Urinary Tract Health in Individuals Using Catheters

Urinary Tract Health in Individuals Using Catheters

By Bilal Chughtai, MD
Urogynecology & Reconstructive Pelvic Surgery, Chief of Urology, Plainview Hospital, NY

About the Author: Dr. Chughtai is a board-certified urologist specializing in urinary tract health, recurrent urinary tract infections, and antibiotic stewardship. His clinical and research work focuses on evidence-based approaches to long-term urinary health.

Urinary Tract Health in Individuals Using Catheters

For many individuals, urinary catheters play an essential role in maintaining bladder function and independence.¹,² Whether intermittent or indwelling, catheters can significantly improve quality of life when combined with appropriate education, routine care, and awareness of bladder health.² A wellness-focused approach emphasizes prevention, comfort, and early recognition of potential concerns rather than focusing only on pitfalls. With the right daily practices and support, many catheter users maintain stable urinary tract health for years.³

Understanding the Urinary Tract’s Natural Defenses

The urinary tract has several natural defenses that help prevent infection, including the flow of urine, the bladder’s lining, and the body’s immune system.⁴ When a catheter is introduced, these defenses may be partially bypassed, which can allow bacteria to enter the urinary system more easily.⁴,⁵ The presence of bacteria in the urine, known as catheter, associated asymptomatic bacteriuria, is common in catheter users and does not always indicate infection or require treatment.⁶ Understanding this distinction helps prevent unnecessary antibiotic use and supports more thoughtful long-term bladder care.⁶

Types of Catheters and Their Care Considerations

Catheters may be used in different ways. Intermittent catheters are inserted several times per day and removed after bladder emptying, while indwelling catheters remain in place continuously, draining urine into a collection bag.⁷ Each method has unique care considerations, but the overall goals are similar: maintain cleanliness, support urine flow, and monitor for meaningful changes.⁸,⁹

Common Catheter-Related Concerns

Individuals using catheters may experience issues such as bladder irritation, sediment buildup in the catheter tubing, leakage around the catheter, or catheter blockage.⁸ Long-term catheter use may also increase the likelihood of urinary tract infections (UTIs), though many people go extended periods without significant complications.⁴,⁶ Skin irritation around the catheter site may also occur and may be exacerbated if moisture accumulates or if the catheter is not well secured.²,⁸ Understanding what is expected versus what is concerning can reduce anxiety and help individuals respond appropriately.² For example, mild changes in urine appearance or odor may occur without infection, particularly if fluid intake varies, while symptoms such as fever, new pelvic discomfort, or sudden blockage warrant medical attention.⁴,⁶

When to Contact a Healthcare Provider

Awareness of warning signs is an important part of maintaining urinary wellness for individuals using catheters.⁹ A healthcare provider should be contacted if symptoms such as fever, chills, or unexplained fatigue develop; if there is new bladder, pelvic, or flank discomfort; or if persistent catheter blockage or reduced urine flow occurs.¹⁰,¹¹ Medical evaluation is also recommended when blood in the urine does not resolve quickly, when sudden leakage develops around the catheter, or when cloudy or foul-smelling urine appears in combination.⁹ In addition, new confusion or unusual weakness, particularly in older adults, should prompt medical attention.¹¹ Early communication with healthcare providers allows prompt assessment and helps prevent minor concerns from progressing into more significant long-term issues.¹⁰,¹¹

Daily Supportive Strategies for Catheter Users

Many supportive strategies focus on consistent daily routines that help maintain a clean drainage system and healthy urinary flow.⁸,⁹ Handwashing before and after handling the catheter or drainage system is one of the most effective ways to reduce infection risk, and individuals who perform intermittent catheterization should follow clean catheterization techniques as instructed by their healthcare professionals.²,⁸ For those using indwelling catheters, keeping the drainage system closed and avoiding unnecessary disconnections helps prevent bacteria from entering the tubing, while ensuring that the tubing is not kinked and that the drainage bag remains below bladder level promotes steady urine flow.⁹ Unless otherwise directed by a healthcare provider, maintaining adequate hydration can help dilute urine, reduce sediment accumulation, and decrease the likelihood of catheter blockage caused by mineral deposits.¹² Following recommended catheter replacement schedules supports proper function and comfort, with the frequency of changes tailored to each individual’s clinical needs.²,⁹ Gentle cleansing of the skin around the catheter insertion site during routine hygiene practices and keeping the area dry can help reduce irritation or breakdown, and regular inspection allows early identification of redness, pressure-related changes, or discomfort.⁸,⁹ In addition, monitoring overall patterns, such as urine output, color, or recurring blockage, rather than focusing on isolated changes can provide helpful information for both individuals and healthcare providers, and keeping a simple record may assist in identifying trends when recurrent catheter-related concerns arise.²,⁹

Comfort, Lifestyle, and Quality of Life

Urinary wellness is closely connected to comfort and daily functioning. Proper catheter securement devices can help reduce pulling or discomfort during movement.⁸ Clothing adjustments, discreet drainage bag options, and nighttime positioning strategies can also improve comfort and sleep quality.² For individuals who perform intermittent catheterization, establishing a consistent schedule that aligns with daily activities can improve bladder health.¹² Emerging evidence supports the use of cranberry products containing standardized proanthocyanidins (PACs) as part of a wellness-focused strategy to help reduce urinary tract infection risk in appropriate individuals, including those using catheter.¹³,¹⁴ A small proof-of-concept clinical study in patients with long-term indwelling catheters found that daily supplementation with a cranberry extract providing 36 mg of bioactive, soluble A-Type PACs was associated with reductions in symptomatic catheter-associated UTIs, bacterial counts, and antibiotic resistance patterns.¹⁷ These findings suggest a potential supportive role for standardized cranberry PACs in catheter-associated urinary health.

The Importance of Ongoing Education and Follow-Up

Ongoing education is a key component of long-term urinary tract health.²,¹²,¹⁵ Individuals who understand how their catheter works, how to maintain hygiene, and when to seek medical advice are better equipped to prevent complications.¹²,¹⁵ Regular follow-up visits provide opportunities to review catheter supplies, address concerns, and update care plans as needed.² Open communication is equally important. Patients and caregivers should feel comfortable discussing symptoms, changes in urinary patterns, or challenges with catheter management.¹²,¹⁶ Early conversations often lead to simple solutions that prevent larger problems later.²

A Wellness-Centered Approach to Living with a Catheter

Living with a catheter does not mean living with constant complications. With modern catheter designs, improved care practices, and strong patient education, many individuals successfully maintain urinary tract health and lead active lives.¹²,¹⁵ A wellness-centered approach focuses on daily habits like hydration, hygiene, and prevention, rather than reacting only when problems arise.⁹ By understanding how catheters influence the urinary system and by adopting supportive care routines, individuals can reduce risk, improve comfort, and maintain confidence in their daily activities.²,¹² Partnering with healthcare providers and staying informed empowers patients with catheter to take an active role in their urinary health, ensuring that catheter use remains a supportive tool for bladder health.¹²,¹⁶

FAQs

Does having bacteria in the urine always mean I have a UTI?

No. The presence of bacteria in the urine, known as catheter-associated asymptomatic bacteriuria, is common in catheter users and does not always indicate infection or require antibiotics.

What symptoms should prompt medical attention?

Fever, chills, pelvic or flank discomfort, persistent catheter blockage, reduced urine flow, blood in the urine that does not resolve, or new confusion (especially in older adults) should be evaluated by a healthcare provider.

How can I reduce the risk of infection with a catheter?

Practicing consistent hand hygiene, maintaining a closed drainage system, ensuring proper catheter positioning, staying hydrated (unless otherwise directed), and following recommended catheter change schedules are key preventive strategies.

Can cranberry products help individuals using catheters?

Emerging evidence supports the use of cranberry products containing standardized proanthocyanidins (PACs) as part of a wellness-focused strategy to help reduce urinary tract infection risk in appropriate individuals.

Is cloudy or strong-smelling urine always a sign of infection?

Not necessarily. Mild changes in urine appearance or odor may occur without infection, particularly if hydration levels vary. However, if these changes occur alongside other symptoms such as fever or discomfort, medical evaluation is recommended.

References

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  2. Ginsberg DA, Boone TB, Cameron AP, et al. The AUA/SUFU Guideline on Adult Neurogenic Lower Urinary Tract Dysfunction: Treatment and Follow-up. J Urol. Nov 2021;206(5):1106-1113. doi:10.1097/ju.0000000000002239
  3. Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA. Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol. Apr 2010;31(4):319-26. doi:10.1086/651091
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  9. Summary of recommendations for catheter use and prevention of catheter-associated urinary tract infections. 
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  12. EAU Guidelines on Urological Infections. 2024 update. Arnhem, The Netherlands: EAU Guidelines Office;. 
  13. Jepson RG, Williams G, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev. Oct 17 2012;10(10):Cd001321. doi:10.1002/14651858.CD001321.pub5
  14. Fu Z, Liska D, Talan D, Chung M. Cranberry Reduces the Risk of Urinary Tract Infection Recurrence in Otherwise Healthy Women: A Systematic Review and Meta-Analysis. J Nutr. Dec 2017;147(12):2282-2288. doi:10.3945/jn.117.254961
  15. Prieto J, Murphy CL, Moore KN, Fader M. Intermittent catheterisation for long-term bladder management. Cochrane Database Syst Rev. Sep 10 2014;(9):Cd006008. doi:10.1002/14651858.CD006008.pub3
  16. Pinder B, Lloyd AJ, Elwick H, Denys P, Marley J, Bonniaud V. Development and psychometric validation of the intermittent self-catheterization questionnaire. Clin Ther. Dec 2012;34(12):2302-13. doi:10.1016/j.clinthera.2012.10.006
  17. Thomas D, Rutman M, Cooper K, Abrams A, Finkelstein J, Chughtai B. Does cranberry have a role in catheter-associated urinary tract infections? Can Urol Assoc J. 2017;11(11):E421–E424. doi:10.5489/cuaj.4472.

Disclaimer

This content is provided for educational and informational purposes only and is intended to summarize current scientific research related to urinary tract health. It is not intended to replace professional medical advice, diagnosis, or treatment. Always consult your physician or qualified healthcare provider with any questions you may have regarding a medical condition or before starting any new supplement or health regimen.

*These statements have not been evaluated by the Food and Drug Administration (FDA). This information is not intended to diagnose, treat, cure, or prevent any disease.