Urinary catheterisation: types of catheter, risks and living with one

A urinary catheter is a flexible tube that is used to empty the bladder. The urine drains through the tube and is collected in a bag, or released into a toilet through a valve. In most cases the catheter is put in place by a doctor or nurse, although some people are taught to insert their own.

The NHS explains that a catheter may be inserted through the urethra, which is the tube that carries urine out of the bladder, or through a small opening in the lower tummy. Many catheters stay in the bladder, so that urine can flow continuously into a drainage bag, but others are put in only for long enough to empty the bladder and are then removed.

Because the tube passes into a part of the body that is normally protected from bacteria, a catheter needs to be inserted with care, looked after properly and used only for as long as it is needed. Those three ideas, correct insertion, good maintenance and not leaving it in longer than necessary, run through all of the NHS advice.

The NHS says 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. Specific reasons listed by the NHS include:

• to allow urine to drain if there is an obstruction in the urethra, for example because of scarring or an enlarged prostate

• to allow you to pass urine if you have bladder weakness or nerve damage that affects your ability to pee

• to drain the bladder during childbirth if you have an epidural anaesthetic

• to drain the bladder before, during or after some types of surgery

• to deliver medicine 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

There are two main groups, intermittent and indwelling, and a third route, the suprapubic catheter, which is a type of indwelling catheter placed through the abdomen. The right choice depends on the reason for the catheter, how long it is needed and what the person can manage.

According to the NHS, many people prefer an indwelling catheter because it is more convenient and avoids the repeated insertions that intermittent catheters need. The trade-off is that indwelling catheters are more likely to cause problems such as infections.

That is one reason the NHS describes intermittent catheters as recommended in most cases where someone needs long-term bladder drainage. People who use them are shown how to insert the catheter themselves, and each catheter is designed to be used once and thrown away. Some people use them at evenly spaced times through the day; others only when they feel the need to pass urine, as advised by their team.

Inserting either type can be uncomfortable, so anaesthetic gel may be used to reduce pain. The NHS adds that some discomfort while a catheter is in place is possible, but that most people with a long-term catheter get used to this over time.

The main risk of a urinary catheter is that it can allow bacteria to enter the body. The NHS says this can cause an infection in the urethra, bladder or, less commonly, the kidneys. Infections linked to catheters are among the most common infections in people staying in hospital, and the risk is particularly high when a catheter is left in place continuously.

Symptoms of a catheter-associated urinary tract infection (UTI) listed by the NHS include pain low down in the tummy or around the groin, a high temperature or feeling hot, cold or shivery, and confusion. The NHS advises contacting a GP or community nurse if you think you have a UTI, as you may need a course of antibiotics.

• Bladder spasms, which feel like stomach cramps, are quite common; they are caused by the bladder trying to squeeze out the balloon, and medicine can reduce their frequency and intensity.

• Leakage around the catheter can result from bladder spasms or from passing a stool, and can also be a sign that the catheter is blocked, so it is essential to check that it is draining.

• Blood or debris in the tube is also common with an indwelling catheter, but can become a problem if the drainage system blocks.

• Less common problems include injury to the urethra on insertion, narrowing of the urethra from scar tissue after repeated catheter use, injury to the bladder if the catheter is inserted incorrectly, and bladder stones, which usually only develop after years of catheter use.

The NHS says it is possible to live a relatively normal life with a long-term catheter, although it may take some getting used to. Before leaving hospital you should be given a supply of equipment, shown how to empty and change it and told where to get more; catheter equipment is generally available on prescription from pharmacies.

The NHS describes several practical points for indwelling catheters. A leg bag has a tap at the bottom and should be emptied before it is completely full, at around half to three-quarters full. Valves should be opened at regular intervals through the day to stop urine building up in the bladder. Leg bags and valves should be changed every 7 days, and at night a larger bag is attached, usually a single-use night bag to reduce the risk of infection, kept near the floor on a stand beside the bed.

To lower the risk of infection and blockage, the NHS advises you to:

• wash the skin where the catheter enters the body with mild soap and water every day

• wash your hands with soap and warm water before and after touching catheter equipment

• stay well hydrated, aiming for pale-coloured urine

• avoid constipation, using fluids and high-fibre foods such as fruit, vegetables and wholegrains

• avoid kinks or bends in the tube and keep drainage bags below the level of your bladder

A catheter should not stop you doing most usual activities. You will be advised when it is safe to go to work, exercise, swim, go on holiday and have sex. For people with an intermittent or suprapubic catheter, the NHS says sex should be possible as usual. It may still be possible with an indwelling urethral catheter in place but can be more difficult, and a doctor or nurse can advise and may suggest a different type of catheter.

Living with a catheter can be challenging, and the NHS points to the charity Bladder and Bowel Community for information and support. If daily activities are proving difficult, speak to a doctor or community nurse rather than putting up with problems.

The NHS says to contact your community nurse immediately if you have severe or ongoing bladder spasms, if your catheter is blocked or urine is leaking around the edges, if your urine is bloodstained or has specks of blood (you may have pulled on the catheter), if you are passing bright red blood, if you have symptoms of a UTI such as lower abdominal pain, a high temperature or feeling hot, cold or shivery, or if an indwelling catheter has fallen out and you do not know how to replace it.

If you cannot reach your community nurse, the NHS advises calling 111. Get medical advice as soon as possible if you think the catheter is blocked, or if you are passing large pieces of debris or blood clots.

Most catheters are fitted and followed up through NHS hospital teams, district or community nurses and continence services, and catheter supplies are generally available on prescription. Some people who need a catheter as part of private surgery will have it fitted there for the duration of the stay. For long-term catheters, ongoing changes and supplies usually run through community services whichever route you started on, so it is worth asking at discharge exactly who will change the catheter and how to reach them out of hours.