Urinary catheterization is carried out for clients only when absolutely necessary

Urinary retention is a condition that develops when an individual is not able to empty his or her bladder of urine. It can be either an acute, a sudden change, or it can be a chronic condition in which the individual gradually over time is unable to completely empty his or her bladder.

Signs and Symptoms 

The signs and symptoms of urinary retention can vary a little bit depending on if the urinary retention is acute or chronic in nature. The signs and symptoms for both types are listed below. 

Acute Urinary Retention

• Inability to urinate 
• Lower abdominal pain (usually severe) 
• Urgent need to urinate  
• Swelling of lower abdominal area  

Chronic Urinary Retention

• Inability to completely empty the bladder while urinating 
• Frequent, small amounts of urination  
• Hesitancy (difficulty initiating urination) 
• Slow urine stream  
• Urge to urinate with little success  
• Feeling the need to urinate immediately after having urinated 
• Lower abdominal discomfort  

It is also important to note that some individuals with chronic urinary retention may not display any signs or symptoms.

Causes

Urinary retention can be the result of a number of factors including:  

• Blockage or narrowing of the urethra  
• Medications (i.e. antihistamines, opiates, antispasmodics) 
• Nerve diseases/conditions (i.e. stroke, diabetes, multiple sclerosis, trauma to spine or pelvis) 
• Infections 
• Surgery  
• Weak bladder muscles

Complications

If left untreated, urinary retention can lead to other complications for the individual. Some of these possible complications include: 

Urinary catheters are used to drain the bladder. Your health care provider may recommend that you use a catheter if you have:

• Urinary incontinence (leaking urine or being unable to control when you urinate)
• Urinary retention (being unable to empty your bladder when you need to)
• Surgery on the prostate or genitals
• Other medical conditions such as multiple sclerosis, spinal cord injury, or dementia

Catheters come in many sizes, materials (latex, silicone, Teflon), and types (straight or coude tip). A Foley catheter is a common type of indwelling catheter. It has soft, plastic or rubber tube that is inserted into the bladder to drain the urine.

In most cases, your provider will use the smallest catheter that is appropriate.

There are 3 main types of catheters:

• Indwelling catheter
• Condom catheter
• Intermittent self-catheter

INDWELLING URETHRAL CATHETERS

An indwelling urinary catheter is one that is left in the bladder. You may use an indwelling catheter for a short time or a long time.

An indwelling catheter collects urine by attaching to a drainage bag. The bag has a valve that can be opened to allow urine to flow out. Some of these bags can be secured to your leg. This allows you to wear the bag under your clothes. An indwelling catheter may be inserted into the bladder in 2 ways:

• Most often, the catheter is inserted through the urethra. This is the tube that carries urine from the bladder to the outside of the body.
• Sometimes, the provider will insert a catheter into your bladder through a small hole in your belly. This is done at a hospital or provider's office.

An indwelling catheter has a small balloon inflated on the end of it. This prevents the catheter from sliding out of your body. When the catheter needs to be removed, the balloon is deflated.

CONDOM CATHETERS

Condom catheters can be used by men with incontinence. There is no tube placed inside the penis. Instead, a condom-like device is placed over the penis. A tube leads from this device to a drainage bag. The condom catheter must be changed every day.

INTERMITTENT CATHETERS

You would use an intermittent catheter when you only need to use a catheter sometimes or you do not want to wear a bag. You or your caregiver will insert the catheter to drain the bladder and then remove it. This can be done only once or several times a day. The frequency will depend on the reason you need to use this method or how much urine needs to be drained from the bladder.

DRAINAGE BAGS

A catheter is most often attached to a drainage bag.

Keep the drainage bag lower than your bladder so that urine does not flow back up into your bladder. Empty the drainage device when it is about one half full and at bedtime. Always wash your hands with soap and water before emptying the bag.

HOW TO CARE FOR A CATHETER

To care for an indwelling catheter, clean the area where the catheter exits your body and the catheter itself with soap and water every day. Also clean the area after every bowel movement to prevent infection.

If you have a suprapubic catheter, clean the opening in your belly and the tube with soap and water every day. Then cover it with dry gauze.

Drink plenty of fluids to help prevent infections. Ask your provider how much you should drink.

Wash your hands before and after handling the drainage device. DO NOT allow the outlet valve to touch anything. If the outlet gets dirty, clean it with soap and water.

Sometimes urine can leak around the catheter. This may be caused by:

• Catheter that is blocked or that has a kink in it
• Catheter that is too small
• Bladder spasms
• Constipation
• The wrong balloon size
• Urinary tract infections

POSSIBLE COMPLICATIONS

Complications of catheter use include:

• Allergy or sensitivity to latex
• Bladder stones
• Blood infections (septicemia)
• Blood in the urine (hematuria)
• Kidney damage (usually only with long-term, indwelling catheter use)
• Urethral injury
• Urinary tract or kidney infections
• Bladder cancer (only after long-term indwelling catheter)

Call your provider if you have:

• Bladder spasms that do not go away
• Bleeding into or around the catheter
• Fever or chills
• Large amounts of urine leaking around the catheter
• Skin sores around a suprapubic catheter
• Stones or sediment in the urinary catheter or drainage bag
• Swelling of the urethra around the catheter
• Urine with a strong smell, or that is thick or cloudy
• Very little or no urine draining from the catheter and you are drinking enough fluids

If the catheter becomes clogged, painful, or infected, it will need to be replaced right away.