Living With a Catheter After Prostate Surgery

During a radical prostatectomy the prostate is removed and the bladder is reconnected directly to the urethra. The catheter holds that new join open and keeps the bladder empty while it heals and seals. It is not optional, and it is not an indicator that something went wrong.

Around a week is typical after robotic or open surgery, though some surgeons leave it seven to ten days. Before you leave hospital, confirm three things: the date of removal, where it happens, and a phone number for problems out of hours.

The leg bag is what you wear in the daytime. It holds roughly half a liter and straps to the calf with Velcro bands. Wear it below the knee. Empty it when it is about half to two-thirds full, because a heavy bag drags on the catheter.

The night bag is larger, around two liters, and connects to the outlet of the leg bag so you do not have to disconnect the catheter itself. Every disconnection is an opportunity for infection, so keep the system closed. At night the night bag hangs on a stand or sits on the floor beside the bed, always below the level of your bladder. In the morning you disconnect and rinse it, and go back to the leg bag alone.

The single rule that governs both: the bag must be lower than your bladder, or urine will not flow.

Most of the pain, most of the bleeding, and a good share of the spasms come from the catheter being tugged. Use a leg strap or a fabric catheter sleeve to fix the tubing to your thigh, leaving a small loop of slack so that standing up or crossing your legs does not pull on the balloon inside the bladder.

Practical things that help: loose trousers or shorts, moving the bag to the other leg if the strap chafes, and stopping to check the tubing before you stand from a chair or get out of a car.

These feel like abdominal cramping and often bring a sudden urge to urinate or a brief leak around the tube. They are the bladder muscle squeezing against the balloon that holds the catheter in place. They are uncomfortable, sometimes sharply so, but they are not dangerous.

First check that the tube is not kinked or being pulled and that the bag is not full. Constipation makes spasms considerably worse, so use the stool softener you were sent home with and do not wait until you are uncomfortable. If spasms are frequent or severe, ask your team about an antispasmodic bladder medication.

Pink or blood-tinged urine is expected, particularly after walking or straining. It usually clears with fluids. What is not routine is passing large clots or solid pieces of debris, because those can block the catheter. Report those.

An empty bag for a couple of hours, especially with rising lower abdominal pain, needs action rather than patience. Work through this list:

1. Is the bag below bladder level?
2. Is the tubing kinked, twisted, or trapped under your leg or a waistband?
3. Is there visible debris or a clot in the tube?
4. Have you been drinking enough?
5. Are you constipated?

If that does not restart the flow, call your surgical team or urology nurse straight away. Blocked drainage after prostate surgery is treated as urgent. Do not attempt to flush or remove the catheter yourself, and do not let anyone who is not trained in post-prostatectomy care remove it, because the balloon and the healing join both need handling correctly.

If you cannot reach your team quickly, go to an emergency department. A catheter that has stopped draining, or one that has fallen out, means urine has nowhere to go, and a bladder that keeps filling becomes painful and can damage the kidneys. The same applies if you are shivering and feverish and feel very unwell, since infection reaching the kidneys or bloodstream moves fast, or if you are passing heavy fresh blood or large clots.

Call your team the same day for a fever of 100.4°F (38°C) or above on its own, foul-smelling or cloudy urine, burning or stinging that is getting worse, worsening lower abdominal pain, or spasms that the medicine is not controlling.

Shower daily and wash gently where the catheter exits. No baths, no pools. Walk regularly, since it helps recovery and bowels, but avoid lifting. Sleep on your back or the side without the bag tubing crossing your body. Most men find the first two nights the worst and then adjust.

The catheter is deflated and slid out in seconds. Most men describe it as odd rather than painful. Afterwards, expect to leak, sometimes a lot, because the tissues are swollen and the sphincter has been resting for a week. Bring more pads than you think you need and a spare pair of trousers. Start pelvic floor exercises exactly as your team instructs, and ask when continence is expected to improve for someone with your surgery, since the honest answer is usually weeks to months, not days.

• Memorial Sloan Kettering — Caring for Your Urinary (Foley) Catheter
• National Cancer Institute — Prostate Cancer Treatment (PDQ), Patient Version