Living with a urinary catheter: practical tips

A urinary catheter is a thin, soft tube that drains urine from the bladder into a bag when the bladder cannot empty on its own. It is most often inserted for acute urinary retention caused by an enlarged prostate, after surgery or with a narrowing of the urethra. For most men it is a temporary solution – a bridge to surgery or to the moment when the bladder starts working again.

A few simple habits make this period safer and easier to bear. Here is what Dr Penev advises his patients in Plovdiv and Karlovo.

Hygiene every day

• Wash your hands with soap before and after every time you touch the catheter or the bag.
• Once a day and after a bowel movement, clean the area where the catheter enters the body with water and mild soap, wiping away from the body. In men, the foreskin is pulled back, cleaned and must always be returned to its normal position afterwards so that it does not swell.
• Do not put antiseptic creams or powders around the catheter unless they have been specifically prescribed.
• Showering is allowed and recommended, with the bag left attached.

The bag and keeping the catheter in place

The catheter works by gravity, so the bag must always be below the level of the bladder, and the tubing must not be kinked or pulled tight. During the day a small bag strapped to the thigh is convenient; at night a larger bag on a stand beside the bed is connected to it. Empty the bag when it is about two-thirds full, without letting the tap touch the toilet or the floor. The catheter itself is fixed to the thigh with adhesive tape so that it does not pull – pulling is a common cause of pain and bleeding. Change the bags as instructed by your medical team and do not disconnect the system unless you need to: every time it is opened, bacteria can get in.

Fluids and digestion

Drink about one and a half to two litres a day, unless your doctor has restricted fluids because of heart or kidney disease; pale yellow urine is a good guide, while concentrated urine irritates the bladder and blocks the catheter more easily. Cut down on coffee and alcohol if you have spasms. Also make sure you have regular bowel movements: an overfull bowel presses on the bladder and is a common cause of urine leaking around the tube. More fibre and exercise are usually enough; if you are constipated, ask your doctor about a suitable remedy.

Moving about, sleep and everyday life

With a catheter you can walk, work and travel – what matters is that the tube is well secured and the bag hidden under loose clothing. Avoid heavy lifting in the first days after the catheter has been inserted. At night, make sure you are not lying on the tube. When travelling, take spare bags, adhesive tape and a document from your doctor about the catheter.

The emotional side is often harder than the physical one. Embarrassment, a feeling of losing control and worry about your partner are natural and usually pass once the catheter is removed. Talk openly with those close to you and with Dr Penev – these questions are part of the conversation in the consulting room, not an awkward subject.

When the catheter is changed and when it is removed

A long-term catheter is changed by a healthcare professional, usually every four to twelve weeks, depending on the material and the doctor’s judgement; do not try to change it yourself. If it was inserted because of urinary retention with an enlarged prostate, a trial without the catheter is usually carried out after a few days of medication. If the bladder still does not empty well after a second trial, the sensible way forward is prostate surgery, which Dr Penev performs at Kaspela University Hospital (UMBAL Kaspela), Plovdiv. The causes of difficulty passing urine and the plan for getting rid of the catheter are discussed at a consultation for urinary problems.

When to see a doctor

Bacteria in the urine are almost unavoidable when a catheter stays in for a longer time and are not treated in themselves – an antibiotic is needed only if there are symptoms. Contact a doctor the same day if you have:

• a temperature above 38 °C, shivering, pain in the back or low in the abdomen, cloudy, foul-smelling urine – signs of a urinary tract infection;
• dark red urine or clots;
• urine leaking around the catheter that does not stop after you have checked the tubing.

If no urine has drained into the bag for two to three hours even though you have been drinking, your abdomen is tense and painful, or the catheter has fallen out, do not wait until the morning: a blocked catheter means acute urinary retention and requires the emergency department or a call to 112 (the European emergency number). The same applies to shivering with a high temperature – possibly the start of a serious infection. How to reduce the risk is explained in the advice on preventing urinary infections.

A catheter is an aid, not a life sentence: with clean hands, a correctly positioned bag, enough fluids and attention to the warning signs, this period passes calmly. If you have questions about catheter care or want to discuss when the catheter can be removed, book an appointment with Dr Penev in Plovdiv or Karlovo.