Urinary catheterisation is a procedure used to drain the bladder and collect urine through a flexible tube called a catheter.
Urinary catheters are usually inserted by a doctor or a nurse. They can either be inserted through:
- the tube that carries urine out of the bladder (urethral catheter)
- 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.
Why urinary catheters are used
A urinary catheter is usually used when people have difficulty passing urine naturally. It can also be used to empty the bladder before or after surgery and to help perform certain tests.
People may also need a urinary catheter to:
- allow urine to drain if you have a blockage in the tube that carries urine out of the bladder (urethra) – for example, because of scarring or prostate enlargement
- allow you to pee if you have bladder weakness or nerve damage which affects your ability to do this
- drain your bladder during childbirth, if you have an epidural anaesthetic
- drain your bladder before, during and/or after some types of surgery, such as operations on the womb, ovaries or bowels
- deliver medication directly into the bladder during certain treatments
- treat urinary incontinence when other types of treatment haven’t worked
The catheter will be used until it’s no longer needed. In some cases, it may be needed permanently.
Types of urinary catheter
There are several different types of urinary catheter. These are inserted and used in different ways.
Intermittent urinary catheters
Intermittent urinary catheters are inserted into the bladder for a limited period of time. They are removed when the bladder is empty.
You should be taught how to do this yourself. This is known as clean intermittent self-catheterisation (CISC).
The catheter is normally inserted into your bladder via the urethra (the tube that carries urine out of the body). The sterile catheter is usually pre-lubricated and ready to use. This helps to reduce any discomfort or damage when inserting the catheter.
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 called Foley catheters.
Urine is drained through a tube connected to a collection bag. This can either be strapped to the inside of your leg or attached to a stand on the floor.
Indwelling catheters are not always free-draining and the catheter is 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 can’t stay in place for more than 3 months, so will need to be changed regularly.
Suprapubic catheters
A suprapubic catheter is a type of indwelling catheter. It’s 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. It can also be used when a person has a long-term condition and 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.
The catheter is usually changed every 6 to 8 weeks.
Complications of urinary catheters
Sometimes urinary catheters can allow bacteria to enter the body. This can cause an infection in the urethra, bladder, or sometimes the kidneys. These types of infection are known as urinary tract infections (UTIs).
Urinary tract infections (UTIs)
UTIs resulting from catheter use are one of the most common types of infection affecting people staying in hospital. This risk is particularly high if your catheter is left in place continuously (an indwelling catheter).
Having a long-term urinary catheter increases your risk of developing a UTI, and can also lead to other problems, such as blockages.
Symptoms of a catheter-associated UTI include:
- pain low down in your tummy or around your groin
- a high temperature (fever)
- chills
- confusion
Do
- regularly wash your hands, body and catheter with warm water and soap – it’s particularly important to clean your hands before and after touching your equipment
- ensure you stay well hydrated – you should aim to drink enough fluids so that your urine stays pale
- prevent constipation – staying hydrated can help with this, as can eating high-fibre foods such as fruits, vegetables and wholegrain foods
- avoid kinks in the catheter and make sure any urine collection bags are kept below the level of your bladder at all times
Other risks
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. Medication may be necessary to reduce the frequency and intensity of the spasms.
Leakage around the catheter is another problem associated with indwelling catheters. This is called by-passing and can occur as a result of bladder spasms or when you open your bowels. Leakage can be a sign that the catheter is blocked, so it’s essential to check that the catheter is draining.
Blood or debris in the catheter tube is also common with an indwelling catheter. This could become a problem if the catheter drainage system becomes blocked
Get medical advice 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 use of a catheter
- injury to the bladder or rectum (back passage) caused by incorrectly inserting the catheter
- bladder stones (although these usually only develop after many years of catheterisation)