Adults experienced a long term indwelling urinary catheter as living with the forces of flowing water.

Main findings Living with a urinary catheter was found to be like living with the forces of flowing water. The following themes emerged. Vulnerability: the force of flowing water was a metaphor to describe the similarity of the movement of urine into the catheter bag to water that is let into and out of a dam. Participants expressed how much their everyday lives depended on the proper functioning of the catheter bag, and how a failed catheter bag made them feel vulnerable. Embarrassment at lack of control: “swish/whoosh” described profound embarrassment over the lack of control of urine flow, especially getting wet in public. The sudden flow of urine was described as a bursting dam.Watchful attention to urine flow: “running all the while” described the continuous flow of urine through the catheter and into the catheter bag. Participants expressed the constant need to be aware of this flow in order to avoid overfilling of the bag and wetting episodes. Noise in the urine bag: “slosh-slosh” referred to the sound of the urine sloshing around in the catheter bag. This noise was not unpleasant but was used as a reminder for emptying the bag. The metaphor of “the spring” was used by 1 participant, who described the catheter as the “waterworks” and the bladder as the “spring”. This participant placed great importance on not dislodging the catheter. Embodied knowledge of urine flow: “paying attention” represented how participants paid attention to their own urine flow patterns and checked their catheter tubing for kinks to help keep the urine flowing freely. Participants were aware of early signs of disrupted urine flow, such as a feeling of fullness or pressure over the bladder. Conclusions Adults living with an indwelling urinary catheter found the experience to be like living with the forces of flowing water. They depended on the proper functioning of their catheter bag and felt vulnerable when it failed. They felt a lack of control of urine flow and embarrassment at public wetting episodes. They were constantly aware of the flow of urine through their catheters and paid attention to when their bags needed emptying and when urine drainage seemed obstructed.