How to Manage Pain During Catheterization?

Under normal circumstances, intermittent catheterization should not cause pain. First-time users may experience mild discomfort, but this generally subsides once the user becomes accustomed to the procedure. On occasion, however, some individuals do experience pain during catheterization. How should this be addressed? This article examines the causes of catheterization-related pain and offers practical guidance.

I. Anatomical Factors

The urethra has abundant nerve supply, with parasympathetic and sympathetic nerve fibers distributed throughout its length. The bladder neck is richly innervated, and its mucosa is highly sensitive to stimuli. Any foreign body or inflammatory irritation can trigger urgency, dysuria, and discomfort in the lower abdomen and perineum. The male urethra is 16–22 cm in length and has three narrow segments and two curvatures. During catheterization, urethral stimulation triggers strong contraction of the urethral sphincter, increasing the difficulty of insertion and causing pain.

Compared to the male urethra, the female urethra is shorter, wider, and straighter, without curvatures or narrow segments, making catheterization relatively easier.

II. Pathological Factors

Urethral abnormalities or strictures may cause pain during catheterization. For example, male patients with benign prostatic hyperplasia (BPH), which leads to urethral narrowing, often experience discomfort during catheterization. If the patient already has a urinary tract infection, catheterization may exacerbate the pain. In such cases, prompt medical evaluation and treatment of the underlying condition should be sought.

III. Psychological Factors

Fear, anxiety, embarrassment, and other negative psychological states can contribute to pain. Excessive mental tension during catheterization may disrupt autonomic nerve function, leading to urethral spasm during insertion, which in turn causes varying degrees of pain and discomfort. For individuals performing self-intermittent catheterization, this pain and discomfort can further heighten anxiety. They may repeatedly attempt different insertion angles or use excessive force, potentially causing urethral injury and even bleeding.

IV. Catheter-Related Factors

The quality of the catheter is critical. If the insertion tip is not sufficiently smooth, has burrs, or is deformed, it may directly injure the urethral mucosa and cause pain. In addition, choosing an inappropriate catheter type or size — particularly a catheter that is too large in diameter — can irritate the urethral mucosa, increase urethral resistance, and lead to pain after insertion.

V. Technique-Related Factors

Proper catheterization technique is essential, especially in male patients. When the catheter passes through the urethral curvatures and narrow segments, failure to adjust the penile angle appropriately and using excessive force can easily cause urethral injury. Inadequate catheter lubrication can also contribute to pain and discomfort during insertion.

Management Strategies

Based on the above factors, the following measures can help reduce the incidence of pain during catheterization:

1. Relax and Stay Calm

Patients should aim to remain as relaxed as possible during catheter insertion and minimize mental tension. Taking a warm bath or performing light relaxation exercises beforehand can be helpful. If resistance is felt during insertion, trying to cough a few times may assist. For wheelchair users, moving to the edge of the wheelchair can relieve perineal pressure and prevent urethral compression. Coughing or adjusting posture helps maintain relaxation and facilitates catheter passage.

2. Choose an Appropriate Catheter

It is essential to select a catheter with a sufficiently smooth surface and smoothly finished drainage eyelets, and to ensure the diameter is appropriate. The following catheter size recommendations are from the European Association of Urology Nurses (EAUN):

① For adult catheterization, a 12–14 Fr catheter should be the first choice.
② For children under 6 months, use a 5 Fr catheter.
③ For children over 6 months: start with 6–8 Fr for boys, 8 Fr for girls, and adjust according to the individual child's circumstances.
④ If any problems arise during catheterization, or if blood clots or sediment are observed in the urine, this often indicates that the current catheter size is inappropriate. Professional medical advice should be sought.

3. Follow Proper Catheterization Technique

Before insertion, ensure the catheter is adequately lubricated, or use a hydrophilic coated catheter to provide continuous lubrication throughout the procedure, reducing friction and protecting the urethral mucosa. All movements should be gentle. Deep breathing can help relax the entire body and reduce pain and discomfort. If resistance is encountered, pause — especially in pain-sensitive individuals, as this may cause strong urethral sphincter contraction and increased urethral resistance. Wait until the patient is fully relaxed before slowly resuming insertion.

For male patients, special attention must be paid to the urethral curvatures during catheterization. Lift the penis to form an angle of approximately 60° with the abdomen to eliminate the prepubic curvature as much as possible, and slowly insert the catheter. When resistance is felt approximately halfway through insertion, this indicates the catheter has reached the second curvature (infrapubic curvature). At this point, gradually lower the penis toward the thighs to form an angle of about 90° with the abdomen. Once resistance disappears, continue insertion.

For female patients, insertion is relatively simpler. However, the catheterization technician should be thoroughly familiar with the location of the urethral meatus, insert gently and slowly, and advance the catheter an additional 2 cm after urine begins to flow. If the catheter accidentally enters the vagina, a new sterile catheter should be used for re-insertion.

Disclaimer

Some of the content in this article comes from online sources. If there is any infringement, please contact us for removal.

The medical information provided here is for reference only and should not be used as a basis for clinical diagnosis or treatment.