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Living with a urinary catheter

Drinking lots of fluids

People with a long-term indwelling catheter need to drink plenty of fluids to keep the urine flowing. Drinking 2 to 3 litres of fluid per day (six to eight large glasses of fluid) can help reduce the risks of blockages and urinary tract infections (UTIs). A balanced diet of fruit, vegetables and fibre is also important to avoid constipation. If the bowel is full, it can press on the bladder causing problems with drainage and may also cause leaking around the tube. Some people with medical conditions may have restricted fluid intake and may need to check with their GP how much they should drink. Fluid intake may need to be increased after periods of exercise.

 

A consultant explains that drinking up to 3 litres of fluid a day can help reduce the risk of...

A consultant explains that drinking up to 3 litres of fluid a day can help reduce the risk of...

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What can patients do to try to prevent these infections?
 
I think the most important thing that patients do is to maintain a high fluid intake. We try and encourage them to drink up to 3 litres of fluid a day. The other interesting point is that they can reduce the risk or encrustation of the catheter if they drink citrates. And that alters the pH at which these crystals come out of solution. And we encourage them to drink a high proportion of citrate with their fluids.
 
What sort of drinks would those be?
 
Well things like Lemon Barley and Lemonade and those sort of things will help them.
 
But not orange?
 
As long as it contains citrate.

 

Many of the people we interviewed stressed the importance of drinking lots of fluids. The drinks they had included cold and boiled water, (decaffeinated) tea and coffee, fruit juice and squashes. Some people, like Charles, used a large leg bag so they could drink as much as they needed throughout the day.

 

Stewart describes his daily drinking routine. He mainly drinks tea and is mostly teetotal.

Stewart describes his daily drinking routine. He mainly drinks tea and is mostly teetotal.

Age at interview: 87
Sex: Male
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I’m sure I’ve had a lot of advice from different people. And, unfortunately, some of them contradict each other. But I do try to drink quite a lot. I might drink more coffee than I should do, but nevertheless it’s mainly tea that I drink. But I do like coffee at certain times. I don’t drink beer or spirits. I’m more or less teetotal, apart from weddings and funerals. Some people have said that, I can’t think what it is now, something that’s quite good for bladders, but I can’t remember what it is.
 
Could it be cranberry juice?
 
Yes.
 
Do you drink anything like cranberry juice? Or some people have said that they drink water with lemon juice squeezed into it…
 
No, I don’t do anything like that.
 
What would you say is your usual routine, day to day, in terms of drinking? So a typical day, what kind of fluids do you drink during the day?
 
Well I get up usually between 7 and half past. I have my breakfast before I get dressed, before I change catheters, in my dressing gown. I make a mug of tea. I have some, I have a dish of cereal and I have a slice of wholemeal bread with marmalade. That’s my daily routine breakfast, except every now and again I have a decent porridge.
 
Mid morning, I’ll have a coffee, well in the, at breakfast time I may have two mugs of tea, depending on how I feel. Usually only one but sometimes I have two. Mid morning, I’ll have a coffee. Lunchtime, I’ll have a coffee after my lunch. 
 
Just recently I’ve started having a drink of tea in the middle of the afternoon, which I haven’t done before and I don’t know if that’s another bad habit I’m getting into. But I have, I mean I’ve been having that recently. And then at tea time I have tea, a mug of tea and then in the evening I have Horlicks. I have a mug of Horlicks. And, in between, I may have a fruit juice or lemon juice or something like that. A drink of squash.

 

 

Drinking lots is important in preventing UTIs. Alok recommends drinking from a bottle rather than...

Drinking lots is important in preventing UTIs. Alok recommends drinking from a bottle rather than...

Age at interview: 37
Sex: Male
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On the internet I have seen various things which people were using, like lemon juice. Someone recommended lemon juice, so I always used to drink lemon juice. And things like that to avoid it [UTIs]. 
 
Everyone, even the carers, nurses and doctors, they always say to drink a lot of fluids. And also try to drink, like most people say try to drink as much as possible of the citric things, because that helps in keeping away UTIs. 
 
One more thing which, in my case, I have discovered is that it depends on how you drink the water. Because in my case, if I drink water from a glass, after drinking one glass I feel that I’m okay. Or, if you start drinking by glass, it’s the count, the psychological count; one glass; two glasses, and you can’t drink much. Whereas in my case, I drink from a bottle. From a bottle, you are drinking and you are not counting. So I always keep a big bottle, not a small bottle. I always keep a big bottle, not a glass. 
 
Try to drink from a bottle because that way I feel that we can drink more instead of drinking from a small glass. Or even if it’s a glass, try to keep a big glass instead of a small glass because, even with one big sip more, it makes a lot of difference in my input. Yes. 
 
So drinking and how you drink is very important. 
 
Yes, how you drink also makes a lot of difference. Drinking is okay, but how you drink, in my opinion, also makes a lot of difference. Because, as I told you, if I drink from a glass, I will drink one or a maximum of two. And instead, if I am thirsty, if you give me a big bottle of one litre, I can drink half a litre just like that. 

 

 

Charles drinks 3 to 4 litres a day. He believes that this, and cleaning his catheter site, has ...

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Charles drinks 3 to 4 litres a day. He believes that this, and cleaning his catheter site, has ...

Age at interview: 57
Sex: Male
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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. And I think that’s one of the things which so many people don’t do, is drink lots.
 
Drink, I probably drink three to four litres of fluid a day, of which probably at least half of that is water. So that’s six glasses, six large glasses of water and then pints of tea and fruit juice and all that sort of stuff, you know. So that’s the one thing which I think has, in inverted commas, “saved me”. And obviously the cleaning, the cleaning of the catheter site.
 
Do you do anything else when you get an infection? Do you drink, try to drink more?
 
Oh, yes, well, your normal stuff, you know. You try and flush out as much as possible. Drink, drink, you know, I mean this is where you’re shoving glasses of water down you just in one go, you know, and really probably even drinking more like five or six litres a day. Something which you would do in the tropics rather, or in the desert, rather than here. But I think it’s probably one, been my one saviour, to be quite honest.
 
Drinking?
 
Drinking lots and lots of, I mean I wish it was, you know, Chateauneuf du Pape or, you know, because I like my wine. I mean none of this stops me from drinking alcohol, by the way. I can still have a glass of wine or two. I can, in fact it’s quite beneficial because I normally match, I normally drink, when I drink a glass of wine I drink twice as much water with it. So no more hangovers, I tell you what, no more hangovers because you’re drinking so much water.
 
Have you ever had a blocked catheter?
 
Never.
 
Good.
 

Specifically because I drink so much. I wash it through. 

People with a long-term catheter can help prevent a UTI from developing by drinking plenty of fluids. Fluid intake should be enough to make the urine look like water or only slightly yellow in colour, and clear. Some people stressed the importance of drinking citric drinks, especially lemon juice, and felt that the amount they drank every day had helped them prevent UTIs and blockages.

 

Martin mixes 100ml of pure lemon juice with 900ml of water. He drinks this morning and night. He...

Martin mixes 100ml of pure lemon juice with 900ml of water. He drinks this morning and night. He...

Age at interview: 51
Sex: Male
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I’d read in the SI [spinal injury] magazine, in various places, that people that are on a high citric drink were getting good results and the catheter wasn’t blocked up. But they never actually said go and buy a load of vegetables, lemons and grapefruits, oranges, and mush them all up, so it wasn’t very helpful. 
 
Anyway a couple of years, I came up with a very simple format, 100ml of pure lemon juice that we get a bunch of lemons. Load of lemons, and then we do them in the machine, get all the pith and all the, you know all that kind of meaty bits out, no pips. And then we put 100ml for every 900ml of liquid.

Of water?
 
Water or, I don’t know, use a little bit of lemonade to make it a little bit sweeter, otherwise it is very sour. But once in the morning and once at night. First thing in the morning, last thing at night, and my catheters have gone to, I think the longest now is fifteen weeks.
 
Oh right.
 
It dramatically just changed, just like that. 

 

Some people we interviewed wondered whether cranberry juice was effective in preventing UTIs, several saying they’d read or received contradictory information. Cranberry juice makes the urine more acidic and so is thought to reduce the number of UTIs. Bacteria are less likely to multiply in acid urine. Some people felt strongly that cranberry juice had helped them, several saying they took cranberry tablets as well as or instead of juice. Current research studies show that cranberry juice may reduce UTI's but is less effective than previously thought*.

 

Badg mixes cranberry juice with water, and tries to drink over 3' litres of fluid a day. Drinking...

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Badg mixes cranberry juice with water, and tries to drink over 3' litres of fluid a day. Drinking...

Age at interview: 58
Sex: Male
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I’ve not had a lot of UTI’s. I drink cranberry juice dilute all the time, in between coffees, and I try not to drink too many coffees because it’s not good for you. 
 
Is the cranberry juice with water? 
 
With water, yeah. Probably under 50% cranberry juice. Probably 30 or 40% cranberry juice and the rest is water. I should imagine I get through a litre box of cranberry juice in two or three days. I try and keep the fluids up, drink on average, I’d say I drink three and a half litres a day, or past three and a half litres a day. Some days I have bad days, some days I drink more...
 
...I was told at the Spinal Unit to keep the fluids up I think they probably suggested four litres a day, but no maybe not, three and a half to four. And I’m always, I just, they just brainwashed me into doing it, and I’ve done it ever since. 
 
Cranberry was and still is, to the best of my knowledge, suggested to be a good thing for keeping bacteria off the bladder wall. It won’t do anything for the pipework of course. And I quite like cranberry juice, probably because I drink it every day. So that’s just become my way of life. I drink currently cranberry, and I drink coffee at home, mostly dilute cranberry. Yeah that’s it. They just brainwashed me into drinking a lot. 

 

 

John Y drinks water, cranberry juice, tea, coffee and some wine in the evening. He's had...

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John Y drinks water, cranberry juice, tea, coffee and some wine in the evening. He's had...

Age at interview: 77
Sex: Male
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How much do you drink? You say you increase your fluids. How much do you try to drink every day? 
 
Well I have 500ml of water before I get out of bed. I then have some cranberry juice and a cup of tea. And then I have coffee at lunch time and afternoon tea, and half a bottle of wine in the evening. And then I drink perhaps 5 to 700 of water just before I go to sleep. So it isn’t quite evenly spaced, but I suppose I’m taking the best part of three litres. 
 
And you said you take some cranberry juice. Did somebody suggest that? 
 
Oh yes it was just, look on the net and you can’t make up your mind. One says it’s a terrible idea to take it, and another says it’s a good idea. Yes, my urologist said “Oh two glasses of cranberry juice a day. It stops the e-coli sticking.” But when you read, other people they say, “Load of hooey, it alters the PH in the wrong direction.” And someone else says it’s altering it in the right direction. So I just don’t know. There’s conflicting information.

 

Some people said they drank lots of fluids when they were at home but less before going out or travelling somewhere. Many left home with an empty leg bag (see Travelling long distance). Annie drank less before going out but felt that she generally didn’t drink enough. Peter Z also felt that he should perhaps drink more. Gordon said he ‘didn’t overdo it’ and drank as he’d always done.

 

Annie usually drinks water and orange juice, finding cranberry juice too sweet and syrupy.

Annie usually drinks water and orange juice, finding cranberry juice too sweet and syrupy.

Age at interview: 64
Sex: Female
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I just have to make sure that I don’t drink too much before going out, and that I come to the meeting with an empty leg bag and then I’m okay.
 
Yes. And in terms of the amount of fluid that you drink every day, were you given much advice on that. Or again,
 
Not really. I mean I don’t drink enough. I know I don’t. I should drink much more. And that’s a constant worry really. But it’s really, most of my symptoms are due to the fact that I have enough, a high enough fluid intake. And I should, I know I should.
 
What do you normally drink? Water or juice.
 
Water and orange juice I drink mostly. A little bit of coffee and a little bit of tea. But mostly water and orange juice.
 
When I was first in hospital, they used to make me drink cranberry juice all the time ‘cos they said it had some sort of content which made your bladder, the environment of your bladder much more unlikely to be colonised by any bacterial infection. And when I look, I couldn’t, endless glasses of cranberry juice, which was very fattening because it was mostly made of sugar. I looked at the contents on the back of the packet, the carton, and it had very little cranberry in it at all. So I absolutely refused to have that anymore. ‘Cos I could see I was going to get so fat. There I was sitting in a wheelchair unable to move, drinking what was really just syrup, so I don’t advocate that. And it made no difference to my bladder at all.
 
I mean if cranberry, if whatever it is, whatever component of cranberry is helpful, then I think it needs to be taken in tablet form, which you can actually, I think you can buy.
 
I haven’t tried to do that and I should probably, ‘cos it might be better than being on Nitrofurantoin, I don’t know. But I don’t, I really don’t believe that cranberry juice is the answer. And that’s fine, that’s my first bit of advice.
 
And you drink water more than anything?
 

Water. Yes.  

 

Peter Z is often told to drink more. He drinks cranberry juice though doesn’t enjoy it. He drinks...

Peter Z is often told to drink more. He drinks cranberry juice though doesn’t enjoy it. He drinks...

Age at interview: 76
Sex: Male
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I’m told constantly I don’t drink enough but it seems quite obvious if you’re already half full of fluid you don’t want to put more in there. It seems that’s what I should do.
 
Do you drink a certain amount of fluid every day?
 
Not really. I take cranberry juice, which I think the lady [nurse] in the hospital recommended. Yeah, I drink that every morning when I first get up, not just to swallow the pills after taking them. I’m not a cranberry juice fanatic. I think it’s over-rated but anyway it seems to work.
 
You have one glass of cranberry juice or
 
Yeah. I think probably I take the odd slug, or I always have a glass in the kitchen there in passing, I’ll have a little drop of that.
 
Do you drink water as well or lemon juice?
 
Not enough, I rarely drink water. I should do more often.
 
Some people have said lemon, fresh lemon juice squeezed into water helps.
 

It tastes quite nice. Yes, lemon in water does help. I drink a lot of lemonade as well which I think, I can’t see does any good really. But according to one of my sons it’s bad for my teeth. My teeth are in a terrible state. 

Stuart, who had a spinal cord injury, said he followed advice given to him in hospital to drink lots of fluids. However, he had to cut down his fluid intake when he was told that his salt levels were diminishing. Sara also felt that drinking too much could have negative effects on other parts of the body.

 

Stuart was advised to drink less cranberry juice. He would have liked more information on how...

Stuart was advised to drink less cranberry juice. He would have liked more information on how...

Age at interview: 61
Sex: Male
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I was told that I must drink substantial quantities of fluid and, to that end, that cranberry juice was very good for keeping urinary infections at bay. And it was later explained to me that, the description that I found helpful was that cranberry juice puts almost like a silicon lining onto surfaces. And if one imagines that the bugs are like the hooky part of Velcro, and that one’s bladder walls and the pipes are like the fluffy bit, the hooks don’t stick in so well and the bugs get washed through. 
 
I was drinking, at that time, about 7 pints of fluid a day, and that was one third cranberry, and then watered down three quarters of a pint to a quarter. I have subsequently taken to adding two slices of fresh lemon into this, squeezed into every pint, and that combination has reduced my urinary infections very substantially. I also tried at different stages adding different types of cider vinegar to it, but that depends on what flavours you like or don’t like. But that has a similar effect. 
 
I then found that, because of the volume of fluid that I was taking, I was diminishing my salt levels. So I was told to cut back on my consumption to nearer to five pints of cranberry a day. I did that, but found that there was greater sediment forming in both the catheter and the leg bag pipe. 
 
I would say that the information you are given is, to say the least, sparse. I think that if you were told recommended amounts to drink, the timing of that.
 
The timing of drinks? 
 
The timing of drinking through the day and what liquids are better and why. I think that the health service could help itself quite a lot by giving people this information. And also pointing out, giving them, people the incentive to help themselves by pointing out the effects of overuse of antibiotics and the greater probability of infections if one doesn’t do this, and the discomfort that the patient will endure. 

 

 

Sara was told she was drinking too much for her bodyweight. She felt uncomfortable when she drank...

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Sara was told she was drinking too much for her bodyweight. She felt uncomfortable when she drank...

Age at interview: 60
Sex: Female
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I drink the requisite 8 glasses (250ml each) or 2 L per day. You can actually drink too much, which can cause problems with other internal organs, don’t ask me which ones. When I went to an MS Society meeting one time, the incontinence nurse told me I was drinking too much for my bodyweight and suggested I tried reducing it. I tried this but didn't feel comfortable. So I reverted to type. 
 
I used to panic when I was under drinking the requisite amount if I was out for the day or involved with meetings, but I don't worry so much now if I am a bit under. 
 
When I was young and active I drank nowhere near this amount but now I feel comfortable, but I do need reminding when I'm busy on the computer. I used to have reminders on my computer that came up at set times. 

 

Drinking alcohol will not affect the catheter but may be unwise for people recovering from surgery or taking certain medication; doctors may advise against it.  

*Cochrane Collaboration 2012.

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Last reviewed October 2018.
Last updated October 2018.

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