Certain urologic procedures can require the placement of an indwelling urinary catheter also known as a Foley catheter. There are other urologic conditions that may require the use of an intermittent catheter, which is only used once and then thrown away.
While it's important to follow your provider's instructions for catheter care at home, we thought giving an overview of what to expect would be helpful. To that end, we asked one of our physician assistants, Kennedy Robinson, to share her insights and best practices.
As with all content on our blog, the following is educational only, not medical advice. Always follow the specific instructions you receive from your doctor.
First, let's back up for a moment. What is a catheter?
KENNEDY ROBINSON: A catheter is a thin, sterile tube used to drain urine from the bladder. There are different types of catheters depending on what the catheter is being used for.
Indwelling Foley catheters are two-way tubes consisting of a balloon at one end, which keeps the catheter in your bladder, and a round drainage opening at the other end that drains externally into a bag that you can wear around your leg or a larger night bag. The tube goes through the urethra.
Suprapubic catheters are similar to indwelling Foley catheters, with a balloon in the bladder and a round drainage opening at the other end that drains externally into a leg or night bag. However, the tubing doesn't exit through the urethra. Instead, it exits through a small hole made in the lower abdomen.
Intermittent catheters are single-use catheters, meaning they are still two-way tubes but do not have a balloon to hold the catheter in the bladder.
What sort of urologic procedures/conditions require intermittent catheters instead of indwelling catheters (like the Foley catheter)?
KENNEDY ROBINSON: Catheters are primarily used for urinary retention due to genitourinary (GU) conditions like neurogenic bladder or bladder outlet obstruction. They are also often used after surgery, such as transurethral resection of the prostate (TURP), and many other procedures, both GU and non-GU.
The duration that a patient will need an indwelling Foley catheter depends on the etiology of their condition and their urologist's recommendations. Indwelling Foley catheters typically are changed every 4-6 weeks.
Intermittent catheters can be used in the office to instill medication directly into the bladder or to drain the bladder. The patient can also use intermittent catheters as an alternative to an indwelling Foley catheter or for patients with a history of urethral strictures to maintain patency (i.e., to remain unobstructed).
Let's talk about intermittent catheters first. What should patients keep in mind regarding catheter care at home?
KENNEDY ROBINSON: Intermittent catheters are single-use catheters. Each patient will receive directions on how many times per day or week they should self-catheterize. Similar to indwelling catheters, any time a patient self-catheterizes, they should begin by washing their hands with soap and warm water and cleaning the entrance of the urethra as well. Patients should only handle the tubing of the catheter, being incredibly careful to avoid touching the tip of the catheter that they'll insert into their bladder. Once they finish self-catheterizing, they should throw away the catheter.
Now let's talk about caring for Foley catheters. What should patients keep in mind?
KENNEDY ROBINSON: Unlike intermittent catheters in which patients insert the catheter themselves, a healthcare professional handles the insertion of the indwelling catheter. Patients with indwelling catheters should maintain their catheters and drainage bags.
Hygiene is critical. You can shower with a catheter. Many people find it easier to shower with a night bag that they can place outside of the shower. We don't recommend taking a bath with the catheter in place. Cleanse your genital area gently during routine daily showering, making sure to pull back the foreskin if you have a penis or to separate the labia if you have a vagina. Do not pull or scrub at the catheter itself.
Always wash your hands before and after handling the catheter. Empty drainage bags when they are about 3/4 full or about every 2-4 hours. To remove the current drainage bag, squeeze the rubber tubing where it attaches to the drainage bag and remove the bag. Wipe both ends with an alcohol wipe and reattach a new bag. Do this whenever changing from one drainage bag to another.
To clean the drainage bag, disconnect the bag from your catheter. Drain all the urine from the bag into the toilet. Rinse the bag with cool water and allow the bag to dry.
What are some common misconceptions about catheters?
KENNEDY ROBINSON: Catheters can be very scary for patients who have never used one or for patients who have had bad experiences with catheter insertions. At Greater Boston Urology, we can use lidocaine jelly in the urethra and different types of catheters that help to make catheter insertion more comfortable.
Catheters can be very liberating for patients with urologic conditions, allowing them to resume their daily activities. Patients can often wear clothing that conceals the catheter and drainage bag so that no one knows they even have a catheter! Having a catheter does not always mean that you will need a catheter permanently, depending on the etiology of your condition.
What are some common mistakes that patients keep making with catheter home care?
KENNEDY ROBINSON: When wearing a Foley leg bag, keep the leg bag straps above your knee; this will help prevent tugging of the catheter in the bladder, which can cause the patient significant pain.
When using a night bag, be sure to keep the drainage bag below the level of your bladder.
Hydrate well with a catheter in place. Many patients decrease their water intake with a catheter. However, this is unnecessary and detrimental to their overall health.
Urine coming out of the urethra around the catheter does not always mean that the catheter is not working. If there is urine in the catheter tubing, the catheter is in the correct position in your bladder and draining. If there is no urine in the tubing and urine is coming out around the urethra, the patient should call their urologist immediately.
When should patients call their healthcare provider about their catheter?
KENNEDY ROBINSON: If a catheter stops draining or comes out, the patient should notify their urologist immediately.
Other signs patients should contact their healthcare provider include a fever of 101 F or higher, bright red blood or clots in the urine, malodorous urine, or abdominal pain.
Are you interested in making an appointment at Greater Boston Urology?
We have locations throughout eastern Massachusetts, including the Cape. Request an appointment with one of our medical providers.