Causes and management of indwelling urinary catheter-related pain.

Urinary catheters can be introduced into the urinary bladder either per urethra or via the suprapubic route; this article examines indications and contraindications to these routes. Catheter pain is subdivided into pain experienced as the catheter is passed, while in situ, and on removal. Relating to pain felt on insertion, risks associated with local anaesthetic/antiseptic gel and the occurrence of paraphimosis are discussed. Once in situ, the type of material used to manufacture the catheter, pressure on the urethra caused by a large Charrière size catheter, or from drainage bag traction, leading to discomfort and possible tissue damage are examined and solutions suggested. Catheter-associated meatal trauma in men and urethral post-menopausal discomfort in women are addressed; likewise, catheter cramp due to bladder spasm or catheter blockage, and interventions are recommended. Encrustation and 'cuffing' may cause pain during catheter removal and again, advice is given. Lastly, the possibility of pain due to fear/non-acceptance of the catheter is raised. In conclusion, once identified, the cause of catheter pain is often treatable, but should not be regarded negatively or ignored, as it warns of potentially harmful conditions and allows intervention before permanent damage can occur.