Living with a urinary catheter

Urinary tract infections (UTIs)

Anyone with a long-term indwelling urinary catheter is at risk of developing a urinary tract infection (UTI). Using a catheter can introduce bacteria into the bladder and cause a UTI. The longer the catheter stays in the bladder, the greater this risk so that, after 30 days, bacteria will inevitably be present in the urine. Bacteria may or may not cause symptoms, but bacteria multiply quickly in the urine and the constant friction of an indwelling catheter on the lining of the bladder ulcerates its surface, enabling the bacteria to invade the bladder wall and blood stream. From the bladder, infection can spread up the tubes or ureters to the kidneys.
Most catheter-associated urinary tract infections (CAUTI) are caused by bacteria but treatment with antibiotics needs to be prescribed with caution. While some people find a low maintenance dose of an antibiotic helpful in controlling recurrent infections, bacteria can become resistant to antibiotics and their elimination can lead to an overgrowth by fungi such as Candida albicans. Catheter users are encouraged to drink 3 litres of fluid every day to try and reduce the risk of infections. CAUTI are one of the most common causes of infections in hospitals. Because of this risk, catheterisation is recommended only as a last resort when other measures have failed.
Different kinds of urinary tract infection are:
  • Urethritis – when the infection affects only the urethra
  • Cystitis – when it affects the bladder
  • Pyelonephritis – which involves the kidneys and is relatively rare
Some of the people we interviewed had had very few or no UTIs since having a catheter. Peter Z felt he’d been lucky to have had hardly any since having a catheter fitted over 25 years ago. Peter Y, who was paralysed after a spinal cord injury, said he had very good professional care for three years and no infections during that time. The problems started, though, when he could no longer afford to have private care. Gavin had had more infections in the early days of having a catheter but fewer as time went on.
Signs and symptoms of a urinary tract infection include:
  • Abnormal urine colour (cloudy urine)
  • Blood in the urine (haematuria)
  • Foul or strong urine odour
  • Frequent and strong urge to urinate, not relieved by passing urine
  • Only passing a small amount of urine despite the frequent urge to ‘go’
  • A painful, burning sensation around the bladder or in the urethra
  • Pressure, pain or spasms in the back or the lower part of the stomach
  • Leakage of urine around the catheter
  • Chills
  • Fatigue
  • Fever
  • Vomiting
  • Feeling tired, shaky and washed out
If an infection has spread to the kidneys, symptoms also include fever, pain in the back or side below the ribs, nausea and/or vomiting.
The people we spoke to had experienced various symptoms when they’d had a UTI, for example a raised temperature, feeling flu-ish, hot, sweaty, having smelly or cloudy urine, pain and bladder spasms.
Because a UTI can spread to the kidneys, antibiotics may be used to treat it. Some people had taken a urine sample to their local surgery for testing there or in a laboratory. Others said they had dip sticks at home, sometimes bought from the local chemist, so they could test themselves and then arrange to see their GP. Most of the time, antibiotics can be taken by mouth. It is important to take them all, even if a person feels better before finishing the course. Some people said that their GP had prescribed an antibiotic for them to keep at home in case they had a UTI when the surgery was closed. Some doctors prescribe a low dose antibiotic to take every day to keep bacteria from growing in the urinary tract.
If the UTI is more severe, the antibiotic is infused or injected into the bloodstream in hospital through an intravenous line, or IV. When Badg had repeated infections, he went into hospital. Antibiotics didn’t seem to be helping so he also had urodynamics and a cystoscopy. Urodynamics assesses how the bladder and urethra are doing their job of storing and releasing urine. A cystoscopy is where a doctor looks into the bladder with a special telescope called a cystoscope. It may be done to try and find the cause of symptoms such as frequent urinary tract infections, blood in the urine, or persistent pain when passing urine.
Annie said she takes the antibiotic nitrofurantoin every day and rarely gets a UTI. She wondered whether taking it daily could cause damage in the long run, especially to her liver. James, Hayley’s carer felt it was good to avoid antibiotics whenever possible. Hayley’s UTI had become resistant to a certain type of antibiotics.
For most people taking an antibiotic is usually enough to get rid of an infection. Jennifer, though, has to have her catheter changed every 3 weeks because she keeps getting infections.
Some people recommended drinking lots of fluids to try and prevent UTIs, or drinking more than usual when a person had an infection. Vicky said she usually got infections when she was drinking less.
Different people recommended different things to try and help prevent infections, including garlic tablets, probiotic drinks, pearl barley, lemon juice and cranberry juice (see ‘Drinking lots of fluids’).
Everyday care of the catheter and drainage bag is also important to reduce the risk of infection (see ‘Looking after the catheter and catheter site’). Melanie, who had a spinal cord injury, often wondered why she was getting UTIs. She watched her body carefully, made a few changes and found these helped.
Less common long-term complications include blood infections (sepsis), urethral injury, skin breakdown, bladder stones, and blood in the urine (haematuria). After many years of catheter use, bladder cancer may develop.

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Last reviewed October 2018.


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