A suprapubic catheter is a medical device used to drain urine from the bladder. It is a flexible tube inserted through a small incision in the abdomen, just above the pubic bone, directly into the bladder. This method is often selected for long-term urinary drainage when using a catheter through the urethra is not feasible or desired. Situations requiring this type of catheter include urethral trauma, certain neurological conditions, or following specific gynecological or pelvic surgeries. This allows individuals to bypass the natural urinary pathway when it is compromised.
Insertion Site Complications
The area where the catheter enters the abdomen, known as the stoma, requires diligent care to prevent complications. Over time, some individuals may develop granulation tissue, an overgrowth of new connective tissue and blood vessels around the site. This tissue often appears as reddish, bumpy, and moist growths that can sometimes bleed easily, and excessive granulation can interfere with catheter changes.
Consistent exposure to moisture from urine leakage or sweat can lead to skin irritation. The skin may become red, tender, and prone to breakdown, making the area uncomfortable. Adhesives and dressings used to secure the catheter can also cause dermatitis in sensitive individuals.
A persistent risk at the insertion site is localized skin infection, or cellulitis. This occurs when bacteria enter the skin, causing redness, swelling, warmth, and pain that can spread from the stoma. Maintaining a clean and dry site is a primary defense against such infections.
Internal Urinary Tract Complications
The presence of a foreign object inside the bladder for an extended period can lead to complications. Catheter-Associated Urinary Tract Infections (CAUTIs) are a frequent concern. Bacteria can travel along the catheter to enter the bladder, leading to infection. Signs of a CAUTI often include cloudy, dark, or foul-smelling urine, and may be accompanied by fever, chills, or discomfort in the lower abdomen.
Another significant issue is the formation of bladder stones. Minerals naturally present in urine can crystallize on the surface of the catheter or the inner lining of the bladder. These deposits, a process called encrustation, can build up over time to form hard stones.
These mineral deposits can cause the catheter to become blocked. Encrustation can narrow the internal channel of the tube, preventing urine from draining effectively. A sudden cessation of urine flow into the drainage bag is a clear indicator of a blockage, which requires immediate medical attention to restore proper drainage.
Long-Term Bladder Changes
Continuous, long-term use of a suprapubic catheter can lead to changes in the bladder’s structure and function. One common experience is bladder spasms, which are sudden, involuntary contractions of the bladder muscle. The bladder may react to the presence of the catheter’s internal balloon as if it were a foreign object to be expelled, causing cramping pain and sometimes leakage of urine around the insertion site.
Because the catheter constantly drains urine, the bladder is no longer required to fill and stretch to its normal capacity. This continuous emptying can lead to a reduction in the bladder’s functional size, a condition sometimes referred to as bladder shrinkage. The bladder walls can become less flexible, and its ability to hold a significant volume of urine diminishes over time.
Chronic irritation of the bladder lining from the indwelling catheter is a recognized risk factor for developing bladder cancer, specifically squamous cell carcinoma. While the absolute risk is low, the constant inflammation over many years can trigger changes in the bladder’s cells. Regular medical follow-up allows for monitoring of bladder health.
Daily Management and Lifestyle Adjustments
Living with a suprapubic catheter involves specific routines to maintain health and comfort. A primary one is a hygiene regimen, which includes washing hands thoroughly before and after touching the catheter or insertion site and cleaning the skin around the stoma daily. Healthcare providers may also recommend a schedule for flushing the catheter with sterile solution to ensure it remains clear of debris and sediment.
Adherence to a regular schedule for changing the catheter and the drainage bags is important for preventing infections. Catheters are typically replaced every few weeks to months, while drainage bags may be changed more frequently. Developing a system for these changes, often with the help of a home care nurse, ensures the equipment remains sanitary and functional.
Simple lifestyle modifications can make daily activities more manageable. Special techniques and waterproof dressings allow for showering while keeping the stoma site dry. Choosing loose-fitting clothing can help conceal the tubing and bag, and maintaining a high fluid intake is encouraged as it helps to dilute urine and reduce the risk of blockages and stone formation.