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Catheter use

Description

I used to use a catheter (the Foley type, not the Foley brand) due to urine retention issues. I expected the problem to be solved at some point, so I was never worried. (The whole thing feels a bit Borg, but without the collective.)
What I did find absolutely shocking though, was the lack of practical information on the subject. Hospitals just a few kms apart provide different and often conflicting information on their websites.
The information below is based on practical experience, more or less using myself as a guinea pig. How many health care providers use a catheter themselves and have practical experience doing the dishes or going to the supermarket while wearing a catheter? Not many I suppose.
The purpose of this document is to fill that gap. It is meant to be used in an open source spirit: Share, improve and publish.

A word of caution

Normally a system of valve-like structures and sphincters (circular muscles) makes sure that the urinary tract is one-way only; Stuff goes out and not in. With a catheter this no longer the case. You have to be very careful about what you hook up to your catheter; Bubbles in drainage hoses move up, carrying who knows what with them.
The use of catheters may be regulated. And regulations vary a lot!

Replacing the catheter

Catheters need replacing every now and then. It's customary to use a lubricant while inserting a (new) catheter.
Ask the person removing the catheter the use lube for removal as well. Just insert lube next to the catheter. It makes removal a lot easier; I had mine removed with lube without any discomfort at all!

When inserting the new catheter, align the ports in a plane parallel to the front of your body; If you wear the hose on the left leg, the balloon port should be at the right. This way the two ports fit neatly under your trousers. (This corresponds with the balloon port being on the left when the catheter points straight up; By putting a U-bend in the catheter this becomes right.)

Unclogging the catheter

A clogged up catheter can be fixed with a sterile saline solution. Your care giver may provide you with information on this subject. I unclogged mine several times.
And sometimes mucus temporarily blocks the catheter; The blockage leads to a pressure buildup, which in turn pushes the mucus out, thus unclogging the catheter.

Bags

The catheter connects to a drainage hose. The hose connects to a collection bag. The whole system is airtight. If it smells (other than a slight plastic smell), there is something wrong.
It's best to use bags with a non-return or anti re-flux valves. This way, urine can't flow back from the bag into the hose. This makes things a lot safer. In some cases the use of these valves is mandatory.
Some bags are sterile. Others are not. In some cases the use of sterile bags is mandatory. New bags should always be clean!
Some bags need to be replaced every day. Others last a week.

Day bag

The most convenient is a small bag strapped to the lower leg, with the top strap just below your knee. (Don't use upper leg bags. They are highly impractical.)
To empty it, just put your foot on the rim of the toilet bowl and open the valve. Aim for the deeper part of the bowl or a (nearly) vertical surface, otherwise droplets may end up on your shoe!
After closing the valve, clean the lower end of the valve with a tissue or some toilet paper. This avoids urine dripping onto your sock. Some recommend cleaning the valve with 70% alcohol (isopropanol).
You don't need baggy jeans for a urine bag. Regular (straight) jeans provide enough space, provided you empty your bag regularly. Skinny jeans probably don't work.
Don't use a bag that is very high; With a 'tall' bag the valve will lean on your sock. Some valves come with a little hose meant to couple to a night bag. If it leans on your sock, just remove it. Removing it also makes the valve easier to clean.
Some bags are covered with fabric. It's supposed to make the bag more comfortable. Make sure you're not allergic to the fabric used.
Some people are a bit embarrassed by this whole catheter thing. Wearing a day bag as described on this page makes the whole thing completely invisible!

Straps

The day-bag is attached to a pair of straps (by means of buttons). Each strap has a hook-and-loop fastener / Velcro-like material or buttons at one end.
I change bags while sitting on the edge of a chair or bed. When I put on a new one, I first attach it loosely on my upper leg, slide it down and then tighten the straps. This way the straps don't move all over the place.
To avoid an entangled mess, store the straps with the 'velcro' bit on the outside. And bags with the 'velcro' bit on one side and the rest of strap on the other.

Night bag

This is hooked to a little frame next to your bed or to a hook on your bed or chair. Note that not all hooks fit your bed. A bed hook may need to be modified to actually work!

Some people connect the night-bag to the day-bag valve. Others remove the day-bag and connect the night-bag directly to the catheter. The latter is probably more convenient; Having a hose connected to your ankle can be very impractical.
And don't mix the two methods: if you change from the night-bag connected to the day-bag to the night-bag connected directly to the catheter, it's probably a good idea to replace the night-bag at the same time.

Universal night bag hook

I modified my hook to fit on: The bed, a central heating radiator, my desk's drawer and when the bag is (almost) empty, the elastic band on top of my underwear. The latter is really handy when you need to do something which requires both hands. This hook also makes it very easy to carry the bag in your hand.

Universal night bag hook

The purple bit used to have a little arm on the back, which is supposed to fit on your bed. Of course, this doesn't work. So I removed it.
The thin white steel rods used to be central heating radiator humidifier hooks. I used water pump- / tongue-and-groove pliers to bend them into shape. Wide brown tape fixes them to the plastic frame.
It may not look pretty, but it does work.

Below the hook with a two litre night bag on a central heating radiator and on a bed. The hose is taped to the hook:

Night bag on radiator Night bag on bed

It is very handy to be able to put this thing just about anywhere.
Modify to suit your needs.

Valves

As far as I know, these come in the following types:

I prefer the cross type.

Bag maintenance

Opinions vary a lot: rinse the bag with water and vinegar, water and soap, with just plain water or don't rinse the bag at all.

If I understand my bag's manual correctly, one should only rinse the night-bag and not the day-bag. And only if it's connected to the day-bag.
If the night-bag is connected directly to the catheter, it should not be rinsed either.

Drainage hoses

Hose types

Some people seem to think that a thicker hose is better. However, the opposite is true;
A thick hose has a larger surface area and therefore more area that debris can stick to.
A thin hose has a faster flow, so any debris will be washed down into the bag more efficiently, effectively cleaning the hose. And don't think a thin hose will get clogged up. Anything that can flow though the catheter, will most definitely flow through the hose.

A flexible hose is more convenient than a rigid one. A rigid hose may also mess with your catheter. The difference is even bigger with a night bag. In some cases a rigid night hose may lead to sleepless nights. Always use a flexible hose for a night bag!
I move about a lot when I'm asleep; I woke up once with my blankets turned 90°. A night hose should accommodate this. When I pull on the hose my bed hook will even slide on the side of my bed towards me without falling off. Not all bed hooks are capable of doing this!

There are several ways of making a hose flexible:

Hoses may be regulated. And care organisations and hospitals may have their own internal guidelines. This should not get in the way of finding a hose that suits you though! Some of these so called guidelines are dead wrong.

Hose length

Some hoses need to be cut to length. Cutting hoses to length works quite well with scissors. Make sure your hands and all the tools you use are clean before cutting hoses. If you use the same scissors to cut tape, remove the tapes' adhesive from the scissors before using the scissors to cut a hose.

Hose path / routing

Pictures of catheters in use make no sense whatsoever! I ride a bicycle and the catheter moving about actually causes injury!
A tip from a nurse working for my GP: To avoid this, the catheter should go up to your lower abdomen and then make a U-turn down towards your leg! This means the first part of the catheter goes up, not down! (Inside the body the last bit of the urethra goes up as well, so up is nature's way.) The U-turn itself should be on your belly, just above your leg (the boundary between the two is clearly visible when you sit down). The coupling with the hose goes on your leg.
The U-turn must be taped to your belly (trim your pubes a bit first). Of course, the catheter needs to be long enough to make this work! Do NOT put the tape directly on the catheter. Put some tissue in between;
Avoid the tape's adhesive (glue) coming in contact with the catheter. Otherwise bits of adhesive may end up inside you!
Try to use underwear as a way to reduce motion (not shorts) and apply some (K-Y) lubricant where the catheter enters your body.
You may need to experiment a bit, to optimise for maximum comfort.
Avoiding bumpy roads also helps. A Citroën like shock absorption system in the bike seat will probably also contribute to comfort. And reduce cycling to an absolute minimum. If you overdo it you still may get hurt. Injuries inside your urethra may become infected. These infections can be very painful indeed and may require the use of powerful pain killers that turn you into a 'zombie'.

Day hose

The bag should have the lower part of the hose halfway between the front and the outside of your leg. This way, the hose bends nicely next to your knee. (A lot of pictures show the hose on the inside leg. However, a hose on the outside of the leg has less- and wider turns.)
This puts the catheter - hose coupling underneath your trouser pocket: When in doubt, just put your hand in or on your pocket to check the connection.
The hose in between crosses the front of your upper leg diagonally. Apply the tape while standing with your legs spread out a little and put the tape halfway your knee and the coupling.

Night hose

For maximum comfort, it's best to fix the hose while in bed. Use tape that doesn't need to cut but can be torn. Apply a temporary fix before going to bed and replace this while in bed:
Stretch your leg and put the coupling high / close to your belly. Otherwise it might disconnect. Tape the upper part of the hose halfway between the inside and the front of your leg. Tape the lower part to the front of your leg about 10 cm above your knee.
If you do this properly, the hose won't disconnect when rolling from side to side. However, if you roll all the way to belly down the hose may become undone. So it's probably a good idea to tape a trash bag to your mattress.

Removing tape adhesive

A tissue with acetone followed by one with an alcohol-water mixture works rather well.
Note: Acetone is not necessarily the same thing as nail polish remover.
Note: There are straps that can be used instead of tape to fix the hoses in place.
Warning: Some plastics dissolve in acetone! When I clean my scissors I make sure the acetone only touches the metal bits.

Switching hoses

In the morning one might not be fully awake yet and in the evening very tired, so it's a good idea to keep everything as simple as possible.
An empty bag is easier to handle than a full one. So empty the bag in use before changing it.
The bag manufacturer may provide a user manual. Unfortunately, manuals usually come with boxes of bags; not with individual bags.

Prepare everything first: tapes cut to length, bags in the right place, etc.
When switching night- and day-bag connectors, I have the day-bag strapped to my leg and the night-bag hooked up to a desk drawer or bed. This way I can switch hoses within a few seconds.

Disconnect hose

Remove the old tape (and then the tape's adhesive).
Put a tissue (or something bigger) under the coupling and keep in mind that there may be bits of urine on couplings, connectors and caps. Use tissues to deal with this as well.
After disconnecting a hose pull it up. This will move most of the urine from the hose to the bag. Next, move the connector in a horizontal position above a tissue. And then put a cap on the connector. Caps are not always completely waterproof, so it's a good idea to wrap a tissue around the cap.

Connect hose

Make sure the hose follows a nice path without weird twists and turns. Put the connector in a horizontal position above a tissue. Remove the cap and put it on an other tissue. Next insert the connector into the catheter.
I dry the connector with a tissue if it's wet. Some recommend cleaning the connectors with 70% alcohol (isopropanol) before making the connection.

Urine flow

I found that if I sit still during hose switching, no or very little urine flows out of the catheter. However, movement (such as leaning forward) may release a dozen ml or more! And if you are very unlucky, mucus is released during the switch leading to a bit of a surge.
Some people recommend using a towel instead of a tissue underneath the coupling during hose switching. If you have a convenient receptacle, even better.

Storing and cleaning caps

Hold the cap above a tissue with the open end down. Then tap it on the tissue. This will remove most of the urine that might be in the cap.
For a more thorough cleaning, rinse the cap with tap water and then with ethanol. Make sure all of the ethanol evaporates completely before reusing the cap. You don't want alcohol vapours in your bladder;
When fully dry the cap might smell ever so slightly of plastic. It should not have any other smell at all.

If caps have similar sizes you can put one on top of an other.
A cap also fits on an old saline solution connector; Cut off the bag and use the clamp / valve on the hose to close it:

Cap holder

You can clean it the same way as a cap.
I suppose you can also put caps in a box or a bag.

Underwear

My fashion sense is very simple: If my body is happy with the clothes I wear, I'm wearing the right clothes.
Some claim that you need to wear loose underwear in order not to restrict the flow. This however, has no basis in fact; Even if you lay in bed on top of the hose, there is still is sufficient flow. Very tight underwear is more likely to restrict the blood flow in your body than it is to reduce the urine flow in your hose.
The most convenient catheter compatible underwear has a shape resembling the swim briefs that divers wear: It fixes everything neatly in place and the catheter coupling is easily accessible. It may not be fashionable, but it saves you a lot of trouble.

Showering

Some use a plug instead of a urine bag during taking a shower. And some a night-bag.
With a plug, urine builds up in the bladder. You need to dispose of this later.
With a night bag, you need to suspend it somewhere. This restricts your movement and risks disconnecting the hose.

Until a got a plug, I used to use a day-bag: I washed the bag and my leg underneath the bag. This of course means that the straps get wet.
Note: Some leg bags are covered with some sort of fabric. It may not be a good idea to shower with those. See: Non woven day bag cover.
Note: If the hose gets disconnected during showering, it's probably a good idea to replace the bag.

After the shower I first replace the U-turn tape and tissue. Next I replace the straps one by one. First the top and then the bottom strap;
I dry the bag and my skin underneath the bag with a tissue. Next I remove the strap and dry the skin where the strap was and the inside of the button holes in the bag (some bags have loops instead) with a tissue. I then apply a dry strap.

Non woven day bag cover

Some day-bags are covered with a material described as 'nonwoven'. The properties of these vary a lot!
To test for shower compatibility, run water over the bag for a minute or so, dry the bag and then wait to see how long it takes to become really dry. If it dries really fast, it's probably OK to shower with this type of bag.

Cleaning the straps

You could just (hand) wash the straps, but when wet after showering it's best to dry them quickly.
I just submerge them in lukewarm water. Stretch the strap bit by bit. Then rinse in water flowing from a tap. Do all of this twice. Next leave them to dry.
For really fast drying, submerge the rinsed straps in 96% (or more) ethanol and stretch bit by bit (the process replaces most of the water by alcohol) and then leave them to dry. The downside of this is that alcohol makes rubber hard and brittle. So this method may limit the lifetime of your straps. Make sure you have a spare pair of straps!
When fully dry the straps should have a slightly rubber like smell and smell of nothing else.
If they smell kind of sour they didn't dry fast enough. When this happens you can clean them with a hydrogen peroxide - (cleaning / white) vinegar mixture, followed by the above procedure. Note that highly acidic vinegar may damage rubber!
For a more conventional hand wash, hypo allergenic shampoo works really well. So you don't have to buy a hand wash laundry detergent just for your straps.
Tip: Hand wash laundry detergent leaves your garments with a soapy smell. Hypo allergenic shampoo does not.

Misc

Alcohol drying

Alcohol drying can mean two different things:

  1. Reduce the amount of water in an alcohol - water mixture.
  2. Use alcohol to dry something really quickly.

If you add alcohol to a moist fabric and wring it out, most of the water will be replaced by alcohol. And alcohol evaporates much faster than water.
This is what I do to dry something small really fast.

For disinfecting 70% alcohol is used.
For alcohol drying, 96% or more.
Don't get the two mixed up.

Disinfecting

Some people are allergic to some disinfectants, including disinfecting soap. An alcohol based disinfectant is usually OK.
See:

There are pre-packaged pads / tissues / wipes containing ca 70% alcohol. A rayon - polyester mix seems to be quite common. If you want to use it on (your) skin, it might be a good idea to buy a 100% cotton version instead.

Soap

The hand soap, shampoo, shower gel, laundry detergent and washing up liquid I use are all hypo allergenic; They don't contain colourant or perfume.
Perfume can be an irritant. Some people are even allergic to it. Perfume also masks smells. And sometimes you need your nose to smell what is going on.
Note: A product containing perfume is never hypo allergenic, regardless of what a manufacturer might claim!

Solvents

Make sure none of these get into your catheter or hoses.

Acetone

I use 100% pure acetone, not nail polish remover.

Ethanol

There are several types of alcohol. Ethanol is the type found in alcoholic beverages such as whisky and beer. Ethanol usually has an added denaturant (see: Denaturation (food)). Make sure the denaturant doesn't leave any residue!
Methanol and MEK / butanone evaporate. Bitrex / denatonium does not. Euro denaturant contains bitrex.

Isopropanol

Some denaturants damage some plastics. This is when isopropanol, also known as isopropyl alcohol is handy.
It has a bit of a pungent odour and a slightly anaesthetic effect though.

Cheap mixes

Supermarkets sell cheap denatured alcohol like products. Sometimes that's all you need.
Note: Keep in minds that some of these products might leave a residue that doesn't evaporate. So you can't use it for everything!

Tape

Brown tape sticks better than white tape, but needs scissors to cut.
Note that a product that is advertised as hypo allergenic has not been tested on all 8.3 billion people on the planet. Some people are allergic to some 'hypo allergenic' products; I'm allergic to some white tapes (not all).
You may need to experiment a bit to find a tape that suits you best.

Tissues

The toilet paper I use is white. So are paper towels / kitchen rolls;
A lot of dyes / printing inks dissolve in alcohol. Some don't dissolve in alcohol but do in acetone. And you don't want cleaning things to cause stains!
Some paper falls apart when wet. Some can cope with water but not with alcohol.
Sheets of toilet paper can be thought of as very small tissues. Sometimes that's all you need. A paper towel cut in two also makes nice small tissues.
You may need to experiment a bit to find the right product.

Catheter sizes

Width

See: French catheter scale.

Length

It's the nature of the beast. Members tend to change size all the time (this is why you shouldn't have adhesive on your catheter) and I don't think catheters are designed with this in mind. They are a bit too short. One may actually end up with a bit of a tug of war between oneself and the catheter's balloon: One can actually feel the pressure caused by the balloon inside the bladder!
If you temporarily want a bit more space, remove the tape from the U-turn and cover the catheter with lube all the way up to the Y-bit where the urine drainage- and balloon port split off.
However, all of this is a bit of a hack and manufacturers really should make longer catheters.
Before being fitted with a catheter, always ask for the longest catheter they have got! If it's too short have it replaced (by someone else / at an other health care facility).
A short catheter can be rather painful. It also interferes with keeping things clean and keeping things in a fixed position. The latter is essential if you want to walk or cycle.

Pads

After using a catheter a very long time, your bladder may have lost it's way a bit. This may lead to urge incontinence; You wake up in the middle of the night, walk to the toilet and start before you are there.
It's possible to train your bladder before removal of the catheter. This can be done by means of a valve between the catheter and the drainage hose. By closing it every now and then your bladder gets used to holding larger amounts of urine. However, I recommend using incontinence pads immediately after catheter removal anyway.

Pads are really high-tech and work very well. They combine a small size with the ability to absorb large amounts of liquid. They are also very comfortable to wear;
The outside is waterproof and is covered with adhesive strips that stick to your underwear. The inside is a capillary layer that sucks your skin bone dry in one to two minutes, so you don't feel wet. In between is a layer that stores liquid many times it's own size and weight.
Keep in mind that pads only work with underwear that keeps your gear firmly fixed in position. Again, don't wear shorts! You don't need stretch, 100% cotton is fine. And it doesn't have to be tight either. Just a good fit will do.
Your bladder will gradually adept and become it's former self, so this is only a temporary thing.