A catheter is a tube in your bladder that removes urine from the body. Because this tube stays in place for an extended period of time, it is called an indwelling catheter. The urine drains from your bladder into a bag outside your body.
When you have an indwelling urinary catheter, you are more likely to develop a urinary tract infection (UTI) in your bladder or kidneys.
UTI - catheter associated; Urinary tract infection - catheter associated; Nosocomial UTI; Health care associated UTI; Catheter-associated bacteriuria
Many types of bacteria or fungi can cause a catheter-related UTI. This type of UTI is harder to treat with common antibiotics.
Common reasons to have an indwelling catheter are:
- Urine leakage (incontinence)
- Not being able to empty your bladder
- Surgery on your bladder, prostate, or vagina
During a hospital stay, you may have an indwelling catheter:
- Right after any type of surgery
- If you are very ill and cannot control your urine
- Abnormal urine color (cloudy urine)
- Blood in the urine (hematuria)
- Foul or strong urine odor
- Frequent and strong urge to urinate
- Pressure, pain, or spasms in your back or the lower part of your belly
- Leakage of urine around the catheter
Other symptoms that may occur with a UTI:
- Flank pain
- Mental changes or confusion (these may be the only signs of a UTI in an elderly person)
Exams and Tests
Urine tests will check for infection:
- Urinalysis may show white blood cells (WBCs) or red blood cells (RBCs).
- Urine culture can help determine the type of bacteria in the urine and the best antibiotic to use.
Your doctor may recommend an ultrasound or CT exam of your urinary system.
People who use this type of catheter will often have an abnormal test and culture of urine from the bag. But even if the test is abnormal, you may not have a UTI. This fact makes it harder for your health care provider to choose whether to treat you.
- If you also have symptoms of a UTI, your health care provider will likely treat you with antibiotics.
- If you do not have symptoms, your health care provider must consider other factors when deciding whether to treat you.
Because there is a risk that your infection may spread to your kidneys, antibiotics are almost always used to treat a UTI.
- Most of the time, you can take antibiotics by mouth. It is very important to take all of them, even if you feel better before you finish them.
- If your infection is more severe, you may need to receive antibiotics through an intravenous line, or IV.
- You may also receive medicine to lessen bladder spasms.
You will need more fluids to help flush bacteria out of your bladder.
- If you are treating yourself at home, this may mean drinking 2 - 3 quarts of fluid a day (ask your doctor if this much fluid is safe for you.)
- Avoid fluids that irritate your bladder, such as alcohol, citrus juices, and drinks that contain caffeine.
After you have finished your treatment, you will have another urine test to make sure the bacteria are gone.
Your catheter will need to be changed when you have a UTI. If you have many UTIs, your doctor may remove the indwelling catheter. The doctor may also:
- Ask you to insert a urine catheter
- Suggest other urine collection devices
- Suggest surgery so you do not need a catheter
Your health care provider may prescribe a low-dose antibiotic for you to take every day. This can help prevent bacteria from growing in your catheter.
UTIs related to catheters can be harder to treat than other UTIs. Having many infections over time may lead to kidney damage or kidney stones and bladder stones.
If a UTI is not treated, you may develop kidney damage and more severe infections.
When to Contact a Medical Professional
Call your health care provider if you have:
- Any symptoms of a urinary tract infection
- Back or flank pain
If you have an indwelling catheter, you must do these things to help prevent infection:
- Clean around the catheter opening every day.
- Clean the catheter with soap and water every day.
- Clean your rectal area thoroughly after every bowel movement.
- Keep your drainage bag lower than your bladder. This prevents the urine in the bag from going back into your bladder.
- Empty the drainage bag at least once every 8 yours, or whenever it is full.
- Have your indwelling catheter changed at least once a month.
- Wash your hands before and after you touch your urine.
Your health care provider might tell you to drink more fluids every day. This is not healthy for everyone, so talk with your doctor before you do this.
Fishman N, Calfee DP. Prevention and control of health care-associated infections. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 290.
Hooton TM. Nosocomial urinary tract infections. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2009:chap 304.
Infectious Disease Society of America. Diagnosis, Prevention, and Treatment of Catheter-Associated Urinary Tract Infection in Adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Inf Dis. 2010;50:625-663.
Norrby SR. Approach to the patient with urinary tract infection. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 292.