Living with a urinary catheter

Indwelling catheters: urethral catheters

There are two main types of catheter:

  • intermittent catheter, where the catheter is temporarily inserted into the bladder and removed once the bladder is empty
  • indwelling catheter, which stays in place for many days or weeks

An indwelling catheter, such as a Foley catheter, can be used to collect urine for the short or long term. It can be attached to a drainage bag or to a valve that can be opened to allow urine to flow out. Near its tip, the Foley catheter has a small balloon that can be inflated with sterile water after it has been inserted into the bladder. When inflated, the balloon keeps the catheter securely in place. When the catheter needs to be removed, the balloon is deflated. To prevent complications from infection, the catheter is regularly exchanged for a new one from 3 to 12 weeks.

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
  • through a small hole in the lower abdomen. This is done in hospital under anaesthetic and is called suprapubic catheterisation (see ‘Indwelling catheters: suprapubic catheters’)

Urethral catheters and suprapubic catheters differ only in how they are inserted into the bladder.

Urethral catheters come in several basic designs. The relative size or diameter of a Foley catheter is described using the French gauge (F). The smallest size allowing effective drainage should be used as larger ones are more likely to cause trauma. However, where there is infection or postoperative bleeding, a larger size minimises the risk of obstruction.

Urethral catheters are usually made of silicone rubber or natural rubber. Sara, who has had a urethral catheter since 1999, said she preferred the silicone ones. Martin, who had a spinal cord injury, was allergic to latex catheters and said they gave him bladder spasms and brought on autonomic dysreflexia. This is a potentially life threatening condition that occurs when the blood pressure in a person with a spinal cord injury above T5-6 becomes excessively high.

An indwelling catheter is used long-term when all other types of treatment have failed. When Peter had a car accident and became paralysed, he used a condom catheter for over 30 years. After several infections and urinary retention, though, he was fitted with a urethral catheter. He felt that he wasn’t given any other options or alternatives. Martin also had a condom catheter first and then a urethral.

Carol, who was diagnosed with endometriosis in 2003, has erratic bladder function and occasionally uses a catheter. After several operations, she had a urethral catheter because of a perforated bladder. Sometimes she has to self catheterise because of urinary retention. The longest she had a urethral catheter was for 4 months.

Some people we interviewed had a spinal injury and were fitted with a urethral catheter when they were first injured.

Some of the people we talked to got on well with a urethral catheter and didn’t see the need to change to any other type. Gordon, aged 96, was offered a suprapubic catheter but did not want an operation at his age. Sara, a woman with multiple sclerosis, was also quite happy with her urethral catheter. She said that she didn’t even notice her catheter even though she had to sit in her wheelchair.

Other people we interviewed, though, had had problems with a urethral catheter. Kenneth was concerned because the balloon had burst on several occasions.

Faye first became ill in 2007 and found it impossible to pass urine. She used an intermittent catheter until 2009 and then a urethral catheter for a while. She now has a suprapubic catheter because her body kept expelling the urethral catheter.

Jennifer, who had Fowler’s Syndrome, had many urinary tract infections (UTIs). At the age of 19, she could not pass urine. At first she tried self catheterisation and then a urethral catheter. She had bladder spasms, blockages and bleeding with it. She later had sacral nerve stimulation, a procedure where electrical currents are used to reset the faulty nerves causing bladder dysfunction. Jennifer found that she could pass urine again normally afterwards but then her body rejected the battery. She then had to have a suprapubic catheter inserted.

Jade, a 22-year-old with Fowler’s Syndrome, had a suprapubic catheter for a number of years. She then had it removed and started intermittent self catheterisation. When she became pregnant, though, that became harder because of the position of the baby. She was given a urethral catheter at 27 weeks. The last few weeks of pregnancy were very difficult because Jade had constant urine infections, and her body often expelled the catheter. She had to have a caesarean at 36 weeks because of the catheter problems and bladder infections, which couldn’t be treated properly while she was pregnant. As soon as the baby was born, she had the urethral catheter removed and went back to self catheterising again.

Some people we spoke to with a spinal cord injury said they had a urethral catheter at first but later changed to a suprapubic. Dave became paralysed after a diving accident in Portugal in 2005. He had a urethral catheter first but, when doctors realised that he would need a catheter long-term, they replaced it with a suprapubic. Because of his injury, Dave couldn’t feel the urethral catheter but said the suprapubic was less ‘intrusive’ (see ‘Indwelling catheters: suprapubic catheters’).
Annie, who had a spinal injury after a horse riding accident, said a urethral catheter was very uncomfortable if she sat on it without realising.

Roger had a spinal injury while on a cricket tour in India. He wasn’t aware when a urethral catheter had been inserted or of any infections. He was told that a suprapubic catheter would be better long-term.

Iain, a 35-year-old with multiple sclerosis, used an intermittent catheter for 5 years and then a urethral catheter for about 8 months. He changed to a suprapubic catheter, though, because he felt it would easier when having sex (see ‘Sex and intimate relationships’).

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Stewart, in contrast, had a suprapubic catheter first but had problems with it. It was a long time ago and, though he couldn’t remember the details, he recalled having a lot of leaking. He was later fitted with a urethral catheter.

A few men were unsure which type of catheter they had. They said that it was inserted through their penis, which is a urethral catheter. Derek had a urethral catheter for 9 years but often bled a lot during catheter changes. Eventually he had laser surgery to his prostate, which had become enlarged, and is now catheter-free.

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Last reviewed October 2018.
Last updated June 2015.


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