The image above shows what a foley catheter is. These are the types of catheters that stay in for days or even weeks.
The balloon that you see, is inflated with saline, after the catheter has passed through your urethra, and that balloon part is in your bladder. Once it's in your bladder, the balloon in inflated, and it keeps the catheter from coming out. The balloon sits on the bottom of your bladder. The catheter stays in your urethra and dangles between your legs when you stand.
Sometimes this can cause the feeling that you need to pee. That is totally normal. The catheter being in your urethra is not super comfortable. Be sure to have something that anchors the catheter to your leg. That will help a lot.
If you are a nurse or doctor, you have probably seen these suckers be pulled out by confused patients. They are usually anchored to your leg, so you don't accidentally pull it out. I'm sure you can image the pain and the damage that could be done to your urethra if it was pulled out! 😕
A foley catheter is used during and after surgery if needed (including a TURBT), if you have an epidural (like when you are having a baby) and if there is urinary retention, meaning you can't pee.
Either the bladder is not contracting right to get the pee out, or the urethra is not letting urine pass. Additionally there can be a blockage that is not allowing the urine to pass. It could be a tumor, an enlarged prostate, or a blood clot blocking urine from exiting your body.
A foley catheter can be hooked up to a urine bag, that can be used to store urine until you can empty it in the toilet. There are large bags that can hold up to 2 liters for overnight use.
I had an emergency experience with acute urinary retention after BCG #12. That was not awesome. Read about that experience in the article below.
Article: I Can't Pee! BCG and Acute Urinary Retention
A straight catheter is much more simple than a foley. It is just a soft and flexible hollow tube, with a hole at the end of it. This catheter can drain urine, and you can also insert fluid or medicine into the bladder through this tube.
For instance, this is done with BCG. Also it can be done with chemotherapy. They put the medication directly into your bladder.
This type of instillation is called intravesical therapy. With intravesical therapy, the doctor or nurse puts a liquid drug right into your bladder rather than giving it by mouth or injecting it into your blood. The drug is put in through a soft catheter (straight cath) that's put into your bladder through your urethra. The drug stays in your bladder for up to 2 hours. This way, the drug can affect the cells lining the inside of your bladder without having major effects on other parts of your body.
Article: BCG Information and Advice for Non-invasive Bladder Cancer
When to ask for a Foley Catheter
This might sound really strange. I know that I NEVER would have thought in my lifetime I would ever ASK for a foley catheter.
If you are asking for a foley catheter, it's often because you are hoping that the catheter can stay for awhile, days or weeks.
So why would I ask my doctor for a foley catheter?
In the article I listed above, about urinary retention, you will notice that I got the foley catheter because I couldn't pee, from the trauma of having BCG #12. My bladder and urethra were done and just couldn't do their jobs anymore.
What was surprising, was how nice the foley catheter was! Yes, it feels like you have to pee, because the balloon sits on your bladder. Yes, there is some irritation in the urethra (especially after having BCG).
- BUT -
The catheter let my bladder and urethra REST! The BCG is so incredibly irritating by #12 that the first hour I was peeing upwards of 15 times in an hour! That first day of BCG is about that same amount - around 15 times during the whole night. It's a lot of waking up. It's a lot of pain, and it's a lot of stress on my body from not getting sleep.
So after I got that catheter with BCG #12 I was pleasantly surprised! The PAIN of the BCG was nearly GONE! No bladder spasms. No urinary frequency and urgency. No feeling like I'm pissing fire and razor blades!
I got SLEEP! It was AMAZING!
So this experience really helped me see that there is a time and place for foley catheters.
Foley Catheters and TURBTs
So after TURBT #1 I was not required to have a foley catheter.
Article: What to Expect with a TURBT
After TURBT #2 I was sill not required to have a foley catheter, but I WANTED one! After the experience with BCG #12, I realized that the foley can really help with pain, urgency, and frequency with urination.
Article: I Can't Pee! BCG and Acute Urinary Retention
So I asked my doctor if I could keep the foley in for a few days. He thought it was a strange request, even after I explained my reasoning, but Dr. McLeod was on board.
The IV pain meds after the TURBT were wearing off, and I hadn't taken any other pain meds yet. I was getting dressed to go home from the TURBT in the hospital, with the foley cath in.
I had to stop getting dressed because of the PAIN from the foley! Tears were suddenly streaming down my cheeks, and I couldn't move!
What happened to the foley being my friend?!?
Well turns out that if you cut open the lining of your bladder (from the TURBT), and insert a RIGID cystoscope through your urethra, nothing is happy about a foley catheter touching the bottom of your bladder and urethra.
Article: Difference Between Rigid and Flexible Cystoscopy
I won't make that mistake again... don't ASK for a foley with a TURBT! Sometimes you might need one, and if that is the case, be ready with some serious pain meds to help.
That being said, if you have a really large bladder tumor that has been removed, and your doctor doesn't send you home with a foley, you can ask for it to stay and not be pulled. If you have lots of bleeding, it can cause large clots that will cause urinary retention, and you will end up in the ER getting a catheter.
Here is a quote from the wife of a bladder cancer patient after a TURBT:
"When my husband had his tumour removed he was sedated so didn’t feel a thing but they removed the catheter at the hospital before I brought him home. In hindsight they should have left it in because I had to call an ambulance two days later because he could not longer urinate and he was in excruciating pain (blood clots caused this). They had to try 3 times to insert a catheter because his prostate was so swollen from the procedure. So make sure to monitor the flow of urine after the procedure."
Foley Catheters and BCG
So I just had BCG #13 this week. Before starting the procedure, I asked if we could change the catheter from a straight cath to a foley cath.
My NP thought this was a strange request! 😂 Most people hate these suckers! Why would you want one!?
I explained to her my positive experience I had after BCG #12. It really made the pain more manageable, and let me get sleep.
She said there is an increased risk of infection (also called a UTI or urinary tract infection) with leaving a foley catheter in. If I got a UTI, then I would need to push the BCG off by a week.
She wanted me to take out the catheter in less than 16 hours (after I woke up the next morning). I agreed.
Things were going well, holding in the BCG. It
felt fine going home (I have a 45 minute drive, holding in the BCG), but when I got home I needed to go number two. So
I sat on the toilet to do my business, and the pee came out! From AROUND the foley catheter!! 
I didn't even know that was a possibility! I bet with my TURBT so recent, my urethra could stretch much farther than just the catheter that was in there. So it did, and the urine squeezed out! BCG also causes my bladder to spasm like crazy, so my bladder was more than willing to help get the urine out as well.
The problem was then, I had the full concentrated BCG in my urethra and it was BURNING! So even if I kept the catheter in, my urethra would get so incredibly irritated, without having further watered down urine pass through it later.
So we had to immediately cut the foley catheter and take it out.
If you ever need to do this, the nurse will show you how. It's super simple. You just cut it with some scissors and pull very gently and it will slide out of your urethra. You can throw away the catheter when it comes out. Make sure you are in the shower when you do this. Both the saline that was in the balloon in the foley catheter comes out, and any urine/BCG left in your bladder.
If you want to know more about BCG and how all that works, check out the article below.
Article: BCG Information and Advice for Non-invasive Bladder Cancer
I haven't given up on the foley catheter and BCG. I still believe it's going to be an incredible tool to help manage the bladder spasms, pain, urgency and frequency.
But I have learned that I need to empty the BCG from my bladder BEFORE going number 2! 😂 That way there won't be so much pressure from my bladder, and it won't leak when doing my business.
Well at least that is my educated guess on the matter.
BCG #14 is next week. I am going to ask for a foley catheter again. I will let you know how it goes!
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