reconnect the drainage system as you have been taught.
Check that:
Urine is flowing
The tubing is not twisted
The drainage bag is below your bladder
Step 10: Clean up
After the washout:
Throw away equipment that is meant for one use
Do not keep fluid from an opened single-use container
Clean reusable containers as instructed
Wash and dry your hands
When should I stop?
Stop the bladder washout if:
The fluid will not go in
You need to push hard on the syringe
The fluid goes in but does not come back out
You develop pain
Your lower abdomen becomes swollen
You develop strong bladder spasms
You see a large amount of blood
The catheter appears to have moved or fallen out
You develop autonomic dysreflexia
You suddenly feel unwell
Do not repeatedly flush a catheter that remains blocked.
The catheter may need to be changed.
What is autonomic dysreflexia?
Autonomic dysreflexia is a sudden and dangerous rise in blood pressure.
It mainly affects people with spinal cord injuries at or above the T6 level.
A full bladder or blocked catheter is one of the most common causes.[6]
Warning signs
Symptoms may include:
A sudden or pounding headache
Sweating
Red or flushed skin above the spinal injury
Goose bumps
Blurred vision
A blocked or stuffy nose
Feeling anxious or that something is wrong
Increased muscle spasms
Pale or cool skin below the injury
Blood pressure that is much higher than usual
Some people may have high blood pressure without obvious symptoms.
What should I do?
If you think you have autonomic dysreflexia:
Stop the washout.
Sit upright.
Lower your legs if possible.
Loosen tight clothing, straps or abdominal binders.
Check your blood pressure if you have a monitor.
Check that the catheter tubing is not bent or blocked.
Allow the bladder to drain without forcing it.
Follow your personal autonomic dysreflexia emergency plan.
Check your blood pressure about every five minutes.
Call 000 if:
Your symptoms do not improve
Your blood pressure remains high
You have a severe headache
You develop chest pain
You have difficulty breathing
You become confused
You have a seizure
You lose consciousness
Do not continue the washout while autonomic dysreflexia is continuing.[6]
Can a bladder washout treat a urine infection?
No.
A bladder washout does not remove all bacteria from the bladder. It does not replace antibiotics when a true urine infection is present.
People with spinal cord injury often have bacteria in their urine without having an infection.
Antibiotics are usually not needed unless symptoms are also present.[1]
Possible signs of a urine infection include:
Fever
Chills or shaking
Feeling unusually tired or unwell
New or increased urine leakage
Increased muscle spasms
New bladder or lower abdominal discomfort
Pain around the back or kidney area
New or worsening autonomic dysreflexia
Blood in the urine
Cloudy or strong-smelling urine together with other symptoms
Contact your doctor or spinal injury service if these symptoms occur.
When should I contact my healthcare team?
Contact your spinal injury, continence or urology team if:
There is more mucus or debris than usual
Your catheter is blocking more often
Urine is leaking around the catheter
Washouts regularly cause pain or spasms
Washouts trigger autonomic dysreflexia
You repeatedly see blood in the urine
You have repeated urine infections
You think you may have a bladder stone
Your usual catheter becomes difficult to insert
Repeated blockage may be caused by:
A build-up of minerals on the catheter
Bladder stones
Infection
Not drinking enough fluid
The wrong catheter size or type
High bladder pressure
A change in bladder function
The cause of repeated blockage should be investigated.[1,5]
Common questions
How often should I perform a bladder washout?
Follow the plan provided by your healthcare team.
Some people with an augmented bladder need regular washouts because they produce mucus.
Other people may only need occasional washouts.
Do not increase how often you perform them without medical advice.
Can I use tap water?
Only use the fluid recommended by your healthcare team.
This may be:
Sterile saline
Sterile water
Boiled water that has been allowed to cool
Do not assume that tap water is suitable.
Should a washout hurt?
A bladder washout should not cause significant pain.
You may notice mild pressure or bladder spasms.
Stop if you experience:
Pain
Strong resistance
Severe spasms
Autonomic dysreflexia
What should the returned fluid look like?
It may contain mucus, sediment or small pieces of debris.
Contact your healthcare team if you notice:
Increasing debris
Ongoing bleeding
Large blood clots
A strong smell together with infection symptoms
Repeated difficulty getting the fluid back out
Can I push harder if the catheter is blocked?
No.
Never force fluid into the bladder.
Never use strong suction to pull fluid out.
This can cause injury, overfill the bladder or trigger autonomic dysreflexia.
Take home messages
Only perform bladder washouts after you have been trained.
Follow your personal bladder washout plan.
Use the correct fluid and amount.
Empty your bladder before starting.
Put the fluid in slowly.
Never force the syringe.
Do not add more fluid if the previous fluid has not drained.
Stop if you develop pain, bleeding, severe spasms or autonomic dysreflexia.
Bladder washouts do not treat urine infections.
Repeated catheter blockage should be medically assessed.
Medical disclaimer
This information is for people with spinal cord injury who have been advised to perform planned bladder washouts.
It provides general information only. It does not replace personal training or advice from your spinal injury team, continence nurse, urologist or other healthcare professional.
Catheters, syringes and washout products may work differently. Always follow the instructions supplied with your equipment and the personal plan given to you by your healthcare team.
References
European Association of Urology. EAU guidelines on neuro-urology. Arnhem: EAU Guidelines Office; 2026.
Husmann DA. Long-term complications following bladder augmentations in patients with spina bifida: bladder calculi, perforation of the augmented bladder and upper tract deterioration. Transl Androl Urol. 2016;5(1):3-11.
Shepherd AJ, Mackay WG, Hagen S. Washout policies in long-term indwelling urinary catheterisation in adults. Cochrane Database Syst Rev. 2017;3(3):CD004012.
Queensland Spinal Cord Injuries Service. Bladder washouts. Brisbane: Queensland Health; 2024.
Centers for Disease Control and Prevention. Summary of recommendations: guideline for prevention of catheter-associated urinary tract infections. Atlanta: Centers for Disease Control and Prevention; updated 2024.
Krassioukov A, Linsenmeyer TA, Beck LA, Elliott S, Gorman P, Kirshblum S, et al. Evaluation and management of autonomic dysreflexia and other autonomic dysfunctions: preventing the highs and lows. J Spinal Cord Med. 2021;44(4):631-83.
Peycelon M, Szymanski KM, Monn MF, Salama AK, Risk H, Cain MP, et al. Adherence with bladder irrigation following augmentation. J Pediatr Urol. 2020;16(1):33.e1-33.e8.