Living with a urinary catheter

Indwelling catheters: suprapubic catheters

An indwelling catheter can be inserted into the bladder in two ways:
  • through the urethra, the tube that carries urine from the bladder to the outside of the body. This is called urethral catheterisation (see ‘Indwelling catheters: urethral catheters’)
  • through a small hole in the abdomen a few inches below the belly button. This is done in hospital under local anaesthetic or a light general anaesthetic, and is called suprapubic catheterisation.
Suprapubic catheters and urethral catheters differ only in how they are inserted into the bladder.
Having a suprapubic catheter involves having a short operation at hospital as an out-patient, though some people need an overnight stay. John Y recalled that the procedure had taken only 5 minutes or so under local anaesthetic and was ‘perfectly straightforward’. Roger, though, found it a bit painful at first and took a while to get used to having a suprapubic catheter. Jennifer said she wasn’t prepared for having a suprapubic catheter and that it took a couple of months to ‘get into a routine with it’.
Suprapubic catheters can be made from various materials. Not everyone we interviewed knew what their catheter was made of. Vicky used a silicone catheter because other materials gave her blisters. Frances found out she was allergic to latex when a latex catheter caused her so much pain she had to go to A&E to have it changed.
Some doctors prefer a suprapubic catheter to a urethral catheter because:
  • When a urethral catheter is used, the urethra may become damaged over time, causing urinary leakage around the catheter. The balloon of a urethral catheter can also damage the bladder neck, leading to urinary leakage. A catheter that is forced through the external sphincter (the muscle that keeps people continent) can also cause damage
  • The catheter is less likely to be sat on and accidentally ‘pulled’.
  • If a suprapubic catheter becomes blocked, urine can drain via the urethra (although this may not be possible for everyone). This can act as a ‘safety net’ for people who get autonomic dysreflexia when their catheter blocks. With a suprapubic catheter, a person has an alternative entry point to their bladder (via the urethra)
  • A suprapubic catheter leaves the genitals free for sexual activity
  • The site of a suprapubic catheter is easier to keep clean
  • The procedure is reversible. When a catheter is removed permanently, the hole heals quickly.
  • A larger size catheter can be used suprapubically, reducing the risk of a blocked catheter.
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Iain preferred having a suprapubic to a urethral catheter and Dave described it as being less ‘intrusive’ because it is away from the genitals. Emlyn, who’d had a suprapubic catheter after surgery for prostate cancer, said that his doctor would see if he can live without it after he’s finished radiotherapy. Emlyn would prefer to keep the catheter, though, because he finds it convenient (see ‘Advantages of living with an indwelling catheter).
Frances, who was diagnosed with multiple sclerosis when she was about 40, was keen to be fitted with a suprapubic catheter. With hindsight, she wished she’d had it earlier because it dealt with the problems of urgency and incontinence. 
Frances and Sharon taped their catheter to the side so that it was discreetly placed inside their clothes near their waist. Others talked about self-image and the siting (positioning) of the catheter. Vicky, who’d had a suprapubic catheter for 9 years, was very conscious of the suprapubic site and had not wanted to have an intimate relationship (see ‘Sex and intimate relationships’). She said, ‘the idea of actually having to show somebody a suprapubic site and the catheter and to have any kind of intimate relationship with somebody, I just couldn’t get my head around it.’ Alex, a 51-year-old woman with MS, worried that her husband wouldn’t find her attractive, and had her catheter re-sited 6 years later.
Jade said she was unsure where the catheter would be sited before she had one. She had bladder spasms whenever the catheter was changed and had to have it changed under general anaesthetic (see ‘Catheter changes’).
Richard, who had a spinal cord injury, said that when district nurses found it hard to change his catheter, they wondered whether he’d need it re-siting. In the end, using a bigger catheter solved the problem.  
Some of the people we spoke to said they’d had a urethral catheter first but changed to a suprapubic because they’d had problems with a urethral (see ‘Indwelling catheters: urethral catheters’). Ian had a spinal injury when he was 16. He had a suprapubic catheter, a urethral, then a suprapubic again.
Deciding whether to have a suprapubic catheter was sometimes a personal choice and other times recommended by doctors. Iain, a 35-year-old man with multiple sclerosis, had a urethral catheter for about 8 months but changed to a suprapubic because it would be easier when having sex. He looked for information about suprapubic catheters on the internet and asked his consultant if he could change. John Y had a condom catheter, then a urethral. He found it uncomfortable and his consultant suggested changing to a suprapubic.
Some people we interviewed had had a spinal cord injury. They’d initially been given a urethral catheter but their doctor had suggested a suprapubic catheter as a better long-term option. Vicky had had a suprapubic catheter for over 9 years. Annie was keen to change from a urethral to a suprapubic catheter but Roger ‘didn’t like the thought of somebody planting something in my bladder forever.’ Annie said, ‘I have this great desire if I have to admit to somebody that I’ve got a catheter, I always have to tell them it’s a suprapubic catheter. For some reason I just don’t want them to think that I’ve got a urethral catheter. This is completely irrational, but it’s still the case. I just like people to know, no, my catheter goes through my abdominal wall. You needn’t worry.’ Michelle had a urethral catheter for about 15 years and then changed to a suprapubic. She found little difference between them. 
Narelle’s husband, David, had a urethral catheter for 3 or 4 months after he’d had prostate cancer and a stroke. When he couldn’t control his bladder without it, a suprapubic catheter was fitted as a better long-term solution.
The disadvantages of a suprapubic catheter include:
  • hypersensitivity around the suprapubic catheter site, but this often lessens with time
  • difficulty in siting the catheter in overweight people
  • discharge from the catheter site. In some people this dries up after a few weeks but in others it may persist. It may be necessary to wear a simple dressing over the site
  • bladder spasms may increase for a few weeks after the operation
Stewart changed from a suprapubic to a urethral catheter because he had a lot of leaking with a suprapubic. A few other people we spoke to were concerned about the long-term effects of having a suprapubic catheter.

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Last reviewed October 2018.
Last updated June 2015.


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