It is sometimes necessary for a person to be fitted with a permanent catheter to empty the bladder. There are many reasons for this which include scarring of the urethra (the tube leading from the bladder to outside the body), damage to the nervous system which prevents the bladder from being emptied normally (for example, a broken back can cause this) or perhaps after injury to the pelvis.
Initially the catheter may be inserted through the urethra, but the doctor may decide that a suprapubic catheter is best. The catheter is inserted through the wall of the abdomen into the bladder after the doctor has made a small cut under local anaesthetic (usually) just above the pubic bone (see diagram). The catheter has a small balloon which is inflated with sterile (germ free) water which keeps it in place. A dry dressing is put around the catheter which drains through a leg bag or a bed bag (sometimes called a night bag).
What Does It Feel Like to Have The Catheter Put In?
This is done in hospital. To be honest, I was a little worried about this part of the proceedings! I felt that I would have liked to have been asleep when the doctor did this, but it wasn't too bad at all. It was done in the ward clinic rather than an operating theatre. Firstly, the doctor squirted some local anaesthetic and lubricating gel into my urethra and then inserted a catheter into my bladder. The catheter was connected to a bottle of water by a tube and the doctor allowed water to flow in through the tube to fill my bladder with the water. I was asked to say when I felt either uncomfortable or that my bladder was nearly full. When this happened, the doctor turned off the water.
He then swabbed my abdomen with antiseptic to kill any germs and then injected local anaesthetic into my abdomen using a syringe and needle. This wasn't painful - the "Just a sharp scratch" was just that! Then the doctor made sure that the anaesthetic had done its job, and made a cut into my bladder and abdomen with a scalpel. To be honest, I didn't look at this point! I could feel him pushing, but it didn't hurt. When he'd made the hole, I could feel the water from my bladder running over my abdomen, but this stopped when he put the catheter into the hole. The water from my bladder then started to flow into the bag which he'd connected to the catheter. The final part was for a dressing to be put around the catheter and, after a quick clean up with a towel, I was ready to walk back to my bed on the ward.
I was offered pain relief for when the anaesthetic wore off - it was a bit sore at first, but it soon settled down. Overnight, a bed bag was used and the next day I was connected to my first leg bag. I'd decided to wear my bag on my lower leg so that I could empty is without undoing my trousers.
On your return from hospital, the district nurse will have been asked to call. She will dress the opening around the catheter for as long as necessary, or until you can do it for yourself. Be prepared to empty a cupboard as she'll bring a heap of supplies. These will be spare catheters in case the catheter comes out (not likely, and you'll get a telephone number for help if you get any problems), catheter wash-out packs, re-catheterisation packs, syringes (to deflate the balloon in the catheter), dressings, dressing kits, bottles of water and more! After the initial supply of bags from the hospital, you'll need to get replacement prescriptions from your doctor. Do this as soon as possible after you come home so that you have spares. I would suggest that you discuss this with the Continency Advisory Service as the nurses there can show you samples of many different products for you to use. The choice of leg bag and night bag is up to you - you can choose whichever you find most comfortable. Now the good news: ask your doctor for form FP96A - you now qualify for free prescriptions (UK only)!
Where you wear your bag is a matter of choice. The two most popular places are the lower leg (which is the most popular place for men as it allows emptying by just pulling up your trouser leg) and the thigh (most popular for women as it allows them to wear a skirt.) In both cases, the bag can be worn on the inside or outside of the leg. I find the inside better as it doesn't get knocked so easily. Holding the bag up can be done by straps or by various support garments - you need to experiment to find out which suits you best. Most of these are available on prescription. One must, as far as I am concerned, is the Simpla G-Strap. This goes round the abdomen and holds the catheter in place and stops it being pulled accidentally. The first time this happens to you, you'll realise why I always wear one to stop just that happening! One round the upper leg also helps to keep the tube in place.
I'll give you my routine as an example of what happens. I shower in the evening, holding the bag onto my leg with a pair of latex straps which I keep specially for this purpose. The fabric backing of the leg bag gets washed in the shower and dries very quickly when blotted with a dry towel. After drying, I then wash around the catheter and opening on the abdomen with gauze swabs and Irriclens, a spray of salt water which is sterile. This saves having to use boiled and cooled water. Some people, after the opening heals, do not need to use a dry dressing: others find a slight discharge and need to keep a dry dressing over the catheter as it leaves the body. be sure to wash any encrustations off the catheter to leave it clean. I then fasten the bag to my 'outside' leg - the one nearer the side of the bed when lying on my back. When in bed, I plug a two litre night bag into the tube on the bottom of the leg bag and open the tap. The night bag is fitted to a metal stand at the side of the bed: you need to buy this as it isn't available on prescription (daft, isn't it?) To prevent the tube from becoming detached, I hold it in place with a leg bag strap around my ankle. It can still become detached, so I would recommend a waterproof mattress cover and absorbent bed pads under the top sheet just in case (ask your district nurse about these). Don't forget, you can claim VAT exemption which does make such purchases a little cheaper. The best form of bladder wash-out is to drink plenty and so, last thing at night, I drink about a pint and a half of water - don't forget, with a two litre bag, you won't have to get up to go to the toilet overnight! This ensures that the tubing stays clear.
In the morning, I disconnect the night bag in the bathroom (don't forget to close the leg bag tap first!) and then empty out the night bag. Wash it through with water a couple of times and put the cap back on the tube. I keep the cap in a polythene bag overnight to keep it clean) I then wash round the catheter again and put a clean dry dressing over it. The waste goes into a yellow clinical waste bag which the council take away each week. This is a free service, again organised through the district nurse. The leg bags and night bags should be changed every five to seven days and go in the waste bag, once they've been emptied. The rest of the day is easy: washing hands before and after emptying the bag through its tap.
I also use a catheter valve (Simcare Uroflo) - this lasts the life of the catheter (the first one stays in six weeks and is changed at hospital and the first, small one is changed for a larger diameter one - thereafter the district nurse will do the changes about every ten weeks). This gives me two advantages - I can shut off the valve when changing the leg bag, stopping dribbling, and I can remove the leg bag, shutting off the catheter, to go swimming. The tubing tucks away inside one's swimming costume and doesn't show.
Hopefully you won't get these, but look out for the following:
Cloudy and/or unpleasantly smelly urine - this may be infected - ask your doctor.
Blood in the urine (haematuria) - the urine turns pink or red. If this happens, drink plenty and see if it clears. If it does, report it to the doctor or nurse next visit. If it does not, report this to your doctor. This is not uncommon at first at the bladder is not used to having a catheter in it and it rubs a bit at first. It does pass though.
No urine output - have you drunk enough or have you taken any drugs such as DF118? Both of these can affect urine output. If you have drunk plenty, and you feel uncomfortable - telephone the district nurse: you may have an obstruction and need a bladder washout. This happened to me the first night when a blood clot blocked the catheter, but, by drinking plenty, I've not had any further problems.
The catheter comes out. RING the district nurse at the emergency number at once. If the catheter is out for more than 15 minutes, the opening in the bladder starts to heal over and you don't want the doctor to have to make another hole, do you .........?
You and the Law:
I've already mentioned the free prescriptions, but there are other aspects to be considered. Register as a disabled person with your local County Council Social Services. You can now take a copy of your registration along to your local council and get certain privileges. For example, Gedling Borough Council do a disabled person's leisure pass so I can go swimming for 80p instead of £1-70!
You are now protected under the Disablement Discrimination Act 1995 and your employer must make suitable allowances for your condition. These include time out to empty your bag and necessary time off work to have your catheter changed. You are allowed "reasonable time off for assessment, rehabilitation and treatment".
I would suggest that you get a RADAR key to get into disabled toilets - these are often much cleaner than the usual public toilets and there is more room to empty your bag in private.
There are four main sources of help. These are:
The hospital which fitted your catheter (but usually only in the first six weeks before the first change)
Your district nurse
The Continence Advisory Service - the nurses there are available in office hours for help and advice and are usually the most accessible. I've found them very helpful.
Good luck. I found that it improved my life considerably. The 'plumbing' doesn't show and people can't tell by looking at you that you've got a catheter fitted. If you have problems, ask for help and advice (see the list above) - they're there to help!
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