Suprapubic catheter
A soft tube placed through the lower belly, just above the pubic bone, directly into the bladder to drain urine. It is used when the bladder cannot empty on its own and a catheter is needed for a long time, and it keeps a tube out of the urethra.
Also called suprapubic catheter, SP catheter, SPC, SP tube, suprapubic tube, suprapubic cystostomy, catheter through the belly, bladder tube through the stomach
- Where
- Clinic procedure room, operating room, or radiology suite
- Anesthesia
- Local numbing in the office, or sedation or general anesthesia in the operating room
- Time in the room
- 15 to 30 minutes
- Hospital stay
- Usually the same day
- Going home with
- Suprapubic catheter draining to a leg bag or night bag, or closed with a valve
- Back to normal
- 1 to 2 weeks
- Back to work
- A few days
Overview
A suprapubic catheter, often called an SP tube, is a soft catheter that goes through the skin of the lower belly, just above the pubic bone, straight into the bladder. A small water-filled balloon at its tip keeps it inside. Urine drains through it into a bag strapped to the leg by day and a larger bag at night, or the tube is closed with a small tap (valve) that you open every few hours.
Compared with a catheter through the urethra, an SP tube is usually more comfortable for long-term use. It avoids the soreness, infection and slow damage that a urethral catheter can cause, especially at the tip of the penis or in the female urethra. It also makes sex, hygiene and catheter changes easier.
The tube can be placed in the office with numbing medicine, usually guided by ultrasound, when the bladder can be filled and is easy to feel above the pubic bone. It is placed in the operating room with a camera inside the bladder when there has been belly surgery before, the bladder is small, or the body shape makes office placement less safe. Radiologists also place them using imaging.
Once the track through the belly wall heals, the catheter is changed about every 4 to 6 weeks. The first change is usually done in the clinic; later changes can often be done at home by a nurse or a trained caregiver.
The parts of your body involved
The bladder sits low in the pelvis, tucked behind the pubic bone. When it fills, it rises above the pubic bone and presses against the lower belly wall, pushing the bowel up and out of the way. This creates a safe window where a tube can pass through the skin, fat and muscle of the belly wall into the bladder without touching anything else. A full bladder is the key to placing the tube safely.
- Bladder
The muscular bag that stores urine. When full, it rises above the pubic bone toward the belly wall.
- Pubic bone
The bone at the front of the pelvis. The tube enters a little above it.
- Belly wall
Skin, fat and muscle the tube passes through. Over 2 to 4 weeks, a healed track forms around the tube.
- Bowel
Normally sits above and behind a full bladder. Past surgery can leave bowel stuck lower down, which is why some people need placement with a camera or imaging.
- Urethra
The usual outlet for urine. With an SP tube, it is no longer needed for drainage, though some urine may still leak from it.
Why it’s done
An SP tube is used when urine needs to be drained for a long time, or when a tube through the urethra is not possible or is causing problems.
- Long-term urinary retention
When the bladder cannot empty because of a blockage or a weak bladder muscle, and surgery to fix the cause is not possible or not wanted.
- Nerve-related bladder problems
People with spinal cord injury, multiple sclerosis or similar conditions who cannot pass a catheter themselves often do better with an SP tube than a urethral catheter.
- Protecting the urethra
Long-term urethral catheters can slowly wear away the tip of the penis or widen the female urethra. An SP tube avoids this.
- A damaged or narrowed urethra
After injury, or with a tight stricture, an SP tube drains the bladder until the urethra is repaired.
- Comfort and daily life
Many people find an SP tube easier to clean and change, more comfortable when sitting, and less in the way during sex.
- After some operations
Surgeons sometimes place one for a few weeks after urethral, prostate or pelvic surgery, so the repair can heal while the bladder drains.
Other options
- Clean intermittent self-catheterization
Passing a thin catheter through the urethra a few times a day and removing it each time. When possible, this is often the preferred long-term option because nothing stays in the body.
- Urethral (Foley) catheter
A catheter through the urethra, fine for short periods. Over months to years it can cause infections, discomfort and damage to the urethra.
- Treating the cause
Some blockages can be fixed, for example by opening an enlarged prostate or repairing a urethral stricture, so no catheter is needed.
- Urethral reconstruction
For a narrowed or damaged urethra, repair surgery may restore normal urination.
- External catheters
Condom catheters for men, and external wicking devices for women, collect leaking urine. They do not help when the bladder cannot empty.
- A catheterizable channel
For some people, a surgeon can build a small channel from the bladder to the belly button, which is emptied with a catheter several times a day and stays dry in between.
Getting ready
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Weeks before
The day before
The day of
In the operating room, step by step
Press play or pick a step. Each drawing shows what your surgeon is doing at that moment. Your team may do some steps differently.
1. Getting ready
You lie flat on your back. The lower belly is cleaned and covered with sterile drapes. In the operating room you are given sedation or general anesthesia; in the office you stay awake.
After the operation
Right afterward
- Right after placement
Pink urine and mild soreness at the site are common for a day or two.
- Learning the system
A nurse shows you or a caregiver how to switch between the leg bag and night bag, empty the bags, and care for the site.
- Going home
Most people go home the same day. After placement with anesthesia, someone needs to drive you.
- Supplies
Make sure you leave with extra bags and dressings, and know who will supply more.
At home
- Site care
Change the gauze dressing daily, or when wet, until the site stops draining, usually 1 to 2 weeks. After that, clean around the tube daily with mild soap and water and pat dry. A little crusting is normal.
- Bags
Use a leg bag by day and a larger bag at night. Keep bags below the level of your bladder, empty them when about half full, and replace them as your team advises.
- A valve instead of a bag
Some people close the catheter with a small valve and open it every 3 to 4 hours. This lets the bladder fill and empty and can keep it from shrinking. Ask whether this is safe for you.
- Fluids
Drink enough to keep your urine pale yellow, often about 8 to 10 cups a day, unless you have been told to limit fluids. Good flow helps prevent blockage and infection.
- Bowels
Avoid constipation. A full bowel can press on the bladder and cause leaking or poor drainage.
- Showering
Showers are fine after 24 to 48 hours. Avoid baths and swimming until the site has healed, and ask your team before swimming.
- Activity
For the first 1 to 2 weeks, avoid heavy lifting and anything that tugs on the tube. Always keep the tube secured to your skin.
- Leaking from the urethra
Some urine may still leak from the urethra, often with bladder spasms. Tell your team; medicines or changes in catheter size can help.
- Sex
Sex is usually possible once the site has healed. Tape the tube to the side or use a valve and empty the bladder first.
- If it falls out
Cover the site with a clean dressing and call your team or go to the emergency room right away. The track starts to close quickly and may need to be reopened.
Recovery timeline
- Day 0Placement
Home the same day with the tube draining into a bag.
- Days 1 to 3Settling in
Some soreness, pink urine and bladder spasms, which ease quickly.
- Weeks 1 to 2The site heals
Drainage at the skin stops and a dressing may no longer be needed.
- Weeks 4 to 6First change
The first catheter change is done in the clinic once the track has matured.
- Every 4 to 6 weeksRoutine changes
Changes in the clinic, or at home by a nurse or trained caregiver.
- Every year or as neededCheckups
Review of how the tube is working, infections, and any blood in the urine. A cystoscopy may be done to check for stones or other problems.
- Long termLiving with it, or removing it
Many people keep an SP tube for years. If the bladder recovers or the cause is fixed, the tube is removed and the track usually closes on its own within a day or two.
What it feels like
For many people, especially those who have lived with a urethral catheter, an SP tube is a relief. The placement is quick, and the adjustment is mostly about routine: bags, site care and regular changes.
Making the decision
A tube in the belly can feel like a big, permanent step, and some people grieve the loss of normal urination.
What helpsAsk what the alternatives are and whether the tube could be removed later. People who switch from a urethral catheter often say they wish they had done it sooner.
During office placement
A sting from the numbing medicine, then pressure and a push as the tube goes in. Most people say it was quicker than they expected.
What helpsSlow breathing helps. Tell the team if you feel sharp pain; more numbing medicine can be given.
The first few days
Soreness at the site, pink urine and bladder spasms that feel like a sudden need to urinate.
What helpsAcetaminophen, spasm medicine if prescribed, and plenty of fluids. These settle within days.
Getting used to the bags
Some people feel self-conscious about the leg bag or worry about leaks and smell.
What helpsLoose pants hide a leg bag well. Emptying regularly and keeping connections clean prevent leaks and odor.
The first change
Worry that it will hurt. Most people feel only brief pressure and a tug.
What helpsAsk the nurse to talk you through each step. Changes get easier as the track matures.
Intimacy and body image
Concern about how a partner will react, and about the tube during sex.
What helpsSecuring the tube to the side or using a valve helps. Many couples find an SP tube much easier than a urethral catheter.
How well it works
A working SP tube drains the bladder reliably, protects the kidneys from back pressure, and keeps a catheter out of the urethra. Success is measured by steady drainage, a healthy site, and few infections or blockages.
- Reliable drainage
The bladder stays empty or is emptied regularly, without episodes of painful retention.
- A protected urethra
No ongoing pressure or damage from a urethral catheter.
- A healthy site
Clean skin with little drainage once healed.
- Regular review
Your team checks for infections, stones and blockages, and whether the tube is still needed.
Risks
Every operation has risks. These are the ones people ask about most, with honest odds where good numbers exist. Your surgeon’s own results matter more than averages.
Common
Common for a day or two after placement and after some catheter changes.
The balloon can irritate the bladder, causing cramps and leaking from the urethra. Medicines can help.
Almost everyone with a long-term catheter has bacteria in the urine. This is not an infection unless it causes symptoms, and it is usually not treated unless it does.
Discharge, crusting or a small bump of pink tissue (granulation tissue) around the tube. Usually managed with cleaning, and the bump can be treated in the clinic.
Less common
Fever, flank pain, cloudy or foul urine, or feeling unwell. Treated with antibiotics, and the catheter is often changed.
Sediment or crystals can block the catheter. More frequent changes and good fluid intake help.
Usually from a pull or a balloon problem. Needs prompt replacement before the track closes.
Can form over months to years with a long-term catheter, and are removed with a scope.
Sometimes the new catheter does not pass easily and the track needs to be reopened or the catheter replaced in the operating room.
Rare
Rare but serious. It can cause belly pain, fever or vomiting in the first days and needs urgent care, sometimes surgery. A full bladder, ultrasound, or a camera inside the bladder lowers the risk.
Rarely, bleeding into the bladder needs a larger catheter, washing out of clots, or a procedure.
Can usually be solved in the clinic.
People who have had a catheter for many years have a slightly higher risk of bladder cancer, so new blood in the urine is checked.
Call your care team or go to the emergency room if
- The catheter falls out: cover the site and call your team or go to the emergency room right away.
- No urine drains for more than 1 hour, and your belly feels full or painful, even after checking for kinks and keeping the bag below your bladder.
- Fever of 101°F (38.3°C) or higher, shaking chills, or new back or side pain.
- Bright red urine or clots.
- Severe belly pain, swelling or vomiting in the first days after placement.
- Spreading redness, swelling or pus around the site.
- If you have a spinal cord injury at the upper back or higher: a pounding headache, flushing or sweating above the injury, or very high blood pressure can mean autonomic dysreflexia, often from a blocked catheter. Check the tube right away and get emergency help.
Questions to ask your surgeon
- Why do you recommend an SP tube for me instead of self-catheterization or a urethral catheter?
- Will it be placed in the office or the operating room, and why?
- Do I need a cystoscopy or other tests first?
- Who will change the catheter, and how often?
- What size and type of catheter will I use?
- Can I use a valve instead of a bag?
- What should I do if it falls out or stops draining?
- What should I do if urine leaks from my urethra?
- How will you decide when to treat bacteria in my urine?
- Could the tube be removed one day if my bladder improves?
Words you may hear
- Suprapubic
- Above the pubic bone.
- Suprapubic cystostomy
- An opening from the lower belly into the bladder for a catheter.
- Foley catheter
- A soft catheter with a small balloon at the tip that holds it in the bladder.
- Balloon
- The small water-filled cuff at the catheter tip that keeps it from slipping out.
- Track
- The healed tunnel through the belly wall that the catheter passes through.
- Leg bag
- A small drainage bag strapped to the thigh or calf for daytime use.
- Night bag
- A larger drainage bag used overnight.
- Catheter valve
- A small tap at the end of the catheter that lets the bladder fill and is opened to drain.
- Urinary retention
- Being unable to empty the bladder fully or at all.
- Neurogenic bladder
- Bladder problems caused by nerve damage or disease.
- Encrustation
- Crystals building up on the catheter that can block it.
- Granulation tissue
- A small bump of moist pink tissue that can grow around a tube at the skin.
- Autonomic dysreflexia
- A dangerous rise in blood pressure in people with high spinal cord injuries, often triggered by a full bladder.
Common questions
Does it hurt to have it in?
Once healed, most people do not feel the tube. Bladder spasms can happen, and medicines help.
Can I shower and swim?
Showers are fine after a day or two. Ask your team about swimming once the site has fully healed.
Will urine still come out of my urethra?
Sometimes. Some people leak a little from the urethra, especially with bladder spasms. Many leak none.
Can the tube be removed if I no longer need it?
Yes. The catheter is taken out and the track usually closes on its own within a day or two, with a dressing over the site.
Can I have sex with an SP tube?
Yes. Most people find it much easier than with a urethral catheter. Secure the tube to one side first.
Why do I have bacteria in my urine but no treatment?
Long-term catheters almost always carry bacteria. Treating them without symptoms does not help and can lead to resistant germs, so antibiotics are saved for true infections.
Can I travel?
Yes. Pack extra bags, a spare catheter and a letter from your team, and know where to get help at your destination.
Sources this page draws on
- British Association of Urological Surgeons, Suprapubic catheter practice guidelines (Harrison and colleagues, BJU International) (2011)
- American Urological Association and Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction, Adult Neurogenic Lower Urinary Tract Dysfunction: AUA/SUFU Guideline (2021)
- Centers for Disease Control and Prevention (HICPAC), Guideline for Prevention of Catheter-Associated Urinary Tract Infections (2009)
- MedlinePlus, Suprapubic catheter care
- Urology Care Foundation, Urinary Retention
Written November 2026. This page explains what usually happens. It is not medical advice and does not replace a conversation with your own surgeon, whose plan for you comes first.