Introduction 

Intermittent self-catheterisation (ISC) is recognised as the gold standard method for bladder emptying (Yates, 2023). My understanding of its impact on quality of life has been shaped not only by research, but also by professional experience. My interest began in 2015 while working in customer support for a catheter manufacturer, speaking daily with people using a wide range of products. Their stories revealed that ISC is far more than just a clinical procedure – it can influence identity, independence, and dignity. This motivated me to explore ISC further during my dissertation for my adult nursing degree completed in 2019.
 
Research continues to reinforce the complexity of ISC experiences. A 2024 analysis from the Continence Care Registry highlighted that comfort, ease of use, and hygiene strongly affect quality of life in ISC users (Newman et al, 2024). Similarly, a nationwide study by Christiaans et al (2025) found that patients using ISC report significantly higher quality of life than those with indwelling or suprapubic catheters. A systematic review showed considerable variation in how ISC-related quality of life is measured yet consistently found both positive and negative impacts on users, depending on physical, psychological and social factors (van Doorn et al, 2024). 
 
Now, working as a clinical continence nurse specialist, I see these influences firsthand, from anatomical and dexterity challenges to the empowering moments when patients realise that they can regain control over their bladder. This article revisits the findings of the literature review I carried out in 2019 alongside more recent literature to explore how ISC continues to shape patients’ quality of life. The themes discussed below were identified through the systematic search strategy undertaken for my dissertation and developed through a process of thematic analysis, in which similar concepts were merged into broader subcategories. The more recent papers found in an updated literature review align closely with these established themes, so underpin the discussion that follows.
 

Common themes in quality of life for people using intermittent self-catheterisation 

Psychological coping and normalisation

ISC can feel daunting at first. Most people move through clear learning and adjustment phases, beginning with uncertainty or fear, gradually building confidence and eventually settling into a routine that fits their everyday life. Alongside this, ISC does not just affect bladder management – it can influence social plans, sexual relationships, work routines and family roles. In Newman et al’s (2024) cross-sectional study of 133 ISC users, 32% reported that ISC stopped them visiting friends and family as much as they would like, highlighting the broader impact on lifestyle. Gender differences were also noted: many men described ISC as a nuisance or a source of stigma, whereas women more often emphasised symptom relief, control, and day-to-day benefits (Logan, 2024). These differences reflect individual ways of processing a significant life change.
 
These lived realities align closely with the research. Psychological coping and the pursuit of normalisation sit at the centre of ISC experiences across a number of studies. Using in-depth interviews, Ramm and Kane (2011) and Shaw and Logan (2013) capture reflections on identity, control, and evolving perceptions of what ‘normal’ looks like after starting ISC.
 
For example, Kessler et al (2008) found that 78% of users reported ISC as easy, and over 80% felt it interfered ‘not at all’ or only ‘slightly’ with daily life. However, 10% experienced marked disruption, and some reported deteriorating quality of life. Yilmaz et al (2014) surveyed 267 people with spinal cord injury, finding early concerns were common: 50.2% feared dependence, and 43.2% felt embarrassed, with women reporting more embarrassment and greater difficulty performing ISC. It is likely that the difficulty and embarrassment women face reflects anatomical and positional challenges, although this was not explored further.
Qualitative findings deepen this picture. Shaw and Logan (2013) identified normalisation as a core process among people with spinal cord injury (who had been using ISC for a mean of five years). Many came to view ISC as the closest thing to natural voiding, tightly linked to independence and control:

‘It’s just like you going to the toilet and me going to the toilet, you know.’

‘It [ISC] was another step of independence…’

Acceptance, avoidance and denial were pivotal psychological responses. Acceptance was often described as reduced anxiety about leaks and a restored sense of control. In contrast, denial and avoidance undermined adherence. One patient experienced recurrent urinary tract infections and long-term damage before recognising the need for consistent catheterisation.

Denial is common, not only at diagnosis but again once at home, particularly for women navigating the grief and loss associated with altered bodily function (Ramm and Kane, 2011). Patient statements such as ‘pretend the whole thing never happened’ and ‘…it’s for old people, not for me!’ reflect this emotional disruption. In contrast, prior bladder difficulties sometimes accelerated acceptance (‘I knew it was going to help me long term…’). This mirrors more recent work in men by Logan (2024), where acceptance was shaped by the person’s life context and bladder symptoms before starting ISC.

More recent evidence continues to highlight the emotional dimension. In a 2023 cross-sectional study of 50 ISC users, Santos-Pérez de la Blanca et al reported that 98% of patients still felt self-conscious about ISC, showing that psychosocial impact persists even among experienced users.
 

Pain and injuring self 

Pain comes up again and again in the research, although people describe it very differently. In one of the earlier studies, Kessler et al (2008) found that severe pain was linked to poorer quality of life. A few participants talked about their quality of life getting noticeably worse, yet none stopped using ISC or took pain relief. This suggests that discomfort may be under-reported or simply accepted as part of the routine, which raises questions about how well pain is being assessed and managed, whether it relates to technique, catheter type, or underlying urethral issues.

A more product-focused study by Logan (2017) was generally positive, with most women reporting no insertion pain (81%) and no discomfort on removal (70%). However, that still leaves around one in five experiencing insertion pain and nearly a third feeling discomfort during removal. These groups are not really discussed in the original paper, even though their experiences are clearly important.

There are also concerns about injury. Yilmaz et al (2014) noted that some people, especially those with spinal cord injury, worried about hurting themselves or getting infections. Despite these fears, almost half still reported an improvement in their quality of life. Bolinger and Engberg (2013) similarly highlighted common issues like urinary tract infections and bleeding, echoing earlier studies that suggest infection risk may be influenced by how often people catheterise.

More recent work backs this up. Santos-Pérez de la Blanca et al (2023) reported urinary tract infections as the most common complication, with participants averaging 1.7 in the past year, although the study still concluded that ISC has a low risk for complications.

However, this creates a difficult balance for some patients. Those who stop or avoid ISC because of urinary tract infections, pain or fear of injury can increase their risk of developing urinary tract infections or further complications as a result of incomplete bladder emptying. It becomes a bit of a catch 22. ISC can help reduce infections but discomfort or anxiety around the procedure may lead patients to skip doing ISC for as long as possible, ultimately putting them at greater risk of infections, bladder deterioration and kidney damage.

The picture remains similar across older and newer studies. Many people manage ISC comfortably, but pain, discomfort and worries about injury can still knock confidence and affect how well people stick with it. Regular pain checks, reviewing technique, choosing the right catheter, and staying on top of infection prevention all play a big role in helping ISC feel more manageable and ‘normal’ for patients.
 

Positioning and hand dexterity 

Positioning and hand dexterity difficulties appear repeatedly across the literature regarding ISC, although they can affect people in different ways. In one of the more frequently cited studies, Bolinger and Engberg (2013) found that 25% of women experienced difficulties with positioning, while participants with multiple sclerosis often struggled with dexterity as a result of evolving spasticity. Because multiple sclerosis-related spasticity changes over time, nurses may find it challenging to assess how these issues will impact patients in the long term, particularly during initial teaching. Similar patterns are seen in the work of Yilmaz et al (2014), who reported notable gender differences in ISC independence among people with spinal cord injury: 47% of women were able to perform ISC compared with 84% of men. The authors suggested that women most commonly struggled with sitting balance and the anatomical complexity of accessing the urethra, whereas men tended to report more dexterity-related challenges.

These findings reflect wider patient experiences captured in qualitative studies. Logan (2017) highlights how many women describe the difficulty of ‘negotiating the female anatomy… as the urethral meatus is less obvious and difficult to locate’. Jenks (2020) further supports this, noting that anatomical variation can complicate identification of the urethral opening. This emphasises the importance of considering where and how ISC is taught, as certain environments or teaching positions may make learning easier or harder for individual patients.

Men face their own environmental and positional barriers, particularly when catheterising outside the home. Public male toilets have only recently begun incorporating disposal bins, and availability remains inconsistent. This can create practical difficulties for men who require privacy, a seated position, and appropriate disposal options. This may affect their willingness or confidence to perform ISC while out in the community.

These challenges show how anatomical and environmental factors can shape patients’ confidence with ISC. Catheter choice further influences comfort, grip, and ease of use, meaning the right catheter can support confidence while the wrong one may worsen existing difficulties. This reinforces the need for individualised assessment and tailored teaching so that patients can integrate ISC into daily life as comfortably and consistently as possible.
 

Nursing approach and learning ISC 

The nursing approach plays a key role in shaping how patients first understand and begin to integrate ISC into everyday life. As seen across earlier themes, the learning phase is rarely just technical – it is emotional, relational and deeply influenced by the way information is delivered. Several participants in Ramm and Kane’s (2011) study described entering the process with limited understanding of their own anatomy or of catheter options, which heightened feelings of fear, embarrassment and inadequacy. Quotes such as ‘I didn’t even know my own body…’ highlight how rushed or task-focused teaching can leave fundamental misunderstandings unaddressed. More recent evidence suggests these early emotional reactions remain common. Logan (2024) stated that embarrassment and fear continue to dominate the initial learning phase, indicating little change in patient experience over time.
 
Clinical pressures also shaped how supported patients felt. Some described teaching as performance driven (‘I had to do it a set number of times before I came out the hospital…’), while others felt moved ‘between jobs’ or exposed to unnecessary observation, including scenarios involving multiple student nurses. Such environments can intensify anxiety, particularly for women who may already face anatomical and positional challenges. Earlier findings by Logan (2017) and Kessler et al (2008) reinforce that many women require more time, privacy and reassurance to build confidence. Jenks (2020) further reported that for many individuals, the anticipatory phase, particularly the preparation and the anxiety leading up to teaching, was more distressing than ISC itself. This finding underscores the importance of a bespoke, patient-by-patient approach, highlighting how personalised communication and skilled, sensitive instruction can alleviate embarrassment and promote long-term adherence (Logan, 2024).
 
Follow up also emerges as a crucial component in the patient’s journey. Bolinger and Engberg (2013) found many users wanted continued support but received limited review after initial teaching, which left them feeling vulnerable to poor technique or reduced confidence. Collectively, these studies emphasise that a paced, respectful and individualised nursing approach should be offered, supported by time, privacy and good communication. This highlights that follow up with patients is essential for both skill development and long-term quality of life.

Conclusions 

ISC continues to remain the gold standard method for bladder emptying, yet this review highlights that the patient experience is shaped by far more than clinical outcomes alone. Across physical, psychological and social dimensions, ISC can influence identity, independence and overall quality of life in complex and highly individualised ways. While many people report relief, control and improved daily functioning, others face challenges such as pain, fear of injury, embarrassment, or difficulties with positioning and dexterity. These experiences evolve over time and are significantly shaped by how ISC is introduced, taught and supported.

Nursing approach emerged as a consistent influential factor across the literature. Personalised, paced and sensitive teaching supported by adequate time, privacy, communication and follow up has been shown to reduce anxiety and improve confidence, adherence and long-term outcomes. Specialist nurses with the appropriate education and expertise are well positioned to deliver this support, both within hospital settings and in the community. Nurses working for catheter manufacturers also play a critical role; they can visit patients in their own homes, offer ongoing follow up, and provide access to up-to-date product information and educational resources that further strengthen patient understanding and confidence. This can be a great supplement to the care initiated in NHS settings, or take away pressures and reduce waiting times faced within the NHS.

Ultimately, when ISC is supported through compassionate, skilled and individualised care, patients are more likely to achieve success, maintain adherence and experience meaningful improvements in their quality of life.

Practice points 

• Teaching environment matters: Where and how patients are taught intermittent self-catheterisation significantly influences their initial experience and long-term adherence. 
• Provide ongoing support: Consistent follow up and access to support improves patient outcomes and positively contributes to quality of life. 
• The impact on quality of life varies: Intermittent self-catheterisation can affect quality of life both positively and negatively, depending on a patient’s previous symptoms, experiences and expectations. 
• Individualised approach: Intermittent self-catheterisation is not a one size fits all intervention – each patient requires a personalised, holistic approach that acknowledges their unique challenges, emotions and needs.