If you or someone you care for has been told they have a urethral stricture, you already know that catheterization can become a significant challenge. A stricture — a narrowing of the urethra, usually caused by scar tissue — can turn a routine self-care task into something painful and unreliable, and sometimes impossible without specialist help.
This guide explains what urethral strictures are, how they develop and are treated, and how they affect catheterization.
What Is a Urethral Stricture?
The urethra is the tube that carries urine from the bladder out of the body. In men, it runs through the prostate gland and the length of the penis. In women, it is much shorter. A urethral stricture occurs when the lining of the urethra becomes scarred, narrowing it and restricting urine flow.
Strictures are far more common in men than in women because of the length and curvature of the male urethra. They are most common in the bulbar urethra and at the urethral opening (meatus), but can occur anywhere along the urethra, and range from a single short narrowing to longer or multiple segments.[1] A narrowing at the bladder neck or within the prostate is usually called a stenosis rather than a stricture.[2]
What Causes a Urethral Stricture?
Most strictures result from scarring (fibrosis) of the urethral lining; a small number are present from birth.[2] Common triggers of scarring include:
- Prior urethral trauma — a straddle injury (falling onto a bicycle crossbar, for example) is a classic cause of bulbar urethral stricture
- Catheterization injury — forceful or repeated traumatic catheterization, or a catheter that is too large, can injure the urethra and lead to scarring over time
- Pelvic fracture — significant pelvic trauma can disrupt the posterior urethra
- Prior urethral surgery — procedures including hypospadias repair, prostate surgery, or TURP can all result in stricture formation
- Infection — historically, gonorrhoea was a leading cause; today, other urethral infections can contribute
- Lichen sclerosus — a chronic inflammatory skin condition that can affect the penile urethra and meatus
- Idiopathic (unknown cause) — in a meaningful proportion of cases, no clear cause is identified
Catheterization itself can contribute to strictures, particularly with forceful insertion, an oversized catheter, or inadequate lubrication. Reported rates of stricture among people who use intermittent catheterization vary widely, from about 5% to 25%. Gentle insertion and good lubrication are the basic protective measures.[1]
Recognizing the Symptoms
Many patients first notice a stricture through changes in their urinary stream or increasing difficulty with catheterization. Common symptoms include:
- A weak, slow, or interrupted urinary stream
- Difficulty starting urination (hesitancy)
- Sensation of incomplete bladder emptying
- Increased effort required during catheter insertion
- Pain or burning during catheterization or urination
- Catheter resistance or inability to advance past a certain point
- Recurrent urinary tract infections (which can be linked to incomplete bladder emptying)
If you have reduced sensation — for example after a spinal cord injury — you may not feel pain or resistance. Bleeding, needing more effort to insert the catheter, or a catheter that stops at the same point each time are your warning signs.
If you suddenly can't pass your catheter, have severe pain during insertion, notice bleeding after catheterization, or have signs of a urinary tract infection (such as fever, chills, or new or worsening symptoms — see our UTI article), contact your healthcare provider promptly. Do not force a catheter past significant resistance. If you have a spinal cord injury at T6 or above, being unable to empty your bladder can trigger autonomic dysreflexia: follow your AD plan and seek urgent care — call 911 if symptoms don't resolve.
How Strictures Are Diagnosed
Diagnosis typically involves one or more of the following:
- Uroflowmetry — a non-invasive test measuring the speed and volume of urination
- Urethrogram (RUG/VCUG) — X-ray imaging with contrast dye to visualize the urethra and identify narrowings
- Cystoscopy — direct visual inspection of the urethra and bladder with a thin camera scope
- Ultrasound — sometimes used to assess stricture length
Treatment Options
Treatment depends on the location, length and complexity of the stricture, as well as your overall health and history. A urologist will recommend the right approach for you:
- Urethral dilation — gradual widening of the stricture using progressively larger dilators; often provides temporary relief but high recurrence rates
- Direct vision internal urethrotomy (DVIU) — endoscopic incision of the stricture; effective for short, simple strictures but recurrence is common in longer or complex cases
- Urethroplasty — open surgical reconstruction; generally considered the most durable option for many strictures when performed by an experienced surgeon
- Intermittent self-dilatation — in selected patients, usually after dilation or urethrotomy, regularly passing a catheter on a schedule set by the specialist can help keep the urethra open. Evidence on how well it prevents recurrence is mixed, and it can be uncomfortable, so it should only be done on medical advice.[1]
Catheterizing with a Urethral Stricture
If you catheterize with a known stricture — whether to empty your bladder or as prescribed self-dilatation — injury to the urethra is the main thing to avoid. Traumatic or forced catheterization can:
- Create a false passage — a new channel forced through the urethral wall beside the true lumen
- Worsen existing scarring through repeated micro-trauma
- Make catheterization increasingly difficult over time
- Cause pain and bleeding that reduces patient compliance with CIC schedules
Tip design, flexibility, size and lubrication can all affect how easily a catheter passes and how much friction it causes. Canadian best practice recommendations describe both angled (Coudé/Tiemann) tips and flexible rounded tips as options for narrowed or obstructed passages, and stress that no single catheter is the right option for every patient.[1] The right choice should be made with your urologist or continence nurse — and a catheter should never be forced past significant resistance.
Is my catheter size right for me? Would a different tip design — straight, Coudé/Tiemann, or flexible rounded — suit my anatomy? Would a pre-lubricated or hydrophilic catheter reduce friction for me? What should I do if I meet resistance or see bleeding? Could I try samples before deciding?
About the IQ Catheter
The IQ Catheter, manufactured by Manfred Sauer GmbH in Germany, is a single-use intermittent catheter, available in hydrophilic and gel versions. Its design combines a soft, rounded tip on a bendable neck, a flexible front section, and a firmer guiding shaft. Like any catheter, it isn't right for everyone; your urologist or continence nurse can help you decide whether it suits you.
IQ Catheter Canada is the exclusive Canadian distributor. Healthcare professionals can request complimentary samples for patients on their behalf — or patients can ask their urologist or continence nurse about the IQ Catheter at their next appointment.
Healthcare professionals can request complimentary IQ Catheter samples for clinical evaluation. Submit a sample request →
This article was written by IQ Catheter Canada, which distributes the IQ Catheter in Canada. It is general information, not medical advice. Talk to your healthcare provider about your own situation.
References
- Nurses Specialized in Wound, Ostomy and Continence Canada, Canadian Nurse Continence Advisors, Urology Nurses of Canada, and Infection Prevention and Control Canada. Clean Intermittent Urethral Catheterization in Adults – Canadian Best Practice Recommendations for Nurses. 1st ed. 2020. PDF
- European Association of Urology. EAU Guidelines on Urethral Strictures. Available at uroweb.org.