A urinary catheter is a thin, flexible tube inserted through the urethra and into the bladder to drain urine. The procedure typically takes only a few minutes and follows a careful sequence: cleaning the area, applying numbing gel, gently threading the tube into the bladder, and securing it in place. While it can feel uncomfortable, most people tolerate it well, especially with proper lubrication and local anesthetic.
What Happens Before Insertion
You’ll be asked to lie flat on your back with your legs slightly apart. The healthcare provider opens a sterile kit containing the catheter, cleaning solution, lubricant, and a drainage bag. Everything is arranged on a sterile surface within arm’s reach, and the catheter is pre-connected to the drainage system so the sealed connection stays intact throughout.
The provider cleans the genital area with an antiseptic solution, typically wiping from the urethral opening outward in a circular motion. For women, this means separating the labia and cleaning around the urethra. For men, the foreskin is retracted if uncircumcised, and the tip of the penis is cleaned. The provider uses their non-dominant hand to hold things in position, and that hand doesn’t touch any sterile equipment for the rest of the procedure.
How the Catheter Goes In
Before the catheter itself, many providers inject a numbing gel containing lidocaine directly into the urethra. For men, about 5 milliliters of this gel is squeezed into the urethral opening, and the opening is pinched shut for at least a minute to keep the gel inside. The gel serves a double purpose: it numbs the tissue and lubricates the passage, making the catheter slide through more easily. When applied to the urethral lining, the numbing effect kicks in within 5 to 7 minutes.
The catheter is then advanced slowly, about an inch at a time. For women, the urethra is roughly 4 centimeters (about 1.5 inches) long, so the catheter doesn’t need to travel far. The provider pushes it in until urine starts flowing, then advances it about another inch to make sure the tip is fully inside the bladder.
For men, the path is significantly longer because the male urethra runs about 20 centimeters (8 inches) from the tip of the penis through the prostate and into the bladder. The provider holds the penis pointed upward and gently pulls it taut to straighten the urethra, feeding the catheter in steadily. Once the catheter has passed through the longer, curved section, the penis is angled downward toward the feet to help guide it the rest of the way. The catheter is advanced until the connector hub reaches the urethral opening, ensuring the tip is well inside the bladder.
How the Catheter Stays in Place
Indwelling catheters, commonly called Foley catheters, have a small balloon near the tip. Before insertion, this balloon is tested by inflating it with sterile water to make sure it holds. Once the catheter is in the bladder and urine is flowing, the provider inflates the balloon using a syringe (usually 5 or 10 milliliters of sterile water). The inflated balloon sits inside the bladder and prevents the catheter from slipping out.
The external end of the catheter is then taped or strapped to your inner thigh. Some providers secure it to the lower abdomen instead, which can reduce pressure on the urethra. The drainage bag is positioned below the level of your bladder so urine flows downward by gravity.
What It Feels Like
Most people describe insertion as an unusual pressure or burning sensation rather than sharp pain. The numbing gel helps considerably, and studies show that topical anesthetics significantly reduce both the severity and frequency of catheter-related discomfort. The sensation of needing to urinate is common and normal, caused by the catheter resting against the bladder wall.
Men generally experience more discomfort than women during insertion simply because the catheter travels a much longer path. The area where the urethra passes through the prostate can feel particularly tight, especially in older men with an enlarged prostate. Slow, steady advancement with plenty of lubricant makes the biggest difference in comfort. If you feel a sharp pain or significant resistance, the provider will stop and reassess rather than force the catheter forward.
Intermittent vs. Indwelling Catheters
Not all catheterizations involve leaving a catheter in place. Intermittent catheterization uses a straight catheter without a balloon. It’s inserted, the bladder is drained, and the catheter is removed immediately. The whole process takes just a couple of minutes. Many people with spinal cord injuries or neurological conditions learn to do this themselves several times a day.
Intermittent catheterization is considered the gold standard when ongoing bladder drainage is needed because it carries a lower risk of urinary tract infections compared to leaving an indwelling catheter in place. Indwelling catheters are reserved for situations where continuous drainage is necessary, such as during surgery, in critical care, or when someone physically cannot empty their bladder on their own.
Situations Where a Catheter Should Not Be Inserted
There are specific signs that make standard catheter insertion unsafe. Blood at the urethral opening is the most important red flag, as it can indicate an injury to the urethra, and inserting a catheter could make the damage worse. Other contraindications include visible signs of urethral infection, significant pain or swelling around the urethra, and the presence of blood in the urine. In these cases, a provider will typically order imaging or consult a urologist before proceeding.
Living With a Catheter After Insertion
Once a catheter is in place, the drainage bag needs to stay below your bladder at all times. When you’re walking, hold the tubing so the bag hangs below your waist. At night, hang it on the side of the bed. If the bag rises above your bladder level, urine can flow backward into the bladder and increase your infection risk.
Catheter-associated urinary tract infections are the most common complication of indwelling catheters. The CDC recommends that catheters be removed as soon as they’re no longer medically necessary, and that the closed drainage system (the sealed connection between catheter and bag) never be broken unless absolutely required. Keeping the area around the catheter clean and staying hydrated both help reduce infection risk.
How a Catheter Is Removed
Removal is simpler and quicker than insertion. The tape or strap securing the catheter to your leg is taken off first. Then the provider attaches an empty syringe to the balloon port and draws back the sterile water, fully deflating the balloon. Once the balloon is flat, the catheter slides out with gentle, steady traction. You may feel a brief tugging or burning sensation, but it passes quickly.
Some people remove catheters at home with guidance from their care team. The process involves emptying the drainage bag, cleaning the area, lying down or sitting comfortably, and using the same size syringe that was used to inflate the balloon (typically labeled 5 or 10 cc) to withdraw the water. A small amount of urine leakage after removal is normal. Most people urinate on their own within a few hours, though it’s common to feel some urgency or mild stinging for the first day or so.