How to Handle Pain During Catheterization?

1. Anatomical Factors

The urethra has abundant nerve innervation, with parasympathetic and sympathetic nerves distributed throughout the entire urethra. The bladder neck is richly innervated, and the mucosa is very sensitive to stimulation. Any foreign body or inflammatory stimulation can cause urgency, dysuria (painful urination), and discomfort in the lower abdomen and perineal area.

The male urethra is 16-22 cm in total length and has three narrowings and two curves. During catheterization, catheter stimulation causes strong contraction of the urethral sphincter, increasing the difficulty of insertion and causing pain.

Compared to the male urethra, the female urethra is short, thick, and straight, with no curves or narrowings, making catheterization relatively easier.

2. Pathological Factors

Pain during catheterization caused by urethral malformations or strictures. For example, male patients with urethral stricture due to prostatic hyperplasia will experience pain and discomfort during catheterization. If the patient already has a urinary tract infection, catheterization may aggravate the pain. In such cases, medical treatment should be sought promptly to resolve the underlying condition as soon as possible.

3. Psychological Factors

Adverse psychological states such as fear, anxiety, and shyness in patients. During catheterization, excessive mental tension and autonomic nervous system dysfunction can lead to urethral spasm during catheter insertion, resulting in varying degrees of pain and discomfort. For patients performing intermittent self-catheterization, this pain and discomfort can further intensify emotional tension, potentially causing them to continuously try different insertion angles and force the catheter in, thereby causing urethral injury and even bleeding.

4. Catheter Factors

The quality of the catheter is very important. If the insertion tip of the catheter is not smooth enough, has burrs, or is deformed, it will directly damage the urethral mucosa and cause pain. Additionally, inappropriate selection of catheter type and size—if the catheter is too thick—will cause some irritation to the urethral mucosa, increase urethral resistance, and cause pain after insertion.

5. Operational Factors：

The technique and skill of catheterization are very important, especially for male patients. When the catheter passes through the curves and narrowings of the urethra, if the angle of the penis is not adjusted in a timely manner and brute force is used to push forward, it can easily cause urethral injury. Additionally, if the catheter is not adequately lubricated, it will also cause pain and discomfort during insertion.

Coping Methods：

Based on the above analysis of various causes, we can take the following measures to reduce pain during catheterization:

1. Relax Your Emotions

Patients should try to relax as much as possible during catheter insertion and eliminate nervous tension. Taking a hot bath or doing some light exercises before catheterization can help one relax more. If you feel resistance during insertion, try coughing a few times. If the patient is in a wheelchair, move to the edge of the wheelchair to release pressure on the perineal area and avoid compressing the urethra. Coughing or changing position helps maintain relaxation and facilitates catheter insertion.

1. Choose an Appropriate Catheter

It is essential to select a catheter with a sufficiently smooth surface and smooth drainage hole edges, and the thickness should be appropriate. Catheter size selection can refer to the recommendations of the European Association of Urology Nurses:

① When catheterizing adults, a catheter with a diameter of 12-14 Fr should be the first choice.

② When catheterizing children under 6 months of age, use a catheter with a diameter of 5 Fr.

③ When catheterizing children over 6 months of age, start with 6-8 Fr for male children and 8 Fr for female children, selecting the appropriate diameter based on the child's specific condition.

④ If there are any problems during the insertion process, or if blood clots or debris (sediment) are found in the urine, this often indicates that the current diameter is inappropriate and professional medical consultation is needed.

1. Standardize Catheterization Procedures

Adequately lubricate the catheter before insertion, or choose hydrophilic-coated catheters to ensure continuous lubrication throughout the catheterization process, reducing catheter irritation and friction, and protecting the urethral mucosa. Movements should be gentle during the procedure. Deep breathing can be used to relax all body muscles and reduce pain and discomfort. If resistance is encountered, pause, especially for pain-sensitive individuals, as this can easily cause strong contraction of the urethral sphincter and increase urethral resistance. Wait until completely relaxed before slowly reinserting the catheter.

When catheterizing male patients, special attention should be paid to the curves of the urethra. When inserting the catheter, lift the penis to form an angle of approximately 60 degrees with the abdominal wall to eliminate the prepubic curve of the urethra as much as possible, and slowly insert into the urethra. When the catheter is inserted nearly halfway and resistance is felt, this indicates the catheter has reached the second curve (subpubic curve). At this point, slowly lower the penis toward the thigh direction to form an angle of approximately 90 degrees with the abdomen. After the resistance disappears, continue insertion.

Catheter insertion in female patients is relatively simple, but the position of the urethral opening should be fully understood. Insert gently and slowly, and after urine is seen flowing out, advance another 2 centimeters. If the catheter is inadvertently inserted into the vagina, replace it with a new catheter and repeat the procedure.

Disclaimer

1. Some of the content in this article comes from online sources. If there is any infringement, please contact us for removal.
2. The medical information provided here is for reference only and should not be used as a basis for clinical diagnosis or treatment.