If you have problems emptying your bladder, your health professional may suggest using a catheter. A catheter is a thin, hollow tube that’s used to drain urine from your bladder. Urine is usually collected in a drainage bag, or drained directly into a toilet.
Catheters may be used when needed (intermittently), or on a more permanent basis.
Types of catheter
There are a few different types of catheter available. They are all inserted and used in slightly different ways.
Intermittent catheters are temporarily inserted through your urethra when needed and removed once you've finished emptying your bladder.
Indwelling catheters are inserted through your urethra and are held in place in your bladder by a small, inflated balloon. They aren't removed after each use.
Suprapubic catheters are inserted into your bladder through a hole in your abdominal wall and are kept in place by a small, inflated balloon. They aren't removed after each use.
Long-term catheters (indwelling and suprapubic) are normally only used when other treatments you've tried have not been successful. They can be useful if you lack of control of your bladder, both during the day and at night.
Intermittent catheters are inserted into your bladder through the urethra – the tube that allows urine to pass out of your body. You carry out this process yourself by guiding a thin, smooth, hollow tube through your urethra and into your bladder until urine starts flowing out of the tube. The other end of the tube is left open so your urine can either be drained into a toilet or collected in a bag. Once the urine stops coming out of the tube, the catheter can be removed and disposed of. You’ll usually need to carry out this process several times a day, depending on how much urine you retain. This process is known as clean intermittent self-catheterisation (CISC).
Using a catheter can seem daunting at first. It’s completely normal for it to take a little bit of getting used to. Expect it to take some time and lots of practise before you feel fully confident. Your MS nurse or bladder and bowel specialist will go through the process with you. They'll support and reassure you until you feel confident using an intermittent catheter independently.
Using an intermittent catheter can be a positive and life-changing step for some people. They can give you better control over your bladder. They can reduce the impact your bladder symptoms have on your daily life and improve your confidence. Using CISC can also reduce the likelihood of urinary tract infections as they ensure the bladder fully emptied.
The process of inserting an intermittent catheter requires you to have good manual dexterity. For this reason, they're not suitable for everyone. If this process would be difficult for you, your health professional may suggest an indwelling catheter instead.
Indwelling urinary catheters are similar to intermittent catheters. They consist of a tube that’s guided through the urethra and into the bladder. However, they're not removed after each use. Instead, an indwelling catheter is kept in place by a small, inflatable balloon that stops it falling out. Your urine drains out the other end of the tube and into a bag, which is discreetly attached to your leg using straps or a sleeve. The bag is then emptied into a toilet when it’s full. At night, the catheter may be attached to a night drainage bag that hangs by the side of your bed.
Some indwelling catheters can be used with a valve, rather than a bag, so you can empty your bladder directly into a toilet. When the valve is closed, your urine will collect in your bladder until you're ready to open the valve and empty your bladder. Valves are not always a suitable option and need to be discussed with a health professional.
Your nurse will insert the catheter for you and teach you how to manage and empty it. This will reduce the risk of hygiene problems when changing drainage devices, which can cause urinary tract and urine infections. Indwelling catheters usually need to be replaced at least every three months.
There are different types of indwelling urinary catheters and they are only available on prescription from a doctor.
An indwelling catheter shouldn’t stop you from having sex. Women can tape the catheter tube up onto their abdomen to keep it out of the way during sex. Men can fold the tube along the shaft of the penis and hold it in place with tape or a condom. A valve is a useful option during sex, so you don’t have to worry about a drainage bag getting in the way.
A suprapubic catheter is a long-term approach to bladder problems. It’s inserted directly into your bladder through a hole in your abdominal wall and is left in place. This is a surgical procedure carried out by a urologist.
Once inserted, your urine drains through the tube and is collected in a drainage bag. It can be easily emptied when full. Drainage bags can be discreetly attached to your abdomen (belly bags) or your leg (eg, on your thigh or calf). Alternatively, you can use a valve which allows you to empty your bladder directly into the toilet. Your urine will be stored in your bladder until you open the valve. A drainage bag can be temporarily replaced with a valve during sex to avoid it getting in the way.
Some people prefer suprapubic catheters as they’re less intrusive and usually easy to manage. They’re also associated with less bladder infections and allow full sexual activity. Suprapubic catheters are usually changed every 4 to 12 weeks.
There can sometimes be problems with healing at the point where the catheter is inserted into the body. There is also the risk of urine infections if the drainage bag is not changed cleanly.
Your health professional may give you a catheter management plan, known as a catheter passport. This contains information about how to care for your catheter at home. It ensures anyone involved in your care (such as a carer or nurse) has the right information about your catheter and its management. You should take it with you to all healthcare appointments, hospital stays and when you travel.
Castel-Lacanal E, et al. Impact of intermittent catheterization on the quality of life of multiple sclerosis patients. World Journal of Neurology 2013;31(6):1445-1450. Summary (link is external)
National Institute for Health and Clinical Excellence. Urinary incontinence in neurological disease: management of lower urinary tract dysfunction in neurological disease. London: NICE; 2012. Full guideline (link is external)
Thomas S, et al. Expert opinion consensus document. Management of bladder dysfunction in people with multiple sclerosis. London: British Journal of Nursing 2022; 31 (3 Suppl 3), S1–32. Full article (link is external)
Welk B, et al. Bladder management experiences among people living with neurologic disease: A systematic review and meta-synthesis of qualitative research. Neurourology and Urodynamics 2018;Nov 29 Summary (link is external)
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Managing your bladder - book
Managing your bladder looks at why bladder problems can be part of MS and provides a practical approach to their management. It includes comments and tips from people with MS who know what it is like to live with bladder problems.