Indwelling Catheter vs. Intermittent Catheter

What Are Urinary Catheters and Why Are They Used?

Urinary catheters are a thin, flexible tube that’s inserted into the bladder through the urethra to drain urine. In healthcare, these catheters are most commonly used when a person can’t do so naturally. 

Being unable to release urine from the body can occur in a range of conditions such as urinary retention (where the bladder doesn’t empty due to nerve problems), an enlarged prostate or following surgery. They can also be used in cases where severe urinary incontinence is present when other treatments aren’t effective. Catheters are one of the most commonly used urology product during and after surgery to keep the bladder empty, especially during long recovery periods. They may also be necessary for people with spinal cord injuries or neurological disorders that interfere with bladder control. As they are one of the most commonly used urological devices, there are different types of catheters for different uses. 

What Is an Indwelling Catheter?

Indwelling catheters, also known as Foley catheters, remain in place to provide continuous drainage. They are held in the bladder by a small balloon and can be connected to either a bedside collection bag or a discreet leg bag. These catheters are typically used when regular self-catheterisation is not practical, such as during extended recovery from surgery, in cases of severe illness or for palliative care. An indwelling catheter uses a soft, flexible tube that is gently inserted through the urethra until its tip reaches the bladder. This tube is secured using a tiny balloon that is filled with sterile water to keep the catheter from falling out. The other end of the tube is connected to a drainage bag, collecting urine from the bladder. An indwelling catheter can be used long term but needs changing every 4 to 12 weeks. Typically, these catheters are changed at the 6 week mark. 

Pros:

• Continuous Drainage: Indwelling catheters provide a reliable way to empty the bladder when the natural ability to do so is compromised. This prevents kidney damage or stretching the bladder beyond its normal capacity (bladder distention).
  
  

• Increased Mobility: Using this kind of catheter allows for more independence in mobility and activity as it allows you to move freely.
  
  

• Convenience: Indwelling catheters are a more convenient urology product to intermittent catheters for those who are unable to self-cathertise with a catheter valve. 

Cons:

• Infection Risk: Indwelling catheters have a high risk of Catheter-Associated Urinary Tract Infections (CAUTIs), which can have permanent damage on the bladder or lead to kidney infections.
  
  

• Discomfort & Irritation: These kinds of catheters can cause bladder spasms, bladder irritation or discomfort in the urethra, especially when accidental tugging on tubing occurs or if the catheter site isn’t being cleaned regularly.
  
  

• Maintenance: In order to prevent infection and other issues, regular cleaning, catheter changes and drainage bag changes are required, which often needs to be performed by doctors or nurses.
  
  

• Blockages & Kinks: If you’re not careful with catheter tubing kinks or blockages may occur. This prevents drainage and can result in backflow where urine moves back into the bladder, causing infection and bladder damage. 

What Is an Intermittent Catheter?

Intermittent catheters, often called “in-and-out” catheters, are inserted only when needed to empty the bladder and then removed immediately afterward. Many people who use them, such as those with spinal cord injuries, may self-catheterise several times a day. An intermittent catheter is a thin, flexible tube that is inserted into the urethra allowing urine to flow out before immediately removing. 

Pros: 

• Mimics Natural Function: Using intermittent catheters mimics the natural function of the bladder by being able to fill anf empty. This reduces pressure on the bladder.
  
  

• Lower Risk of Infection: Intermittent catheters generally have a lower risk of contracting CAUTIs. There is also a lower risk of long-term complications.
  
  

• Improved Bladder & Kidney Health: Using intermittent catheters prevents urine buildup, reducing pressure on the kidneys and protects upper urinary tracts.
  
  

• Concealable: Intermittent catheters can be concealed, making this a discreet urology product. This makes it easier to manage and continue with work, activities and a social life. 

Cons:

• Time-Consuming: As this is done independently, it can take some time to learn and perform the technique of inserting the catheter yourself.
  
  

• Risk of Complications: The most important part about using an intermittent catheter is that the tools and technique you use are clean. Not following a strict clean can result in urethral damage or a CAUTI.
  
  

• Fluid Management: Requires strict monitoring of fluid intake, avoiding excess alcohol and caffeine.
  
  

• Equipment Dependant: For intermittent catheters to perform successfully, it’s essential you are using the right type and size of catheter. This can take some time to figure out. 

Key Differences Between Indwelling and Intermittent Catheters

UTI Infection Risk and Hygiene

Intermittent catheters are generally the lower risk option of preventing infection and maintaining hygiene. This is because of the continuous presence that the indwelling catheter has in the bladder, increasing the risk of bacteria entering the urinary tract and forming biofilms and encrustations. Using intermittent catheters involves more rigorous hygiene practices when being inserted whereas with an indwelling catheter, it’s essential to establish a catheter care routine to maintain hygiene.  

Comfort and Quality of Life

Overall, intermittent catheters are considered more comfortable and promote and better quality of life due to the fact that they can be inserted and removed after use. Indwelling catheters are constantly present which may cause discomfort, pressure or the feeling of being full. They can also restrict mobility and people with indwelling catheters often feel dependant on a carer or family member for catheter changes and management. 

Intermittent catheters have lower infection risks, are relatively comfortable – if you purchase the correct size – and, allow for greater independence and mobility with the ability to self-manage bladder function anywhere. 

Cost and Maintenance Differences

Intermittent catheters are more expensive as they are designed to be single-use items in order to maintain hygiene. While they are the more expensive option, these catheters offer lower long-term osts due to the reduction in complications when compared to indwelling catheters. 

Choosing the Right Catheter Type

Choosing between an indwelling and an intermittent catheter all depends on your medical condition, lifestyle, duration of use and your ability to self-manage. It’s also important to listen to your doctor’s recommendations as they will know what is the best option for you based on your condition. Likely, if you have limited mobility and can’t perform self-catherisation or need continuous drainage for a short period of time like during surgery, an indwelling catheter will be considered. If you want more independence and mobility and prefer fewer complications, like UTIs, an intermittent catheter will be considered. 

Conclusion

Both indwelling and intermittent catheters play vital roles in supporting people who are unable to empty their bladder naturally. Indwelling catheters provide continuous drainage and are often essential in situations where self-catheterisation isn’t possible, such as during surgery recovery, severe illness or limited mobility. However, they require ongoing monitoring and meticulous care due to higher risks of infection, discomfort and long-term complications.

Intermittent catheters, on the other hand, more closely mimic normal bladder function and are generally associated with greater comfort, independence and a lower risk of urinary tract infections when proper hygiene techniques are followed. While they may require more effort, training and upfront cost, they often lead to better long-term outcomes and improved quality of life.

Ultimately, the most suitable catheter type depends on individual medical needs, lifestyle, mobility and clinical guidance. Regular review by healthcare professionals, combined with correct usage and hygiene practices, is essential regardless of catheter type to minimise complications and ensure safe, effective bladder management.

Sources

Melbourne Bladder Clinic — Intermittent Self Catheterisation (Australia)
Detailed resource on what intermittent self-catheterisation (ISC) is, how it works, and its benefits in bladder and kidney health. Covers clinical rationale and practice. (bladderclinic.com.au)
URL: https://bladderclinic.com.au/patients/resources/intermittent-self-catheterisation#:~:text=What%20is%20intermittent%20self%2Dcatheterisation,prevent%20recurrence%20of%20the%20stricture.

Better Health Channel — Urinary Catheterisation (Victoria Govt, Australia)
Government-run health information on urinary catheterisation including indwelling and intermittent catheter types, how they’re used, and general guidance for patients. (Better Health Channel)
URL: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/urinary-catheterisation

Continence Matters — Having an Indwelling Catheter (Australia)
Consumer health resource explaining indwelling catheters (continual use), care, and what to expect with long-term catheter use. (continencematters.com)
URL: https://continencematters.com/health-information/catheters-and-pads/having-an-indwelling-catheter/

Cleveland Clinic — Urinary Catheter: Purpose, Types, Placement & Complications
Comprehensive overview of urinary catheter types, indications, and procedural information (international standards, U.S.-based clinic). (Cleveland Clinic)
URL: https://my.clevelandclinic.org/health/treatments/catheter