A urinary catheter is any tube system placed in the body to drain and collect urine from the bladder.
Catheter - urine; Foley catheter; Indwelling catheter; Suprapubic catheters
Urinary catheters are used to drain the bladder. Your health care provider may recommend a catheter for short-term or long-term use because you have or had:
- Urinary incontinence (leakage of urine or the inability to control when you urinate)
- Urinary retention (being unable to empty the bladder when you need to)
- Surgery that made a catheter necessary, such as prostate or gynecological surgery
- Other medical conditions such as multiple sclerosis, spinal cord injury, or dementia
Catheters come in many sizes, materials (latex, silicone, Teflon), and types (Foley, straight, coude tip). A Foley catheter, for example, is a soft, plastic or rubber tube that is inserted into the bladder to drain the urine.
In general, the smallest possible catheter will 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.
There are three main types of catheters:
- Indwelling catheter
- Condom catheter
- Intermittent (short-term) catheter
INDWELLING URETHRAL CATHETERS
An indwelling urinary catheter is one that is left in place in the bladder. Indwelling catheters may be needed for only a short time, or for a long time. These catheters attach to a drainage bag to collect urine. A newer type of catheter has a valve that can be opened to allow urine to flow out, when needed. An indwelling catheter may be inserted into the bladder in two ways:
- Most often, the catheter is inserted through the urethra, which is the tube that brings urine from the bladder to the outside of the body
- Sometimes, the doctor will insert a tube, called a suprapubic catheter, into your bladder from a small hole in your belly. This is done as an outpatient surgery or office procedure.
An indwelling catheter has a small balloon inflated on the end of it. This prevents the catheter from sliding out of the body. When it's necessary to remove the catheter, the balloon is deflated.
Condom catheters are most frequently used in elderly men with dementia.There is no tube placed inside the penis. Instead, a condom-like device is placed over the penis. A tube leads from this device to a drainage bag. The condom catheter must be changed every day.
INTERMITTENT (SHORT-TERM) CATHETERS
Some people only need to use a catheter on occasion. Short-term, or intermittent, catheters are removed after the flow of urine has stopped. For more information on this type of catheter, see: Clean intermittent self-catheterization.
A catheter is usually attached to a drainage bag. There are two types:
A leg bag is a smaller drainage device that attaches by elastic bands to the leg. It is usually worn during the day, because it fits discreetly under pants or skirts. It is easily emptied into the toilet.
A down drain is a larger drainage device. It may be used during the night. This device is hung on the bed or placed on the floor.
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.
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.
HOW TO CARE FOR A CATHETER
To care for an 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.
If you have a suprapubic catheter, the opening in your belly and the tube must be cleansed daily with soap and water, then covered with dry gauze.
Drinking plenty of fluids can help prevent infections. Discuss this issue with your health care provider.
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.
If bladder spasms occur or 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. Sometimes spasms are caused by the catheter irritating the bladder. Such spasms can be controlled with medication, although most patients eventually adjust to the irritation and the spasms go away. If you have been shown how to irrigate (or flush) the catheter, doing so may help reduce spasms. If you have not been instructed on irrigation, and urine is not flowing into your collection device, contact your health care provider immediately.
Complications of catheter use include:
- Allergy or sensitivity to latex
- Bladder stones
- Blood infections (septicemia)
- Blood in the urine (hematuria)
- Kidney damage (usually only with long-term, indwelling catheter use)
- Urethral injury
- Urinary tract or kidney infections
Contact your health care provider if you develop or notice:
- Bladder spasms that do not go away
- Bleeding into or around the catheter
- Catheter draining very little or no urine, despite drinking enough fluids
- Fever or chills
- Leakage of large amounts of urine around the catheter
- Skin breakdown around a suprapubic catheter
- Stones or sediment in the urinary catheter or drainage bag
- Swelling of the urethra around the catheter
- Urine with a strong smell, or that is thick or cloudy
If the catheter becomes clogged, painful, or infected it will need to be replaced immediately.
Moy ML, Wein AJ. Additional therapies for storage and emptyhing failure. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Sauders Elsevier; 2007: chap 70.
Wierbicky J, Nesathurai S. Spinal cord injury (thoracic). In: Frontera WR, Silver JK, Rizzo Jr TD, eds. Essentials of Physical Medicine and Rehabilitation. 2nd ed. Philadelphia, Pa: Saunders Elsevier; 2008: chap 147.
Reviewed By: Louis S. Liou, MD, PhD, Assistant Professor of Urology, Department of Surgery, Boston University School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.