Choosing The Best Catheter For Paraplegics

Reading time: 8 minutes

When it comes to choosing a catheter, it ranks among the top five biggest decisions concerning your new life.

Unlike a wheelchair, you can make a decision and change it as many times as you want, whenever you want, so long as you’re willing to go through the niceties. There are about 5 categories to consider when you’re making this decision. Similar to my other posts, we’ll go for a ride with the Cosmo of Rehab Past and look at my experiences, mistakes, and logic. Towards the end, there will be a questionnaire to help you decide what style catheter might suit you, or rather, what types to avoid.

Before we begin, there is a paradox that merits some consideration. Experience is a teacher that cannot be replaced, but the time spent on the experiences that can be taught is time wasted.

For some of what I preach, the written word has a limited impact, spoken word alike. Personally, I don’t like to take advice in the realm of wheelchairs. Many times I’ve been misguided by a pungent mixture of naivete and trust that the guide knew more about me than me. Like Charlie Munger, I have many mental models that I use to judge whether or not to accept and act on advice. All I can say is that a lot of what I talk about, categorically, regards important endeavors. Be skeptical, but don’t neglect the weight of how helpful my experiences can be in guiding yours to a better place. Instead of paving your path, I try to draw the borders in which you can pave your own path and give you some best practices for paving an effective path along with some steps to consider taking.

It’s good to remember this is my experience as a man, the general guidelines for choosing a catheter can apply to women, but my experience might be far from the female equivalent.

Fade in: rehab. I just arrived from the hospital and learned how to cath firsthand. It’s a tedious process. It never occurred to me that it would be different, I guess I didn’t think about the future of catheters too much, no one gave me any inclination that I’d be using different catheters until the last few days of rehab. It’s a flat package, sterile, about the size of a tablet. One side is clear plastic and the other is like wax paper. The contents of the package are medical gloves, a piece of soft paper – the type they lay on your chest at the dentist, a sauce packet of medical lubricant, another sauce packet with sterilizing swabs, and a catheter. The catheter has a bag attached to it with measuring lines if you keep track and the tube leading into the bag has a plastic cover over it. At the end of the tube, or the front, there is a little blue nozzle. The process is methodical, almost ritualistic. The point of the extra precautions – the gloves and sterile pad – is to avoid a UTI. Especially in rehab, they take every measure to make sure you’re safe and healthy so you can focus on recovery.

First, you wash your hands, properly expose yourself, open the package, then you put on the gloves making sure not to touch anything because the gloves are sterile and if you touch anything other than the sterile contents, you’re getting ten minutes in the corner and give me your phone too. After the gloves are on, you grab the paper cloth and lay it out on your exposed lap, grab the sterilizing swabs and use them to clean yourself off, proceed to grab the catheter, take the cap off the nozzle, take the lubricant packet, put some lubricant on the nozzle and the rest is medical.

After you’re done, you empty the warm contents into the toilet and then throw out everything else. It takes a while and there’s no chance being in a hurry will help. In rehab, we were on a schedule to cath every couple hours and were expected to deliver 200 – 400 mL.

Flash forward, soon before I leave rehab. My occupational therapist and I are going through a document and looking at different types of catheters and what options I have. She brings me a few samples to try and see which ones I like. This was the first time I had to choose a catheter and I really didn’t know what mental models to be using and how to judge what type of catheter will be good for me. Before I made my decision, I had talked with someone who came into the rehab facility to answer some questions of mine. He told me what catheter he used and that’s the one I chose. I made a big mistake. It didn’t work out for me at all. It was my fault to take advice so readily. Luckily, I knew what other types of catheters there were because my OT and I had talked about them and I tried them.

Myself, I use intermittent catheters, though there are a few different types of catheters you may use depending on the situation and need.

  • Intermittent catheters are one-time, short term catheters.
  • External catheters are ones that don’t go in but go over. Used in a rain collector fashion.
  • Long term catheters are, well, long term. It could be all day or for a week, whichever your doctor advises and what works for you.

I will be referencing a specific brand – Hollister – so that we can stay in one place while we talk about the different types and what you should consider.

The first catheter that I used and subsequently stopped was one without a bag attached. It was just the tube and the tube didn’t have any covering over it (there is a version with a covering over it). It had a little slide bar on the tube that I used to grab the tube without touching it.

The first catheter I used

The issues I had with it was that it took both of my hands to use the catheter, but once I got it to where it needed to be, I would also need to hold something at the end, like a bottle or container, to collect and I didn’t have much tube left to properly aim, or ease of holding a container.

Along with that, the package was the shape of a ruler but a fair bit longer, this made packing it into a backpack difficult, I didn’t want to bend it (I don’t think I was supposed to). Other than the length, it was pretty flat and packable so, if you travel with a duffel bag or a larger bag, then this would work well for you.

When I was done cathing, I had to throw it away, and it didn’t fit nicely into any of my trash cans. I tried to find new ways to use the catheter that would work better. Instead of using a container, I tried using an extra tube and even a mini aqueduct. I had a plastic tube that I put the end of the tube into so that I would extend the catheter length and then the attached tube would be long enough to go into the toilet. The aqueduct was similar, except it wasn’t pliable and just acted as a ramp leading into the toilet. The problem with these solutions is that I need a toilet, if I’m on an airplane or not able to get close to a toilet, then I’m back to the container.  

I realized that I needed a bag attached to the catheter. I knew exactly what I wanted, in fact I already had a few. The process for catheters at home had a great time reduction. It went from taking every precaution to kissing the edge of the danger zone. All I did was open the catheter, make sure not to touch the tube, which was actually hard because this was an open tube, and after the pool was drained, I threw out the catheter.

The new catheter I got was supremely compact and much more fitting for my lifestyle. Not the size of a tablet, not the size of a 2 foot ruler, it’s the size of a table coaster. If I fold it in half, it’s the size of my palm, but considerably thick.

This means I can fit it into my pocket and if I’m wearing a jacket, I could have one or two in each pocket and no one would be wiser. It still has the same length tube but is curled up (and meant to be) along with a bag attached as well as a cover on the tube. The cover on the tube means that I can grab the tube and use it to help me use the catheter.

The catheter style I have now, with the bag attached, has been very useful for when I’m on an airplane. In the air, as I’ve been plenty of times, you have to cover up when you cath, which means you’re literally in the dark.

Trying to cath in the darkness of cover from a jacket, without touching the tube and catching it all in a container while on an airborne, turbulent prone chair house is a mission of impossible heights. A mission I never had to attempt because of my quick transition to my pocket friendly catheter.

When you’re choosing a catheter, consider what matters more to you:

Environmental sustainability or Convenience

Extra safety precautions or Minimalism

Travel friendly or Cost friendly

You can compare any of these to any other.

Here are some examples of features/questions you may want to consider and what they mean:

Does it come lubricated? – if you don’t want to carry a packet of lubricant with you, then get pre-lubricated. It depends on if you care more about the convenience or if it’s cheaper to get a catheter that isn’t lubricated.

Is the tube covered? – this is about safety of having an exposed tube that could lead to a higher chance of a UTI, it’s more environmentally sustainable if there isn’t a cover (less plastic use) and it might be cheaper as well. Having the cover allows you to touch the tube to use the catheter.

What else comes with it? – you can get packs of catheters that come with gloves and sterilizing swabs, but do you care more about being very cautious or about environmentally sustainable as well as cost and compatibility? If it just comes with the tube or a tube with an attached bag, that’s about as little as you can get.

How compact is it? – look into the shape/size of the packet the catheter comes in. Can you imagine using a small backpack when you go out in town and brining this catheter with you? Think about how often you’ll be travelling or venturing out and if compatibility will matter, if you’re more of a stay at home or work person, then consider how easily the package and catheter can be thrown out. (the long tube didn’t fit well in my trash can).

How long does it last? – Some catheters have expiration dates on them, the lubricant might dry out and so on. The expiration date might matter because if you buy in bulk for travelling, then you’ll most likely buy 3 or 4 months supply at once and you need to know that the catheters won’t expire towards the end.

Now you should be ready to throw wind to the caution and rationally select a catheter. One thing to note is the question that precedes all of the guidance above is, what do you need? Your doctor, nurse or therapist should be able to tell you what planet your voyaging – if you’ll be using intermittent catheters or otherwise, that will define which categories you search through and subsequently use the above guidance to help.


Immediate action items: If you have yet to leave rehab, start asking about catheters and consider these parameters when you choose one. If you’re out of rehab, can your catheter better align with who you are?  

Summary: When we choose a catheter, there are many aspects that we aren’t even aware of, which can lead to mistakes. Herein lies some helpful guidelines for what to consider when choosing a catheter. There isn’t a best catheter for everyone, there is only the best catheter for you, individually.

Overdeliver: More likely than not, you can easily get a sample of the catheters you’re considering. Sometimes you can request a sample directly from the manufacturers website or send an email to a representative. This way, you can try out many types and make a better decision along with expanding your knowledge of what options you have.

Don’t Hesitate: A Message to All Paraplegics

This applies to everyone, actually

Reading time: 6 minutes

At the beginning of my journey, I was in the hospital (of course), and I was extremely uncomfortable with everything. The thought of a catheter makes anyone squirm, even at this point, over a year after using catheters every day, I try not to think about it.

I’m not as manly as you might think. For the 6 days, I was in the hospital after my surgery, I hated when I had to “cath.” I would take a pillow and put it over my face and tell the nurse to just tell me when it was over. Even though I couldn’t really feel it, I was afraid that I might.

Just a few days before, I was walking and NOT using a catheter, I didn’t even know what a catheter was.

I took it to an extreme. By the third or fourth day, I was down from four IV’s to just one. I didn’t need much of any medication. However, I was so terrified of being able to feel the catheter that I still took pain killers. I demanded it. I didn’t need them at all, though.

That’s how scared I was about feeling the catheter.

Right now, I’d go back in time and slap myself.

Don’t make the same mistake. For using a catheter or anything, really.

When I went to rehab a few days later, I knew something had to change. I realized that I can’t be scared about cathing if I expect to recover and gain my independence back.

The very first day, the nurse who came in, his name was Caesar (his name is Caesar), I told him that I need to cath (it was a long ride from the hospital to rehab) and that he needs to teach me how to do it.

Two mistakes I made in the hospital:

  • I didn’t take responsibility for myself and I avoided doing what was necessary
  • I didn’t learn how to be responsible for myself

Some of you might not physically be able to cath, that’s totally fine.

The point here is that you have to do everything you’re capable of doing.

In the hospital, I could have asked the nurses and doctors about how catheters work, best practices, and how to do it.

Visualize what life will be like once you’ve recovered. For me, it involves living a life of freedom – traveling and exploring. I might buy an RV and live a life of touring the country. If that happens, and I hope it does, I will probably have to poop in the woods at some point.

When I was scared of cathing, did I expect someone else to do it for me my whole life, when I absolutely can do it for myself? Honestly, I can’t understand why I was even okay with someone else doing that for me.

It gets a little worse.

A catheter is only for #1. What about #2?

This next part is 18+

Don’t continue reading unless you’re prepared to feel uncomfortable.

If you’re not 18, but in a wheelchair, then you’ll probably be familiar with this, so for anyone in a wheelchair, this is another day in the park. (Not that it’s nearly as pleasant).

For me, and it may differ drastically for everyone, this is called the bowel program. I came up with many names, such as “poopy program” or anything that didn’t sound so medically uptight. After all, I already had a finger up my ass.

It took me much, much longer to accept that I had to “manipulate my bowels.” I don’t remember when I first did it myself, but if you’re patient and a fast reader, I probably mentioned it in one of my Instagram posts.

This is one of those things that I look back and shake my head a little. I don’t remember if I ever pooped in the hospital, but before I tell you about my first time doing this myself, here’s how it worked in rehab when I didn’t do it for myself.

At a set time every night (rehab was very regimented), I would grab my fancy hospital bed remote and press the button I was all too familiar with. The SOS. The help button. 

The nurse assigned my room would come in. We always bantered and had good conversations. They would grab the incontinence pad unless I already had one under me. It’s pretty much a square diaper. I would take off my diaper. By now, the door was shut and my Mom had left the room, thank God. 

The first step for the nurse was to put on some medical gloves, then some medical lubricate on their finger and while I lay on my left side, go in and clear out the colon. Then, with the “ready to go” stuff out, we wrapped it up in the incontinence pad and like planned magic, there was another pad underneath. Part two is that a laxative was put in and the nurse left, waiting for me to call 15 minutes later to take the second incontinence pad, wrap it up and we’re done.

The song I played.

Nurses were both men and women. One time, I played this song as one nurse came in. Luckily, she thought it was funny. Even when a nurse is coming in to put their finger in your butt and pull out poop, you can still be lighthearted. 

This went on for a lot longer than it should’ve. If you’re reading this while you’re in rehab or even still in the hospital, then I’m happy. 

I want this message to get to as many people as it can early on. 

This was something that I just couldn’t accept doing for a long time. It was outside of my comfort zone. This was astronomically out of my comfort zone. I didn’t expect it to be done for me forever and again, I was completely able to do it for myself. Because of that, I can’t imagine why I was so much more comfortable with someone else doing this.

The first time I did my own bowel program

I had prepared. The past three or four nights, I wasn’t just lying on my side in silence. I was asking for gruesome details. I knew that I needed to do this on my own. In rehab, they also have standards they hold you to. They expect you to progress and have thresholds for how long you can be in one spot. I had reached the limit for how long I could avoid doing this. 

It was the nurse that I carelessly whispered who came into my room and told me to get up and do it myself. Instead of doing my bowel program on the bed, which would’ve been a lot harder, she had me get into my wheelchair, go into the bathroom and transfer onto the toilet commode (a cushioned chair with a hole in the middle). At this point, she was giving me the tough love that I am more than thankful for. I live for tough love. She wouldn’t believe me that this was actually my first time and that I still didn’t know what I was doing. 

I double gloved. I wanted to put as much distance between me and this process. Two gloves was the best I could do. After that, I put on the lubricant and manipulated my bowels. 

A quick note: while I was doing this, the nurse told me that sometimes this will cause people to pee and that sometimes people peed on her! It takes a brave person. She was still helping me and making sure to coach me through this unthinkable process, so, she was sitting right in front of me. You can use your arm to point “it” down while you do this (doesn’t apply to women). 

Ever since that day, I’ve been doing the bowel program myself. I only wish that I had done it myself a lot earlier than I did. 


Immediately actionable item: Ask yourself, am I avoiding doing something that I shouldn’t be? Set a plan to do it today, or begin the process today.

Summary: Don’t hesitate cathing or your bowel program. Do as much as you can early on. You’ll have to do it on your own at some point. I waited way too long to do some things on my own. It takes a lot of courage, but it’s something you need to do. 

Over-deliver: A lot of people won’t give you the tough love you need. They’ll give you the easy way out and help you if you ask. If things seem too easy, ask for tough love.

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