A-Z

Living with a urinary catheter

Catheter valves

A catheter valve is a tap-like device that fits into the end of a urethral or suprapubic catheter, which allows urine to be stored in the bladder and emptied straight into the toilet or bag. The tap can be switched on to stop drainage or off to drain urine from the bladder thus allowing the bladder to fill and empty as normally as possible. Most people who have a long-term catheter now use a catheter valve (with or without a bag) because it is generally felt that the bladder should not be kept empty at all times as it reduces bladder capacity and tone. The catheter valve at the end of the catheter acts in a similar way to the tap at the bottom of the leg bag that is used to empty the leg bag when it’s full. Here, people talk about their experiences of drainage bags.

The aims of using a catheter valve are:

  • To get the bladder used to holding a volume of urine again
  • To improve the bladder capacity
  • To get the bladder to hold between 300-500ml of urine
  • To have the catheter valve closed off all day except when the bladder is drained 4-5 times per day by opening the valve for a couple of minutes (or until drainage stops).
 

A consultant shows an example of a catheter valve and how it can be fitted into the end of a...

A consultant shows an example of a catheter valve and how it can be fitted into the end of a...

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The catheter can be drained either continuously into a urine collection bag or one can use a catheter valve and drain the bladder intermittently. The advantage would be to use, for the patient, would be to use a catheter valve to drain the bladder and, in those circumstances then, they don’t have to wear a urine collection bag. But they do need good manual dexterity and they need to have good cognitive ability too. 
 
Many people have a catheter because they are unconscious maybe, or they are undergoing surgery and you are having to monitor their urinary output under these circumstances. But if the bladder is being drained for somebody who’s developed retention of urine, then a catheter and a catheter valve was very much easier for the patient than having to wear a urine collection bag on the leg.
 
The catheter valve, it’s quite crude. But this is known as a flip flow valve and this fits into the end of the Foley catheter. And this can be just drained. The flip flow catheter can just be drained by turning this lever. That is the catheter valve fitted into the end of the Foley catheter, just like that. And it comes out and can be fitted into the end of the catheter.

 

Many people prefer to use a catheter valve because it may reduce the risk of infection and blockage by intermittently flushing the catheter with urine. Having a valve without a bag is also more discreet and comfortable than having a drainage bag. There are many different types of valve (e.g. flip flow valves). Overnight, the catheter can be left on free drainage.

Some people we interviewed started using a catheter valve soon after an indwelling catheter was fitted. Some had a valve at the end of the catheter and no leg bag; others had a leg bag as well as a valve. People can choose to use a catheter valve without a urinary drainage bag by regularly opening the valve over a toilet/jug or similar receptacle to drain the bladder. A leg strap can be used to support the catheter tubing and catheter valve. Some people used a catheter valve all the time, without a drainage bag, except when travelling or playing sports.

 

Having a suprapubic catheter fitted was ‘very simple’. Charles decided early on to have a flip...

Having a suprapubic catheter fitted was ‘very simple’. Charles decided early on to have a flip...

Age at interview: 57
Sex: Male
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The actual [suprapubic catheter] operation is done at the bedside. And I’m, you know, a bit flip about it. This bloke comes along with a local anaesthetic and a Black & Decker and drills in and chucks the, puts the tube in and away you go. 
 
I mean, again it’s a, the operation is, well, you don’t see it to be quite honest. And you don’t feel it. And I never felt any pain regarding it. So you had an idea something was going on. I mean it wasn’t noisy or anything, so it wasn’t upsetting from that point of view. Obviously you’re a bit nervous about it because, you know, something’s being shoved in your body, which is unusual. I mean it’s not like putting an earring in or something like that. 
 
But, you know, as I said, I’d made up my mind that this is the way I wanted to go. So maybe was prepared for the worst. And the worst was nowhere near what actually happened. I mean it was very, very simple. The catheter was put in, bags were put on. 
 
I was given basically a list from a supplier of what was needed and I decided to go for, very quickly actually, for a flip flow because that actually gives you the benefit of being able to disconnect leg bags or night bags with ease. It’s like isolating part of your central heating system. I mean it was a very good thing to do.
 
Has it a valve you can close and open?
 
Oh, yes, a little valve. So you have the catheter, then this thing plugs in, which is about, it plugs into the end of the catheter. And you then plug your leg bag into it. I actually opted for a large-volume leg bag, which is three-quarters of a litre. Normally it’s only half a litre. But I did that because I decided very early on to take their advice and drink lots.

 

 

Jade always uses a valve, except if she is admitted to hospital with an infection. Normally she...

Jade always uses a valve, except if she is admitted to hospital with an infection. Normally she...

Age at interview: 22
Sex: Female
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I only ever had a valve. Unless I was obviously admitted into the hospital with an infection, then they would make me put it on a bag so that they could measure the urine output and the colour of it and things like that. 
 
But when I was at home having my usual, normal social life, I never had a bag on in case it burst or something.
 
So you could wear clothes without people noticing?
 
Yes, yes. I used to just tuck it down the side of my knickers or under my jeans or whatever.

 

 

At first Jennifer had a valve and a leg bag. In the summer she wanted to wear short trousers and...

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At first Jennifer had a valve and a leg bag. In the summer she wanted to wear short trousers and...

Age at interview: 26
Sex: Female
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 When you had the urethral catheter, did you have a bag or did you just empty it?

 
No, I had it on a valve. At the very first I had it on a bag but I think it was the summer time, I wanted to wear short trousers. I wanted to go on nights out without having it, I really didn’t like it.
 
So I can’t remember who or when or where, someone introduced me to the flip-flow valve, which just fit’s on the end. It’s just like a tap because there wasn’t actually anything wrong with the way my bladder stored anything. It could hold [urine], it was still fine, it was just releasing it out of it [that was difficult].
 
So it was ideal for me. So I had the valve on it, so yeah it was dead discreet just used to tuck up in the top of my knickers and that was it…...
 
……I also think it’s massively important, and it all depends on the reason you’ve got a catheter, is to have a valve on it and not a bag. Because when you have a bag on it, I found your infections increase so much because your bladder is always empty. It rubs you a whole lot more because your bladder is empty. So when your bladder’s full, if you, well when your bladder’s got something is moist inside, got some urine in it, it expands. So the edges of your, you know it’s quite hard to explain but the walls of your bladder aren’t sitting on that balloon. They’re being pushed away from it. Whereas if your bladder is empty all the time, it’s just like sandpaper rubbing together and it’s going to hurt. 
 

Badg switches his flip flow valve off twice a day, in the morning and before going to sleep. He...

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Badg switches his flip flow valve off twice a day, in the morning and before going to sleep. He...

Age at interview: 58
Sex: Male
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I use a flip flow catheter valve, somewhat sporadically, basically about twice a day. When I get up in the morning I close it off and then I open it again. I can feel my bladder start to be full. And, blissfully, even if I couldn’t feel it, if I have leg bags full or I’ve got a blockage, I will actually leak urethrally before I descend into bad dysreflexia, so I’m quite lucky there really. 
 
But I haven’t really seen any good documented benefits of keeping your bladder stretched in the long term. If you’re not about to start using it again, which I don’t think I am, but I do use the flip flow. I close it off in the morning and then open it when my bladder fills and then I generally close it off at bedtime because I always read or watch something on the laptop, do some work when I go to bed because I get bad pain in my feet for a while when I change position. So, by the time I’m ready to lie down, normally my bladder has filled up again. 

 

Pat’s husband Rob used a flip flow valve and a small leg bag. She encouraged him to remember to switch off his valve at some point every day. Rob said that some valve tubes were softer than others and could loosen by the end of the week, causing leaking. Several others talked about the leaking problems they’d had when the valve got caught on clothing and opened, or when they’d forgotten to close it. With a catheter valve, people can bathe or shower as usual and several mentioned switching off the valve before showering.

 

Rob's valve and bag is changed every week. Sometimes the rubber tube is stiff and difficult to...

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Rob's valve and bag is changed every week. Sometimes the rubber tube is stiff and difficult to...

Age at interview: 70
Sex: Male
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The flip flow, the bag, are all changed once a week. So they have a seven days span. Unfortunately, the little rubber tubes that connect them, some of them are stiff, the rubber is stiffer than other times and some of them are quite difficult to actually connect up. But the softer ones, when they get towards the end of a week, they can start to get loose. And in fact I have had one when, I mean because you’re moving around trying to do some things quickly or you’re stretching a bit further, suddenly go “oops” and you feel down and you realise that the pipe is no longer connected…..
 
…..And the other one is, you asked earlier about either rolling your trouser leg up, it has occurred and I don’t even know how because I can’t work out how, that the drain switch on the bag has got caught in either the top of your trousers and somehow the next thing you suddenly find is that you’re dripping, and you’ve got wet shoes.
 
That must be awful. 
 
It has happened more than once unfortunately, very rarely, yes you get a nervous check having to do this every sort of, but it, and sometimes I mean it does happen and I can’t even work out how it’s happened. 

 

 

Sharon uses a valve without a leg bag. She had an embarrassing experience when she forgot to...

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Sharon uses a valve without a leg bag. She had an embarrassing experience when she forgot to...

Age at interview: 52
Sex: Female
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Can you talk a little bit about how it drains and do you have a valve and all that sort of thing?
 
Yes, I’ve got a valve on mine. I don’t wear a bag because I still get the feeling, I know when I want to go to the toilet so I just go and release the valve.
 
That’s quite easy then?
 
Yes. I mean it has made my life easier in some ways because I know, well it has got blocked now and again and you have to get the nurse out. But knowing that I can just go and have a wee and it’s not going to take me five or ten minutes…..
 
Have you ever had to cope with any sort of embarrassing incidents?
 
Yes. One was quite funny. We’d been out for the evening up to a club up the road and some friends came back with us for coffee. And I’d had a wee before I left the club and I’d obviously forgot to shut the valve off. And when I got home I must admit I did, I thought, luckily enough I had black trousers on. I thought, took my shoes off and I stood, I thought that floors wet. And I thought, I did blame the dog. I thought that blooming dog’s had a wee there. It was out in the hallway, and all of a sudden my legs started to feel wet and I thought no, that’s not the dog, it’s me.
 
But I didn’t say anything I just run upstairs, I blamed the dog and cleaned myself up and put a different pair of, another black pair of trousers on, but that’s the only embarrassing thing, but then they didn’t know because I blamed the dog anyway.
 
So it hasn’t been too bad?
 

No.  

Several people discussed the advantages of using a valve, but others would have liked more information about the various types of valves available and the benefits of catheter valves.
 

Vicky uses a flip flow valve but wonders if they have long-term benefits for people with...

Vicky uses a flip flow valve but wonders if they have long-term benefits for people with...

Age at interview: 40
Sex: Female
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I have a flip flow mainly because I was told as an in-patient that I should have one. That it was healthy to block off the catheter and actually let your bladder expand and to try and mimic that natural process. And then I know so many people that don’t know about flip flows, don’t use flip flows, and I think it would be interesting to know a bit more about flip flows. 
 
I went to a conference as a user and we did a panel. And one thing that came up in conversation there as well, does a flip flow actually do anything anyway? The idea that the paralysed bladder has any elasticity, is it worth bothering with etcetera? And that was quite interesting and, to this day, I will always use a flip flow because if it stops my bladder shrinking, stops me having to have any surgery to correct problems that have happened as a result of not flip flowing, then I’d always rather err on the side of caution and use one. But there’s so many people I know that don’t use them.
 
Nobody’s mentioned one before.
 
Right.
 
So that’s quite interesting.
 
Yeah. Even people who went through the spinal unit with me, some of them weren’t advised about flip flows and some were. There didn’t seem to be any great consistency. And it would be interesting to understand a bit more about flip flows and whether they do actually do what I think and hope they might do or not.

 

The catheter valve should be changed every 5-7 days, preferably when the leg bag is replaced. Hands should be washed first and then the bladder emptied by opening the tap. When the urine has drained, the valve can be removed and replaced with a new one. To open the valve, a person must have sufficient use of their hands. Hayley, born with spinal muscular atrophy, would like a new valve designed for people with poor dexterity. She’d like to be able to open and close her own valve instead of relying on her carer James.

 

James, Hayley's carer, describes how he changes her catheter valve every week. It's easy and now...

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James, Hayley's carer, describes how he changes her catheter valve every week. It's easy and now...

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How often do you change the valve? 
 
Pretty much once a week. I think it’s meant to be once every five days, which is why we won’t, I won’t change the catheter because it’s so easy to just let it pass. So that’s why we’ve let the district, DNs [district nurses] come in and do it. 
 
And can you describe what happens when you change the valve? Do you have to have sterile gloves and that sort of thing or not? 
 
No, not really because it’s all out, it’s all open so I just, basically I just pinch the end of the catheter, I open up the new valve. My hands are washed but sort of like it’s not gloves and everything else. Just open it up, make sure the valve’s flipped open and take the old one off. And pop the new one straight on. 
 
Make sure there’s a little bit of urine comes through and then when that’s finished, shut it off, dry it and chuck the other one in the bin. Wash my hands and job done. It’s sort of like, I mean it’s quite weird talking about it because it’s just sort of like a natural thing to do. 

 

Some people with a spinal cord injury also had poor use of the hands so opening a catheter valve or tap was difficult. A few had at first tried using a valve but went onto free drainage (see ‘Drainage bags’).

 

Melanie had more infections when she used a valve without a bag. Having a bag makes her feel ...

Melanie had more infections when she used a valve without a bag. Having a bag makes her feel ...

Age at interview: 55
Sex: Female
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I was always determined to be as independent and as normal as possible, to make as much recovery as possible. And some of the nurses started encouraging me to consider doing intermittent, using a flip flow valve on the catheter so that I would collect urine in my own bladder and then empty it.

 
They were reluctant, I have to say the doctors were not so keen on this in the hospital. I think maybe because of more infection rates, I don’t know. But they were a little bit resistant to this, but I was very keen because it made me feel like I was getting better, if that sounds that that my bladder was expanding and collecting urine. I could actually feel when my bladder was, it pleased me because I could feel that my bladder was, when my bladder was quite full. I didn’t have any leakage urethrally.
 
Did the nurses explain why they thought it was a good idea?
 
They thought it was a good idea for me because I was quite young and quite active and determined to sort of keep going.
 
I’m surprised the doctors didn’t think it was a good idea.
 
Just slightly more conservative I think. As it turns out I’m back on a leg bag. Because I came home with the, doing it with the flip flow and collecting it in my own bladder.
 
Oh I see, with no bag.
 
With no bag. I came home doing that, but that’s when I started getting infections. I had some UTIs when I was in hospital with reasonable regularity, but I suppose I was so busy doing physiotherapy, the whole routine was such that I wasn’t, I didn’t fall prey to infections in the same way. I didn’t have so much time to notice them if you like.
 
When I came home I was still doing the flip flow with the valve. I started to get infections and I could smell when the urine was, I could smell immediately when I had an infection. I took advice from the spinal unit who said well one thing to do is to go back to the leg bag.
 
Do you sometimes close it off using the valve even though you’ve got a bag?
 
No.
 
So it’s just on continuous drainage?
 
It’s on continuous drainage, yes. So when the infection, the urinary infections started to take hold after I’d come home, I fairly swiftly went back to using a leg bag strapped to my leg reluctantly. But I thought it would just be temporary. Unfortunately, I’ve remained with it. I think given my hand function, it’s probably a bit easier. It’s probably slightly easier for me to manage. It’s less, I feel more disabled with it and I feel less like a normal woman if you like. But maybe I’m just being a bit more realistic and accepting that the flip flow wasn’t really suited for me.
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Last reviewed October 2018.

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