Urinary tract infection is one of the biggest concerns for those of us with long-term indwelling catheters (both urethral and suprapubic). And sadly, there is a bunch of misinformation out there about how to help prevent a UTI.
I’m a huge fan of scientifically gathered evidence. I’m also a fan of not wasting time and effort. If there is no scientific foundation for doing something – like drinking cranberry juice to treat a urinary tract infection – then I don’t waste time and hope on it. One of my favorite questions about anything is: “is there any evidence to support that?”
My urologist told me there isn’t any evidence to support a lot of the things things people do prevent UTI once a long-term indwelling catheter is placed, things like sterilizing and washing every little thing, avoiding detaching an SP catheter for showering, etc. But because I am also a fan of “trust, but verify,”I’m much happier when I have read the results of a study myself.
I don’t actually have all my questions answered yet, but the report I read this morning was extremely enlightening. It was Diagnosis, Prevention, and Treatment of Catheter-Associated Urinary Tract Infection in Adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America from the Oxford Journal, Clinical Infectious Diseases. It’s pretty long and involved, and like I said, it didn’t answer all of my questions. But here is a summary (though I recommend you read it for yourself). The following refer to catheter associated bacteria and UTI specifically, as opposed to the lucky folks who live catheter-free. Also, keep in mind that folks with indwelling catheters are going to have bacteria in the urinary tract. The difference is whether they just colonized (not causing symptoms), or if they invade your tissues (UTI).
- There is no evidence that Antimicrobial coated catheters reduce the amount of bacteria or the likelihood of UTI.
- There is no evidence that cranberry products reduce catheter associated bacteria or the liklihood of UTI.
- There is no evidence that daily meatal (opening of the urethra) cleansing reduces the risk of UTI.
- There is no evidence that catheter irrigation with either antimicrobials or normal saline reduces risk of UTI.
- There is no evidence that adding antimicrobials or antiseptics to the drainage bag reduces the amount of bacteria or risk of UTI.
- There is no evidence that routine catheter change (like every 2-4 weeks) reduces the risk of bacteria or UTI.
I would still like some actual evidence to support (or not) other things I’ve heard, like never letting your bag touch the floor, wiping drainage bag connection points with alcohol swabs when you change bags (like from nighttime bedside bag to daytime leg bag), washing drainage bags with vinegar and/or soap after disconnecting them, letting bags dry out by making sure both ends are open (I’ve actually heard doing the opposite of this!), plugging (or otherwise blocking) the end of your catheter when showering (this may actually be really bad for you – potentially causing colonized urine to back-flow into your ureters or kidneys), pinching the end of your catheter when changing bags to limit exposure to the air, and a few others.
If you come across any valid studies with results in those areas, please – please – please let me know, either by leaving a comment below or contacting me through the contact page. I’ll update this post as I get that information.
Some of the countermeasures I listed above (the ones I can’t find evidence for) I will continue to do just hedge my bets; things like washing my hands and using alcohol swabs.
Things We KNOW You Should Do To Prevent Urinary Tract Infection
Certain things are proven to increase risk of UTI and should always be done. These include:
- Keeping the drainage bag below the level of your bladder to prevent back-flow of already-drained urine back into your bladder
- Changing indwelling catheters once every month
- Drinking lots and lots of water – early and often – to help keep everything moving
I hope this helps keep our knowledge current and correct to the greatest extent possible. Like I said earlier, I am a big fan of the scientific process, which includes replacing old knowledge with new. So if you find good, solid information on preventing urinary tract infections in folks wearing long term indwelling catheters (either urethral or suprapubic), please help me keep this page current.
Be healthy!
Ken
I would sure like to know if there are any foods or fluids that affect the sediment eventually blocking the supra pubic tube. Are there any foods or fluids I can stay away from to help the flow??
if you do find time to answer this ~` Thank you for your time!
Hi George,
I am not aware of types of foods that would end up causing a blockage in an SP tube. I never had that problem. However, if you get sediment or encrustation blocking your catheter, it is probably due to infection. “Bacterial infections make the urine alkaline, so that crystals form on the catheter surface. These obstruct the flow of urine so that the bladder steadily distends.” (reference: https://healthtalkonline.org/peoples-experiences/chronic-health-issues/living-urinary-catheter/blockages#ixzz2q1lIxmGS
Under Creative Commons License: Attribution Non-Commercial No Derivatives).
If you look at the link above, you’ll also find a stat that says half of all people with long-term catheters have this problem. (references’ Kohler-Ockmore and Feneley, 1996; Getliffe, 1994). Drinking lots of fluids helps some people (have not found clinical evidence for this) according to the above story. It seems to make sense. If you have a higher volume of urine, perhaps the concentration of crystals would be lowered. I am NOT a medical professional, though. I did do quite a lot of research and never found any evidence that what you eat or drink affects what happens to your catheter. Once you have the long-term catheter, drinking cranberry products does nothing for you (according to Oxford Journal, Clinical Infectious Diseases, 2009). See may article https://livingwithacatheter.com/urinary-tract-infection-and-catheter-care/ on that. But if I were you, I would try really increasing your fluid intake – just water – and see if that helps.
good luck,
Ken
I’m a c6-7 quadriplegic and been in a wheelchair for 15yrs. I’ve had a supra pubic for 11yrs. I’ve recently been taking extra c especially when feeling the beginning of a uti. I will take almost 2000mg it has helped dramatically especially before a change. I thought this might help others and doesn’t hurt because you can’t o.d. with it maybe diarrhea but just back off one till you don’t have it anymore and it’s what your body needs anyway to help boost your immunity. And we need as much as possible considering all the things that knock our immunity down.
Thanks Regina! Yes, as much a devotee of the scientific method as I am, there is still much about the human body we don’t know. And I am heartily in favor of “hedging your bets” when there is little-to-no downside, as in the case of taking vitamin C like you do.
Thanks for posting, and good luck!
Ken
“Certain things are proven to increase risk of UTI and should always be done.”
Guess that is “decrease”
Thanks David. That actually depends on quite a lot of things. For example, if you are an otherwise healthy male, there is no evidence – because it is impossible to gather enough usable data, based on the frequency of UTIs since they are so rare – to “prove” anything on that score. For women, the occurrence is frequent enough in otherwise healthy women to know that cranberry products do help. But once colonized, there is nothing (short of ending the colonization by removing the catheter, which is not possible for many) at all that is “proved” to decrease risk of actual infection. There is a correlation for remaining as healthy as possible, and preventing the backflow of urine through the catheter tube (keep the bag below the level of the insertion point), and a few other things. But one thing that has NOT shown any clinical data is the use of antibacterial substances or detergents – in those already colonized (wearing an indwelling catheter) has any effect on decreasing infection risk. It’s amazing what you discover when you look at the actual data. OF course, I would change my stance on anything if presented with peer-reviewed clinical data.
Ken
It would seem to me that continuous intake of vitamin C, while having an indwelling urinary catheter, would tend to acidify the urine stream and the contents of one’s bladder. As you point out, bacterial infections tend to make the urine alkaline, although it is not clear whether this is a necessary and/or sufficient condition to foster a UTI. And vitamin C in large doses would tend to counter the alkaline condition and lower pH significantly. Whether this would prevent formation of a UTI is unclear to me. Any evidence to share, Ken?
Jim – According to The Mayo Clinic – “Vitamin C may decrease the risk of developing urinary tract infections during pregnancy and in the elderly. Further research is needed to confirm this finding.” So there doesn’t appear to be evidence applying to non-elderly people who are not pregnant. But since there is “some” evidence of Vitamin C helping, it might be worth taking more of it. In general, one cannot overdose on Vitamin C. It’s water-soluble and the body can’t store it for long. HOWEVER – it can make you nauseous if greater than 2,000 mg/day.
Hope that helps.
Ken
Please be aware that megadoses of vitamin C can also cause kidney stones.
Ken, thanks for the website. Incredibly useful as I prepare for my surgery.
Have had a supre pubic catheter for 5 years and have up till 7 months ago had to have IV Antibiotics in hospital for at least a week every three months as I am unable to take antibiotics in tablet form due to a reaction to all antibiotics all my life. In July last year whilst in hospital again I had a visit from an Infectious Disease Doctor and after a discussion on my care of the catheter and my bags he suggested one thing to me that I have followed for the past 7 months and have not had an infection. A product on the market in Australia called Milton is an anti bacterial solution and claims to resist 99.9% of germs. The method I have used is to remove my daytime bag at night and connect my overnight bag to the catheter and place Milton solution in the day bag as per the instructions and adding water to fill the bag and leave soaking for around an hour. Repeat in the morning for the overnight bag. At exactly the same time I commenced this procedure I change my catheter to a silver lined one . I am pleased to say that I have not had an infection for the 7 months and no trips to hospital apart from having my catheter changed monthly. I do replace by bags every week as a further precaution. I do not know whether it is the Milton solution or the silver catheter but I am not going to try and prove which one helped or perhaps it was a combination of the two things. I suspect perhaps it is the MIlton.
I hope this may help others to get some relief from these dreaded UTI’S. If you wish any other information I would be happy to discuss my experience with you.
Thanks for the post, Graham! Yeah, I hear ya. When you change 2 things and something works, all you care about is that SOMETHING WORKS:). And I would not ask you to ever risk another UTI just for the sake of trying to get evidence of which thing worked. It wouldn’t necessarily be conclusive anyway. I’m so glad to hear that you have been able to avoid the hospital after so much hardship with the little bugs! Personally, I’m inclined to believe it was the silver lining doing most of the heavy lifting on this one. But who knows? Even though there wasn’t a shred of evidence that keeping my night-time bag on in the shower would help prevent another UTI for me, I never took another shower in all those months without keeping my bag on in the shower (resting on the floor since the night-time tube is so long). And guess what? I never got another UTI either. My justification was that it doesn’t take much extra effort on my part to leave the bag on. And there’s no harm in it. So why not? Hedging my bets. I’m guessing there is no downside to trying the Milton solution, especially if someone else already has tried everything else, including the silver, and is still getting UTIs. So I say go for it in that situation. What do you have to lose?
Thanks again for the comment. And congrats on being UTI free!
Ken
I have had a superbic tube for more than 10 years, but continue to have UTIs again and again. Please let me know how you use the Milton solution in the bed bag and leg bag. Also do you leave the solution in very long when rinsing out the bags. Please let me know how you do this I am tired of getting infections.
This posting are very educational and so helpful. I greatly appreciate all the advises because i learned a lot.
My husband does not want to change to night drainage bag, he will rather wake up every three -four hours at night to empty up the day bag. Is this Unhealthy?
Thanks,
Yamila,
Hi Yamila. I don’t know if it is unhealthy, per se. But I would think he would be more comfortable getting more sleep by using a bedside bag at night. How does he know when to get up? Does he set an alarm? Because if urine from the bag is backing up into his bladder because it is too full, that may well be unhealthy.
Switching from a daytime leg back to a night time bed bag is pretty fast and easy. It took me about 3-5 minutes. He only needs to rinse out his day bag and hang it to dry. There is no evidence at all that cleaning the day bag is any healthier than just rinsing it.
What is he worried about? Why does he not want to change it?