Urinary Catheterization

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Introduction

Urinary catheterisation - NHS Choices

A urinary catheter is a flexible tube used to empty the bladder and collect urine in a drainage bag.

Urinary catheters are usually inserted by a doctor or nurse.

They can either be inserted through the tube that carries urine out of the bladder (urethral catheter) or through a small opening made in your lower tummy (suprapubic catheter).

The catheter usually remains in the bladder, allowing urine to flow through it and into a drainage bag.

This page covers:

When they're used

Types

Looking after your catheter

Risks and problems

When urinary catheters are used

A urinary catheter is usually used when people have difficulty urinating  naturally. It can also be used to empty the bladder before or after surgery and to help perform certain tests.

Specific reasons a urinary catheter may be used include:

  • to allow urine to drain if you have an obstruction in the tube that carries urine out of the bladder (urethra) - for example, because of scarring or prostate enlargement
  • to allow you to urinate if you have bladder weakness or nerve damage that affects your ability to pee
  • to drain your bladder during childbirth if you have an epidural anaesthetic
  • to drain your bladder before, during or after some types of surgery
  • to deliver medication directly into the bladder, such as during chemotherapy for bladder cancer
  • as a last resort treatment for urinary incontinence when other types of treatment have been unsuccessful 

Depending on the type of catheter you have and why it's being used, the catheter may be removed after a few minutes, hours or days, or it may be needed for the long term.

Types of urinary catheter

There are two main types of urinary catheter:

  • intermittent catheters - these are temporarily inserted into the bladder and removed once the bladder is empty
  • indwelling catheters - these remain in place for many days or weeks, and are held in position by an inflated balloon in the bladder

Many people prefer to use an indwelling catheter because it's more convenient and avoids the repeated insertions needed with intermittent catheters. However, indwelling catheters are more likely to cause problems such as infections.

Inserting either type of catheter can be uncomfortable, so anaesthetic gel is used to reduce any pain. You may also experience some discomfort while the catheter is in place, but most people with a long-term catheter get used to this over time.

Read more about the types of urinary catheter.

Looking after your catheter

If you need a long-term urinary catheter, you'll be given detailed advice about looking after it before you leave hospital.

This will include advice about getting new catheter supplies, reducing the risk of complications such as infections, spotting signs of potential problems, and when you should seek further medical advice.

You should be able to live a relatively normal life with a urinary catheter. The catheter and bag can be concealed under clothes, and you should be able to carry out most everyday activities, including working, exercising, swimming and having sex.

Read more about living with a urinary catheter.

Risks and potential problems

The main problems caused by urinary catheters are infections in the urethra, bladder or, less commonly, the kidneys. These types of infection are known as urinary tract infections (UTIs) and usually need to be treated with antibiotics.

You can get a UTI from either short- or long-term catheter use. However, the longer a catheter is used, the greater the risk of infection. This is why it's important that catheters are inserted correctly, maintained properly, and only used for as long as necessary.

Catheters can also sometimes lead to other problems, such as bladder spasms (similar to stomach cramps), leakages, blockages, and damage to the urethra.

Read more about the risks of urinary catheterisation.

How-is-it-performed

Types

There are several different types of urinary catheter, which are inserted and used in different ways.

The main types are described below. You can also read a summary of the pros and cons of the different types of catheter, to compare your options.

Intermittent urinary catheters

In most cases, intermittent urinary catheters are recommended. These catheters are inserted several times a day, for just long enough to drain your bladder, and then removed.

You should be taught how to insert the catheter yourself. It's usually inserted into your bladder through the urethra (the tube that carries urine out of your body).

The sterile catheter is usually pre-lubricated to reduce the risk of any discomfort when you insert it.

One end of the catheter is either left open-ended to allow drainage into a toilet or attached to a bag to collect the urine. The other end is guided through your urethra until it enters your bladder and urine starts to flow.

When the flow of urine stops, the catheter can be removed. A new catheter is used each time.

Indwelling urinary catheters

An indwelling urinary catheter is inserted in the same way as an intermittent catheter, but the catheter is left in place.

The catheter is held in the bladder by a water-filled balloon, which prevents it falling out. These types of catheters are often known as Foley catheters.

Urine is drained through a tube connected to a collection bag, which can either be strapped to the inside of your leg or attached to a stand on the floor.

Indwelling catheters are sometimes fitted with a valve. The valve can be opened to allow urine to be drained into a toilet, and closed to allow the bladder to fill with urine until drainage is convenient.

Most indwelling catheters need to be changed at least every three months.

Suprapubic catheters

A suprapubic catheter is a type of catheter that is left in place. 

Rather than being inserted through your urethra, the catheter is inserted through a hole in your abdomen and then directly into your bladder. This procedure can be carried out under general anaesthetic, epidural anaesthetic or local anaesthetic.

A suprapubic catheter is used when the urethra is damaged or blocked, or when someone is unable to use an intermittent catheter.

The catheter may be secured to the side of your body and attached to a collection bag strapped to your leg. Alternatively, a valve can be attached that opens to allow urine to be drained into a toilet, and closes to allow the bladder to fill with urine until drainage is convenient.

This type of catheter is usually changed every six to eight weeks.

The British Association of Urological Surgeons (BAUS) website has a more detailed leaflet on inserting a suprapubic catheter (PDF, 242kb).

Read more about living with a urinary catheter.


 

living-with

Living with

It's possible to live a relatively normal life with a long-term urinary catheter, although it may take some getting used to at first.

Your doctor or a specialist nurse will give you detailed advice about looking after your catheter.

Catheter equipment

You'll be given a supply of catheter equipment when you leave hospital, and you'll be told where you can get more supplies from. Catheter equipment is generally available on prescription from pharmacies.

You'll also be shown how to empty and change your equipment.

Intermittent catheters

Intermittent catheters are usually designed to be used once and then thrown away.

How to use them varies from person to person. You may be advised to use them at regular intervals spaced evenly throughout the day, or only when you feel you need the toilet.

The British Association of Urological Surgeons (BAUS) website has more detailed leaflets on self-catheterisation in men (PDF, 158kb) and self-catheterisation in women (PDF, 160kb).

Indwelling catheters

Indwelling catheters can either drain into a bag attached to your leg, which has a tap on the bottom so it can be emptied, or they can be emptied into the toilet or suitable receptacle directly using a valve.

You should empty the bag before it's completely full (around half to three-quarters full). Valves should be used to drain urine at regular intervals throughout the day to prevent urine building up in the bladder. Leg bags and valves should be changed every seven days.

The bag can be attached to your right or left leg, depending on which side is most comfortable for you. 

At night, you'll need to attach a larger bag. Your night bag should either be attached to your leg bag or to the catheter valve. It should be placed on a stand next to your bed, near the floor, to collect urine as you sleep.

Depending on the type of night bag you have, it may need to be thrown away in the morning or it may be emptied, cleaned and reused for up to a week.

The catheter itself will need to be removed and replaced at least every three months. This is usually done by a doctor or nurse, although sometimes it may be possible to teach you or your carer to do it.

The BAUS website has a more detailed leaflet about the management of urethral catheters (PDF, 173kb).

Preventing infections and other complications

Having a long-term urinary catheter increases your risk of developing urinary tract infections (UTIs), and can also lead to other problems, such as blockages.

To minimise these risks you should:

  • wash the skin in the area where the catheter enters your body with mild soap and water at least twice a day
  • wash your hands with warm water and soap before and after touching your catheter equipment
  • make sure you stay well hydrated - you should aim to drink enough fluids so that your urine stays pale
  • avoid constipation - staying hydrated can help with this, as can eating high-fibre foods, such as fruit and vegetables and wholegrain foods
  • avoid having kinks in the catheter and make sure any urine collection bags are kept below the level of your bladder at all times

Read more about the risks of urinary catheterisation.

Your regular activities

Having a urinary catheter shouldn't stop you from doing most of your normal activities. You'll be advised about when it's safe for you to go to work, exercise, go swimming, go on holidays, and have sex.

If you have an intermittent catheter or a suprapubic catheter, you should be able to have sex as normal.

Indwelling catheters can be more problematic, but it's still usually possible to have sex with them in place. For example, men can fold the catheter along the base of their penis and cover them both with a condom.

In some cases, you may be taught how to remove and replace the catheter so you can have sex more easily.

When to get medical advice

Contact your community nurse (the hospital or your GP practice can give you a number to call) or your GP practice if:

  • you develop severe or ongoing bladder spasms (similar to stomach cramps)
  • your catheter is blocked, or urine is leaking around the edges
  • your urine is bloodstained or has specks of blood in it (you may have accidentally pulled on your catheter); contact your community nurse if you continue passing bloodstained urine or urine with blood specks
  • you're passing bright red blood (contact your GP as soon as possible)
  • you have symptoms of a UTI, such as lower abdominal pain, a high temperature and chills
  • your catheter falls out (if it's indwelling and you haven't been taught how to replace it)

Go to your nearest accident and emergency (A&E) department if your catheter falls out and you can't contact a doctor or nurse immediately.

Read more about the risks of urinary catheterisation.

Support groups and further information

Living with a catheter can be challenging. You may find it useful to get more information and advice from support groups and other organisations.

For example, the Bladder & Bowel Community provide information and support for people with bladder and bowel conditions.


Risks

Risks

The main risk of using a urinary catheter is that it can sometimes allow bacteria to enter the body.

This can cause an infection in the urethra, bladder or, less commonly, in the kidneys. These types of infection are known as urinary tract infections (UTIs).

Urinary tract infections (UTIs)

UTIs caused by using a catheter are one of the most common types of infection that affect people staying in hospital. This risk is particularly high if your catheter is left in place continuously (an indwelling catheter).

Symptoms of a catheter-associated UTI include:

  • pain low down in your tummy or around your groin
  • a high temperature (fever)
  • feeling cold and shivery 
  • confusion

Contact your GP or community nurse if you think you have a UTI. You may need a course of antibiotics.

Other risks and side effects

Bladder spasms, which feel like stomach cramps, are also quite common when you have a catheter in your bladder. The pain is caused by the bladder trying to squeeze out the balloon. You may need medication to reduce the frequency and intensity of the spasms.

Leakage around the catheter is another problem associated with indwelling catheters. This can happen as a result of bladder spasms or when you open your bowels. Leakage can also be a sign that the catheter is blocked, so it's essential to check that it's draining.

Blood or debris in the catheter tube is also fairly common with an indwelling catheter. This could become a problem if the catheter drainage system becomes blocked

Get medical advice as soon as possible if you think your catheter may be blocked, or if you're passing large pieces of debris or blood clots.

Other, less common, potential problems include:

  • injury to the urethra (the tube that carries urine out of the body) when the catheter is inserted
  • narrowing of the urethra because of scar tissue caused by repeated catheter use 
  • injury to the bladder or rectum (back passage) caused by incorrectly inserting the catheter
  • bladder stones (although these usually only develop after years of using a catheter)