Urinary catheters do cause discomfort for most people, though the intensity ranges from a brief stinging sensation to significant pain depending on the type of catheter, how it is inserted, and your individual anatomy. In one study of women undergoing catheterization in an emergency department, the average pain score landed at about 24 out of 100, meaning most patients rated it as mild to moderate. But that average masks real variation, and roughly two-thirds of catheter patients report at least some symptoms while the catheter is in place. The good news is that several straightforward interventions can reduce pain at every stage, from insertion through removal.
What Insertion Actually Feels Like
Most people describe catheter insertion as a burning or pressure sensation that lasts anywhere from a few seconds to about a minute. A thin, flexible tube is guided through the urethra into the bladder, and the urethra has nerve endings that respond to stretching and friction. The sensation is often compared to an intense urge to urinate combined with a sting. Once the catheter is in and the balloon (if it is an indwelling type) is inflated, the acute insertion pain usually fades within a minute or two.
Pain levels vary meaningfully by sex and age. The male urethra is considerably longer and curves through the prostate, which can create more friction and a longer period of discomfort during insertion. Anatomical and physiological differences between men and women require different catheterization techniques, and nurses are trained to adapt their approach accordingly.1PubMed. At a glance: urinary catheterisation in males and females Among women, younger patients (roughly ages 18 to 59) report higher pain scores than older women, with the average difference being meaningful enough to show up clearly in clinical data.2Academic Emergency Medicine. Factors Affecting Pain Scores during Female Urethral Catheterization Interestingly, that same study found no significant difference in pain based on the size of catheter used, which suggests that technique and lubrication matter more than the tube’s diameter for the insertion experience itself.
Why Lidocaine Gel Makes a Real Difference
If someone tells you “it’s just a quick poke, no numbing needed,” the research disagrees. Lidocaine-based lubricating gel (sometimes called lignocaine gel) applied before catheterization meaningfully reduces pain compared to plain water-based lubricant. In one randomized trial, women who received lidocaine gel reported a median pain score of 6 out of 100 during the procedure, compared to 33 out of 100 for those who got plain lubricant.3PubMed. Comparison of lignocaine and water-based lubricating gels for female urethral catheterization: a randomized controlled trial A separate trial confirmed this, showing that the lidocaine group experienced a significant drop from their pre-procedure anxiety-related pain to their actual procedural pain, while the plain-gel group saw no such drop.4PubMed. A randomized controlled study to compare the 2% lignocaine and aqueous lubricating gels for female urethral catheterization
Despite this evidence, lidocaine gel is not universally used, particularly for women. Some hospitals default to plain lubricant for female catheterization on the assumption that the shorter female urethra makes the procedure quick enough to skip anesthesia. If you are facing a planned catheterization and have the opportunity to discuss it ahead of time, asking for lidocaine gel is a reasonable request backed by clinical evidence. For men, lidocaine gel is more routinely used because of the longer urethral path, but it is worth confirming regardless of your sex.
Pain That Sticks Around After the Catheter Is Placed
Insertion is just the opening act. For many patients, the real discomfort comes afterward and is often described as a persistent urge to urinate, cramping in the lower abdomen, or a burning feeling that does not go away. A survey of hospitalized patients found that about 65% reported ongoing symptoms from their urinary catheter.5PubMed Central. Patients knowledge and experience with urinary and peripheral intravenous catheters That is a substantial majority, and it tells you that some degree of discomfort while a catheter is dwelling inside you is normal, not a sign that something has gone wrong.
The clinical term for this ongoing discomfort is catheter-related bladder discomfort, or CRBD. It happens because the catheter tip and balloon irritate the bladder wall, triggering involuntary muscle contractions, essentially bladder spasms.6PubMed Central. Catheter-Related Bladder Discomfort: How Can We Manage It? These spasms can feel like sudden, intense cramping that comes and goes. Some people also feel the mechanical sensation of the catheter itself shifting inside the urethra when they move, which can produce a pulling or pinching feeling.
Beyond the bladder’s reaction, the catheter’s physical properties play a role. The material the catheter is made from, the pressure it exerts on the urethral walls (especially with larger sizes), and traction from the drainage bag tugging on the catheter can all contribute to ongoing soreness and even tissue damage over time.7PubMed. Causes and management of indwelling urinary catheter-related pain Securing the drainage bag so it does not pull on the catheter, typically by taping it to the thigh or using a leg strap, is one of the simplest things that reduces this type of pain.
Medications That Help With Bladder Spasms
If you are dealing with bladder spasms from an indwelling catheter, particularly after surgery, several medications have been studied and shown to help. The research landscape here is surprisingly active, and a few options stand out.
Anticholinergic drugs like oxybutynin, solifenacin, and tolterodine work by blocking the receptor signals that cause involuntary bladder contractions. A large network meta-analysis found that tolterodine significantly reduced moderate-to-severe CRBD at multiple time points after surgery, and solifenacin was also effective at reducing both the frequency and severity of spasms.8PubMed. Comparative effectiveness of interventions for managing postoperative catheter-related bladder discomfort: a systematic review and network meta-analysis Solifenacin was particularly notable for having minimal side effects in patients recovering from urethral surgery.9PubMed Central. Interventions for the Management of Bladder Spasms in Adults with Indwelling Urinary Catheters: A Nursing Practice-Oriented Systematic Review
Gabapentin, a nerve-pain medication, also showed promise. In one trial, it cut the incidence of CRBD nearly in half compared to a control group.10PubMed Central. Strategies for the prevention of catheter-related bladder discomfort: A PRISMA-compliant systematic review and meta-analysis of randomized controlled trials Dexmedetomidine, a sedative sometimes used in surgical settings, was another strong performer in the same meta-analysis. Ketamine and regional nerve blocks have also been studied, primarily in post-surgical patients. Most of these are prescribed by the medical team rather than something you would request by name, but knowing they exist means you can advocate for better pain control if standard measures are not enough.
How Catheter Design Affects Comfort
Not all catheters feel the same going in or staying in. For people who perform intermittent self-catheterization, meaning they insert and remove a catheter several times a day to empty the bladder, the surface coating of the catheter makes a measurable difference. Hydrophilic-coated catheters have a slippery polymer layer that activates with water, creating a smoother surface that reduces friction against the urethral lining.11PubMed Central. Hydrophilic catheters: an evidence-based analysis A randomized crossover study found that these coated catheters reduced urethral micro-trauma compared to standard uncoated catheters, as measured by reduced blood in the urine afterward.12European Urology. Hydrophilic-Coated Catheters for Intermittent Catheterisation Reduce Urethral Micro Trauma
More recently, a randomized trial tested chlorhexidine-coated hydrophilic catheters against conventional silicone Foley catheters and found a striking difference. The average insertion pain score was about 4.2 out of 10 with the coated catheter compared to 6.6 with the conventional one, and removal pain followed a similar pattern. Over 83% of patients in the coated-catheter group reported only mild pain during removal, compared to about 43% in the conventional group.13PubMed Central. Improved patient comfort and procedural efficiency using chlorhexidine-coated hydrophilic urethral catheters: a randomized controlled trial If you are facing repeated catheterizations, asking about hydrophilic or pre-lubricated catheters is worth the conversation.
Alternatives That Tend to Hurt Less
When the clinical situation allows it, alternatives to a standard indwelling urethral catheter can significantly reduce pain. The choice depends on why the catheter is needed, how long it will stay, and the patient’s anatomy.
For men who need a catheter primarily for urine collection rather than bladder drainage, condom catheters (also called external catheters) are a dramatically more comfortable option. These fit over the penis like a sheath and connect to a drainage bag without anything entering the urethra. In a randomized trial, patients rated condom catheters as both more comfortable and less painful than indwelling catheters.14PubMed. Condom versus indwelling urinary catheters: a randomized trial A separate observational study confirmed that complication rates during placement were much lower: about 14% for condom catheters versus 43% for indwelling ones.15PubMed Central. Condom Catheters versus Indwelling Urethral Catheters in Men: A Prospective, Observational Study The obvious limitation is that condom catheters only work for male anatomy and cannot actively drain the bladder.
Suprapubic catheters, which enter the bladder through a small surgical opening in the lower abdomen rather than the urethra, are another option that bypasses urethral pain entirely. After prostate surgery, patients with suprapubic catheters reported significantly less penile pain than those with standard urethral catheters at the one-week mark.16PubMed. An Assessment of Patient Comfort and Morbidity After Robot-Assisted Radical Prostatectomy with Suprapubic Tube Versus Urethral Catheter Drainage The trade-off is that suprapubic placement requires a minor surgical procedure to create the opening.
Intermittent catheterization, where you insert a catheter just long enough to empty the bladder and then remove it, avoids the continuous irritation of a dwelling catheter. A Cochrane review comparing indwelling and intermittent approaches found that patients with indwelling catheters reported substantially more pain.17PubMed Central. Urinary catheter policies for short-term bladder drainage in adults The downside is that intermittent self-catheterization can feel frustrating and difficult initially, particularly for people learning the technique after surgery.18American Journal of Obstetrics and Gynecology. A randomized controlled trial of clean intermittent self-catheterization versus suprapubic catheterization after urogynecologic surgery Once people get the hang of it, though, the overall burden tends to be comparable to an indwelling catheter, with neither approach clearly winning on patient-reported difficulty or embarrassment scores.19American Journal of Obstetrics and Gynecology. Catheter burden following urogynecologic surgery
What Removal Feels Like
For an indwelling (Foley) catheter, removal involves deflating the small balloon that holds the catheter inside the bladder and then sliding the tube out. Most people feel a quick pulling or burning sensation that lasts a few seconds. It is generally described as less painful than insertion, partly because it is faster and partly because the urethra has had time to accommodate the tube’s presence. With the hydrophilic-coated catheters mentioned earlier, removal pain is typically mild for the large majority of patients.
After removal, it is common to feel some burning during urination for the first day or two. You may also notice urinary urgency or frequency, meaning you feel like you need to go more often and more suddenly than usual. These symptoms typically resolve on their own within 24 to 48 hours. Research on early catheter removal following gynecological surgery found that patients whose catheters were taken out sooner reported less pain and fewer voiding disturbances than those who kept them longer, and only a small number needed re-catheterization afterward. The early-removal group also got out of bed sooner and left the hospital faster. This suggests that if your medical team offers early removal as an option, taking it tends to work out well for most patients.
When Pain Means Something Is Wrong
While some discomfort is expected, certain symptoms suggest a complication that needs medical attention. Catheter-associated urinary tract infection is the most common one. Signs that warrant a call to your healthcare provider include:
- Fever: new onset of temperature elevation while a catheter is in place or shortly after removal.
- Suprapubic tenderness: pain or sensitivity in the lower abdomen directly above the pubic bone that feels different from the usual catheter discomfort.
- Flank pain: pain in the side or back, near the kidneys, which can indicate the infection has moved upward.
- Cloudy or foul-smelling urine: a change in urine appearance or odor.
- New confusion: particularly in older adults, sudden delirium can be a sign of urinary infection.
Clinical assessment tools for catheter-associated infection focus on fever, suprapubic tenderness, flank tenderness, and delirium as the key signs to watch for.20PubMed Central. A Tool to Assess the Signs and Symptoms of Catheter-Associated Urinary Tract Infection: Development and Reliability If you are experiencing any of these alongside your catheter discomfort, it is worth reporting promptly rather than assuming it is just normal irritation.
In rare cases, catheterization itself can injure the urethra, particularly with traumatic or difficult insertions. This is uncommon with routine, gentle catheterization, but when it does happen, it can lead to urethral scarring that narrows the passage over time. One study tracking patients after catheter-related urethral injuries found that about three-quarters eventually developed some degree of urethral stricture, with some needing procedures to widen the passage again. This underscores why gentle technique and proper lubrication matter so much during the initial insertion.
The Role of Anxiety and Simple Comfort Measures
Pain perception is not purely physical, and anxiety about catheterization can genuinely amplify how much it hurts. If you have ever tensed up anticipating a needle and felt the poke hurt more than expected, the same phenomenon applies here. Muscle tension in the pelvic floor makes insertion harder and more uncomfortable, which creates a feedback loop of pain and more tension.
Deep, slow breathing and conscious relaxation of the pelvic muscles during insertion are among the simplest things you can do to reduce pain. Some hospitals have started exploring music therapy as a distraction and relaxation technique. A study of men undergoing catheterization for prostate-related issues found that those who listened to music during the procedure had higher rates of successful first-attempt catheterization and shorter durations of spasm-related pain, alongside lower pain scores shortly after the procedure.
Asking questions beforehand also helps. Knowing what to expect, how long the procedure takes, and what sensations are normal removes the element of surprise. If the idea of catheterization is causing you significant anxiety, mentioning it to your nurse or doctor is not trivial. They may be able to adjust timing, offer a mild sedative, or simply walk you through each step as it happens. Patients who feel informed and in control consistently report better pain experiences across all kinds of medical procedures, and catheterization is no exception.
Older Adults and People With Cognitive Impairment
Catheter pain takes on additional complexity in older adults, particularly those with dementia or cognitive impairment. These patients may not be able to articulate what they are feeling or distinguish catheter discomfort from other sources of pain. Instead, discomfort often manifests as behavioral changes: increased agitation, aggression, resistance to care, or restlessness. Hospitalized patients with dementia who experience pain tend to show declines in physical function and increases in behavioral symptoms like wandering and verbal outbursts. Caregivers and medical staff need to be especially attentive to these nonverbal cues rather than assuming the patient is comfortable simply because they are not complaining in words.
For older adults without cognitive impairment, the news is somewhat encouraging on the insertion-pain front. As noted earlier, women over 60 tend to report lower pain scores during catheterization than younger women. However, they are also at higher risk for catheter-associated infections and may be more susceptible to the delirium that accompanies those infections. The calculus for this population often leans even more heavily toward the shortest possible catheter duration and the use of alternatives like condom catheters for men or intermittent catheterization when feasible.