Suprapubic Catheters

A suprapubic catheter is a hollow flexible tube that is used to drain urine from the bladder. It is inserted into the bladder through a cut in the tummy, a few inches below the navel (tummy button). This is done under a local anaesthetic, or a light general anaesthetic.

Why do I need a suprapubic catheter?

Anyone who cannot empty their bladder may need a catheter. A suprapubic catheter may be chosen because it is more comfortable and less likely to give you an infection than other catheters. Suprapubic catheters are sometimes used for the following reasons:

• Urethral trauma (damage that has been caused to the urethra - the tube where urine comes out)
• People who require long-term catheterisation and are sexually active
• After some gynaecological operations e.g. colposuspension for stress incontinence
• Some wheelchair bound people find this method simpler
• People who cannot perform self-catheterisation
• Long-term catheterisation for incontinence. Although this is not recommended, sometimes medical staff feel it appropriate to avoid skin problems or other medical complications.

What happens to the urine?

The are two options:

• Free drainage: where the urine drains out from the catheter and is then generally stored in a drainage bag.
• Catheter valve: a valve at the end of the catheter used in place of a drainage bag. Urine is stored in the bladder and is emptied through the catheter straight into the toilet or bag.

Your doctor may recommend that you clamp the catheter for some time during the day so that the bladder does not shrink.

Who inserts a suprapubic catheter?

The doctor will insert your first suprapubic catheter during the initial operation. A small balloon at the tip of the catheter is inflated to prevent it falling out. A doctor or nurse can change the catheter in your home, or in their surgery or urology department. You, or a member of your family, may also be taught to change the catheter. You must not try to remove it without medical advice.

 How often does a catheter need changing?

The first catheter change is usually carried out after 4-6 weeks. After this it can vary from 4-12 week intervals depending on the type of catheter and your own situation.

What do I do with the drainage bag?

There are two kinds of bags: a leg bag and a bag used while you are in bed. A leg bag is worn under your normal clothes during the day - it is held in place by straps or a 'holster'. There are different makes of leg bags available - Incontact has a fact sheet on the different types. A night drainage bag is much larger and is attached to the leg bag to hold all the urine that drains from the bladder overnight. It is a good idea to place a basin under the night drainage bag in case of leakage.

How do I look after my suprapubic catheter?

Always wash your hands before and after emptying your catheter bag, or before and after emptying your bladder using the valve. After the operation to insert your suprapubic catheter, you should wash the area around the insertion site with boiled water, which has been allowed to cool slightly. Some people find cleaning the wound with Irriclens sterile saline solution a good method of keeping the area clean.

A dressing will cover the wound after the operation and you should keep it in place until the wound has healed. Although not always necessary, many people prefer to wear a dressing around the wound all the time. The type of dressing may vary. A dry gauze swab is sufficient for some people, but using tape to secure it can be problematic due to pubic hair. Lyofoam K dressings (with a hole in them) have proved successful for some people

It is better to take showers rather than baths as sitting in water for long periods may delay the wound from healing. For the first few days after the operation, you should keep a waterproof dressing on. Once the wound has healed it is perfectly okay to shower normally, although avoid using scented products as these can irritate the area.

Remember that you must keep a spare catheter at home. If the catheter comes out, it must be replaced within a short time (20 minutes) otherwise the opening will close. If you have been taught how to, carefully re-insert the catheter (ensure you wash your hands thoroughly and clean the area around the insertion site first). Then get help from your doctor or nurse as soon as possible.

Will I still be able to have sex?

Yes. A suprapubic catheter should not get in the way of sexual activity.

What kind of problems should I watch out for?

Here are some of the problems to watch for:

• The catheter falls out
• Urine is not draining out of the catheter
• You feel unwell with pain, fever and abdominal discomfort
• Urine is leaking around the catheter - this can be normal around a new catheter site
• The area around the catheter becomes red and sore
• There is bleeding

If you notice something unusual or feel unwell, contact your doctor or nurse.

Will I have to change my eating and drinking habits?

In order to prevent urinary infections and encourage drainage, you should drink lots of fluid (about 2 - 3 litres a day). Water or fruit juice is often recommended, especially cranberry juice as this can help prevent bladder infections. Try to avoid constipation - make sure that you include wholemeal bread, fruit and vegetables in your diet.

A few tips from people with a suprapubic catheter:

"Before showering, make sure you drain your bladder or empty your leg bag. Connect the valve to stop drainage while you are showering."

"I use baby wipes to keep the insertion site clean."

"Make sure that you have infections treated quickly - don't leave it thinking they will go away. Get advice from a professional. Also make sure you take any medication that is prescribed."

"Using bladder wash-out solution keeps the bladder flushed to help prevent any blockages and also helps during infection." (Your district nurse will give advice on this and how to use bladder wash-outs if they are required.)

"If I had my time over again, I would not use free drainage (into a bag) as it loses all bladder control."

"Suprapubic catheters are a much safer form of long-term catheterisation than indwelling urethral catheters, which have many more side effects."

"I use a valve throughout the day. I used to use a Sims Portex Valve, but have just changed to a Bard FlipFlo. I found that, during night drainage, the Sims Portex would come adrift. The Bard is good at night, but can be uncomfortable during the day."

"I take a multivitamin tablet every day, drink plenty of fluids and take an analgesic for pain when I need it."

Who will provide support when I am at home?

Your district nurse should be informed and, if she is not already familiar with suprapubic catheters, will be given training. Your continence advisor, doctor and district nurse should be able to give you advice. You can also get information from your urology department.

Bard InfoLine(open from 12.30-4.30 Monday to Friday). An experienced nurse is available to answer any questions you have and give you advice on any difficulties. Tel: 0800 591783

The Continence Foundation also has a help line with a trained nurse available Monday-Friday 9.30-12.30. Tel: 0845 345 0165