Urinary catheter patient journey

A urinary catheter is a thin tube that drains urine from the bladder into a drainage bag. It is usually inserted by a health care professional during a stay in hospital or a doctor’s surgery/your own home.

If you or someone you care for is living with a permanent catheter, it is possible that you may be taught how to ‘clean intermittent self-catheterise’ (or CISC). Being able to change your own catheter or that of someone you care for greatly improves the lives of people who are housebound with bladder issues, children with kidney issues and adults with spinal injuries.

There are two ways of inserting a catheter and your doctor will discuss which is best for you. 

• A urethral catheter is a small flexible tube inserted into your bladder through your urethra (the tube which carries urine from the bladder).
• A suprapubic catheter is a tube that gets inserted through a small opening made below your belly button. Depending on the reason and type of catheter required, it can be used for moments (minutes, hours or a couple of days), for acute conditions (short term; usually a few days or weeks), chronic conditions (long term) or in rare cases, can be fitted permanently.

You may be told you will need a catheter for several reasons including:

• you have an obstruction in the urethra (the tube which carries urine from the bladder) - this can be due to scarring, having an enlarged prostate or, in rare cases due to kidney or bladder stones
• you need to have your bladder drained before, during or after surgery
• you've had a baby delivered by caesarean section (C-section) or have had an epidural
• you need to urinate but have bladder weakness (urine leaks from the urethra) or nerve damage (such as an injury to the spinal cord)
• other treatments for urinary incontinence haven't worked (if a patient is particularly old or frail, for example)

In rare cases, a catheter may be used to deliver medication such as chemotherapy into the bladder as part of the treatment for bladder cancer.

The two main types of urinary catheters

The type of catheter you need is dependent on your reason for needing it, how long you need it for and other health issues you may have.

• Intermittent catheter - a temporary catheter that is inserted into the bladder through the urethra to drain urine into either a disposable container or a toilet. It is removed once the bladder is empty. The thin pre-lubricated tube is packed to ensure it is sterile (clean) and a new catheter needs to be inserted and removed several times a day. It should be in place just long enough to empty your bladder. You will be given a prescription for the right size and fit for you and it is possible to be taught how to do this method of catheterisation at home.
• Indwelling catheter - similar to the intermittent catheter, the indwelling catheter (sometimes referred to as a Foley catheter) is designed to stay in place for around three months. The catheter is held in place by a sterile water-filled balloon which stops it from falling out. If you are fitted with a free-draining catheter, it will drain into either a bag that will strap to your leg or into a collection pot. The catheter can also be fitted with a valve that allows you to empty urine from your bladder straight into the toilet or a collection pot. A suprapubic catheter is also a type of indwelling catheter but it is inserted into a small opening in your tummy (usually near to your belly button). This type of catheter is more suited to a person who has problems with their urethra (it may be blocked or damaged). Again, while this type of catheter is more long term, it will still need to be changed every six-to-eight weeks.

Your life and looking after your catheter

It may take you a while to physically and emotionally adapt to using a long term catheter, however you will eventually be able to live a relatively normal life. Specialist nurses will be able to give you detailed advice on looking after your catheter as will your doctor if you have any further concerns. Having a catheter shouldn’t stop you from doing most of your normal activities and you will be given personal advice on things such as work, exercise, holidays and sex.

Specific information on how to look after your catheter and your health will vary from person to person so if you are unsure, you should seek advice from your specialist nurse or GP.

You will be given detailed instructions and supplies to get you started once you have had an indwelling catheter fitted or are using an intermittent catheter. After this, your nurse will let you know where you can pick up further equipment. This is usually done in the form of a prescription for equipment or catheters that fit your own personal needs. These can be dispensed at most pharmacies or by registering for a home delivery service.

How often and when you will need to empty your bladder or the bag attached to the catheter will depend on your circumstances. For intermittent catheters, you may be advised to empty at regular intervals during the day or only when you feel the need to pass urine. For indwelling catheters, your nurse might suggest you empty the bag when it is half full. If you have a valve that drains directly into a toilet or container, you'll have to empty it at regularly spaced intervals to ensure that the bladder does not become too full.

Preventing infections and keeping good levels of hygiene is very important with any type of catheter you have.

To minimise the risk of urinary tract infections (UTIs) you should:

• keep hands, body and equipment clean by regularly washing with warm water and soap
• stay hydrated by drinking lots of clear fluids and lowering your caffeine intake (your urine should stay pale), avoiding constipation (keeping regular stool movements)
• check for kinks in the catheter if you use an indwelling catheter (they prevent urine from draining)
• ensure the drainage bag is below your bladder level

You should seek advice from your specialist nurse or doctor if you experience unusual pain or symptoms of feeling unwell (such as a fever, chills, blood in your urine). If your indwelling catheter falls out and you have not been taught how to replace it, contact your nurse or doctor immediately. If you are unable to get hold of anyone, you should visit your nearest accident and emergency department (A&E).

Sources used in writing this article are available on request.

_{Last revised: 17 April 2020}

_{Next review: 17 April 2023}