Saubere intermittierende Selbstkatheterisierung (SIK): Ein Schritt-für-Schritt-Patientenleitfaden

Zuletzt aktualisiert: August 16, 2026

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If your doctor has recommended clean intermittent catheterisation — often shortened to CIC — it is completely natural to feel nervous at first. The idea of passing a thin tube to empty your own bladder can sound daunting. But here is the reassuring truth I share with every patient: it is a safe, straightforward skill that most people learn surprisingly quickly, and it gives back control and independence. This guide walks through what it is, why it is recommended, and how it is done.

One thing first. This is a reminder for people who have been taught CIC, not a substitute for that teaching. The first few catheterisations should be done with a nurse or doctor watching, because the things that go wrong — wrong angle, forcing against resistance, wrong catheter size — are the things a second pair of eyes catches immediately and an article cannot. If you have been given a catheter without being shown how to use it, ask to be shown before you start.

What Is Clean Intermittent Catheterisation?

Clean intermittent catheterisation is a way to empty your bladder by gently inserting a thin, flexible tube through the urethra into the bladder. You do this a few times a day, usually four to six, on a schedule similar to normal urination. Once the bladder is empty the catheter comes out. No permanent tube, no bag strapped to the leg — just a routine emptying whenever it is time. It is most often recommended when the bladder does not empty on its own.

Why Is CIC Recommended?

CIC offers several genuine advantages. It protects your kidneys by keeping the bladder from becoming dangerously overfull, and it lowers the risk of urinary tract infection compared with a permanent indwelling catheter left in place. It gives you independence — you manage your own bladder at home, at work, or while travelling — and it mimics natural bladder function, letting the bladder fill and empty on a regular cycle.

Why Clean Instead of Sterile?

A common question is why the team recommends a clean technique rather than a fully sterile one. Trials comparing the two have not shown a clear difference in infection rates, so clean technique does not put you at higher risk. It is also far simpler and faster — no sterile gloves, drapes or antiseptic solutions, just thorough handwashing and a clean catheter — which makes it realistic to do several times a day, almost anywhere. It costs less. And because it is simpler, people are more likely to keep to their schedule, which is the single most important factor in preventing complications.

What You Will Need

• A clean, single-use catheter (your provider prescribes the correct size and type — a catheter that is too large is a common reason for pain and bleeding)
• Water-soluble lubricant, unless your catheter is pre-lubricated or hydrophilic-coated
• Soap and water for handwashing
• A clean container or toilet to drain into
• Optional: a small mirror (helpful for women while learning) and moist wipes or a washcloth

Step-by-Step Instructions

Before You Begin

1. Gather your supplies — catheter, lubricant, and a container or toilet ready.
2. Wash your hands thoroughly with soap and water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitiser.
3. Get into a comfortable position — sitting on the toilet, standing with one foot raised, or lying down, whichever works for you.

Preparing the Area

Gently clean the genital area with soap and water or a moist wipe. For women: spread the labia with your non-dominant hand and clean from front to back to avoid bringing bacteria toward the urethra — a mirror helps you locate the opening while learning. For men: if uncircumcised, gently retract the foreskin, then clean the tip of the penis with a front-to-back motion.

Inserting the Catheter

1. Open the catheter package carefully, touching only the funnel end you will hold — not the insertion tip.
2. Apply lubricant generously to the insertion tip (skip this if your catheter is pre-lubricated or hydrophilic-coated — activate it with water as directed on the package). Do not be sparing with lubricant; most urethral discomfort comes from too little of it.
3. Gently insert the catheter into the urethral opening. For women: insert slowly, about 2–3 inches (5–7 cm), until urine begins to flow. For men: hold the penis at roughly a 60–90 degree angle from the body and insert slowly, about 6–8 inches (15–20 cm), until urine flows. If you feel resistance, take a slow deep breath, relax, and use gentle steady pressure — never force the catheter. Forcing can tear the urethra and create a false passage, which turns a routine task into a hospital problem.

Draining the Bladder

Let the urine drain completely into the toilet or container — you can press gently on your lower abdomen to help empty the bladder fully. Once the flow stops, withdraw the catheter slowly, pausing if more urine begins to flow and waiting until it stops again before continuing.

After You Finish — Including the Step People Forget

Remove the catheter completely and dispose of single-use catheters in the bin — never flush them. Wash your hands again, and note the amount drained if you have been asked to keep a record.

If you are uncircumcised, pull the foreskin forward again over the head of the penis before you finish. This is the step that most often gets forgotten, and leaving the foreskin retracted can lead to Paraphimose — the foreskin becomes trapped behind the head, swells, and cannot be pulled back down. It is painful, it worsens over hours, and it is a urological emergency. Make replacing the foreskin the last thing you do, every single time, so it becomes automatic. If it does become stuck and swollen, do not wait to see whether it settles — go to an emergency department.

Tips for Success

• Stick to your schedule. Catheterise at regular intervals as recommended, usually every four to six hours. Do not let the bladder overfill — skipping catheterisations is the most common reason things go wrong.
• Drink fluids normally unless told otherwise.
• A little blood in the first few attempts is common as the urethra adjusts, and it usually settles quickly. Persistent bleeding, or fresh blood rather than a trace, needs to be reported.
• Store supplies in a clean, dry place, and carry a kit when you go out so you can stay on schedule.
• Use the catheter you were prescribed. If it hurts consistently, the answer is usually a different size or coating rather than pushing harder — that is a conversation worth having rather than tolerating.

About Bacteria in the Urine

Something that surprises many people on CIC: after a while, a urine sample will almost always grow bacteria. That by itself is not an infection and does not need antibiotics. Repeated courses given for a positive culture in someone who feels well cause harm without benefit — side effects, resistance, and bowel infection — and the reasoning is set out in bacteria in your urine without symptoms.

What matters is symptoms: fever, new pain, worsening burning, feeling unwell, or a sudden change in your usual pattern. Those are the reasons to have the urine tested — not a routine check while everything feels normal.

When to Call, and When to Go In

Go to an emergency department, do not wait:

• You cannot pass the catheter and your bladder is full. A bladder that cannot be emptied needs to be emptied, and that may need a different approach than you can manage at home.
• Fever with shaking chills, or feeling rapidly and severely unwell — this can be an infection reaching the kidney or bloodstream.
• Heavy or continuing bleeding from the urethra, rather than a trace on the catheter.
• A retracted foreskin that has become swollen and will not come forward.

If you have a spinal cord injury at or above the mid-back, one more warning is essential. A pounding headache, sudden sweating or flushing above the level of your injury, blurred vision, a stuffy nose or a slow pulse can be autonomic dysreflexia — a dangerous rise in blood pressure, most often triggered by a full bladder or a blocked catheter. Sit yourself upright, drain the bladder if you can, and get emergency help. This is not something to wait out, and anyone who catheterises because of a spinal injury should know these symptoms by heart.

Contact your provider in the next day or so for cloudy, foul-smelling or bloody urine that does not improve; pain or burning that is getting worse with catheterisation; difficulty inserting the catheter even when the bladder is not full; or persistent leaking between catheterisations, which may mean the schedule needs adjusting.

Most importantly, remember that learning CIC is a process. It gets easier and more routine with practice, and the independence it offers is well worth the initial learning curve.

If you have questions or would like hands-on guidance, Dr. Soarawee Weerasopone consults at Bangkok Hospital Hauptsitz and at Samitivej Sriracha Hospital, Chonburi — 088-022-1445. Bladder function assessment, including urodynamic studies, is part of the wider bladder service.

Bangkok Hospital Telemedicine is available for patients who cannot attend in person, including international patients — arrange it in advance by email to the Urology department at bhquro@bdms.co.th. It suits reviewing your schedule, catheter choice or a recurring problem; being taught the technique for the first time needs to be in person. Samitivej Sriracha is in-person only.

Referenz: Prieto JA, Murphy CL, Stewart F, Fader M. Intermittent catheter techniques, strategies and designs for managing long-term bladder conditions. Cochrane Database Syst Rev. 2021 Oct 26;10(10):CD006008. doi:10.1002/14651858.CD006008.pub5.

Häufig gestellte Fragen (FAQ)

What is clean intermittent catheterisation (CIC)?

Clean intermittent catheterisation is a method of emptying the bladder by gently inserting a thin, flexible tube through the urethra into the bladder several times a day, then removing it once the bladder is empty. It is used when the bladder cannot empty fully on its own, and it mimics the natural fill-and-empty cycle without needing a permanent catheter. It should be taught in person before you start doing it alone.

Warum eine saubere Technik anstelle einer sterilen anwenden?

Trials comparing the two have not shown a clear difference in infection rates, so clean technique is not riskier. It is also simpler, faster and cheaper — thorough handwashing and a clean catheter rather than sterile gloves, drapes and antiseptics — which means it can be done almost anywhere and is easier to keep up with. Consistent adherence is the most important factor in preventing complications.

If I am uncircumcised, is there anything extra to remember?

Yes, and it is the most commonly forgotten step: pull the foreskin forward again over the head of the penis after every catheterisation. Leaving it retracted can cause paraphimosis, where the foreskin becomes trapped behind the head, swells and cannot be brought forward. It is painful, worsens over hours and is a urological emergency. If it happens, go to an emergency department rather than waiting to see whether it settles.

How often should I catheterise?

Most people catheterise about four to six times a day, roughly every four to six hours, on a schedule similar to normal urination. The exact frequency is set by your provider. The key principle is never letting the bladder become overfull, which protects the kidneys and lowers infection risk — and, for people with spinal cord injury, avoids triggering autonomic dysreflexia.

I have a spinal cord injury. What should I watch for?

If your injury is at or above the mid-back, learn the signs of autonomic dysreflexia: a pounding headache, sudden sweating or flushing above the level of injury, blurred vision, a stuffy nose or a slow pulse. It is a dangerous rise in blood pressure most often triggered by a full bladder or blocked catheter. Sit upright, drain the bladder if you can, and get emergency help. Do not wait it out.

Do I need antibiotics if my urine test grows bacteria?

Usually not. Almost everyone on long-term intermittent catheterisation will grow bacteria on a urine culture, and that alone is not an infection. Antibiotics are for symptoms — fever, new or worsening pain or burning, feeling unwell, or a clear change from your usual pattern. Repeated courses for a positive culture in someone who feels well cause side effects and resistance without benefit.

Es ist normal, wenn bei Beginn des CIC ein wenig Blut auftritt.

A small amount of blood or mild irritation is common in the first few catheterisations as the urethra adjusts, and it usually resolves quickly. Heavy or continuing bleeding is different and needs urgent assessment. So does fever with chills, worsening pain, or urine that stays cloudy and foul-smelling.

Was soll ich tun, wenn ich beim Einführen des Katheters Widerstand spüre?

Never force it. Pause, take a slow deep breath and relax — muscle tension is a common cause — then try again with gentle, steady pressure and plenty of lubricant. For men, holding the penis at the correct angle helps. Forcing can tear the urethra and create a false passage. If you still cannot pass the catheter and your bladder is full, that is a reason to go in rather than keep trying.

Haftungsausschluss: This content is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters. It is intended for educational purposes only, does not constitute medical advice, and is not a substitute for being taught this technique in person. No advice, diagnosis or prescription is given through personal messaging channels or social media. Always follow the specific instructions given by your own healthcare provider. If you cannot pass the catheter with a full bladder, develop fever with chills, bleed heavily, or have a foreskin that becomes trapped and swollen, seek emergency care.