How to Perform Clean Intermittent Self-Catheterisation (CISC) After a Spinal Cord Injury

For many people living with a spinal cord injury (SCI), clean intermittent self-catheterisation (CISC) is the preferred method of long-term bladder management. It allows the bladder to empty regularly, helps maintain low bladder pressures, protects kidney function, improves continence and reduces many of the long-term complications associated with indwelling urinary catheters when performed correctly.¹–⁵

Although learning to catheterise yourself may seem daunting initially, most people become confident after receiving education from a spinal rehabilitation team, continence nurse or urologist. With practice, CISC usually becomes a routine part of daily life.¹,²

Why is bladder management important after spinal cord injury?

Following a spinal cord injury, communication between the brain and bladder is disrupted. Depending on the level and severity of injury, the bladder may:

Fail to empty completely
Empty unexpectedly
Store urine at high pressure
Become overactive
Lose normal bladder sensation
Develop detrusor sphincter dyssynergia (DSD)

If the bladder is not managed appropriately, elevated bladder pressures and incomplete emptying may lead to:

Recurrent urinary tract infections (UTIs)
Kidney damage
Bladder stones
Urinary leakage
Autonomic dysreflexia
Reduced quality of life.¹–⁴

For most people with SCI who are able to perform catheterisation independently or with assistance, intermittent catheterisation is considered the gold standard of bladder emptying.¹–⁴

What is clean intermittent self-catheterisation (CISC)?

CISC involves passing a small flexible catheter through the urethra into the bladder several times each day to completely drain urine.

Once the bladder has emptied, the catheter is removed immediately. Unlike an indwelling catheter, nothing remains inside the bladder between catheterisations.

Who is suitable for CISC?

Your urologist may recommend CISC if you have:

Neurogenic bladder following spinal cord injury
Chronic urinary retention
Incomplete bladder emptying
High post-void residual urine volumes
Detrusor sphincter dyssynergia
A reconstructed urinary tract

How often should I catheterise?

The frequency of catheterisation depends on:

Your bladder capacity
Fluid intake
Kidney function
Urine production
Urodynamic findings
Whether you void naturally between catheterisations

For most adults with SCI, catheterisation is performed approximately every 3 to 4 hours, although this may not be suitable for everyone.¹–⁴

The aim is generally to keep bladder volumes below approximately 400–500 mL, helping prevent bladder overdistension and maintaining safe bladder storage pressures.¹,³

Your treating urologist or spinal rehabilitation team will develop an individualised catheterisation schedule based on your bladder function.

What equipment will I need?

You will generally require:

A single-use intermittent catheter
Hydrophilic or pre-lubricated catheter (if prescribed)
Water-based lubricant (if required)
Soap and water or alcohol-based hand sanitiser
Toilet or collection container
Mirror (particularly helpful for women learning the technique)

Many people with SCI find hydrophilic catheters easier and more comfortable because they reduce friction during insertion and removal, although the most appropriate catheter varies between individuals.²,⁵

Step-by-Step Guide

Step 1 – Wash your hands

Wash your hands thoroughly with soap and water.

If this is unavailable, alcohol-based hand sanitiser is an appropriate alternative.

Good hand hygiene is one of the most effective methods of reducing catheter-associated infection.²

Step 2 – Prepare your catheter

Open the catheter packaging carefully.

Avoid touching the section of catheter that will enter your urethra.

If using a hydrophilic catheter, prepare it according to the manufacturer's Instructions for Use.

If using a standard catheter, apply sterile water-based lubricant if required.

Step 3 – Position yourself comfortably

Catheterisation may be performed:

Sitting on the toilet
Sitting in a wheelchair
On a commode
Standing
Lying in bed

Choose whichever position provides the safest access and greatest independence.

Step 4 – Insert the catheter

Men

Hold the penis gently upwards at approximately 60–90 degrees.
Slowly insert the catheter into the urethra.
Mild resistance may be felt at the external urinary sphincter.
Relax, breathe slowly and continue gently.
Never force the catheter.
Once urine begins to flow, advance the catheter another 2–3 cm to ensure the drainage holes are completely inside the bladder.²

Women

Separate the labia.
Identify the urethral opening.
A mirror may assist while learning.
Gently insert the catheter until urine flows.
Advance another 2–3 cm.

Step 5 – Empty the bladder completely

Allow urine to drain until the flow stops.

Towards the end of drainage, some people find it helpful to:

Lean forwards
Slowly withdraw the catheter a few centimetres
Cough gently

These manoeuvres may assist complete bladder emptying.

Step 6 – Remove the catheter

Withdraw the catheter slowly.

Pause briefly if additional urine drains.

What if I cannot feel my bladder filling?

Many people with SCI have absent or reduced bladder sensation.

Instead of relying on sensation, catheterisation should be performed according to a regular schedule.

Phone reminders, alarms or bladder diaries can help establish a consistent routine.

Autonomic Dysreflexia

Individuals with spinal cord injuries at or above the T6 level are at risk of developing autonomic dysreflexia (AD).

A full bladder is the most common trigger.¹,⁴

Symptoms include:

Sudden severe headache
Facial flushing
Sweating above the injury level
Goosebumps
Anxiety
Blurred vision
Markedly elevated blood pressure

If these symptoms occur:

Sit upright immediately.
Loosen any tight clothing.
Check whether your bladder is full.
Catheterise if appropriate or ensure your catheter is draining freely.
Seek urgent medical attention if symptoms do not resolve promptly or blood pressure remains elevated.

Autonomic dysreflexia is a medical emergency and should never be ignored.

Preventing Urinary Tract Infections

People with SCI have an increased risk of UTIs because of altered bladder function.

You can reduce your risk by:

Washing your hands before catheterisation.
Performing catheterisation on schedule.
Avoiding bladder overfilling.
Maintaining adequate hydration.
Preventing constipation.
Using the correct catheter technique.
Following your clinician's bladder management plan.¹–⁵

Routine prophylactic antibiotics are not recommended for most patients because they promote antimicrobial resistance and have not consistently been shown to reduce symptomatic UTIs.³

Importantly, cloudy or strong-smelling urine alone does not necessarily indicate infection.

Symptoms that may suggest a UTI include:

Fever
Feeling generally unwell
Increasing bladder spasms
New urinary leakage
Pelvic discomfort
Increased autonomic dysreflexia
Burning discomfort (if sensation is preserved)

Common Problems

The catheter will not pass

Possible causes include:

Urethral sphincter spasm
Urethral stricture
Enlarged prostate
Incorrect insertion angle

Never force the catheter.

Seek medical review if this becomes recurrent.

Blood on the catheter

A small amount of bleeding may occasionally occur while learning.

Persistent bleeding or repeated bleeding should be assessed by your urologist.

Leakage between catheterisations

This may indicate:

Catheterisation is too infrequent
Bladder overactivity
High bladder pressures
Urinary tract infection
Excessive fluid intake over a short period

Your bladder management programme may require adjustment.

When should I contact my urologist?

Arrange medical review if you experience:

Difficulty inserting the catheter
Heavy bleeding
Recurrent urinary tract infections
Recurrent autonomic dysreflexia
Increasing urinary leakage
Bladder stones
Difficulty emptying your bladder
Persistent pain during catheterisation

Frequently Asked Questions

Can I travel?

Yes. Carry extra catheters, hand sanitiser, lubricant if required, disposal bags and a spare change of clothing. A letter from your treating doctor may be helpful when travelling internationally.

Can I still have sexual activity?

Yes. The catheter is removed after bladder emptying, so there is no permanent catheter to interfere with sexual activity.

Do I need sterile gloves?

No. CISC uses a clean technique, not a sterile surgical technique. Good hand hygiene and appropriate catheter handling are sufficient for most people performing self-catheterisation at home.²

Will I need to catheterise forever?

Some people recover bladder function following spinal cord injury, while others require lifelong bladder management. Your urologist will monitor your progress with regular clinical reviews and, where appropriate, kidney imaging and urodynamic studies.¹,³

Key Points

Clean intermittent self-catheterisation is the preferred long-term bladder management strategy for many people with spinal cord injury.¹–⁴
Most people catheterise approximately 4–6 times per day, depending on bladder capacity and urine production.¹–⁴
Avoid allowing the bladder to overfill.
Never force a catheter if resistance is encountered.
Learn to recognise autonomic dysreflexia if your injury is at or above T6.
Regular follow-up with your urologist is important to protect long-term bladder and kidney health.

Conclusion

Clean intermittent self-catheterisation (CISC) is considered the preferred long-term bladder management strategy for many people with spinal cord injury because it helps maintain low bladder pressures, protects kidney function, promotes continence and reduces many of the complications associated with long-term indwelling catheters when performed correctly.¹–⁵

Most people become confident with catheterisation after appropriate training from a urologist, continence nurse or spinal rehabilitation team. Establishing a regular routine, maintaining good hand hygiene and adhering to an individualised catheterisation schedule are key to successful long-term bladder management.¹–⁵

NOTE: The information provided in this guide is intended as a general educational resource only. It describes the principles of clean intermittent self-catheterisation using a generic technique and is not specific to any individual catheter brand or model. Individual catheter systems may have different preparation, lubrication and insertion instructions. Always follow the manufacturer's Instructions for Use (IFU) supplied with your prescribed catheter and the advice of your treating urologist, spinal rehabilitation team or continence nurse. If you experience difficulty inserting the catheter, recurrent urinary tract infections, bleeding, increasing autonomic dysreflexia or concerns about your bladder management, seek medical review promptly.

References

European Association of Urology. EAU Guidelines on Neuro-urology. Arnhem: European Association of Urology; 2025.
European Association of Urology Nurses. EAUN Guidelines: Urethral Intermittent Catheterisation in Adults. Arnhem: European Association of Urology Nurses; 2024.
Ginsberg D, Gousse A, Keays M, et al. Adult Neurogenic Lower Urinary Tract Dysfunction: AUA/SUFU Guideline. J Urol. 2021;206(5):1097-1105.
Consortium for Spinal Cord Medicine. Bladder Management for Adults with Spinal Cord Injury: A Clinical Practice Guideline for Health-Care Providers. Washington (DC): Paralyzed Veterans of America; 2021.
Prieto J, Murphy CL, Stewart F, Fader M. Intermittent catheter techniques, strategies and designs for managing long-term bladder conditions. Cochrane Database Syst Rev. 2021;10:CD006008.
Welk B, Campeau L, et al. Canadian Urological Association guideline: Adult neurogenic lower urinary tract dysfunction. Can Urol Assoc J. 2023;17(1):E1-E27.
Panicker JN, de Sèze M, Fowler CJ. Neurogenic lower urinary tract dysfunction: clinical management and therapeutic approaches. Nat Rev Urol. 2015;12:667-678.