Adaptation to Clean Intermittent Catheterization From Introduction Through Implementation: What Patients and Families Need to Know: A Position Document From the International Children's Continence Society (ICCS)

BACKGROUND: Clean intermittent catheterization (CIC) plays a key role in the management of children whose neurological, anatomical, or functional conditions hinder complete or spontaneous bladder emptying. Its significance extends beyond clinical outcomes, influencing family relationships, psychosocial development, school experiences, and the child's long-term independence. AIM: This position paper outlines the consensus of experts from the International Children's Continence Society (ICCS) on the broader impact of CIC on children with bladder dysfunction and their families. It offers practical recommendations for everyday life, integrating family perspectives, clinical experience, and observational insights. The paper addresses key aspects such as family dynamics, body image, self-esteem, school participation, peer relationships, and the transition to self-management and adulthood. METHODS: The content is based on evidence from the scientific literature, supplemented by expert consensus in areas where direct research evidence is limited. Due to the paucity of studies specifically containing cohorts involving just children, studies involving heterogeneous populations (both children & adults) are cited. This is not meant to be a systematic review of all available literature involving CIC. RESULTS: Central topics include optimal timing and preparation for initiating CIC, strategies to foster independence and reduce family stress, and school accommodations such as access to private facilities and flexible schedules to maintain privacy and dignity. It also highlights guidance on communication, social inclusion, and adolescent sexuality, supported through youth-focused counseling and peer networks. It provides checklists and evidence-based recommendations to help healthcare professionals, educators, and caregivers design individualized CIC plans that promote adherence, psychosocial well-being, and quality of life from childhood to adulthood.