A urinary catheter is any tube system placed in the body to drain and collect urine from the bladder.

Urinary catheters are sometimes recommended as a way to manage urinary incontinence and urinary retention in both men and women. There are several different types of catheters. They may be used for a variety of different reasons.

URINARY CATHETERS

Urinary catheters may be used to drain the bladder. This is often a last resort because of the possible complications from long-term catheter usage. Complications of catheter use may include:

• Bladder stones
• Blood infections (septicemia)
• Blood in the urine (hematuria)
• Skin breakdown
• Urethral injury
• Urinary tract or kidney infections

After many years of catheter use, bladder cancer may also develop.

Your health care provider may recommend a catheter for short-term or long-term use. Long-term use catheters are called indwelling catheters.

Catheters come in a large variety of sizes, materials (latex, silicone, Teflon), and types (Foley catheter, straight catheter, coude tip catheter). For example, a Foley catheter is a soft plastic or rubber tube that is inserted into the bladder to drain the urine.

Experts recommend that the smallest possible catheter be used. Some people may need larger catheters to control urine leakage around the catheter or if the urine is thick and bloody or contains large amounts of sediment.

Be aware that larger catheters are more likely to damage the urethra. Some people have developed allergies or sensitivity to latex after long-term latex catheter use. These people should use the silicone or Teflon catheters.

LONG-TERM (INDWELLING) URETHRAL CATHETERS

A catheter that is left in place for a period of time may be attached to a drainage bag to collect the urine. There are two types of drainage bags.

One type is a leg bag. It is a smaller drainage device that attaches by elastic bands to the leg. A leg bag is usually worn during the day, because it fits discreetly under pants or skirts. It is easily emptied into the toilet.

The other type of drainage bag is a larger drainage device (down drain). It may be used during the night. This device is usually hung on the bed or placed on the floor.

HOW TO CARE FOR YOUR CATHETER

If the catheter is clogged, painful, or infected it may need to be replaced immediately.

To care for the indwelling catheter, cleanse the urethral area (where the catheter exits the body) and the catheter itself with soap and water every day. Also thoroughly cleanse the area after all bowel movements to prevent infection. Experts no longer recommend using antimicrobial ointments around the catheter, because they have not been shown to actually reduce infections.

Increase your fluid intake to reduce the risk of developing complications (unless you have a medical condition that prohibits large amounts of fluid intake). Discuss this issue with your health care provider.

The drainage bag must always stay lower than the bladder to prevent urine from flowing back up into the bladder. Empty the drainage device at least every 8 hours, or when it is full.

Take care to keep the outlet valve from becoming infected. Wash your hands before and after handling the drainage device. Do not allow the outlet valve to touch anything. If the outlet becomes obviously dirty, clean it with soap and water.

HOW TO CLEAN YOUR DRAINAGE BAG

Some experts recommend cleaning the drainage bag periodically. Remove the drainage bag from the catheter (attach the catheter to a second drainage device during the cleaning).

Cleanse and deodorize the drainage bag by filling the bag with two parts vinegar and three parts water. You can substitute chlorine bleach for the vinegar and water mixture. Let this solution soak for 20 minutes. Hang the bag with the outlet valve open to drain and dry the bag.

WHAT TO DO FOR A LEAKING CATHETER

Some people have occasional leakage of urine around the catheter. This may be caused by a catheter that is too small, improper balloon size, or bladder spasms.

If bladder spasms occur, check to see that the catheter is draining properly. If there is no urine in the drainage bag, the catheter may be blocked by blood or thick sediment. Or, there may be a kink in the catheter or drainage tubing.

If you have been instructed on an irrigation (flushing the catheter) procedure, try to irrigate the catheter and see if this helps. If you have not been instructed on irrigation and urine is not flowing into your collection device, contact your health care provider immediately.

Other causes of urine leakage around the catheter include:

• Constipation or impacted stool
• Urinary tract infections

POTENTIAL COMPLICATIONS

Contact your health care provider if you develop any of the following:

• Bleeding into or around the catheter
• Catheter draining little or no urine despite enough fluid intake
• Fever, chills
• Leakage of large amounts of urine around the catheter
• Urine with a strong smell or becomes thick or cloudy
• Urethral swelling around the catheter

SUPRAPUBIC CATHETERS

A suprapubic catheter is basically an indwelling catheter that is placed directly into the bladder through the abdomen. The catheter is inserted above the pubic bone. This catheter must be placed by a urologist during an outpatient surgery or office procedure. The insertion site (opening on the abdomen) and the tube must be cleansed daily with soap and water and covered with a dry gauze.

These catheters usually are changed by qualified medical personnel. The catheter may be attached to the standard drainage bags described above. A suprapubic catheter may be recommended:

• After some gynecological surgeries
• In people who need long-term catheterization
• In people with urethral injury or obstruction

Complications of suprapubic catheter use may include:

• Bladder stones
• Blood infections (septicemia)
• Blood in the urine (hematuria)
• Skin breakdown
• Urine leakage around the catheter
• Urinary tract or kidney infections

After many years of catheter use, bladder cancer may also develop.

HOW TO INSERT A CATHETER (MEN)

1. Assemble all equipment: catheter, lubricant, sterile gloves, cleaning supplies, syringe with water to inflate the balloon, drainage receptacle.
2. Wash your hands. Use betadine or similar cleansing product (unless instructed otherwise) to clean the opening of the urethra.
3. Apply the sterile gloves. Make sure you do not touch the outside of the gloves with your hands.
4. Lubricate the catheter.
5. Hold the penis on the sides, perpendicular to the body. Stretch the penis away from the body.
6. Begin to gently insert and advance the catheter.
7. You will meet resistance when you reach the level of the external sphincter. Try to relax by deep breathing, and continue to advance the catheter.
8. Once the urine flow starts, continue to advance the catheter to the level of the "Y" connector. Hold the catheter in place while you inflate the balloon. Some men have developed urethral injuries due to the balloon being inflated in the urethra. Take care to ensure the catheter is in the bladder. You may try to irrigate the catheter with a few ounces of sterile water. If the solution does not easily return, you may not have the catheter far enough in the bladder.
9. Secure the catheter, and attach the drainage bag.

HOW TO INSERT A CATHETER (WOMEN)

1. Assemble all equipment: catheter, lubricant, sterile gloves, cleaning supplies, syringe with water to inflate the balloon, drainage receptacle.
2. Wash your hands. Use betadine or a cleansing product to clean the urethral opening. In women clean the labia and urethra opening using downward strokes. Avoid the anal area.
3. Apply the sterile gloves. Make sure you do not touch the outside of the gloves with your hands.
4. Lubricate the catheter.
5. Spread the labia and locate the opening below the clitoris and above the vagina.
6. Slowly insert the catheter into the opening.
7. Begin to gently advance the catheter.
8. Once the urine flow starts, advance the catheter another 2 inches. Hold the catheter in place while you inflate the balloon. Take care to ensure the catheter is in the bladder. If you feel pain while inflating the balloon, stop. Deflate the balloon, advance the catheter another 2 inches, and attempt to inflate the balloon again.
9. Secure the catheter, and attach the drainage bag.

HOW TO REMOVE A CATHETER

Indwelling catheters may be removed in two ways. One method is to attach a small syringe to the inflation port on the side of the catheter. Draw out all the fluid until you are unable to withdraw any more fluid. Slowly pull the catheter out until it is completely removed.

Note: Never remove your own catheter unless you have been trained by your health care provider. Only remove it when your doctor says you can.

Some health care providers instruct their patients to cut the inflation port tubing before it reaches the main tubing of the catheter. After all the water has drained out, slowly pull out the catheter until it is completely removed. Be careful not to cut the catheter anywhere else.

If you cannot remove the catheter with only slight pulling, notify your health care provider immediately.

Notify your health care provider if you are unable to urinate within 8 hours after catheter removal, or if your abdomen becomes distended and painful.

SHORT-TERM (INTERMITTENT) CATHETERS

Some people may only need catheterization on an occasional basis. These people can be taught to catheterize themselves to drain the bladder when needed. They don't have to constantly wear an external device.

People who may benefit from intermittent catheterization include:

• Anyone who is unable to properly empty the bladder
• Men with large prostates
• People with nervous system (neurological) disorders
• Women after certain gynecological surgeries

The process is similar to the procedures described above. However, the balloon inflation is not performed, and the catheter is removed after the flow of urine has stopped.

See also: Clean intermittent self-catheterization

Moore KN, Fader M, Getliffe K. Long-term bladder management by intermittent catheterisation in adults and children. Cochrane Database Syst Rev. 2007;(4):CD006008.