Sometimes your medical condition may necessitate the passing of a urinary catheter.
This may be due to some mechanical problem passing urine (urinary retention) or, post surgery, or in order to carefully measure your hourly urine output, an important physiological indicator if you are really unwell.
If you have never had one before the very idea of a catheter can be intimidating to say the least. But the actual insertion, if done carefully, should be no more than mildly uncomfortable.
Once in place, other than being a nuisance having to manage the drainage bag and tubing and all, it usually is not a big problem.
I am going to run through the actual insertion steps of an indwelling catheter (or IDC) in fairly graphic detail to give you a good idea of what will happen, and how it will all actually feel. I think this is important.
In a normal male, the urine tube (urethra) leaves the bladder from a small opening called the trigone. It then passes through the prostate, making its way down the length of the penis where it emerges at the head (known as the glans) in a hole called the urinary meatus.
Before even beginning this procedure the doctor or nurse doing it will explain what is about to happen, and why, and then make sure you are in a comfortable position and in a private environment.
The catheter, usually known as a Foley catheter (named after Frederic Foley who first designed it) is a flexible tube made of silicone or coated latex. It actually has two internal tubes or lumens passing down its length. The larger, is for the passage of urine and this tube is open at both ends. The smaller, is used to inflate a balloon at the tip of the catheter with sterile water to stop it falling out once inside the bladder.
The catheter itself and all the other equipment that will be used are sterile. And the nurse or doctor inserting it will be using a sterile technique so as not to introduce any infection into your bladder.
The catheters come in a variety of sizes. Ideally you want the smallest size that will still allow the best drainage of urine. If the catheter is too large there is a small risk of causing erosion of the bladder neck and urethra as the catheter rubs against it as you move around.
If it is too small urine will simply flow around the catheter resulting in a probable wet bed.
So in order to select the best size the person inserting the catheter will usually have a look at the diameter of your urinary meatus.
Once inserted the catheter will be connected to a drainage bag. There are several different sorts including ‘leg bags’ and hourly measure bags.
All the necessary equipment (which usually comes in a specific kit) will be assembled and opened onto what is called a sterile field (usually on a hospital trolley)
OK. So let’s get it in.
Let’s say it is a nurse inserting your catheter today. Usually they will make sure you are laying comfortably, well covered, on your back, with straight legs that are slightly apart.
The nurse will perform a thorough hand wash and then don sterile gloves.
At this point the nurse will ask you to move your blanket down to expose your penis. It is important to keep you arms and hands well away from the area once you have done this so as not to contaminate the area.
Next, the nurse clean your penis with saline soaked gauze. This can be a little cold.
If you have a foreskin (around 1 in 6 males worldwide are circumcised) this will be gently pulled back as it is cleaned.
Um, one question.
At this point I am going to digress to answer a question that I know some of you have been thinking: “But what if I start to get an erection with all that fiddling around going on?”
Honestly, this very rarely happens. Very rarely.
If it does, despite the inevitable embarrassment you might feel, it’s really no big deal. Doctors and nurses have seen it all before.
Once your penis has been cleaned it will be surrounded with a sterile drape.
A specialised syringe filled with anaesthetic jelly is now used. Relax, there is no needle here. The syringe has a smooth plastic taper at its end that is placed up against your meatus and the contents (around 10 mls) is slowly pushed in. This can be slightly uncomfortable.
Afterwards, you may feel the nurse squeezing just below the glans (head) for a short time to stop the jelly oozing out before it has taken effect. It is important here for the nurse not to rush. It takes at least 3 minutes for the anaesthetic jelly to work properly and this will make a big difference to your comfort level as the catheter is passed.
The nurse will now pick up the catheter in one hand, and lift your penis up straight (to straighten out your urethra) with the other. The catheter is slowly advanced down along your urethra. You will probably feel the pushing but it should not be painful.
There are 2 potential roadblocks as the catheter advances. The first is a group of muscles around the urethra known as the external sphincter, and the second is your prostate.
If resistance is felt, the nurse will get you to try to relax and take a few deep breaths or perhaps to give a few coughs.
At this point the catheter usually advances. If there is any resistance this is the time there may be a little discomfort. If the nurse cannot pass the catheter at this point it will be removed and further assistance may be sought.
The catheter is advanced most of the way in to ensure the balloon is inside your bladder before it is inflated. The nurse will be waiting to see a flow of urine from the catheter to confirm it is in the right place. This may take a short time as all that anaesthetic jelly tends to clog the end of the catheter and it may take a minute or so before it ‘melts’.
Once this occurs a syringe of sterile water (usually around 10 mls) will be attached to the second port on the catheter and the balloon will be inflated. You will not feel this.
Once the balloon is inflated, the catheter is gently pulled back until resistance is felt. It is now connected to the drainage bag and a urine specimen is usually collected.
The catheter will be secured by using a special tape to stick it to your abdomen or leg so it does not pull.
Sometimes the catheter will not need to remain in place and will be removed as soon as the bladder has drained and a specimen obtained.
At this point it is also worth mentioning that if the nurse retracted your foreskin back before inserting the catheter, it is very important that it be pulled back into its normal position. You can remind them if they forget.
Failure to do so can in some instances lead to a swelling and constriction of the penis known as paraphimosis.
And that’s about it.
You may be aware of the catheter for a while after it is first inserted, but usually any discomfort settles. Staff will familiarise you with how to manage the catheter bag and get up and mobile if you are able.
What you should do.
Your catheter will be removed as soon as is possible, as having a catheter in place increases the risk of getting a urinary tract infection or CAUTI (catheter associated urinary tract infection). Some things you can do to help minimise the risk of this are:
- Try to always keep the drainage bag and tubing below the level of your bladder.
- When moving around be careful that the bag or tubing does not catch on anything placing tension on the catheter.
- Keep your genital area as clean as possible whilst the catheter is in place.
- Ensuring a frequent fluid intake may also decrease the risk of infection.
Other things to pay attention to:
- Notify staff if there is any sudden change of colour of your urine in the collection bag.
- Notify staff if there are any blood clots in the collection bag.
- Notify staff if the catheter disconnects from its tubing. Do NOT just reconnect it yourself.
Of course, let the medical staff know if you are experiencing any other problems.