Hernia surgery is a common procedure that repairs weakened areas in the abdominal wall, a frequent site for hernias. Patients often have questions about the recovery process, including the potential need for a urinary catheter. While not every patient requires catheterization, understanding the circumstances that might lead to its use can help manage expectations and promote a smoother recovery. This article clarifies why a catheter might be needed, its types, and what to expect during and after removal.
Reasons for Catheter Use
The primary reason for a urinary catheter after hernia surgery is postoperative urinary retention (POUR), the inability to urinate despite a full bladder. Anesthesia, particularly general and spinal anesthesia, can interfere with normal bladder function and sensation, making it difficult to empty the bladder. Pain medications, especially opioids, also contribute to POUR by inhibiting the urge to urinate and affecting bladder muscle function.
Surgical factors, such as longer operative durations, bilateral hernia repairs, or inflammation and swelling affecting nearby nerves, can contribute to temporary bladder dysfunction. Patient-specific factors, such as advanced age, a history of benign prostatic hyperplasia (BPH) in men, diabetes, or a higher body mass index, may further increase the risk of developing POUR.
POUR is common, occurring in approximately 5-25% of patients after hernia surgery. If the bladder is not emptied, it can overdistend, leading to discomfort and damage. A catheter is then inserted to decompress the bladder, relieve symptoms, and restore proper function.
Understanding Catheter Types
When a urinary catheter is needed after hernia surgery, two main types are indwelling and intermittent catheters. An indwelling catheter, often known as a Foley catheter, remains in the bladder for a period, continuously draining urine into a collection bag. This type is held in place by a small, water-filled balloon inside the bladder, preventing it from slipping out.
Alternatively, an intermittent catheter is used for temporary drainage. Unlike indwelling catheters, intermittent catheters are inserted into the bladder to drain urine and then immediately removed once the bladder is empty. This method is used multiple times a day as needed. A suprapubic catheter, a type of indwelling catheter, might be inserted directly into the bladder through a small incision in the lower abdomen, bypassing the urethra.
Catheter Removal and Post-Surgery Care
The duration a catheter remains in place after hernia surgery can vary, but it is short-term, often just until the patient can urinate independently. Many patients have their catheter removed within a day, or when they can urinate without assistance. The average time a catheter is in place ranges from three to eight days, though some are removed sooner or kept longer depending on individual recovery and medical needs.
During catheter removal, some individuals may experience a temporary burning sensation or discomfort. After removal, it is common to have increased frequency of urination or a mild burning feeling when urinating for a short period, usually resolving within 24 to 72 hours. Staying well-hydrated by drinking water can help alleviate these symptoms and support bladder recovery.
Monitoring for signs of a urinary tract infection (UTI) is advised after catheter removal. Symptoms of a UTI can include fever, chills, pain in the lower abdomen or back, cloudy or strong-smelling urine, or a frequent and sudden urge to urinate. If any of these symptoms develop, or if there is severe pain in the lower back or abdomen, blood in the urine, or an inability to urinate, contact a healthcare provider promptly.
Reducing the Likelihood of Catheterization
While the need for a catheter often depends on surgical and physiological factors, some measures can reduce the likelihood of catheterization. Staying adequately hydrated before and after surgery supports normal urinary function, though over-hydrating immediately before the procedure should be avoided. Discussing any pre-existing urinary concerns, such as an enlarged prostate, with the surgical team beforehand allows for proactive management.
Attempting to urinate before pain medication fully takes effect or as soon as medically advised after surgery can also be helpful. Early mobilization, as encouraged by medical staff, can promote overall recovery and help restore normal bodily functions, including urination. A routine intraoperative catheter placement during laparoscopic inguinal hernia repair has not been shown to reduce the risk of postoperative urinary retention.