I.
A catheter is a tube that is installed via the urethra or a lower abdominal incision to drain urine or faeces in a way different from the normal manner, because of the patient’s medical condition.
The removal of impurity in this way is out of the patient’s control, as he is not able to control it, and the urine naturally collects in a bag that is always with the patient.
In this case, the urine is almost constantly flowing via the catheter into the bag.
There are two types of catheter:
The first type is the intermittent catheter, in which a tube is inserted through the urethra or the opening of the anus, to empty the bladder of urine or to empty the colon of faeces. This type is used occasionally.
There is no confusion about this, because the urine or faeces exit from the usual places, so their exiting is regarded as minor impurity in and of itself, and wudu’ is invalidated by that. This is subject to the same rulings as urine and faeces that come out in the usual manner, with regard to purification and prayer.
The second type is the indwelling catheter, in which an incision is made in the abdomen to drain urine or faeces.
This type shares with the first type – catheters inserted into the urethra and anus – the fact that urine or faeces are coming out most of the time, and it differs from it in the fact that the impurity is not draining via the usual exit, rather urine or faeces are coming out through an opening beneath or above the navel. (See: Mawsu`at Fiqh al-Qadaya al-Mu`asirah/Fiqh al-`Ibadat, 168).
II.
Draining of urine and faeces via an indwelling catheter invalidates wudu’, and the patient must do wudu’ for every prayer, according to the majority of scholars.
Al-Babarti al-Hanafi (may Allah have mercy on him) said: Emission of impurity from the body of a living human invalidates the state of purity, no matter how it happens, according to our view, and it is the view of the ten Sahabah who were given the glad tidings of paradise, Ibn Mas`ud, Zayd ibn Thabit, Abu Musa al-Ash`ari, Abud-Darda’ and the earlier Tabi`in (may Allah be pleased with them).
End quote from Al-`Inayah Sharh al-Hidayah, 1/38.
Ash-Shirazi (may Allah have mercy on him) said: If the usual exit becomes blocked, and an opening is made in the lower abdomen, wudu’ is invalidated by what comes out of it, because the human must have an exit from which urine and faeces come out. So if the usual exit is blocked, this [incision in the abdomen] becomes the exit, and wudu’ is invalidated by what comes out of it.
End quote from Al-Muhadhdhab fi Fiqh al-Imam ash-Shafa`i, 1/49.
Al-Bahuti (may Allah have mercy on him) said: With regard to emission of impurities from any other part of the body: if the impurity is faeces or urine, it invalidates wudu’ even if it is a small amount from beneath or above the stomach, whether both exits are open or are blocked, because of what we have noted above about the general meaning of the verse: {or [if] one of you comes from the place of relieving himself} [An-Nisa’ 4:43]. And the Prophet (blessings and peace of Allah be upon him) said: “except in the case of faeces or urine,” because these are things that usually come out [of the body].
End quote from Kashshaf al-Qina`, 1/124.
Thus it becomes clear that emission of impurity through a catheter of either type invalidates wudu’, and the patient is subject to the same rulings as those that apply to the one who suffers from ongoing incontinence that does not stop. Therefore he must do wudu’ when the time for each prayer begins, after which he may pray with that wudu’ whatever prayers he wants to, voluntary and obligatory, and do whatever other acts of worship he wants, so long as the time for that obligatory prayer has not ended, and it does not matter if any urine or faeces comes out of him during that time.
III.
As for the ruling on offering prayer, when the impurity is in a special bag that is attached to the worshipper, since patients may have to use these bags for a long time due to chronic illness, or they may have to use them permanently, if it is not too difficult for them to change or empty the bag when purifying themselves for prayer, the best is for them to change it or empty it, so as to reduce the impurity.
But if it is too difficult for them to change or empty the bag, they should pray as they are, and they do not have to change or even empty the bag when wanting to pray, because Allah, may He be Exalted, says: {Allah does not place on any soul a burden greater than it can bear} [Al-Baqarah 2:286] and {So fear Allah as much as you are able} [At-Taghabun 64:16].
See: Athar al-Ajhizat at-Tibbiyyah fil-`Ibadat, 140-159.
Al-Hattab (may Allah have mercy on him) said: It is recommended in Al-Mudawwanah to avoid that by using a cloth.
Sanad said: It is not obligatory, because he will be praying with the cloth when there is impurity on it, like praying in his garment.
Sanad said: Is it recommended to change the cloth?
Al-Ibyani said: It is recommended to do that before praying, and to wash it.
According to the view of Sahnun, that is not recommended, and washing the private part is easier for him than that.
End quote from Mawahib al-Jalil fi Sharh Mukhtasar Khalil, 1/143.
The Permanent Committee was asked about a similar case:
I am the imam of a mosque and I am suffering from bowel cancer. The doctors determined that the disease is in the part of the colon where waste matter collects, and that there is no option except to remove it. And in fact they did the surgery and blocked the exit, and they made an opening in the abdomen for faeces, and we use plastic bags every day which are attached to this opening with glue so that no smell, sweat or any off-putting thing can come out. Then twenty-four hours later we remove the bag and wash the opening thoroughly, then attach another bag. I lead the prayers in the mosque; is my leading of the prayer valid or not?
They replied: Praise be to Allah and blessings and peace be upon His Messenger and his family and companions. To proceed:
If the matter is as you described, then your wudu’ is invalidated by whatever faeces comes out of you into the bag, whether the amount is small or great, and you must do wudu’ for every prayer, like those who suffer urinary incontinence and women who suffer ongoing non-menstrual bleeding (istihadah).
You are excused for wearing the bag, which contains impurity, when praying, and for faeces coming out into the bag whilst you are praying.
End quote from Fatawa al-Lajnah ad-Da’imah, 4/453.
IV.
If putting prayers together will enable the patient to purify himself properly when emptying or changing the bag and doing wudu’, it is permissible for him to put prayers together. So he may put Zuhr and `Asr together, and put Maghrib and `Isha’ together, at the time of the earlier or later prayer, whichever is easier for him, because hardship resulting from illness is one of the excuses that make it permissible to put prayers together. The Prophet (blessings and peace of Allah be upon him) granted a concession to the woman who was suffering from ongoing non-menstrual bleeding (istihadah) to put prayers together.
It was narrated that `A’ishah (may Allah be pleased with her) said: A woman suffered from ongoing non-menstrual bleeding (istihadah) at the time of the Messenger of Allah (blessings and peace of Allah be upon him), and she was instructed to bring `Asr forward and delay Zuhr, and do ghusl for both prayers together, and to delay Maghrib and bring `Isha’ forward and do ghusl for both prayers together, and to do ghusl for Fajr prayer. Narrated by Abu Dawud, 294; classed as authentic (sahih) by al-Albani in Sahih Abi Dawud.
Al-Bahuti (may Allah have mercy on him) said: It is permissible to put Zuhr and `Asr together at the time of either of them, and to put Maghrib and `Isha’ together at the time of either of them. These four are the prayers that may be put together: Zuhr and `Asr, and Maghrib and `Isha’, at the time of either prayer, either the earlier of the two prayers or the later…
If it is too difficult for the patient not to put prayers together and that will tire him, [we may note that] the Prophet (blessings and peace of Allah be upon him) put prayers together without there being any situation of fear or rain, and according to one report: without there being any situation of fear and when not travelling. Both reports were narrated by Muslim from Ibn `Abbas, and there is no excuse other than that except sickness.
And it is soundly narrated that it is permissible for the woman suffering from ongoing non-menstrual bleeding (istihadah), which is a kind of sickness, to put prayers together. And Ahmad argued that sickness is more difficult than travelling.
End quote from Kashshaf al-Qina`, 2/5.
And Allah knows best.