Urinary catheterisation

Sometimes the bladder needs extra support to empty properly. Urinary catheterisation provides a way to safely drain urine (wee) when bladder function is affected by illness, injury, surgery or other health conditions. With the right catheter and support, many people are able to stay comfortable, protect their urinary system health and continue their usual daily activities with confidence.

Why might a catheter be needed?

A catheter may be recommended if:

• you experience urinary retention. Urinary retention is when the bladder does not empty completely, or cannot be emptied at all, when passing urine (wee). This can make it difficult to start urinating, cause a weak urine stream, or leave a feeling that the bladder is still full after going to the toilet
• a blockage is preventing urine from leaving the bladder
• you have a neurological condition affecting bladder function
• you need support after surgery or during recovery from illness
• bladder function needs to be monitored for a period of time
• other bladder management options are not suitable or effective.

Difficulty emptying the bladder can happen for many reasons, including some health conditions (such as multiple sclerosis, Parkinson’s disease or stroke), nerve problems or injuries affecting bladder control, an enlarged prostate or a blockage that affects urine flow.

How does it feel to have a catheter inserted?

Some people may experience some discomfort when having a catheter inserted, but pain is not common. Mild pain or discomfort during the procedure is usually not a cause for concern. If you’re feeling worried or anxious about catheter insertion, tell your healthcare team and they can talk you through the process.

Types of urinary catheterisation

There are two main types of urinary catheterisation:

• intermittent catheterisation – the catheter is inserted through the urethra (wee tube) into the bladder to empty it, then removed, several times a day
• indwelling catheterisation – the catheter is inserted through the urethra or through the wall of the stomach, into the bladder and left in place for a period of time.

Intermittent catheterisation

Intermittent catheterisation involves inserting a catheter into the bladder to drain urine (wee) and then removing it slowly once the bladder is emptied. This is repeated throughout the day, usually at similar intervals to normal toileting. Your healthcare team will talk you through the process.

Many people are able to perform intermittent catheterisation themselves after training from a health professional. For others, a carer or health professional may help them.

For many people, intermittent catheterisation is the preferred long-term option because it allows the bladder to fill and empty regularly while reducing some of the risks associated with long-term indwelling catheters. It can support independence, comfort and participation in usual activities, including sexual relationships.

Indwelling catheterisation

An indwelling catheter remains in the bladder continuously and is changed regularly by a trained health professional. The timing will vary from person to person depending on their situation. Your healthcare team will work out a plan with you.

An indwelling catheter may be inserted:

• through the urethra (urethral catheter), or
• through the lower abdomen (belly) directly into the bladder (suprapubic catheter – ‘suprapubic’ means above the pubic bone).

A small balloon filled with sterile water keeps the catheter in place inside the bladder.

Indwelling catheters may drain:

• continuously (all the time, without stopping) into a drainage bag, or
• through a catheter valve that is opened to empty the bladder at regular intervals, then closed again.

For some people, a catheter valve may be more convenient and discreet and increase independence by allowing the bladder to fill and empty in a more natural way. The valve must be opened regularly to avoid overfilling the bladder.

Drainage bags and accessories

A range of drainage bags and accessories is available to support different lifestyles and levels of mobility.

Options include:

• discreet leg bags for daytime use
• abdominal or waist-worn bags
• larger overnight drainage bags
• bedside drainage bags for people with limited mobility.

Your health professional can help you choose equipment that is comfortable, secure and appropriate for your daily activities. Correct positioning and securing of the tube can help reduce pulling, discomfort and irritation.

Choosing the right catheter

There is no single catheter that suits everyone. When choosing a catheter, your health professional will consider:

• the reason catheterisation is needed
• how long it is likely to be required
• catheter size
• catheter material (for example, silicone)
• comfort and how easy it is to use
• your mobility and hand function
• your daily activities and lifestyle
• drainage and support options.

The aim is to find the simplest and safest option that supports your health, comfort and independence. Your healthcare team will tell you where to access the catheters you need, and the cost will vary depending on the type and product.

Call the National Continence Helpline on 1800 33 00 66 for free advice from a nurse continence specialist on choosing the right catheter for your needs.

Looking after yourself at home

Learning to care for a catheter takes time, and support is available.

Your health professional will teach you how to:

• use and care for your catheter safely
• empty and change drainage bags
• maintain good hygiene
• recognise possible problems
• know when to seek help.

Possible complications

Most people use catheters successfully. However, complications can sometimes occur. These may include:

• urinary tract infections
• catheter blockage
• bladder spasms
• leakage around the catheter
• discomfort or irritation
• injury to the urethra or bladder.

Seek urgent help if you experience fever, foul-smelling or cloudy urine (wee), severe pain or the catheter is not draining. Your doctor can provide treatment and advice.

If you feel like the catheter or drainage bag are not fitted correctly, your healthcare team can help with this.

Maintaining good catheter care and seeking help early when problems arise can reduce the risk of complications. Long-term catheter use should be reviewed regularly with your healthcare team.

Other options

In some situations, alternatives to catheterisation may be available. These may include:

• bladder retraining programs
• pelvic floor muscle training (pelvic floor exercises)
• continence products
• medicines
• external collection devices for some men
• treatments that address the underlying cause of bladder emptying difficulties.

Your healthcare professional can advise you on options that may be suitable for you.

Where to get help

• Your GP (doctor)
• Your urologist
• National Continence Helpline Tel:1800 33 00 66
• Local continence clinic or service
• Your continence, urology or community nurse