Revision date: March 2012
Catheters are small rubber or plastic tubes that can be inserted
through the urethra into the bladder. Catheters are an almost
sure-fire way to empty the bladder. Both men and women can use
You may have had some experience, perhaps an unpleasant experience
with catheters if you were ever hospitalized for surgery. Usually,
the catheters used in hospitals are “Foley” catheters, which have an
inflatable balloon on them to keep them in place inside your
paruresis sufferers may find some uses for Foley catheters, the kind
of catheter we are talking about here is NOT designed to be held in
place. Rather, the
catheters our participants use do not have the inflatable balloon,
and are intended to be inserted, held in place for perhaps 10
seconds to 60 seconds, and then immediately removed. This process is known as intermittent catheterization. It is used when necessary, and the catheter is not left in
place as is commonly done in hospital practice.
People with paruresis who use catheters perform what is known as
clean-intermittent-catheterization (CIC). That means the catheters
are inserted as needed, on an intermittent basis. It also means the
catheters don't need to be sterile. They just need to be thoroughly
clean. However in recent years sterile catheter prices have dropped
tremendously and there are now many good single use sterile
catheters on the market. Also, nowadays Medicare and many private health insurance
companies will pay for catheters. Therefore, it is now usually no longer necessary to clean and
reuse them, instead use
sterile catheters whenever possible.
The use of catheters to empty the bladder is easy, quick, discreet,
and should not be painful.
There is some risk of infection, especially in women, but your
physician can appropriately deal with this risk.
Catheters are easily carried in a woman's purse, a man's pants
pocket, or carry-on luggage. They are easily stored in desk drawers
and automobile glove compartments or consoles. Many users place them
within a zip-lock bag, along with a packet of a
water soluble sterile
lubricating jelly and a disposable hand wipe.
Here are examples of the type of lubricant which is appropriate: E-Z
Lubricating Jelly (water soluble sterile 0.1 oz = 3 g); Aplicare
#82-280; Fougera Surgilube, 3 g packets. There are undoubtedly other similar products on the market. For many years KY Jelly was recommended, however we have
heard that it is no longer sold as a sterile product. If you can find sterile KY Jelly in small packets, it should
work too. We suggest avoiding larger multi-use tubes of lubricant.
You might wish to follow your doctor’s advice on brand, or choose
what you like.
However, NEVER use Vaseline
or any lubricant other than a sterile water soluble lubricating
jelly appropriate for catheter insertion. Use caution when purchasing “personal lubricants” as these
may not be suitable for catheter insertion.
There are catheters that do not need lubrication. One brand name is LoFric. These seem to be popular in Europe
and the UK. They are available in the USA too. The decision about
which type to use is always a matter of personal choice, arrived at
in consultation with your physician.
Catheters are available in a number of different styles, sizes, and
materials. Anyone who decides to try them will need to do some
experimenting to find out which kind works best. It is a very
Catheters are manufactured from latex rubber, silicone, PVP plastic,
other types of plastic, even Teflon. You may find one material to be
more comfortable than another.
Persons with latex allergy
need to avoid rubber catheters.Most of the participants in our “Talk About It” bulletin
IPA Talk forum seem to like Cure brand
catheters and Bard (Bardia) red rubber catheters.
The inserted end of catheters is manufactured with different shapes.
We recommend against the use of catheters with tapered tips unless
your doctor wants you to use that type of catheter. You should decide what is best for you through consultation
with your doctor and experimentation with different brands, sizes,
styles, and materials.
Some catheters have a slight bend near the tip. These are called
Coude catheters. Many men prefer the Coude shape (some women find
them easier to insert as well), but one must be careful to keep the
proper orientation of the catheter tip while inserting it. Coude catheters are manufactured with marking on them to help
you keep the proper orientation of the catheter throughout the
insertion process; usually it is a “dimple” on the funnel end, but
it might be guide marks, as are found on some Mentor Brand
While it is possible to obtain catheters and learn
to use catheters without medical supervision, there are serious
risks involved without proper training and instruction. IPA strongly
advises everyone to get a physician's approval and instruction in
catheter use before trying them. Once you’ve been trained, you can
safely and confidently use a catheter whenever it is needed to drain
your bladder in an emergency situation, or for providing a urine
sample during a drug test.
Catheters can be purchased at medical supply stores, some drug
stores, and through on-line mail-order medical supply companies.
Usually, no prescription is needed unless you want your insurance
company to pay—but practices vary from store to store, and from
state to state.
The prescription requirements
seem to vary throughout the country. We recommend that people who
use catheters obtain a note of authorization from their physician,
and keep this note with them at all times; especially for air
travel. However, TSA has
no issues with the catheters themselves, and the lubricant can be
taken through the check point in your 1 Q baggie. Please remember to bring extras and pack extras
for your time away and your return trip in your luggage.
There are also external catheters available that don't need to be
inserted into the urethra. Some of our participants like them, but
they require that you can control the urinary muscles in order to
drain your bladder. Therefore many of us cannot use them. External catheters have a rubber sleeve that fits over the
penis, a collection bag, and a system of valves and drain tubing to
connect up to the bag. There is a product for women too. External catheters can be worn discreetly and a number of
people have reported they can be useful. These are often
available without prescription in medical supply stores, and there
is a product available on-line called the
Stadium Pal (Stadium Gal for women.) For those
who can use external catheters with leg bags to collect urine, they
may be very helpful. If considering this option,
remember that security
personnel might give you a pat-down search for hidden objects and
you may need to explain about the external catheter and leg bag.
Probably these should not be used for air travel these days; check
the TSA web sites for guidance.
Frequently Asked Questions:
1) Where can I buy them? Try a medical supply store in your
community, or use a search engine to find a medical supply store on
line. From time to time people will post a URL on the
IPA Talk forum.
Also, your physician can help you locate a supply store.
2) Do women need special instructions? Yes. See
our page on
Catheter tips for women for more
3) How much do they cost? It varies. Reusable rubber
catheters run between about $7.00 and $12.00. Remember, they can be
cleaned and reused many times. Disposable catheters may cost as
little as .50 cents. One on-line retailer is selling Cure brand
Coude Catheters for .79 cents each. They are usually sold in cartons of 30, but some supply
stores will sell them individually. Some people wash and reuse
While it is best to not reuse catheters, and usually not necessary
with today’s modest prices, washing and reusing catheters was a
common practice until just a few years ago.
4) How long does it take to empty my bladder with a catheter?
This depends on the diameter of the catheter and how much urine
needs to be expelled. A few seconds to a minute is an average time.
It takes a minute or less to lubricate a catheter and insert it.
5) How will I know that the catheter has entered my bladder?
Urine will start to flow. Once the flow starts you will not be able
to stop it until your bladder is completely empty. When the flow
stops it is time to remove the catheter. While extremely
unlikely to happen very small diameter catheter can be over inserted
and become knotted. A urinary catheter should only be inserted to
the point that urine is obtained – then stop. We suggest sticking
with 12 - 14 Fr catheters unless directed otherwise by your
physician. The 14 Fr for rubber and 12 Fr for plastic are often good
Again, individual preferences and medical advice need to be
indicates “French,” and is merely a designation for diameter of the
catheter. The larger the
number - the larger the catheter.
6) How do I clean and sterilize catheters? There are two
types of catheters. Disposable catheters are designed for single
use. Disposable catheters are packed in sterile packages and are
sterile when first taken from their package. Try to avoid touching
the lower sterile end and keep it from touching any surface such as
Reusable catheters do not need to be sterile. It is sufficient to
clean them with water and a little soap, then rinse them well with
water and again if possible with ordinary rubbing alcohol. Let them
alcohol (rubbing alcohol) is available inexpensively at most retail
cleaning, rinse once with 70% alcohol and then with 90-91% alcohol
to help dry the catheter. If you need to quickly reuse them, rinsing with water is
sufficient. Tap water will do. We recommend against using the water
available in airplane lavatories or other places where the water is
stored in containers.
CAUTION—rubbing alcohol is sometimes impossible to find in other
countries, so plan ahead when traveling abroad, and
DO NOT ATTEMPT TO BRING
ALCOHOL IN YOUR LUGGAGE. IT IS A FLAMMABLE LIQUID. IMPORTANT: Advances in the
manufacture of catheters should make reusing catheters a thing of
the past. The Cure Brand
catheters are excellent and inexpensive. Many participants who have
tried them have posted very positive comments about them on the
IPA Talk forum
bulletin board. But, every person is different. There are distinct personal preferences and physician
preferences to be considered in making your choices.
7) What does it feel like after I have removed the catheter?
There may be a slight residual urge that will quickly pass. There
might be a slight burning sensation. The first time you urinate
after having used a catheter there might be a brief mild burning
sensation. With time and
practice you will feel nothing unusual and catheter use will become
8) Where can I find out more? Ask your doctor and post your
questions on the
IPA Talk forum.
9) How do I find a doctor who will prescribe catheters? Talk
to your primary doctor or call around to various urologists in your
community. It seems that about 50% of the urologists will readily
agree to teach you how to use catheters and the other 50% will
adamantly refuse to help you. So call around before making an
appointment. Ask to speak with the nurse. Explain that you will want
to be taught how to do intermittent self-catheterization. Ask if the
doctor is likely to agree to teach that to you. Do not agree to any
expensive tests until you obtain a commitment that you will be
taught how to use catheters.
10) How can I convince my doctor to prescribe catheters and teach
me how to use them? While it is not possible to predict what any
individual doctor might do, we recommend that you go to our Bulletin
Board. There are links
there to an article published at the official website of the
American Urological Association Foundation.
Copy it, bring it with you, and ask the doctor to read it
before he examines you or talks with you about the reason for your
visit. The article is short, and will only take the doctor a minute
or two to read. If you
need help locating this, please ask at our “Talk About It” bulletin
board on the
IPA Talk forum.
11) How much practice does it take? It all depends on you.
Some people are more squeamish than others or more sensitive
internally. We recommend that you practice at home a few times
before going out into situations where you may need the catheter.
12) How often can I use catheters? Most people use them
infrequently, as an emergency aid when they cannot find a place
where they can empty their bladder. Usually, catheters might be used
once or twice during a trip, visit, or event. It is OK to use them
more regularly. But, most paruretics don't find that necessary.
13) What about infections? Yes, there is an infection risk.
But, there are things you can do to reduce your risk. Men can use
disposable iodine or other disinfectant wipes to cleanse the glans
penis before inserting the catheter, and perhaps wear disposable
sterile gloves. Drink plenty of fluids at the first opportunity after using a catheter,
when you know you will be able to safely use a toilet. Empty your
bladder frequently. Perhaps drink especially cranberry juice.
Perhaps take cranberry pills that are sold over the counter.
There are both over the counter and prescription medicines that can
help prevent infections or treat infections. Usually it is not necessary to take these though it is a good
idea to have them on hand. Your physician can help you decide what to use.
14) What can I do to relieve internal irritation? This is a
rare problem that either goes away quickly or may be a symptom of
infection if it persists. There are some over the counter medicines
containing phenazopyridine that tinge your urine a red color and
provide a mild anesthetic effect. Most people will not need this.
Phenazopyridine is also helpful for relieving the symptoms of an
infection. It does not treat the infection. There is also a prescription form of this medicine and there
are some other medicines that may be helpful. This is something you should discuss with your doctor.
15) Where can I learn more? Read and participate in our
IPA Talk forum.
Many participants use catheters and will gladly answer your
16) Will using a catheter be damaging to my recovery? Some
believe that any action that allows a person with paruresis to avoid
urinating in a public restroom will harm their efforts at
recovering. But, IPA has not established that catheter use is indeed
harmful. There is no clear answer at this time. On the
IPA Talk forum our bulletin board participants
have reported that having a catheter with them provides an extra
measure of security and a reduction in anxiety, because they know
there will always be a way to drain the bladder if they encounter a
situation that is beyond their ability to cope.
As of this writing, it is IPA’s opinion that catheter use can be
very helpful for managing paruresis, but it is not substitute for
working on recovery. In other words, catheters should be used only
on an occasional basis, and only after other methods have failed to
work (such as trying to reduce anxiety, trying different restrooms,
etc.) Catheter use is also valuable if a person needs to produce a
urine sample for a drug test and cannot risk being accused of drug
use because they cannot provide the sample. The decision to use catheters, and under what circumstances
with what frequency is a very personal and individual decision that
can only be made by each individual with input from their own
Catheter use is not a
substitute for a recovery program that includes support groups,
graduated exposure therapy, and cognitive behavioral therapy. As a
person works on a recovery program the need for a catheter should
decrease over time.