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’.

Melanie had a suprapubic catheter inserted under local anaesthetic. She felt very sore when the...

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Age at interview: 55

Sex: Female

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I tried the intermittent, it didn’t work. So suprapubic seemed to be the final option and I was given literature etcetera.

And what was it like having it inserted under local anaesthetic?

That was very, very sore I have to say. I mean, because I’m incomplete [partially paralysed], having a, it wasn’t sore at the point of it being done but when the anaesthetic wore off, it was incredibly sore. I mean I could feel it and I could feel I’d had a vital organ punctured.

Was that local anaesthetic injected, or was it an epidural?

It was injected, yeah, it was injected.

How long did the pain or discomfort go on for after it was inserted?

It was a few hours. It was, I mean I felt pretty ropey for about 24 hours. And I had to get extra pain killers.

Jennifer didn't know she'd have to dress the wound every day. Seeing pictures beforehand would...

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Jennifer didn't know she'd have to dress the wound every day. Seeing pictures beforehand would...

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Age at interview: 26

Sex: Female

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I went back to my local hospital who discussed about putting a suprapubic catheter into me. So a catheter like through my stomach, through my abdomen but lower down. And straight into my bladder.

And what sort of discussion did you have? Were you well informed about the advantages and disadvantages?

I think I was well informed, I was well informed in the fact that it would be an easy way to empty my bladder. My bladder wouldn’t be able to push it out. It wouldn’t hurt to walk as much anymore, and that kind of thing. What I really didn’t expect was how bad the bladder spasms would be and how painful it was afterwards. And how long it took really to get into a routine with it. It took a good six to eight weeks after having it done.

I was, and maybe it was just me, but I was under the impression when my consultant discussed it with me that having a urethral catheter can just be done in an out-patients, it seemed dead quick, ten minute job. That’s the end of it. Suprapubic catheter, he said, “Yes, oh it’s alright. Yeah we do it in theatre so you’ll be asleep. You’ll have a little wound on your stomach, that’s it, and a bit of a tube coming out. Not a big deal.” So he really played the whole situation down, maybe for my benefit I don’t know, but I was really not prepared for the way, you know, it was.

How were you afterwards when you woke up?

It was very, very painful. It was very painful. And it was painful to sit up for the first twenty four hours, and it was a really weird sensation inside me. It’s a sensation I don’t even think I can describe. It was very strange. And at that stage it drained, they told me I could still use a valve so I wasn’t really expecting, I suppose ‘cos I’d never really had an operation before, other than appendix years and years and years ago, that I’d have to dress a wound everyday. ‘Cos obviously the, you know it never heals around it. It’s an open wound so it needs a dressing on it every day. So I never really kind of thought of that. So that came as a bit of a shock.

So I was, I think I was in for about a week, so after a week of you know being in I was discharged.

So they didn’t show any pictures of what it would look like on your stomach?

No pictures.

That would have been useful wouldn’t it?

Yeah. And I look back now and I think to myself, “Why didn’t I look this up on the internet? You know why didn’t I search it on the internet while I was in hospital?” But I don’t think you do. I think I was ill at the time, I had quite a nasty infection that I’d been battling for a few days and you know I just, I just wanted to go home.

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.

Vicky gets blisters with some materials. A silicone catheter is ‘the least irritating’ to her skin.

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Age at interview: 40

Sex: Female

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I had a problem with the material. I don’t think I’m allergic to the materials but I think, where they’re in contact with my skin and where I might just lean forwards and move around a bit, during the day it just rubs my skin a little bit and I find I get blistered quite easily.

And the same goes for the little piece of rubber that are in the middle of each leg strap to help it grip and stop it sliding down. That also will blister me if the straps are too tight, and I don’t have any strap to hold the tube in place on my thigh because I had to give that up. It just continually blistered me no matter how carefully we put it on, it just always blistered.

The catheter is a silicone one, which seemed to be the least irritating to my skin. But still every morning we wrap it in a bandage to keep the material away from direct contact with my skin. And if it does, I think if we don’t do it quite carefully and there’s a bit showing through, I find I’ll have a blister by the end of the day.

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.

A consultant describes some of the advantages of a suprapubic catheter.

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There are two ways of putting a catheter in the bladder, either through the urethra, through the natural passage, or it can be put through the lower abdomen as a result of a minor surgical operation. It can be performed in many cases under local anaesthetic.

If a patient has to have a catheter permanently, a lifelong catheter, then there are many advantages for them and their carers to have a suprapubic catheter. As I’ve said already, the male urethra is 18 centimetres long and it’s lined by glands, and the catheter will block these glands and you can get infections in these glands. When the catheter is changed, the catheter tip can damage the surface of the urethra and problems can arise as a result.

The suprapubic catheter is more comfortable for patients and it is easier to manage for the carer or the clinical team in many cases. But it’s a matter of choice very often from the patient and it’s very simple. If they do have a suprapubic catheter put in, if it comes out, the opening into the bladder very rapidly closes actually, so that it soon heals. It isn’t, so to speak, a final irreversible operation.

Are there any disadvantages of having a suprapubic catheter?

If you ask patients who have had both, most people will say they find a suprapubic catheter much more comfortable than having a urethral catheter. They don’t get the irritation. Males for example, if they have a urethral catheter, it can cause irritation. It can cause erections and difficulties from that point of view and they’re free from those sorts of complications if they have a suprapubic.

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 shows how she wears her leg bag. She can wear tight jeans, shorts and swimwear. She also...

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Age at interview: 64

Sex: Female

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This is the bag. That’s the tap end but on one side as you can see, it’s velvety, it’s sort of, it’s cotton backed, so it doesn’t affect the skin. It doesn’t make you sore or a rash or anything. And it just goes nicely there like that. That goes inside the trousers, just like that.

And how do you keep it in there?

And there’s no tube. And on the top there’s these little eyelets and I just thread through it, I thread a lace. Either a football lace or a piece of ribbon. I’ve got lots of different ones. I match them with the different colour pants I’ve got. Cos you can get these in shocking pink, purple, orange, and this is what I do. I just tie it; I’ve got a red one on today. And it’s just tied. And that’s where it is. In there. Not down my leg anywhere.

And because it holds 600 ml, that’s a fair amount which is spaced out nicely. If you’ve got a smaller bag you’ve got a big lump. But this size, and it’s so easy to empty. I’ve only got to just get the tap out, and I can empty it whether I’m sat down or on the toilet. And it just all tucks in. And I can wear quite tight jeans and shorts. Or even a swimsuit.

Yes. Can you show me your catheter as well, for the recording.

Yeah.

I need to know when you’re ready.

My flies are undone. Now I wish I’d lost a lot of weight you see before you came.

This is the female length catheter. And so the only tubing you’ve got once that’s inserted is that little bit there, which just goes in like a little loop there. And it’s connected straight to the bag, to that end. So there’s no tubing, absolutely no tubing. So you’re almost peeing straight into the bag, into there.

So there’s no, it doesn’t kink, whereas if you’ve got a longer length which you’ve got to sort of tuck and put away, I find it kinks. And you get into all sorts of trouble, apart from the weight of it, you’d be surprised how heavy that is if that’s hanging off that, you know the opening, the sore, the catheter site itself. And these have been terrific, and these are the Manfred Sauer ones.

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.

Alex was shocked when she saw the catheter because it was so close to her vagina. She wondered if...

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Age at interview: 51

Sex: Female

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I went for the operation which was done under sedation, very simple, for me anyway, it was, I just fell asleep and woke up and it was all done and very neatly. But when I woke up and I looked at where it was put, I was really alarmed because it was very low down on my kind of pubic bone, really near my vagina and really near my clitoris.

And I thought, “Oh my God”, and I didn’t say this to anyone, not my husband, nobody. But I thought, “Oh my God, am I going to be able to have sex again, will it get in the way?” and then I thought, “Am I even going to be able to have an orgasm again?” Because I had like this plastic tube right near a very sensitive place but I didn’t say anything about this.

It took me two years to decide to have it re-sited because I hate hospitals, but I did have it done and it’s great because now it’s much more out of the way for sex so it isn’t quite as annoying as it was before.

It’s a little bit higher up is it now?

Yes, it’s higher up.

So almost at the level of the belly button?

No, it’s to one side, because I wanted it slightly to one side because the good thing this time was the siting was done in consultation with me and my consultant and that is brilliant. Because then you can both have a discussion about, well I said I’d like it here and then he could say well actually here might not be so good because of this, then me and my husband could decide again where we wanted it.

That’s good.

So that was really good but that took quite a few

Six years.

Yes, of talking, and the fact I would say to anybody who is going to have a suprapubic catheter, ask about siting. Decide where you would like it and then have a conversation about that because it’s really important to do that.

A consultant explains what rules doctors follow in siting a suprapubic catheter.

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How do you decide where exactly to insert the suprapubic catheter? Do you have a discussion with the patient about that beforehand?

Well there’s not a great deal of choice where you put the suprapubic catheter in. It just has to be above the pelvic bone, about 2 centimetres above the pelvic bone and you have to make sure that the bladder is filled under the abdominal wall. That’s one of the most important aspects because if, for example, they’ve had abdominal surgery and there’s a scar in that area, you may have bowel stuck down behind the scar and there is a risk, a serious risk, that you may penetrate the bowel when putting in the catheter.

So there are very clear rules, so to speak, for the clinician to follow before he puts in a suprapubic catheter.

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’).

It was strange at first to have a tube coming out of his stomach. Within days, though, Gavin had...

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Age at interview: 28

Sex: Male

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Most off putting thing about having my suprapubic catheter was just, one minute you’ve got a stomach there and then the next minute you’ve got a stomach with a tube coming out of it. And it’s more strange than off-putting but, within days, you don’t see it at all. So you very quickly adapt and change to suit really. And that goes with every other problem really. You quite quickly find a way round things or a different way of doing something, or not doing it at all, and doing something completely different.

Hayley's catheter was sited a bit higher than her belly button because of her condition (spinal...

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Hayley's catheter was sited a bit higher than her belly button because of her condition (spinal...

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Age at interview: 46

Sex: Female

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I had it sited a little bit higher than my belly button and, because I’m very twisted, my belly button actually points right virtually because my scoliosis (a back condition that causes the spine to curve to the left or right side) is quite bad. And so it’s kind of almost in the middle but alongside the belly button. It’s very removed from personal areas. If somebody has to help you with a change, actually changing the catheter, they don’t see anything personal at all, they just see a bit of your tummy.

Is that one of the reasons why you decided to site it there?

Well it’s, yeah I just think it’s much cleaner as well. I think it’s a lot easier to wash with soap and water. That’s the preferred method in general is soap and water to keep it clean. It does occasionally get a bit sort of mucky and a little bit crusty, again it’s a wound. If you imagine it’s a permanent wound so the body’s always healing around it.

Definitely at least once a day twist it round, completely all the way round twizzle. It moves in and out as your bladder fills and deflates, and as you eat and deflate as well.

The main thing really is keeping it clean. I have a dressing as well on it because it’s still in contact with my other skin, well my leg and fabric and that sort of thing, so I like to keep it a bit cleaner. And just every day wash it with soap and water.

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.

Richard decided to have a suprapubic catheter because he bled with intermittent self...

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Age at interview: 59

Sex: Male

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Did they (medical staff) try intermittent catheterisation while you were there?

Yeah, they did yes. Like I say on two occasions, and one I had quite a bit of bleeding. So they decided, well we discussed it, they give, you know I had a discussion with the urologist and they told me what my options were. And so really I decided for myself that it was going to be a suprapubic catheter.

And you were fitted with that before?

Just before I came out. I had, I think it was a fourteen millimetre, which I didn’t have any trouble with blockage. But whenever they used to change it, I used to get difficulty over the nurses, the district nurses used to have difficulty re-entering the new suprapubic catheter. And so, in the end, they said it needed re-siting.

So I went back to the hospital after probably after about nine months. And they decided that rather, than re-site it, they put a bigger catheter in. So I think I’m on 20 millimetres now.

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.

A urethral catheter was eroding the end of Ian’s penis so he changed to a suprapubic. He’s now...

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Age at interview: 39

Sex: Male

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In 1988 while playing rugby for a school team, I broke my neck so was taken to hospital. And so didn’t have a choice. And when I came round I didn’t realise I had a catheter for a while ‘cos I didn’t know that was going on. But I had a suprapubic put in then. And then a few years later they exchanged it for a urethral one. But then changed it back again about ten or so years ago to a suprapubic, so I’ve had one for quite a while, yeah.

Did they discuss the changes with you? Were you given much of a choice? Obviously at the beginning you came round and you had one so that was what they decided what was best at that point.

Yes and then they thought, I think they said a urethral one would be easier to change in case of blockages. But then the urethral one was sort of eroding away the end of the penis, so they had to change back and put a [suprapubic] one in. So I sort of had one in situ probably as long as at least ten years.

Yeah. So in 1988 when it all happened, how old were you at that point?

I was 16.

Faye had no time to think about changing from a urethral to a suprapubic catheter. Everything...

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Faye had no time to think about changing from a urethral to a suprapubic catheter. Everything...

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Age at interview: 29

Sex: Female

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It [urethral catheter] was coming out every day to every three days, and I kept having to have it re-done until eventually the nurses got fed up of coming, so they arranged with the urologist for me to have a suprapubic catheter in.

When you had the urethral one did they blow up a little balloon with water to try and keep it in position?

Yeah.

It still came out?

Yeah, it hurt.

Right. What did you think of, were you involved with the decision to try to change from the urethral to the suprapubic catheter?

No I weren’t involved in it. I just got a phone call from the continence nurse telling me about how I were going in hospital the following Tuesday to have it done.

What did you think about that?

It had, it all happened too fast, I didn’t really have time to think about it.

What sort of information were you given?

None. Just that it would be painful for a few days afterwards. I had a pre-op but the consultant was too busy and just trying to work his way through patients, so all I did was sign a form and that was that.

So were you given any written information about it?

Nope. I were given the consent form, other things that could go wrong.

And you didn’t, did you have a chance to look up on the internet or find out anything?

No. With me already working in hospitals I knew what one was…….

So you came home?

I came home,

And since then what’s it been like having a suprapubic catheter?

It’s been a daily struggle.

A daily struggle?

Yeah.

Can you explain why?

Yeah. I’ve constantly got an infection.

Whereabouts? In the bladder or round about the site?

Yeah, in my bladder. And I just never know what one day from the next is going to be like, if I’m going to be ill or not.

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.

Alex restricted how much she drank and found it tiring and difficult changing pads. She resisted...

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Age at interview: 51

Sex: Female

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I’ve got MS, Multiple Sclerosis. When I first became ill, I had very minor symptoms and it didn’t really affect my life much. Then after about ten years, I would say, I began to have quite major problems, disability wise, that did affect my life. One of which was I became incontinent, with urinary incontinence. So I started wearing continence pads but it got to the stage where, because with my MS, it was very tiring and difficult to change the pads.

So I found myself limiting the amount of fluid that I drunk, and actually getting to the stage where I didn’t want to go out much because I was worried about whether I would need a loo and even if I needed a loo it would be too tiring and difficult to change my pads. So I really felt that my life was being severely limited. Plus my health was at risk because I just was not drinking the amount of fluids that I needed to.

So I talked to my continence nurse who was great, and she suggested the idea of maybe a suprapubic catheter. I completely dismissed this to begin with. Then I went to my urologist who was really great and he recommended a suprapubic catheter. And he was great he, he said ‘Obviously anything is your decision but I think this might really help you.’ Again I really didn’t like the idea. My continence nurse showed me a suprapubic catheter and I just, I really didn’t like the idea. I felt like I’d be like some awful version of the bionic woman with this kind of plastic tube coming out of me. And for me my body image is really important, so I didn’t like the idea at all. My urologist said to me he thought it could be really liberating but I was still resistant.

I want to make the point that, for me, having a suprapubic catheter has totally liberated me, really changed my life. I’ve been able to go abroad on long haul flights. I can go out for the whole day visiting people or doing work shops or training or giving public speeches without having to worry about, “Do I need the loo, I can’t drink this.” I’m able to drink as much water as I like, and it really helps me.

Ann had problems with leaking, retention and infections. The second consultant she saw was ‘kind...

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Age at interview: 81

Sex: Female

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My bladder trouble started around the time I had a hysterectomy for uterine cancer. After that, my bladder was a bit iffy but manageable and no real problem. But then two years after my hysterectomy, I had a secondary and I had to have radiotherapy, including a 24 hour implant, during which time I had to lie absolutely still in bed. It was very interesting lying absolutely still in bed. And that meant 24 hours on only hospital sandwiches ‘cos you couldn’t sit up to eat anything or drink anything. It was quite an ordeal.

After that the bladder trouble really got increasingly bad. And I ended up getting a whole series of infections, difficulty in both sometimes in passing urine, but difficulty in not dribbling. And last year I had I think it was 15 courses of antibiotics for bladder infections. And I found myself dribbling all day and flooding at night, and it was just unbearable.

So when I was offered a catheter I thought oh dear that wouldn’t be at all possible because I was so sore down below because of the urinary problems. But then they explained to me that a suprapubic catheter would be what they would offer. And I thought well that should be possibly okay.

So after a lot of waiting around for hospital appointments and having difficulty with a consultant who didn’t want to know, I then got side stepped and sent to another one who was kind and competent and willing to see me, and willing to do the necessary. And I did have time with him to find out what he thought, what good he thought it would do. And he particularly wanted me, if I agreed to have a suprapubic, to have it under general anaesthetic because he wanted to see if he could stretch my shrunken bladder and get it to be more tolerant and hold more volume of fluid.

John Y had a urethral catheter for a few days. He said a suprapubic was more comfortable because...

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Age at interview: 77

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So first of all you had the condom catheter for a bit?

Well yes, it’s not a catheter that, it’s a

Bag to collect urine, yes.

It’s a Conveen, it’s called Conveen.

Then you’d had a urethral catheter

For two or three days.

And how did you find having that?

Oh most unpleasant. That particular occasion, the person who came to do it didn’t give me any notion about how to fix it. It was just dangling and pulling and I had, it’s not something I’d want to live with at all. But I think I was rather poorly advised at that moment. She should have said, “This is how you handle a urethral catheter. This is how you should fix it so that it doesn’t pull.” And I didn’t get any of those. And though I do notice on the nursing chart she said she’d explained it all, but she hadn’t.

Anyway it was a great relief to get a suprapubic, which was so much more comfortable.

To go back to the urethral one. Was that just fixed to a leg bag?

Well yes, but now let me think how she did it initially. Dear God, I don’t remember. Yes, it was, but it wasn’t supported in any way. It was only for two or three days. All I remember, it was dangling and pulling.

Not comfortable at all.

Not comfortable at all.

How long ago was that?

Thirteen months.

And then you had an appointment to see the

Urologist. And he took a thorough history and examined my prostate and said it wasn’t very big really. And I said, “Well is it, you don’t have to have a big prostate, it just has to be big in the wrong place.” And he said, “Well do you have to strain when you pass water?” And I said, “I usually find, if I strain, I can get something out.” And he said, “That sounds more like bladder neck spasm than it does prostate.”

But he said, “I don’t think it’ll recover. I think in your situation you might just as well go for it. But I will if you want me to.” Well it was clear in his mind that the easiest thing was just to go for the suprapubic catheter.

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.

After chatting with her consultant, Michelle decided to change to a suprapubic catheter. Losing...

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Age at interview: 45

Sex: Female

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Can you explain why you made that decision to change?

Well I think roughly every two years, you go on, I go back to my spinal unit and have, well we term it an MOT. It’s basically a once over everything. Gives you a chance to catch up with your consultant, find out whether there’s been any advances in the treatments, particularly for bowel and bladder care. It allows them to do the ultrasound and the x-rays to find out how the bladder and the bowels are operating. Whether there’s any build up of kidney stones, bladder stones, all of that sort of thing.

And I suppose it was about, oh it must have been about 15, 16 years ago, and at that time we were talking about the fact that I’d had the urethral catheter for a long time. And that the spinal unit was finding that, I think the research and the outcomes from having suprapubic catheters was quite good at that point. And was felt to be one, you know, one further way of cutting down the chances of getting bad bladder infections, and the, probably the ease of maintenance around the suprapubic versus the urethral.

And through chatting around all of that with my consultant, I decided that it was probably about the right time to change. And so I went into my spinal unit and they took me down to theatre and made the insertion into my bladder through the stomach wall. And I’ve had a suprapubic ever since.

Was that done with a local anaesthetic?

No, it would have been a local anaesthetic, again it was probably an epidural again they did that under.

And can you say a bit more about what it’s like to have a suprapubic catheter?

Yeah, I mean the one downside I suppose is, because of the insertions through the stomach, I’ve lost some of the muscle flexibility in the stomach. So my stomach size has increased a bit, which it probably wouldn’t have done ordinarily.

But other than that, I mean I suppose from a practical point of view, there’s not much difference between having had the urethral one or having the suprapubic, just one went into my urethra and one comes out of my stomach

Doctors decided that a suprapubic catheter would be better for Gavin because he was getting...

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Age at interview: 28

Sex: Male

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Just going back to when you were in hospital. You became aware that you’d been catheterised, was there any discussion about this?

Initially, I can vaguely remember being told and asked to see if it was okay, see if I could be catheterised. But wasn’t really aware of it, like I said. I did have quite a few bad bladder infections that had backed up to my kidneys whilst I was in hospital. And again, being spinal injured, that brings on certain other affects. And so I suffered quite badly with that, and that put me on bed rest for another week each time. So, over the six months, I was probably a month in bed on top of that because of the urine infections.

And for that reason, and because of the limited function in my hands, it was decided that medium or short to medium term, a suprapubic catheter would be more suitable. And, since then, yeah, you know it’s proven to be a lot more suitable, or a lot easier to use.

Yes. So has the mobility in your hand, has that improved over the course of time?

I don’t think the mobility has. The strength in my fingers has improved but I’m not able to move my fingers any more. I’m more confident using my fingers, so I’m able to use what I’ve got better, but I don’t think I’ve got much more function.

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.

David could control his bowels but not his bladder. The doctor recommended a suprapubic catheter...

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He’d [David] had prostate cancer treated by radiotherapy two years before, which is about 6, 7 years ago now. And obviously very successfully because his PSA is still 0.1, whatever the grade is, I can’t remember, but it’s very low. And so that was fine.

But when he went into hospital with the stroke, he had a huge bladder capacity, which the bladder was very distended. And they put in a urethral catheter and drained off nearly 6 litres of urine. So that stayed.

Three or four months later, they tried very hard to see if he could live without a catheter. But obviously the control wasn’t there. He had control over his bowels, but not control of that. So then eventually it was recommended by a doctor that David had a suprapubic catheter, which has been very, very successful.

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.

Melanie describes the advantages for her of having a suprapubic rather than urethral catheter.

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Age at interview: 55

Sex: Female

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If you were trying to reassure somebody who was trying to make a decision about having a suprapubic catheter as opposed to a urethral catheter, what are the pros and cons as far as you’re concerned?

For me, I can see it and I can control it. Because I can’t separate my pelvis and I couldn’t explore myself urethrally the way some people might be able to do. But, for me, the suprapubic is much easier, more functional. It allows me to take responsibility. I also think I would find a urethral catheter very sore, and I couldn’t go horse riding or anything like that.

This enables me still to horse ride, to go on an exercise bike, that kind of thing that I couldn’t do urethrally. Because around the urethral area, I am, I still have some, a little bit of sensation and I think I would find it very sore.

That’s a big advantage.

It’s a big advantage, yes. The suprapubic, you don’t get any pain from the suprapubic. You can keep it clean. You can see whether it’s functioning or not. I can see the colour of my urine. I can see if there’s sediment in it. I can smell it. I can, it gives you control back in a situation where God knows we all feel we’re completely out of control.

That’s really important.

It is important. Once you come to terms with the situation, you think, “Okay, well how best can I deal with it, given that that’s the way it is?” And I have to say the suprapubic has proved to be the best for me without doubt.

Charles, who has multiple sclerosis, was worried about the risks of infections and kidney failure...

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Age at interview: 57

Sex: Male

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2010, yes, I started getting infections, UTIs, urinary tract infections, mainly at catheter change time. But in 2011, I actually started, I had a series of UTIs which took probably three months to sort out and included a hospitalisation because of a reaction to one of the drugs which I was given.

Anyway subsequent to that, after the end of that, I actually went to see a consultant urologist to talk about indwelling catheters, suprapubic catheters, and actually was given some information which sort of indicated that it’s a problem, right. I was actually given some things to read which indicated it was an indwelling, the suprapubic catheters were technology which hadn’t changed in fifty, sixty years, would have an impact on my life expectancy, especially regarding urinary tract infections and also kidney, renal failure in general because of a backflow to the kidneys.

Last reviewed October 2018.
Last updated June 2015.