You need this basic info to consider this option.
Let's start this section off with a cautionary statement about catheters. We, as non-medical people, will not recommend internal catheters or the procedure called "clean intermittent catheterization". Catheterization is an invasive procedure of inserting a tube through the urethra to reach the bladder and drain urine. We feel that any kind of internal catheterization is a medical issue and is best decided by a health care professional or under the care and supervision of a health care professional in concert with the patient. We do observe that anytime a foreign object is introduced into your body, there is risk of damage and causing an infection most often referred to as UTI (urinary tract infection).
An internal collection device, such as a catheter (a hollow plastic tube), may be recommended for certain individuals to ensure that the bladder is emptied on a regular schedule and does not overfill. Intermittent catheterization -- the periodic insertion of a catheter into the urethra, past the sphincter muscle and into the bladder -- is performed at regular intervals each day (usually every 3 to 6 hours). These devices are usually used in managing cases of neurogenic and overflow incontinence.
Catheters used for intermittent catheterization range in size. Catheters usually are attached to a drainage tube and/or bag. Since intermittent catheterization completely empties the bladder, wetting accidents can be avoided.
Intermittent catheterization poses a risk of infection because the catheter must pass from the external environment to the internal environment of the body. Therefore, hand washing is required before touching the catheter or drainage bag. In addition, the catheter should be cleaned after each use.
Source: The Urology Channel: http://urologychannel.com
An internet forum one day yielded this series of exchanges:
My doctor recommended either internal or external...he feels either is better than as he put it "incontinence".....
Lyle USA - Thursday, April 26, 2001
In my case it would be indwelling: I have been told by my district nurse that sheath catheters are not really suitable for someone as active as me. Whenever I've been in hospital I've had an indwelling catheter which I didn't enjoy much.
James Warren Winchester, UK - Thursday, April 26, 2001
Warren and Mandrax, what type of catheter are you being pressured into a Foley internal Catheter or a Condom external Catheter and by who.
Lyle PA USA - Thursday, April 26, 2001
Warren... you're not the only one who is pressured by Doctors, family etc, to use a catheter. There's a tide of "anything is better than diapers" thought in today's medical profession.
Mandrax USA - Thursday, April 26, 2001
We will discuss only the external collection devices consisting of condom caths and urinals. We caution you, again, to consult your health care professional to determine whether this incontinence management method is appropriate for you and your individual situation.
For information regarding internal catheters, check out the information at the following site where they talk about the different types of internal catheters and how to take care of them:
http://www.avera.org/avera/adam/1/003981.adam
The following information has been drawn from Urology Channel:
External collection devices, such as external catheters (for example, FreedomCath), are urine storage products that may be useful for short-term incontinence treatment in men. Condom catheters are made of latex rubber, polyvinyl or silicone. They are affixed to the shaft of the penis by adhesive, latex or foam strap devices, and they are connected by a tube to a urine-collecting bag.
Other devices include external urinals, which consist of a collecting pouch attached to an athletic supporter (for example, the McGuire urinal); these devices usually can be connected to a leg bag.
External catheters are preferred over indwelling catheters for patients who do not have urinary retention, yet these devices also may lead to urinary tract infection. In addition, external catheters may cause damage to the penis due to friction, ischemia (insufficient blood flow), and obstruction.
To avoid complications, these devices should not be used improperly or for prolonged time periods. External catheters usually are not recommended for frail elderly individuals with mental disabilities or people with sensory nerve loss.
Urine collection devices also are available for women, but more research is needed to determine the effectiveness of these products. Some of the reported side effects of these systems are reddening of the skin near the urethra and itching in the pubic region.
Source: The Urology Channel: http://urologychannel.com
Simply stated, a condom catheter and leg bag system consists of a condom worn on the penis with tubing running to a leg bag which is worn on the leg with elastic straps. When you have a void (wetting episode), the urine flows down the tubing and is collected in the bag. The bag has a bottom discharge tube with a valve and can be periodically emptied into a toilet.
An internet forum contributor provides the following:
Basically there are three different types of condom catheters and all require you to start with your penis clean and dry and pubic hair held out of the way.
1. "Texas catheter": This is a condom catheter that is rolled onto the penis and then there is a spongy tape that is wrapped around on the outside this is supposed to keep the condom on the penis. [This type did not work for this contributor- ed.]
2. Self-adhesion / self stick / self sealing: This is a condom catheter that already has the glue on them, and all that is necessary is to roll it on. These do work well but in some cases the glue may have a reaction on the delicate skin of the penile shaft.
3. Two-piece system. First you wrap a two-sided tape around the penis and then roll the catheter on and over the two sided sticky tape. The two sided tape sticks to the penis and then the condom sticks to the tape and forms a good seal. [This type works well for this contributor, and he found that the taping lasts 24 hours or more. - ed.]
My own experience is limited to the second type listed, self-adhering condom catheters. We hope that others will contribute their experience with other methods of attaching and retaining a condom on the penis. We shall add their contributions to this primer.
Let's take a look at getting a system and what is involved with putting it on, living with it and taking it off. I am going to recommend the supplier HDIS only because of personal experience with easily obtaining everything needed - including options of various condom and collection bag sizes. HDIS carries the Conveen line manufactured by Coloplast. What ever you order from HDIS arrives discreetly.
Condom catheters are available in five sizes from extra small to extra large. While many of us suppose that we are extra large, remember that the device is supposed to stick on and stay on. It will work much better if it is close to the right size. So do your own estimating... I'm no giant, I started with medium. Stick with the 10-pack until you have the size "down pat" before ordering the 100-pack. The condoms do not come with tubing, only a short tube molded into the end of the condom that will accept the adaptor that comes with the leg bag and its tubing.
Start with the small bag! Bags get heavy in a hurry, it seems, and they also swell and feel strange when they start binding your trouser legs. Get the 17-ounce bag, which will come in a 5-pack, each bag having its own tubing and a separate adaptor taped on at the end of the tubing to insert into the stubbie tube of the condom. Don't forget leg bag straps. One set will do, but two will let you rotate them so you can wash them every few days.
OK, about $75 later you have your equipment: 10 condoms, 5 bags and a set of straps. Where do we begin? Well, you are going to be sticking something on to your penis and that something is just about like a band-aid. Pubic hair will pose to be a problem to some extent. If you can just "grin and bear" some pain when removal time comes, that's fine. Some have suggested shaving the pubic hair from the shaft of the penis. OK, I'm a wimp and so I figured pulling a band aid off bare skin is much less painful than when hair is involved so I lathered up well in the shower and proceeded to carefully shave the pubic hair from the shaft of my penis. Well, let me say that I am not in any hurry to do that again! If you think your face is sensitive, wait until you experience the sensitivity of the skin on your penis! As gentle as I was, it was one burning experience, and I really don't think I'll ever repeat that experience!
After your shower in the morning, dry off thoroughly and let your penile skin air dry while you do other personal morning things. Whether you shaved your penile shaft or not, you have to deal with the rest of the pubic hair. The secret lies in taking a paper towel and tearing a hole in the center and insert your penis through the hole while pulling the paper towel up as far as possible leaving your penis protruding through the paper towel. The paper towel holds all that pubic hair out of your way.
You'll note the condom will have an applicator built in, a plastic collar of sorts to hold between finger and thumb that keeps the rolled condom in place on the head of the penis while you start to unroll the condom onto the shaft of the penis. A partial, but not full, erection or some degree of stiffness is a great asset. It is important for uncircumcised males to ensure that the foreskin stays down in place over the head of the penis. In case you were not aware of it, a prolonged period with the foreskin retracted can result in an unpleasant condition (I cannot recall the appropriate name), and the condition is swelling of the foreskin tissue. But, given a partial erection with the foreskin remaining over the head of the penis, you proceed to hold the condom firmly in place on the head of the penis and unroll it. The paper towel is supposed to keep your pubic hair away and the sticky surface of the condom will start as the condom first unrolls and will continue as you unroll it fully. Plastic wrap and a little pull tab included in the apparatus supposedly makes this operation easier.
OK, the condom is now stuck onto your penis. Now attach the leg bag with straps to the inside of your left leg at the ankle. This is the most common position for right-handed folks. The straps allow for an upper strap above the calf and the lower strap at the ankle. Right now the bag is empty, flat and nice and light! It's hard to imagine what the bag will do as it fills, becomes heavier and tends to slide down, But that's what experience will teach you. Most times the straps are velcro so you can readjust them if it becomes necessary later on. If you start with the straps snug but not cutting off circulation, you should be in good shape. I found that I needed a "garter" above the knee which I made from ¾-inch wide elastic and small safety pins. Additional short straps connected the "garter" strap above my knee to the bag strap that was just below my knee.
An aside: the elastic is found in fabric/sewing stores and sometimes in a "notions" section of a "big-box" store such as Walmart. There are different widths and different types. Width determines strength. You can take any brand you can find, I think the "braided" designation is generic and choose a content that is high in rubber since that's what provides the stretch and tension. The StretchRite brand Braided Elastic, made by Rhode Island Textile Co., that I use is 68% polyester and 32% rubber.
Now for a part that will be very personal with each of us. Can you tolerate the condom and the tubing hanging off your penis all day, or do you want some support for the penis and the tubing? I knew right off that I was not going to like having the tubing hanging from my penis and moving around as I walked so I opt for support underwear and pull on a pair of cotton briefs (Jockey shorts). Lead the tubing from the leg bag up your leg and insert it under a leg band of the cotton briefs. See where it comes out, length wise, reaching the end of the condom. You are going to cut the tubing to suit yourself but, before you cut it, be sure you are standing up and the length is right, sit down and see if the length is still satisfactory. When you figure that it is right, cut the tubing still a bit on the long side. Insert the adaptor into the tubing and the other end will plug into the tubing stub on the end of the condom. You are now connected to the leg bag. Be sure the valve on the leg bag bottom tube is secure; it should be a clamp arrangement that pinches the dump tube shut until until you release it to empty the leg bag.
I use two additional straps to secure the tubing. Since I only want light tension, I'll cut these straps from 1/4" wide elastic. The safety pins to make these straps and bag garters can also be found in the fabric/sewing stores. Buy either stainless steel or all brass pins; the small ones will do just fine. They allow you to change the tension of your straps easily by repinning. That's much harder to do if you sew the straps. I'll place one strap right up in my groin to supplement the strap effect provided by the leg band of the underpants. The second goes right above the knee. The idea here is to keep the tubing from flopping around as you walk.
Now you need to walk around a bit - and sit down. Cross your legs if you usually do that. See how everything feels. Stand up; squat down. From the standing position put your left leg up on the side of the toilet bowl where it will be when you are going to empty the bag. During all this movement, note the feel of the tubing and determine whether you want to shorten it. Be careful, and put up with the tubing a bit too long, at least while you are new to this, until you experience the settling effect of the bag as it fills. The bag will most likely settle down your leg a bit, and if the tubing can't accommodate that, you are not going to be comfortable. Settle for longer length than what you really need at first. You can cut it shorter after you have experienced several days and several fill-and-empty cycles with the leg bag.
Get dressed and get out in the world! Long pants are a given! Tubing and leg bags look really, really ugly, so shorts are totally out of the question. If you've been wearing diapers to manage your incontinence, I think you are now in for a very different experience. You may not feel as secure without the familiar bulk of the diaper, but freedom has its own reward. The fact that nearly all your perineal skin is getting an airing out is really good for the health of your skin and will give you a very pleasant feeling of airiness or freedom.
I can't imagine your having any difficulty feeling the leg bag getting heavy as it fills. One of the new sensations you will have to get used to is the tubing along your thigh and leg will warm up each time you void. That is a very different sensation. After you have experienced that several times, check the bag! As you gain experience, simply reaching down and feeling the bag through your pants leg will indicate how full it is. Until you reach that point, find some private place to pull up the trouser leg and visually check the bag. Empty the bag any time it is half-full or more. To empty the bag, just go into the men's room, choose a stall for privacy, lift the seat and put your left foot up on the rim of the toilet. Pull down your sock, retrieve the dump tube and aim it in the toilet bowl while you release the dump valve/clamp. When empty, close the valve and dry it with toilet tissue and tuck it back into your sock.
During the day, what can go wrong? Just as when diapered, the most vulnerable position is sitting. If the tubing kinks or the condom is oversized, and/or your penis has retracted or shrunk to a small state, any of these events can cause a leak at the condom-penis interface. That leakage will mean wet pants and wet furniture. Develop your technique in applying the condom and go through several days of trials in the safety of your home or other controlled environment before venturing to the office! After you've tried a condom for several days (and always a new one each day!) you should be able to tell if the size is right, and try one size up or down to see whether improvements can be made.
If you cut the tubing too long, it will just be bulky, and you'll constantly be feeling it as you move around. If you cut it too short, you will feel the pull on your penis, and that won't be comfortable as you can imagine. Your penis most likely is going to change size after you applied the condom. Pubic hair caught in the apparatus has been my biggest "pain" - and you generally have no choice but to grin and bear the pain until the evening shower.
I've heard of instances of the tubing disconnecting at the leg bag from others using systems other than the Conveen. Such an event would result in a very wet sock and shoe and possibly a puddle on the floor but not wet pants. That cannot happen with the Conveen system since the tubing is part of the leg bag... unless, of course, you fail to secure the dump valve properly. I did that once and had the wet sock and shoe to prove it. The only catastrophic event I can imagine is having a condom blow off or the tubing disconnect at the adaptor between the condom and the leg bag tubing. If you have done your homework and done the testing in safe quarters, you should have your technique refined to a point that problems will not occur!
A condom catheter and leg bag should pose no difficulty in any normal activity. Certainly athletic activity can be ruled out, for the most part. If your work is, say, that of an auto mechanic and you find yourself on your back on a creeper, you may have a higher-than-normal risk of a leak or blow-off at the condom. Walking or any normal business activity with a leg bag is not a problem. As the bag fills, it certainly becomes heavier and tends to settle further down around your ankle. Here is where figuring the length to cut the tubing is more art than science. I found my "garter" arrangement above the knee to be a big help.
At this point it is appropriate to point out the specialized "pants" which are designed to hold leg bags! "Netti" is one such brand. Their "One Legged Pants", are pulled on like underwear and they have a pouch to carry and support a urine collection bag. Unfortunately, I can't provide any personal experience with that item! The Netti pants are only available for a thigh-carry of the bag, and that's not convenient for me to empty. I want the bag down at my ankle for ease of emptying. Yet, others may find they like the thigh-carry for the bag!
OK, we got through the day! We learned to monitor the leg bag and empty it as necessary and the condom remained stuck on our penis, and there were no surprises! Now we are home at the end of the day and it's into the shower. Empty the leg bag; remove the leg straps; disconnect the tubing from the condom and set the bag aside. Step into the shower with the condom still attached and lather up with hot water. They kept telling me that hot water and soap was the secret to getting the condom to come off easily. But, to be honest with you, it's never easy! Peeling that condom off was only one step this side of medieval torture! Again, we all have different levels of pain or discomfort. I will advise to take your time and peel the condom slowly with lots of soap and water. After the shower, I would look forward to the no-nonsense practicality of a diaper for the night and not repeat the condom experience until the next morning.
The condom gets tossed, of course. The leg bag needs to be rinsed out and dried. Use a second leg bag on day two and a third leg bag on day three. On day four you can go back to bag #1. I would recommend going a month with three bags, using one bag each day, all day, but resorting to diapers at night.
If you wanted to continue with the leg bag at night, as we must when using the leg bag to combat a tough case of diaper rash, you may want to then get a bigger bag for overnight since you don't have to wear it on your leg, but will hang it from the bed frame. When you wear a condom catheter and tubing to bed, you may be surprised to learn how adaptable you are when it comes to tossing and turning. I thought it would be a disaster since I usually move all over the place when I sleep, but when I put on a condom catheter and the tubing, it is a different story. I really believe that we can adapt and won't pull the tubing off in the middle of the night. At least I can say it has never happened to me! I may not sleep as well, and I'll wake more often as I move around and feel the pull on the tubing but I've not had any major problems sleeping with a condom catheter and tubing to a drainage bag. I should add that a couple of weeks is perhaps the longest stretch that I have used a catheter and leg bag 24/7 including sleeping with a condom cath. Once any rash is cleared up, I go back to diapers that I find much more secure, comfortable and user-friendly!
When using a condom catheter 24 hours a day, most folks can safely leave one condom on for that period of time. It needs to be peeled off and replaced only once a day, and that can be morning or night as you wish. I would think that long term use of self-stick condoms would be self-limiting. In that I mean that if the skin gets sore, you would back off using the self-stick condoms. For me, the practical limit is one week. For you, it could be forever!
Input from internet forum contributors: (Note we have not edited the following but directly transferred the statements made by various contributors to this Primer.)
I've had good success with the two piece condom cath, and recommend Bard as an excellent brand, along with Uro-San by Mentor.
Be careful; most condom catheters are made of latex rubber which can cause problems for some folks with allergies, but there are also catheters made of silicone and are allergic free. Convene Urisheath is one non latex condom catheter.
Leg bags can vary from brand to brand, one man prefers the Bard line of bags.
The biggest problem most people find is the leg bag and tubing that connects bag to condom cath. Making sure the tubing is either taped to your leg or strapped so it will not move around can solve this. Anyone who says the tubing comes disconnected must have done something wrong. Once the tubing is connected firmly it takes a lot to remove it, it will not pull off by itself.
When I was working, I used a urostomy bag. I made an adapter that fit the bag and let me connect the catheter, then hung the bag on my stomach. This worked for many years for me at work, and it was never found out that I had trouble with incontinence. It is hard working in a shop with 40 men and hiding incontinence, but I was able to do it!
Now a company makes a belly bag, but they say on their web site it is not supposed to be used with a condom catheter; only a Foley (internal) catheter. But my makeshift bag did the same thing and I never had any infections from it.
One thing with condom catheters there is always a chance of infection. The most improvement thing to remember is cleanliness and this is also a closed system. In all the years I used catheters I never had an infection or much trouble with them. I never had a leak with this system the leg bag holds 36 oz - more than anyone puts out.
Problems with catheters tape and adhesive can make you sore if not used correctly. They aren't the best night protection if you toss and turn much. If you force urinate, it is possible to have it come off but I never had this problem.
I also would recommend if anyone is thinking of using a catheter, talk to your doctor before you do. But I would recommend the same for diapers, if they aren't used right they can cause you grief also.
MEDEXUS URO Inc. offers a unique approach wherein their condom catheter sticks onto the head of the penis only, it is not a full condom that rolls onto your penis. They call it a "Daisy" and it looks a bit like that flower with the tubing connection in the center and the open petals that will close on and stick to the head of the penis. What caught my attention was the special adhesive that totally "releases" when you come to removing it. That would be a major improvement in the lives of condom catheter wearers!
The web site is very informative and the demo series is well done and shows you exactly what the system is and how it is put on and removed. Well worth taking a look. www.medexusdaisy.com
Rubber urinals have been around for a long long time. I cannot claim any experience with one! My penis is small, especially in its retracted or limpid state, and my fear is the penis won't stay reliably in a urinal. My thoughts are that a urinal would be good for the guy who can maintain a partial erection all the time or is just plain "well hung" to use the vernacular. A rubber urinal typically has an inner lining with an opening that you insert your penis through. It is held over your penis and secured with straps that are akin to a jock strap. The tubing to the leg bag and attaching the leg bag are probably very similar issues to those we faced with the condom catheter arrangement.
A major advantage of the rubber sheath urinal is that there is no adhesive, and it would or should be much friendlier to the sensitive skin of the penis! Your penis can slap around inside the urinal depending on your level of activity. Again, we are all different in pain/sensation levels. The urinal is reusable, and for your work in properly cleaning and caring for it, you get a pay back in not constantly buying supplies needed with the throw away condom catheter system. For constant wear, two urinals would be minimal; one for wear and one being cleaned and drying out. Yet with no stick-on security, I consider wearing a urinal to bed could pose a problem. Perhaps we will hear from folks with such experience and will add it to this Primer. The sheath urinal is a bit bulkier than the condom cath, but nothing that loose-fitting pants would not easily conceal.
Finally, an internet forum contributor says
There is a McGuire male urinal, which works very similar to a condom catheter but is reusable. I have used this model and it works well. Fit is most important.
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