Managing urinary incontinence by containing leakage using indwelling catheters

Indwelling urinary catheters (IUC) are no longer routinely used to manage urinary incontinence and are only acceptable for very specific indications.

Indications for IUCs include use of short-term urethral catheters for accurate monitoring of urinary output and maintenance of urinary system functioning, in the period following genito-urinary surgery eg for continuous bladder irrigation to prevent urethral obstruction from blood clots.

IUCs are also used to relieve severe urinary retention and obstruction of urine outflow eg for men with prostate enlargement.

Long-term IUCs (defined as longer than 30 days) may be used to promote comfort in people with terminal illness, or severe skin breakdown, where prolonged urine contact may be harmful.

They may be useful for people who live alone, or with physical disabilities who need to manage long-term urinary incontinence or urinary retention and are unable to self-catheterise or do not have a caregiver who is willing to do it.

IUCs, include supra-pubic catheters, where the catheter is inserted into the bladder via a small incision in the abdominal wall above the pubic bone. This route may be preferred over urethral catheters for reasons of comfort and ease of access, for example among people who use wheelchairs or with restricted hip mobility or spasticity. It is a better form of long-term IUC for people who are sexually active.

It is emphasised that IUCs should never be the first method of choice simply to manage urinary incontinence. They should only be considered when all possibilities to promote urinary continence have been tried.

It must also be remembered that use of an IUC prevents the person from being continent of urine because a urethral catheter holds the urethral sphincter ‘open’ to continuously drain urine as it enters the bladder. Similarly a supra-pubic catheter will drain urine continuously because there is no sphincter mechanism in the bladder wall.

So while an IUC, whatever the type, may be the ‘best’ way to manage long-term incontinence for some people, the decision should only be made in partnership with the person and must reflect the person’s individual needs and circumstances.

Further reading

Refer to the Continence Product Advisor website for detailed information about types of catheters and aspects to consider when assessing for and recommending a particular type of product^[1].

A summary of good practice, and other points to consider in relation to catheter use, is provided by the Association for Continence Advice Top Tips on Indwelling Catheters^[2].

For a more comprehensive overview of catheter use and catheter care see the publication by the Wound, Ostomy and Continence Nurses Society. (2016). Care and management of patients with urinary catheters: A clinical resource guide (available in PDF format)^[3].

References

_{1. Indwelling catheters. Continence Product Advisor. [Cited 28 August 2018] Available from: https://www.continenceproductadvisor.org/products/catheters/indwellingcatheters}

_{2. Top tips on indwelling catheters. Association for Continence Advice. [Cited 2018] Available from: https://www.aca.uk.com/education/useful-documents-concerning-continence/top-tips-bladder-and-bowel-issues/}

_{3. Care and management of patients with urinary catheters: A clinical resource guide. Wound Ostomy and Continence Nurses Society. 2016. [Cited 28 August 2018]. Available in PDF format from: https://cdn.ymaws.com/www.wocn.org/resource/resmgr/publications/Care_&_Mgmt_Pts_w_Urinary_Ca.pdf}