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A urinary catheter is used to empty the bladder and may be recommended if you have urinary incontinence, urinary retention, or other medical conditions
A urinary catheter is used to drain the bladder and collect urine in a bag in the following cases:
- Obstruction in the urethra (tube that carries urine out of the bladder) due to issues such as scarring or prostate enlargement
- Bladder weakness or nerve damage that affects your ability to urinate
- During childbirth if there is an epidural anesthetic involved
- Before, during, or after some types of surgery
Urinary catheters are also used for:
- Delivering medication directly into the bladder, such as during chemotherapy for bladder cancer
- Treating urinary incontinence when other types of treatment fail
- Maintaining hygiene in patients who are bedridden
Common conditions that may require the placement of a urinary catheter include:
- Urinary incontinence (leaking urine or being unable to control when you urinate)
- Urinary retention (being unable to empty your bladder when you need to)
- Hydronephrosis (swelling of the kidney) due to buildup of urine
- Multiple sclerosis, spinal cord injury, or dementia
- Neurogenic bladder (loss of bladder control due to a brain, spinal cord condition, or nerve condition)
What causes urinary retention?
Urinary retention can be caused by several factors:
- Obstruction: Urinary obstruction can be caused by:
- Intrinsic: Any abnormality within the urinary tract system can cause intrinsic obstruction. These include:
- Stones
- Strictures
- Stenosis
- Blood clots
- Tumor
- Extrinsic: Any abnormality outside the urinary tract system can cause extrinsic obstruction. Enlargement of the abdomen, uterus, or other organs of the pelvic floor can compress the bladder, ureters, or urethra, causing urinary obstruction.
- Intrinsic: Any abnormality within the urinary tract system can cause intrinsic obstruction. These include:
- Infectious and inflammatory diseases: Common infectious and inflammatory diseases that cause urinary retention include:
- Cystitis (inflammation of the bladder)
- Urethritis (inflammation of the urethra)
- Prostatitis (inflammation of the prostate gland)
- Vulvovaginitis (inflammation of the vagina and vulva)
- Drugs: Drugs that have anticholinergic or alpha-adrenergic properties cause urinary retention because these drugs block involuntary muscle movement.
- Neurological disorders: Conditions that cause nerve dysfunction and lead to urine retention include:
- Others: Other conditions that lead to urinary retention include:
- Trauma
- Psychogenic
- Fowler syndrome in women (a condition in which the muscle of the urinary tract fails to relax)
Additionally, a urinary catheter is used to diagnose the causes behind various urinary tract and genital issues. Diagnostic indications include:
- Monitoring of urine output
- Imaging of the urinary tract
- Sample collection for urine analysis
When should urinary catheters be avoided?
Urinary catheter placement is not appropriate in every condition. Some conditions that may prevent the successful placement of a urinary catheter include:
- Any trauma to the lower urinary tract, such as a urethral tear
- Evident urethral infection
- Blood in the opening of the urethra (meatus)
- Gross hematuria (blood in the urine)
- Urethral pain or discomfort
- Low compliance from the person
- Low bladder volume
How is a urinary catheter placed?
The technique for placing a catheter in men and women is slightly different.
Men
- The physician cleans the area with povidone-iodine and prepares local anesthesia and lubricant to apply on the site.
- Next, the physician uses their nondominant hand to hold the penis in an upright position.
- They instill the lubricant-local anesthesia combination into the meatus.
- After 2-3 minutes, the physician introduces the catheter into the urethra.
- The physician waits for the urine to return to the attached bag, which indicates the correct placement of the catheter.
- Finally, the catheter balloon is inflated to keep the catheter in place.
Women
- The physician applies the povidone-iodine solution to the meatus.
- After identifying the meatus, the physician inserts a lubricated catheter tip into the meatus.
- The physician waits for the urine to return to the attached bag.
- The catheter balloon is inflated.
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What are the complications of placing a urinary catheter?
Possible complications associated with urinary catheters include:
- Urinary tract infection (UTI) (most common complication which occurs because of the long-term placement of the urinary catheter, often caused by Escherichia coli and Klebsiella pneumonia; recurring UTI may be associated with antibiotic resistance)
- Chronic bladder infection caused by urine retention at the base of the bladder due to obstruction caused by a balloon of the catheter
- Pain due to friction on the drainage bag
- Temporary stinging sensation in men (often occurs during the application of lubrication gel, which can be minimized by cooling the gel to 39.2 F)
- Paraphimosis (a condition in which the foreskin doesn’t return to its original position after being retracted or pulled back)
- Urethral injury (any injury or trauma to the urethra)
- Catheter obstruction (can occur due to the buildup of particles or sediments caused by cloudy urine due to bacterial presence; flushing can be beneficial in removing sediments but if flushing doesn’t work, catheter replacement may be required)
- Urine leakage from the urethral opening outside the catheter which may occur because of bladder cramps (these spasms can be painful and can be alleviated with anticholinergic medications such as oxybutynin.)
- Negative effect on quality of life, especially for people with long-term dwelling catheters
