What is a urinary catheter?
A catheter is flexible or semiflexible or rigid tube that is passed through a narrow passage so that fluids may be introduced or removed. A catheter that is left in the urinary bladder to drain the urine is called urinary catheter. The procedure of introducing the catheter is called catheterisation. A catheter may be left in temporarily or permanently in the bladder.
How is the catheter retained in the bladder?
There are different types of catheters and the one used in the bladder is called Foley Catheter (named after Frederick Foley, Boston, Massachusetts, USA). It has a balloon near the tip that helps the catheter to remain in the bladder.
How big and long are the catheters? The catheter size is described in French (F or FR) or Charrière (Ch) (Joseph-Frédéric-Benoît Charrière, a 19th-century Parisian maker of surgical instruments) scale (1F = 0.33mm = 0.013”). Foley catheters are available from 6-28F and their length is 30cm for men and shorter length for women. Foley catheter is also known as indwelling or self-retaining catheter. For adults 14-16F catheters are used.
When is a catheter needed?
Temporary catheterisation is required after major operations because of patient’s difficulty in moving and also to measure and check the production of urine. It is removed after the person is able to move out of the bed. Catheter is left temporarily in the bladder after most of the operations on bladder, prostate and urethra. Catheter is also needed when a person cannot pass urine from the bladder (Urinary retention).
Permanent catheterisation is required when there is nerve damage to the bladder (for example spina bifida) and the person is incontinent of urine.
In some patients catheter is passed and removed after the bladder is emptied. It is called intermittent catheterisation. If the patient is doing this themselves its is known as ‘self intermittent catheterisation.
How is catheterisation performed?
The catheter is usually inserted into your bladder through the urethra. The sterile catheter is lubricated with a sterile lubricating gel, and a local anaesthetic cream may be applied to numb the opening of your urethra. One end of the catheter is attached to a bag to collect the urine. The other end is inserted into your urethra and guided through it until it enters your bladder and urine starts to flow. Once the urine is drained the balloon of the Foley Catheter is filled with sterile water. What are the risks of infection with catheterisation? There is always a risk of infection (or persistent presence of bacteria in the urine) with catheterisation (CAUTI- Catheter Associated Urinary Tract infection). In hospitals alone more than 40% of infections originate in catheterised patients. Bacteria are present in more than 25% of patients who have a catheter for more than 7 days. The infection may occur in the waterpipe (urethra), in the bladder (Cystitis) or in the kidneys (pyelonephritis). In men infection can also occur in the testicles (epididymo-orchitis). Bacteria may enter outside the catheter along the outer surface or through the inside of the catheter. You may get fever, feel unwell, and start passing blood in the bag, experience pain in the bladder or in the kidneys area. You may also feel tired, exhausted and feel sick.
How do I prevent infections?
Everyday maintenance of catheter and bag is extremely important. Gently clean the opening of urethra where the catheter enters. Clean with tap water and make sure that deposition of mucous or anybody material on the catheter. Avoid disconnecting the catheter to the bag often and only do it with clean hands. Make sure that the tubing is not handled too much. Using a smaller catheter reduces the chances of infection. Make sure you take enough fluids to flush the urinary system and dilute the urine. In women catheter infections can be precipitated by sexual activity.
What are other catheter related problems?
Blocking of catheter is one of the commonest problems. When the catheter is blocked you may experience bladder spasm and pain in the bladder area. With the bladder spasm urine starts flowing on the side of the catheter causing urinary leakage. Sometimes the tubing is kinked, or sediment in the urine can block the catheter. In some individuals constipation can cause problems with the catheter drainage. Latex catheter could cause allergic reaction in sensitive individuals.
What are the complications of long-term catheterisation?
Encrustation (deposition of solid particles on the catheter) could lead to stone formation in the bladder. Urinary infections and kidney damage are other complications of long-term catheterisation. On occasions urethra might get damaged causing bleeding and later stricture.
How is intermittent catheterisation (IC) performed?
Clean intermittent urinary catheter (CIC)
In Clean intermittent catheterisation (CIC) is special catheter is used by patients themselves at home. It can be useful for people with long-term bladder conditions that do not allow proper emptying of the bladder. Patients are able to do this after training. An incontinence adviser/Nurse will teach you how to place the catheter through your urethra and into your bladder. Once the tip of the catheter is in your bladder urine flows out through the catheter. The urine can be guided directly into the toilet. To start with, using a catheter can feel uncomfortable or even a little painful, but this should gradually subside over a period of time. How many times a day you have to catheterise is decided by your Nurse Practitioner or Advisor.
CIC is used in the following conditions:
- Spinal cord injury
- Spina bifida
- Multiple sclerosis Prostate enlargement where no treatment can be given
- Urethral stricture (Narrowing)
Is there any way of draining the bladder without going through the waterpipe (Urethra)?
Yes, it is possible and is done with suprapubic catheterisation. With this technique, Foley catheter is surgically inserted directly into the bladder through the lower part of the belly (abdomen). Usually a suprapubic catheter is used when there is urethral damage, or bladder drainage is required for a long-term condition and they cannot or do not want to use a clean intermittent catheterisation.
Some indications are:
- Problems in the urethra or in the bottom area
- Injury to Urethra or pelvic floor
- Complex urethral or abdominal surgery
- Patients in wheelchairs or patients who want to maintain sexual relationships
- Patients with faecal incontinence who might soil urethral catheters
How is suprapubic catheterisation (SPC) done?
Suprapubic catheterisation is usually considered when urethral catheterisation is not possible or unsuccessful. This usually happens in presence of urethral injury, urethral stricture, malignancy of prostate and enlargement of prostate gland. The procedure is performed under local anaesthetic with or without sedation. Ultrasound examination of the lower abdomen before passing the catheter is important and useful. This is mainly to locate the bladder and conform that it is well distended before the passage of catheter. If the bladder is not seen on the ultrasound the procedure is not performed. Placement of the catheter is usually done by a specialist doctor in operating theatre. SPC is not done in presence of bladder cancer, important devices in the abdominal wall and small contracted or fibrotic bladder Complications of SPC include bleeding, injury to other abdominal organs and urinary and/or wound infection.
Is SPC better than urethral catheterisation?
Some doctors and nurses recommend suprapubic catheters. The reason for this is that in theory, there are fewer microbes on the wall of the lower belly in front of the bladder than on the genital area, thereby reducing the risk for infection. Suprapubic catheter renders the genitalia to be free of any messy attachments and so it could help with self-image and sexual functioning. Other patients like the feel of its comfort and convenience.
When do I know that I have a problem with the catheter?
This is an important aspect of catheter care. If your catheter is completely blocked obviously catheter needs replacing immediately. Following are some indications where you should get in touch with your carer.
- If you feel that you are getting fever and/or shivering it is an indication of urine or blood infection.
- Bladder spasms that are not going away
- Urine leakage on the side of the catheter. This happens with blockage of the catheter or high bladder pressures
- Blood in the urine or bleeding from the urethra showing up outside the catheter. This may need further tests and assessment.
- Retraction of the foreskin in men (paraphimosis) and inability to pull it back on the tip of the penis
- Swelling of urethra
- Strong urine smell and urine looks cloudy – indicates urinary infection
- Catheter is not draining even though you are taking enough fluids
- Excessive debris, stones, sediments
Some tips to get your catheter going smoothly
- Plenty of fluids. This is does not mean gallons and gallons! Your carer or doctor will advise you regarding how much fluids you could day per day.
- Make sure the catheter remains clean outside particularly the area that comes in contact with the urethra. This can be achieved by gentle cleaning it every day with soap and water. It is also important to clean after bowel movement.
- If you have a suprapubic catheter, clean the opening in your belly and the tube with soap and water every day. Then cover it with dry gauze.
- Wash your hands before and after handling the drainage device. Do not allow the outlet valve to touch anything. If the outlet gets dirty, clean it with soap and water.
- Make sure that the tubing is not kinked, pulled excessively.
- Regular change of catheters.
The condom catheter is one of the simplest devices to put on in men with urinary incontinence. The condom catheter has a sheath (condom) with its tip connected to a tube to drain the urine. The sheath fits on the shaft of the penis like condom and the tube is attached to the urine bag. Before fitting in a device like this a proper assessment of incontinence should be done. It is much simpler than urethral or suprapubic catheterisation. To facilitate proper fitting pubic hair has to be trimmed.
Mr Vinod Nargund is a Consultant Urological Surgeon specialising in Urological cancer, male sexual and fertility problems. He was trained in Urology at the City Hospital Belfast, the Royal Infirmary Bradford and the Churchill and John Radcliffe Hospitals in Oxford. You can view all of his qualifications on his biography page.