Those of us suffering from the many forms of urinary incontinence may find ourselves faced with the possibility having to use a catheter ("cathing") for a period of time. I know many of you are probably familiar with these (unfortunately), but I thought I would pass along some tips I've learned over the years.
Before I go too much further I want to point out that this site, IncontinenceNetwork.com, has several good articles on catheters and catheterization.
I have three situations in which I have to cath:
1) I do a weekly instillation of Gentamicin to keep any bacteria in my bladder under control.
2) I usually have my friend "Foley" for a period of time after a Botox procedure.
3) Once "Foley" leaves, I sometimes have to perform what my doctor call "in and out cathing," meaning intermittent catheterization to remove residual urine.
Types of Catheters and Catheterization
Catheters come in several types, but the basics are Foley and non-Foley:
A Foley catheter has a little balloon at the tip, which, when inflated, keeps the catheter from slipping out of the bladder. They are designed for "long-term" use, and are often referred to as "indwelling catheters." Generally they need to be changed every month or so, if they are needed for that long.
Non-Foley catheters have no such balloon and are designed for intermittent use, meaning only when the bladder needs to be emptied.
One other notable difference is the tip design. Some have straight tips, while others have curved tips, called "Coude" tips. Generally men with intact prostates and most women can use straight tipped catheters. Men who have had prostate surgery may require a Coude-tipped catheter.
Catheters come in a variety of lengths and diameters. For the most part male catheters are 16 inches long. Catheters for women tend to be shorter, but don't necessarily have to be.
Catheter diameter is measure using the French Scale (FR), which is the approximate circumference in millimeters. A 14 FR catheter has a circumference of 14 mm and a diameter of about 4.5 mm, or just under 3/16".
It is important to use the correct size. Generally the largest catheter diameter that can be tolerated comfortably should be used. Some of the reasons for this are:
- The larger the diameter, the stiffer the catheter. This actually makes insertion easier. If the catheter is too small, it may actually fold up inside the urethra.
- Better seal inside the bladder and urethra.
As it's best to follow your doctor's instructions, I won't cover how to perform catheterization in this Sharepost. There are lots of sources on the Internet.
Foley Catheter Care
It's important to take proper care of the catheter. This involves cleaning as necessary, and taking care of the urinary opening if needed.
- Always wash your hands before and after doing catheter care. Use soap and warm water. Antibacterial soap is not required, but may help.
- Keep your skin and catheter clean. Clean the skin around your catheter at least once or twice at day. Gently clean the catheter as well. I generally just use a non-scented baby wipe. There may be some thick drainage that may result in a crusty residue. It is very important to clean up after going to the bathroom. Also, I recommend clipping the hair down there. I'm not suggesting this be funny or gross: nothing is more uncomfortable that having your catheter pull hair into your urinary opening!
- Always keep your urine (drainage) bag below the level of your bladder. While it is important to keep the bag below the level of your bladder, I have found you don't want to keep it too low. This can cause a "suction" effect which is very uncomfortable. It needs to be kept low enough to prevent any backflow of urine. The drainage bag will become contaminated with bacteria over time, and you don't want this bacteria to enter your bladder.
- Proper underwear. I have found that loose fitting boxers work best. They keep pressure of the catheter, which is uncomfortable.
- Drink, drink, drink. If your doctor allows it drink at least 8 cups of liquids a day. Limit the amount of caffeine: it's irritating to your bladder which is already irritated from the catheter. It is best to stay away from alcohol. When Foley visits me, I usually try to drink at least a quart of fluid before bedtime. This increases night time urination which flushes my bladder and the catheter out. Why not, you don't have to get up anyways!
- Do not tug on the tubing. It hurts! Don't be clumsy like me and step on the tubing when walking. You should have a leg clamp, but you may also want to clip the tubing to your clothing, especially at night.
Intermittent Catheter Care
Caring for an intermittent catheter is not as complicated but some have some of its own issues:
- Cleanliness. Cleanliness is probably a bigger issue with intermittent catheterization than with a Foley. Remember, you are inserting a tube several times a day into you bladder. It is very important to wash your hands with a good quality soap before starting. It is also very important to clean your urinary opening before starting. My local urologist indicated it is okay to use a baby wipe for this, but you might want to use soap and water to be sure. It's probably unnecessary to use a cleaning solution such as Betadine, but follow your doctor's advice. I dry everything off with paper towels.
- Lubricant. I prefer not use an OTC lubricant like KY jelly because it's usually not sterile. Several bacteriostatic (meaning they inhibit the growth of bacteria) lubricants comes in single-use foil packs and are obtainable with a doctor's prescription. If you having to cath a lot, they are worth the money.
- Catheter re-use. Depending on your doctor's recommendations it is possible to re-used intermittent catheters. My doctor allows one week of re-use. After this period of time, even if the catheter looks okay, it is best to throw it out. Catheters can develop a biofilm over time that can't be seen. This may cause a bladder infection if the bacteria gets into your bladder.
- Catheter care. After use, clean the catheter with soap and warm water. Be sure to flush the inside as well as you can by holding the funnel end near the faucet with a strong stream of water running. Don't touch the underside of the faucet with it. Once clean either dry it with a paper towel or allow it to air dry. Store the catheter in a clean plastic bag. I don't close bag, preferring to leave it open to allow air to circulate. Any dampness may promote the growth of bacteria.
I hope most of you never have to do this, as it's not any fun. But for those of you who do, maybe you can learn something from my experiences.