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Addressing Catheter-Related Mental Health Issues: Strategies for a Better Quality of Life
Neurogenic bladder may be a result of SCI, Spina Bifida, MS, and other conditions, requiring the use of a catheter for bladder management. Medical conditions and stress may alter neurotransmitters in the brain, linked to physical and emotional changes after a traumatic event.
The need for catheters is a direct result of another health condition, which may come with mental health concerns or emotional challenges. Research shows a relationship exists between emotional domains and achieving a “new normal” after a traumatic event, such as an SCI. It has been hypothesized that the use of catheters may impact users’ emotional status; however, further investigation is necessary to discover the extent of the neurogenic bladder’s impact on emotional and mental health.
Common Mental Health Challenges:
Depression and anxiety associated with catheter use: It’s important to note the difference between grief/sadness and depression. Grief/sadness/anger/etc are not uncommon feelings after a traumatic event; however, depression is a clinical condition that impacts a person’s ability to engage in their daily tasks, and it significantly impairs their thoughts and feelings.
Research shows that females demonstrate a significant increase in both depression and anxiety compared to males; this difference is compared between those who are independent and those who require assistance for bladder management.
Achieving the optimal level of independence for bladder management takes time and may change as functional abilities change.
“The best way to combat your feelings of helplessness and confusion is to arm yourself with information on what a (spinal cord injury) is, and what it means in terms of short-term planning and long-range goals.” -Christopher & Dana Reeve Foundation
Concerns may exist surrounding pain/discomfort, leakage between catheterizations, intimate relationships, and more. Discuss these with your clinical team and know that strategies and options exist to promote your health and quality of life.
Body Image Concerns and Self-Esteem Issues:
– Research shows that both males and females report having concerns with their body image and self-esteem, as pertaining to bladder management.
– Rebuild your identity, accommodating for a “new normal”
Social Anxiety and Isolation:
– Research shows that those who perform intermittent catheterization are generally socially connected; however, this is impacted significantly by the difference between those who require assistance, and those who do not.
– Increased social interactions improve quality of life; therefore, it is important to learn how to perform intermittent catheterization in a variety of community settings, implementing problem-solving techniques to develop the optimal long-term outcome.
Coping Strategies:
Mindfulness and relaxation techniques: BREATHE! This will help to alleviate stress/anxiety, and allows prevent pelvic muscles from contracting, resulting in resistance/difficulty with catheter insertion.
Cognitive behavioral therapy approaches: Understanding the barriers/triggers behind bladder management will facilitate the motivation for active participation and progress toward goals through hands-on treatment approaches. Has the potential to improve compliance with bladder regimen by helping individuals to identify barriers, implement problem-solving skills, and regain control.
Support groups and peer connections: Peers know what you’re going through better than anyone else…!
– Christopher & Dana Reeve Foundation
Techniques for Building Confidence:
Ensure you have all necessary supplies prior to intermittent catheterization.
– Perform catheterization in a private environment that is conducive for you.
– Obtain the optimal position to promote bladder emptying, based on individualized functional abilities and bladder management strategy.
– BREATHE! This will help to alleviate stress/anxiety, and help prevent pelvic muscles from contracting, resulting in resistance/difficulty with catheter insertion.
– Practice your individualized bladder management strategy in a variety of settings and environments: restaurant, gym, gas station, and more. This will further develop your troubleshooting skills, ultimately improving your independence
Tips for Maintaining Privacy and Dignity:
– Catheters are available in a variety of compact and discreet packages that fit in a purse, cross-body, or backpack.
– Ask for help when needed!
– Adapting to different environments (work, travel, etc.)
– Ensure you have an adequate number of catheters (include extra!) and all necessary supplies to manage infection risk.
– Practice in a variety of environments to improve problem-solving and troubleshooting different scenarios and bathroom layouts.
– Covering yourself with a blanket could maintain privacy; using a closed system catheter may also be beneficial for the management of infection risk, and ease with urinary drainage and collection. If a closed system is not available, a leg or drainage bag can be utilized for efficient urine collection and containment.
– Catheters are permitted in both checked bags and carry-on luggage. When checking your luggage with catheters, ensure you are bringing extra catheters and supplies in your carry-on!
Managing Catheter-Related Anxiety:
Addressing fears of complications or malfunctions
Know your body:
– What is your regular output?
– Are there any physical changes to your urine?
– Are your spasms increasing?
– Be aware of potential complications or concerns with self-catheterization, and know when to contact your doctor.
Strategies for Reducing Stress During Catheterization:
– Ensure you have all necessary supplies prior to intermittent catheterization.
– Perform catheterization in a private environment that is conducive for you.
– Obtain the optimal position to promote bladder emptying, based on individualized functional abilities and bladder management strategy.
– BREATHE! This will help to alleviate stress/anxiety, and help prevent pelvic muscles from contracting, resulting in resistance/difficulty with catheter insertion.
– Don’t force catheter insertion because this could damage the urethra.
– Everyone goes to the bathroom; everyone does it differently. Normalize your bladder management method. Comfortability and confidence are contagious!
– Answer questions, as you’re comfortable, and normalize intermittent catheterization as your healthy method of bladder management to maintain your quality of live and overall health.
Building a Support Network:
Importance of family and friend support
– If the individual becomes ill or unable to perform intermittent catheterization for any reason, it’s important to have a support system of individuals who are trained in ISC and can step in to maintain bladder and overall health.
– Help with normalizing your bladder management strategy for overall health and long-term outcomes.
Working with healthcare professionals
– Working with a nurse and/or urologist may be beneficial in preventing your risk of UTI, and long-term bladder management and health.
– An occupational therapist will work with you to develop the optimal strategy for independence, health, and quality of life. This may include adaptive equipment, positioning strategies, wheelchair dressing tips, and more.
– A counselor or therapist may help with coping and adjusting after trauma. Counseling/therapy may also provide tools and strategies for long-term success.
Online communities and resources
Enhancing Body Image and Self-Esteem
Reframing perceptions of self with a catheter
– Opportunity to rebuild and expand upon self-identity!
– Everyone goes to the bathroom; everyone does it differently. Normalize your bladder management method. Comfortability and confidence are contagious!
Clothing tips and lifestyle adjustments
– Modified clothing options
– Adaptive equipment and strategies to assist with dressing
– Indwelling and external catheters, tubes, and drainage bags may be hidden discreetly underneath clothing.
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Celebrating personal achievements and milestones:
-Consider monthly, weekly, and daily milestones: What was achieved this month, that may not have been feasible 3 months prior?
Seeking Professional Help
When to consult a mental health professional
– When you feel it is necessary, would be beneficial, and are ready!
– Physical and psychological manifestations: Increased pain, change in appetite, altered sleep patterns, negative thoughts, feelings of hopelessness, and more.
Types of therapy beneficial for catheter users
– Pharmacological treatment (medications)
– Psychotherapy/counseling
– Cognitive behavioral therapy: engaging in meaningful activities to improve well-being by changing the way one thinks and behaves.
– Physical exercise/activity
– Combination of exercise, medications, and therapy
Integrating mental health care with physical care
– Mental health care is a necessary aspect of recovery AND ongoing progress.
– When mental health conditions and physical conditions coincide, there is a direct impact to quality of life and long-term health outcomes; therefore, it’s important to take control of your health!
– Exercise releases endorphins, which improves your overall well-being