If you or someone you care for has been told that bladder drainage is needed, you may have heard about two main options: an indwelling catheter that stays in place continuously, or intermittent catheterization (CIC/ISC) where a catheter is inserted and removed several times a day. Understanding the differences between these approaches — honestly, including the tradeoffs — helps patients make informed decisions alongside their healthcare team.
This article provides a clear comparison of both options.
What Is an Indwelling Catheter?
An indwelling urinary catheter — often called a Foley catheter — is a hollow, flexible tube inserted into the bladder through the urethra and held in place by a small balloon inflated with sterile water inside the bladder. Urine drains continuously through the catheter into an attached drainage bag worn on the leg during the day, and a larger overnight bag at night.
There is also a variation called a suprapubic catheter, which is inserted through a small opening made surgically in the lower abdomen rather than through the urethra. For long-term use, this avoids irritation of the urethra and can make sexual activity easier.
Indwelling catheters need to be changed periodically — typically every few weeks to three months, depending on the catheter type and the person. Changes are usually done by a nurse, or by a trained caregiver for some suprapubic catheters.
What Is Intermittent Catheterization?
Intermittent catheterization — clean intermittent catheterization (CIC) or intermittent self-catheterization (ISC) — involves inserting a catheter into the bladder to drain urine, then removing it completely. There is no catheter in place between sessions. The procedure is typically performed 4–6 times per day, wherever the person happens to be.
Intermittent catheters sold in Canada are generally single-use and discarded after each use. The procedure takes a few minutes once learned, and most people can learn it — often in a single teaching session with a nurse.[1]
Why Someone Might Need a Catheter
Both types of catheterization are used when the bladder cannot drain properly on its own. Common reasons include:
- Urinary retention — inability to fully empty the bladder — due to BPH, urethral strictures, post-surgical changes, or neurological conditions
- Neurogenic bladder from spinal cord injury, multiple sclerosis, spina bifida, or other neurological conditions
- Acute urinary retention as an emergency measure
- Post-surgical recovery (e.g., after prostate surgery, bladder surgery, or certain gynaecological procedures)
- Incontinence management as a last resort when other treatments have failed
- Instilling medications directly into the bladder
Head-to-Head Comparison
| Factor | Indwelling (Urethral) | Suprapubic | Intermittent (CIC) |
|---|---|---|---|
| How it works | Stays in place continuously; balloon holds it in bladder | Stays in place; enters through abdominal wall | Inserted and removed multiple times daily |
| UTI risk | Higher — continuous foreign body in bladder | Higher — similar to urethral | Lower — no catheter left in place |
| Urethral trauma | Risk of ongoing urethral irritation/damage | No urethral impact | Possible with repeated insertion; reduced by gentle technique and good lubrication |
| Bladder function | Bladder no longer fills and empties normally; may lose capacity over time | Same as urethral indwelling | Bladder fills and empties; function better preserved |
| Sex life | Can be affected; requires discussion | Better suited to sexual activity | No catheter in place between catheterizations |
| Independence | No active participation required | No active participation required | Patient controls their own bladder management |
| Physical requirements | None — suitable for those who cannot self-catheterize | None after insertion | Requires hand function and learning the technique — or a trained caregiver |
| Who changes it | Nurse, typically every few weeks to three months | Nurse or trained caregiver, typically every few weeks to three months | Patient, caregiver, or nurse each time |
| Discreetness | Leg bag visible; requires management | Bag under clothing; site management needed | No external equipment when not catheterizing |
The Case for CIC: Why It's Usually Preferred When Possible
Clinical guidelines generally favour intermittent catheterization over long-term indwelling catheters when a person (or their caregiver) is able to do it.[1][2] The main reasons:
- Lower infection risk. An indwelling catheter provides a continuous pathway for bacteria into the bladder. Bacteria in the urine is thought to be nearly universal within about three weeks of an indwelling catheter, compared with over half of intermittent catheter users,[1] and guidelines recommend intermittent catheterization as an alternative to indwelling catheters to reduce catheter-associated infections.[2]
- Better preservation of bladder function. When a catheter drains the bladder continuously, the bladder muscle has no opportunity to contract normally. Over time the bladder may lose capacity. With CIC, the bladder fills and is emptied on a schedule, more like its normal cycle.
- No leg bag. Without a drainage bag and tubing, many CIC users report feeling less restricted in social and physical activity.
- Easier intimacy. With no catheter in place between catheterizations, sexual activity is generally easier than with a urethral indwelling catheter.
- Fewer long-term complications. Bladder stones, urethral damage and chronic bladder changes are generally more common with long-term indwelling catheters than with CIC. CIC has its own risks — including UTIs and urethral strictures — which gentle technique and good lubrication help reduce.
CIC requires enough hand function (or a trained caregiver), the ability to learn and remember the procedure, and adequate bladder capacity. It isn't suitable for some people — for example, those whose bladder pressures are high enough to need continuous drainage.[1] In those situations, an indwelling or suprapubic catheter may be the right choice. The decision should always be made individually with your healthcare team.
Living Well with an Indwelling Catheter
If you need an indwelling catheter — urethral or suprapubic — these practices help reduce complications. Always follow your nurse's and the manufacturer's instructions:
- Wash the catheter entry site and surrounding area daily (or as advised) with soap and water; dry thoroughly
- Keep the drainage bag below the level of the bladder at all times to prevent urine backflow
- Drink enough fluid to keep your urine pale — your care team can give you a target that suits your health — and limit caffeine and alcohol
- Never disconnect the leg bag from the catheter unless changing it — every disconnection is an opportunity for bacteria to enter
- Change drainage bags as directed (often every 5–7 days for leg bags), always with a sterile replacement
- Watch for signs of blockage, bypassing, or infection and contact your nurse promptly
Transitioning from Indwelling to Intermittent Catheterization
Many patients who begin with an indwelling catheter — particularly after acute urinary retention, surgery, or a period of acute illness — are candidates to transition to CIC once their condition stabilises. This is worth discussing proactively with your urologist or continence nurse. The transition is common, and many people who make the switch find CIC better suits their daily life.
For people who are able to perform CIC — themselves or with a caregiver — guidelines generally favour it over a long-term indwelling catheter, mainly because of lower infection risk and more independence. An indwelling or suprapubic catheter remains an important and appropriate option when CIC isn't feasible or suitable. The right choice is an individual one, made with your healthcare team.
About the IQ Catheter for CIC Users
If you are starting or continuing with intermittent catheterization — or transitioning from an indwelling catheter — it's worth trying a few catheters to find one that suits you.[1] The IQ Catheter from Manfred Sauer GmbH is a single-use intermittent catheter, available in hydrophilic and gel versions, with a soft, rounded tip on a flexible front section and a firmer guiding shaft. It is available in Canada exclusively through IQ Catheter Canada.
Healthcare professionals can request complimentary IQ Catheter samples for evaluation. Submit a sample request →
This article was written by IQ Catheter Canada, which distributes the IQ Catheter in Canada. It is general information, not medical advice. Talk to your healthcare provider about your own situation.
References
- Nurses Specialized in Wound, Ostomy and Continence Canada, Canadian Nurse Continence Advisors, Urology Nurses of Canada, and Infection Prevention and Control Canada. Clean Intermittent Urethral Catheterization in Adults – Canadian Best Practice Recommendations for Nurses. 1st ed. 2020. PDF
- Hooton TM, et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 international clinical practice guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010;50(5):625–663.