Suprapubic catheters: Uses, care, and what to expect
A catheter usually includes a flexible tube that drains the urine and a place for the urine to empty into, such as a bag. A person may need a catheter if they cannot urinate on their own.
There are several different types of catheters. The one most frequently used is known as a urethral catheter. It is inserted directly into the urethra, where urine naturally comes out of the body.
A suprapubic catheter may be an option for people who cannot have or do not want a urethral catheter. This type of catheter has some advantages over a urethral catheter, but it also needs special care to avoid infections and other problems.
Find out how this catheter works, when it is a good option, and how to care for it.
Suprapubic catheters are not used as often as urethral catheters, but may be recommended if long-term use is expected.
A suprapubic catheter offers an alternative to the frequently used urethral catheter.
Suprapubic catheters may be used:
- when the urethra is damaged or injured
- if the pelvic floor muscles are weakened, causing a urethral catheter to fall out
- after surgeries that involve the bladder, uterus, prostate, or nearby organs
- if the person is sexually active and needs a catheter for a longer period of time
- for long-term use, as it may be more comfortable and easier to change than a urethral catheter
Long-term use of suprapubic catheters is sometimes needed when the person:
- has a bladder blockage that cannot be corrected with surgery or other treatments
- has incontinence that is causing skin rashes and irritation or making them worse
- is terminally ill or severely impaired, making bed changes difficult or painful
How it works
Inserting a suprapubic catheter requires a minor surgical procedure.
People are given numbing medicine, or anesthetic, to manage any pain from the procedure. A surgeon makes a small cut in the abdomen, usually a few inches below the belly button.
A suprapubic catheter does not come into contact with the urethra or genital area.
The catheter has a small balloon at the end, and once the catheter is in place in the bladder, the doctor inflates the balloon. This balloon helps prevent the tube from falling out.
Risks and benefits
There are various risks that a suprapubic catheter may pose. Any concerns should be discussed with a medical professional.
Both suprapubic and urethral catheters have some risks.
If bacteria get into the catheter and travel to the bladder, they can cause an infection. The infection can affect the urinary tract and bladder and can spread to the kidneys.
This type of infection is known as CAUTI or catheter-associated urinary tract infection. CAUTIs can become serious, especially in those with weakened immune systems and other health conditions.
A person's chances of developing an infection increase the longer the catheter is in place.
An article in American Family Physician cautions against the long-term use of catheters unless absolutely necessary. Complications of long-term catheter use include:
- kidney inflammation
- chronic kidney infections
- kidney or bladder stones
- sepsis, an extreme and life-threatening response to infection
A report in Translational Andrology and Urology states that infections and complication rates are about the same for suprapubic and urinary catheters.
But, the authors note, suprapubic catheters are often considered to be more comfortable and that people prefer them. This is because:
- Suprapubic catheters may be easier for a person to change and clean for long-term use.
- A cut in the belly may be more comfortable than having a catheter placed in the urethra, especially if the person is in a wheelchair.
- A person may feel more confident with a belly incision instead of a device placed in the genital area.
Another study also found that people prefer the suprapubic catheter over a urethral one overall. However, the authors state, they found a "significant mortality rate" associated with the insertion procedure in high-risk people.
People at high-risk may have other medical conditions or previous surgeries that make them more likely to develop complications. "The procedure may be simple but some patients and their conditions are not," the authors state.
For this reason, the study authors recommend:
- careful screening of people before inserting a suprapubic catheter
- good medical care after the procedure
- giving antibiotics through a vein during the procedure to help prevent bacterial infection
Care steps for a catheter
Suprapubic catheters can often be managed at home, either by the individual or a caregiver. Caring for a suprapubic catheter takes some time and requires careful attention to cleanliness.
Following a few steps from the beginning will help people get off to a good start with the catheter and minimize the risk of infection.
Get instructions and ask questions
Receiving professional instruction on how to care for a catheter is important. A doctor should provide clear direction, and be able to answer any questions.
Before going home with a suprapubic catheter, it is crucial for people to understand how to care for it to help avoid problems if they or a family member will be caring for it.
People should talk with their doctor and get any questions answered. Get handouts or have someone write down each step that is needed.
This early learning is key to success, according to a report published in Home Healthcare Nurse.
Questions that may be helpful to ask include:
- How can the catheter be kept clean? Thorough hand-washing before and after touching the catheter is vital.
- How often should the catheter be changed? This will vary based on the person's medical condition and how long they need the catheter.
- What are the steps necessary to changing the catheter? Steps such as using lubricant on the tube, emptying or draining the device, and attaching a new bag may need to be reviewed.
- What kind of care is needed for the insertion site? People often go home with a wound dressing that may need to be kept in place until the wound has healed.
- When can the person take a shower or bath? Showers are usually recommended with gentle cleansing and soap, but baths and hot tubs are often not advised.
- How much fluid should the person drink? The user may benefit from drinking extra water to keep the bladder and kidneys flushed out, which can lower the risk of a urinary tract infection.
Get necessary supplies
If a person needs a suprapubic catheter long-term, they will need certain supplies. Discuss what these supplies might be with the doctor or nurse before going home.
The person may get a prescription for some of the extra catheter supplies and can purchase them at a medical supply store or pharmacy.
Supplies may include:
- extra catheter tubes and bags
- sterile cleaning solution
- disposable gloves
- sterile lubricating gel that helps to insert the catheter
- prescribed medications
Know the signs of infection
The signs of a catheter infection include:
- redness or tenderness around the cut in the belly
- feeling an urgent need to urinate
- pain while urinating
- cloudy or discolored urine
- fever greater than 104°F
The risk of infection can be significantly reduced by washing hands with soap and water for 30 seconds before and after changing, emptying, or handling the catheter.
Signs of an infection require medical care. If any appear, one should call a doctor or go to the nearest emergency room.
Overall, many people prefer suprapubic catheters over urethral catheters. Suprapubic catheters still require careful use and attention to cleanliness, however.
Using a catheter, especially in the long-term, should be discussed with a doctor to determine the benefits and risks.
Suprapubic catheters may offer a more comfortable alternative to the standard urethral catheter and may offer people a way to manage incontinence and other issues better.