Catheters

A catheter is a long, thin tube inserted up the urethra or through a hole in the abdominal wall into the bladder to drain urine (subrapubic catheter). Draining the bladder this way has been used to treat incontinence for many years. Bladder catheterization may be a temporary or a permanent solution for urinary incontinence.

In cases of overflow incontinence resulting from obstruction, some people respond well to temporary continuous Foley catheter drainage. Their bladder capacity returns to normal, and the strength of their bladder (detrusor) muscle improves. This treatment is more likely to benefit people without neurologic injury. It usually takes at least one week of catheter drainage depending on the degree of bladder muscle injury to see the benefits. If the incontinence has not resolved after four weeks, then the bladder is unlikely to recover using catheter drainage alone.

If the underlying cause of the overflow problem is bladder outlet obstruction, normal voiding may return after the obstruction is relieved. If the obstruction cannot be relieved, periodic catheterization is usually the best long-term treatment, although surgery may be required. Sometimes, a permanent catheter may need to be considered.

Different types of bladder catheterization include indwelling (left inside the bladder) urethral catheters, suprapubic tubes, and intermittent self-catheterization.

Indwelling Urethral Catheterization (Foley Catheterization)

Indwelling urethral catheters are commonly known as Foley catheters. Urethral catheters used for extended treatment need to be changed every month. These catheters may be changed at an office, a clinic, or at home by a visiting nurse. All indwelling catheters that stay in the urinary bladder for more than two weeks begin to have bacterial growth. This does not mean that you will have a bladder infection, but infection is a risk, especially if the catheter is not changed regularly. Foley catheters should not be used for prolonged periods (months or years) because of the risks of UTI, and a subrapubic tube may be recommended. Urethral catheters are not used to treat urge incontinence. Other problems associated with indwelling urethral catheters include encrustation of the catheter, bladder spasms resulting in urinary leakage, blood in the urine (hematuria), and inflammation of the urethra (urethritis). More severe complications include formation of bladder stones, development of a severe skin infection around the urethra (periurethral abscess), kidney (renal) damage, and damage to the urethra (urethral erosion).

Most doctors use a suprapubic catheter for long-term catheterization and only use Foley catheters to the following situations:

• As comfort measures for terminally ill patients
• To avoid contamination or to promote healing of severe pressure sores
• In case of urethral obstruction that prevents bladder emptying and cannot be operated on
• In individuals who are severely impaired for whom alternative interventions are not an option
• When an individual lives alone and a caregiver is unavailable to provide other supportive measures
• For acutely ill people in whom accurate fluid balance must be monitored
• For severely impaired people for whom bed and clothing changes are painful or disruptive

Suprapubic Catheterization

A suprapubic catheter is a tube surgically inserted into the bladder through an incision made in the abdomen (above the pubic bone). This type of catheter is used for long-term catheterization, and when the tube is removed, the hole in the abdomen seals up within one to two days. The most common use of a suprapubic catheter is in people with spinal cord injuries and a malfunctioning bladder. As in the urethral catheter, a doctor or nurse must change the suprapubic tube at least once a month on a regular basis.

The suprapubic catheter has advantages compared to the urethral catheter: The risk of urethral damage is eliminated, a suprapubic tube is more patient-friendly, bladder spasms occur less often because the suprapubic catheter does not irritate the outflow area of the bladder, and suprapubic tubes are more sanitary because the tube is away from the urethra/anal area (perineum). Suprapubic tubes may cause fewer urinary tract infections than standard urethral catheters.

Suprapubic catheters are not used in people with chronic unstable bladders or intrinsic sphincter deficiency because involuntary urine loss is not prevented. A suprapubic tube does not prevent bladder spasms from occurring in unstable bladders nor does it improve the urethral closure mechanism in an incompetent urethra. Potential problems with long-term suprapubic catheterization are similar to those associated with indwelling urethral catheters, including leakage around the catheter, bladder stone formation, UTI, and catheter obstruction. Other potential complications include skin infections (cellulitis) around the tube site.

Intermittent Catheterization

With intermittent catheterization, or self-catheterization, the bladder is drained at timed intervals rather than continuously. In order to do intermittent catheterization, you have to be able to use your hands and arms; however, a caregiver or health professional can perform intermittent catheterization for a person who is physically or mentally impaired. Intermittent catheterization works best for people who are motivated and have intact physical and cognitive abilities. Of all three possible options (urethral catheter, suprapubic tube, and intermittent catheterization), intermittent catheterization is the best way to empty the bladder for motivated individuals who are not physically handicapped or mentally impaired.

The bladder must be drained on a regular basis, either based on a timed interval (for example, on awakening, every three to six hours during the day, and before bed) or based on bladder volume. Advantages of intermittent catheterization include independence and freedom from an indwelling catheter and bags. Also, sexual relations are uncomplicated by a catheter. Potential complications of intermittent catheterization include bladder infection, urethral trauma, urethral inflammation, and stricture formation. However, studies have demonstrated that long-term use of intermittent catheterization appears to be better compared to indwelling catheterization (urethral catheter or suprapubic tube), with respect to urinary tract infections, renal failure, and the development of stones within the bladder or kidneys.