Urinary catheterisation

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 doctors or nurses in hospital or the community.

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.

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.

Why urinary catheters are used

A urinary catheter is usually used in people who have difficulty passing urine naturally. It can also be used to empty the bladder before or after surgery and to help perform certain tests. Specific reasons 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 which affects your ability to pee
• to drain your bladder during childbirth, if you have an epidural anaesthetic
• to drain your bladder before, during and/or after some types of surgery, such as operations on the womb, ovaries or bowels
• to deliver medication directly into the bladder, such as during chemotherapy for bladder cancer
• as a treatment for urinary incontinence when other types of treatment haven’t worked

The catheter will be used until it’s no longer needed. This may be for a short time and will be removed before leaving hospital, or it may be needed for longer or even permanently.

Types of urinary catheter

There are 2 main types of urinary catheter:

• intermittent catheters – catheters that are temporarily inserted into the bladder and removed once the bladder is empty
• indwelling catheters – catheters that remain in place for many days or weeks and are held in position by a water-filled balloon in the bladder

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

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 will 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 problem 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 they usually need to be treated with antibiotics.

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

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

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 are then removed.

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 your body). The sterile catheter is usually pre-lubricated and ready to use to reduce any discomfort or damage 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 referred to 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 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 are not suitable to remain in place for longer than 3 months, so will need to be changed regularly.

Suprapubic catheters

A suprapubic catheter is a type of indwelling catheter. 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 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.

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.

Before being discharged from hospital, a specialist nurse will give you detailed advice about looking after your catheter.

Catheter equipment

You will be given a supply of equipment to take with you when leaving hospital, and told where to get further supplies in the future. In most cases, catheter equipment is available on prescription from pharmacies.

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

Self-catheterisation

If you have been taught to use intermittent catheters, you should insert them several times a day to drain urine into a toilet or bag. These catheters are usually designed to be used once and then thrown away.

How often intermittent catheters need to be used differs 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.

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.

Bags should be emptied before they become 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.

Both bags and valves should be replaced and thrown away about every 5 to 7 days.

At night, you will need to attach a larger bag to your valve or regular bag. This 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 3 months. This will usually be done by a doctor or nurse, although sometimes it may be possible to teach you or your carer to do it.

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.

You will be advised about measures to take to minimise these risks, such as:

• regularly washing your hands, body and catheter with warm water and soap – it’s particularly important to clean your hands before and after touching your equipment
• ensuring you stay well hydrated – you should aim to drink enough fluids so that your urine stays pale
• preventing constipation – staying hydrated can help with this, as can eating high-fibre foods such as fruits, vegetables and wholegrain foods
• avoiding kinks in the catheter and making 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 will be advised about when it is safe for you to go to work, exercise, go swimming, go on holidays, and have sex.

If you have an intermittent or suprapubic (inserted through your tummy) 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 seek medical advice

You should contact a district nurse or nurse practitioner (you may be given a phone number to call before discharge from hospital) or your GP if:

• you develop severe or persistent bladder spasms (similar to stomach cramps)
• your catheter is blocked, or urine is leaking around the edges
• you have persistent blood in your urine, or are passing large clots
• you have symptoms of a UTI, such as pain, a high temperature (fever) and chills
• your catheter falls out (if it’s indwelling and you haven’t been taught how to replace it)

If your catheter falls out and you can’t contact a doctor or nurse immediately, go to your nearest accident and emergency (A&E) department.

Support groups and further information

Living with a catheter can be a challenge and you may find it useful to seek more information and advice from support groups and other organisations.

The main disadvantage 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 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).

Symptoms of a catheter-associated UTI include:

• pain low down in your tummy or around your groin
• a high temperature (fever)
• chills
• confusion

Contact your GP, district nurse or nurse practitioner if you think you have a UTI, as you may need to take antibiotics.

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 fairly common with an indwelling catheter. This could become a problem if the catheter drainage system becomes blocked

Seek 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 years of catheterisation)