Clean Intermittent Catheterization for Boys
If your son cannot empty his bladder completely, or has a problem with urine leakage, a catheterization program may need to be started. These problems are commonly seen in children with spina bifida, spinal cord injuries, or some urinary tract defects.
Here is information from the American Academy of Pediatrics that will help you understand the basics of clean intermittent catherization (CIC). This information does not take the place of one-to-one teaching. Contact your child's doctor or other health care professional if you have any questions.
What is clean intermittent catherization (CIC)?
Clean intermittent catheterization (CIC) is a technique used to remove urine from the bladder. This is done most often by placing a thin, flexible tube (catheter) through the urethra into the bladder to drain the urine. Some patients drain their bladder through a surgically constructed channel from their abdomen to their bladder, bypassing their urethra.
Why is CIC important?
Urine is the waste product produced by the kidneys. The bladder is the container in the body that holds the urine until it is emptied. The human body needs to empty its bladder of urine several times a day. The bladder can be drained by urinating or by using a catheter.
If your child needs CIC, your child's doctor will tell you how often your child's bladder should be emptied. It can be emptied as often as every 2 to 4 hours, depending on your child's condition.
CIC is especially important because it
Reduces accidents (wetting). It lets your child empty his bladder so that he has fewer accidents. Older children may no longer need to wear diapers. It also helps stop the odor and skin problems that come from being wet with urine.
Reduces the risk of urinary tract infections. Regularly emptying the bladder reduces the risk of urinary tract infections caused by bacteria that stay in the bladder too long. (See "Signs and Symptoms of a Urinary Tract Infection" box.)
Reduces the risk of reflux and potentially of back pressure on the kidneys. Reflux is a condition where urine from the bladder goes back up to the kidneys. This can cause serious kidney damage.
What supplies are needed?
It is best to have all your supplies organized and ready when you need them. Keep the following items in a clean, dry container such as a plastic shoebox or cosmetic case:
Catheters. Your child's doctor will prescribe the appropriate catheter size for your child.
Disposable wipes or a washcloth. Your child's genitalia will need to be cleaned before CIC.
Lubricant. Use only a water-soluble (able to be dissolved in water) lubricant. You can buy the lubricant at pharmacies or drugstores. Do not use oil-based lubricants, such as petroleum jelly, because they do not dissolve in water.
Container. You may need a container to drain your child's urine into, if you are not doing his CICs on the toilet or if you need to record how much he drains.
Syringe. You will need a syringe for cleaning the catheter.
How is CIC done?
Figure 1. Boy seated on a toilet and using a catheter.
Figure 2. Location of the urethra in a boy.
Before you begin, have your box of supplies within easy reach. Next, wash your hands with soap and water and dry them. You can also use a waterless cleaner, such as an antibacterial hand cleanser that does not require water. Then
Place your son onto his back or, if it is easier for both of you, have him sit on the toilet (Figure 1) or in his wheelchair. If he is doing his own CIC, he may stand or sit on the toilet or in his wheelchair.
Clean the tip of his penis with a washcloth or disposable wipes in a circular motion by starting at the center and working outward. If your son is uncircumcised, pull back his foreskin so that the tip of his penis is visible before cleansing.
One end of the catheter has holes. Place a generous amount of the water-soluble lubricant onto the end with the holes.
Place the other end of the catheter into a container or let it drain into the toilet.
Hold your son's penis upright. Gently insert the lubricated end of the catheter into his urethra (Figure 2) about 4 to 6 inches until urine begins to flow. You may need to lower his penis as you continue to insert the catheter. It may become slightly more difficult to insert just before entering his bladder. Do not worry, this pushback is normal. Continue to gently insert the catheter with steady pressure until you feel the catheter slip into his bladder. Once urine flow begins, insert the catheter about an inch farther to allow the urine to flow better.
Hold the catheter in place until the urine flow stops. You may gently press onto your son's lower abdomen, or ask him to squeeze his abdominal muscles or lean forward, to be sure his bladder is empty.
Remove the catheter once the urine flow stops completely. Hold your finger over the end of the catheter while removing it. This step will prevent any urine in the tube from dripping out.
If your son is uncircumcised, gently replace his foreskin over the end of his penis by pushing it forward.
Wash your hands. Clean and store your catheter as your son's doctor has directed.
Signs and Symptoms of a Urinary Tract Infection
Call your child's doctor if your child has any of the following signs and symptoms of a urinary tract infection:
Fever greater than 101°F
Abdominal or back pain
Pain or burning during CIC
Less urine than usual from CIC
Frequent need to urinate or catheterize
Leaking of urine between CICs (more than usual)
Cloudy or hazy urine with a strong odor
How do I clean CIC supplies?
It is very important that you keep your child's CIC supplies clean. Make sure you wash your hands often and well whenever you perform CIC. If you are using disposable catheters, throw the catheters away after each use.
If you have reusable (metal or latex-free) catheters, you should wash them with soap and water after each use. You can use a syringe to squirt soapy water and plain water through the catheters. Rinse them completely and allow them to dry. After they are dry, store them inside a plastic bag, traveling toothbrush holder, or any other clean container.
Throw catheters away as soon as they become brittle or lose their flexibility or as soon as their holes become rough.
It may take a while to get used to doing CIC, but keep in mind that as you and your child become more used to this process, it will become easier. Talk with your child to explain exactly what you are doing. If your child is not doing CIC on his own, explain that when he is old enough, he should be able to do CIC without your help. Encourage your child to be independent. And remember, it is natural for you or your child to have questions. Feel free to talk with your child's doctor about any questions or problems that you or your child is having with CIC. Eventually, CIC can help make daily life easier and better for you and your child.
The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.