A catheter is a thin, flexible tube that is inserted into the body to drain urine from the bladder or administer medications. Catheters can be inserted through the urethra (urethral catheter) or through a small incision in the abdomen directly into the bladder (suprapubic catheter).
In some cases, an inserted catheter can migrate or move from its original position. This movement can occur soon after insertion or years later. Catheter migration is uncommon but can cause complications if not treated. Recognizing the signs and symptoms is important to identify migration and receive appropriate care.
What is catheter migration?
Catheter migration refers to the unintended movement or displacement of the catheter from its original inserted position. The catheter may move either partially or completely out of place. Some of the most common types of catheter migration include:
- Downward (further into the urethra or bladder)
- Upward (back toward the bladder opening or out of the urethra)
- Sideways (into the bladder wall)
In men, downward migration is most common as the catheter moves further into the urethra. In women, upward migration is more likely to occur if the catheter slips back toward the urethral opening.
What causes a catheter to migrate?
There are several potential causes and risk factors for catheter migration:
- Improper catheter sizing or placement
- Catheter is not properly secured in place
- Movement or physical activity can dislodge catheter
- Weakened bladder muscles or frequent bladder spasms
- Scar tissue or strictures in the urethra
- Excess coughing or straining
- Obesity
- Malposition due to anatomy or previous surgery
Certain types of catheters such as Foley catheters have a balloon at the tip that is inflated to hold them in place. If this balloon deflates too soon, the catheter can become loose and migrate.
Who is at risk for catheter migration?
Some individuals have a higher risk of catheter migration than others. Risk factors include:
- Men – the male urethra is longer
- Older adults – weakened bladder muscles
- People with obesity
- Frequent urinary tract infections
- Neurological conditions that affect bladder control
- History of urethral surgery or radiation
- Chronic cough, constipation, or difficulty urinating
- Active lifestyle or frequent physical activity
Those with long-term indwelling catheters inserted for weeks or months at a time have an increased risk over time as the catheter loosens.
What are the symptoms and signs of catheter migration?
Catheter migration may cause a variety of symptoms, often related to obstruction or leakage of urine. Common signs and symptoms include:
- Difficulty draining the bladder
- Decreased urine output
- Leaking urine around the catheter
- Feeling of blockage when urinating
- Bladder or flank pain
- Blood in the urine
- Abdominal pain or pressure
- Increased urinary frequency or urgency
In some cases, the catheter may be partially obstructed but still drain some urine. Or leakage may occur alongside the catheter. Total blockage of urine output is a medical emergency.
Other signs that may indicate catheter issues include inflated balloon not deflating, inability to irrigate the catheter, and increased resistance when removing the catheter.
Complications from catheter migration
If catheter migration is not treated promptly, it can lead to complications such as:
- Urinary tract infection
- Bladder stones
- Kidney damage
- Sepsis
- Bladder distension or rupture
- Urethral trauma or strictures
The severity depends on the degree and direction of migration as well as how long the problem goes uncorrected. Upward migration toward the urethra increases infection risk. Downward migration raises concerns of trauma and kidney issues.
When to see a doctor
It is important to contact a healthcare provider right away if you experience any signs of catheter issues or migration. Seek emergency care for:
- No urine output from the catheter
- Excessive leaking around the catheter
- Inability to reposition or irrigate the catheter
- Fever, chills, or flank pain suggesting infection
- Bleeding or pain with urination
Routine follow-up is also key to identify early catheter concerns before complications occur. See your doctor if you have any symptoms between routine visits.
Diagnosing catheter migration
If catheter migration is suspected, the following tests may be performed:
- Physical exam – External catheter position is assessed. Your doctor may gently pull on the tubing to see if there is resistance.
- Bladder scan – Non-invasive ultrasound evaluates urine volume in the bladder.
- Urine tests – Looks for signs of infection.
- Cystoscopy – A tiny camera inserted into the urethra to visualize the lower urinary tract.
- Imaging – CT scan, MRI, or retrograde urethrogram to show catheter position.
Your symptoms, medical history, and exam findings will determine which tests are needed. Imaging often confirms the diagnosis.
Treating catheter migration
Treatment depends on the type of catheter, severity of migration, and symptoms:
- Readjustment – Your provider may try to gently reposition the catheter back into place.
- Removal and replacement – If repositioning isn’t successful, the migrated catheter is removed and replaced with a new one.
- Suprapubic catheter – If urethral catheters won’t stay in place, a tube may be inserted through the abdomen directly into the bladder.
- Medications – Antibiotics to treat infection or medication to relax bladder muscles.
- Surgery – Rarely needed but an option for complicated cases.
Identifying and quickly treating the cause of migration is crucial to prevent complications. Underlying factors like bladder spasms may need to be addressed.
Preventing catheter migration
Some tips to help prevent catheter migration include:
- Ensure proper catheter sizing, positioning, and balloon inflation.
- Secure the catheter tubing with tape or a special holder.
- Avoid pulling, tugging, or excessive movement of tubing.
- Prevent bladder spasms with medication if needed.
- Follow clinician instructions for catheter care and hygiene.
- Attached a urine collection bag below the level of the bladder.
- Empty the collection bag regularly.
- Contact your provider if any symptoms develop.
Using the smallest size catheter possible and monitoring for issues are key to minimize complications.
Conclusion
Catheter migration occurs when the catheter slips out of position, which can obstruct urine flow and lead to numerous complications. Being aware of the signs – like trouble urinating, leaking, pain, or bleeding – is crucial to identify migration. Seek prompt medical attention if you suspect your catheter has moved. With early detection, your doctor can correctly reposition or replace the catheter and prevent further problems.