Specialist Products

• Introduction
• Catheters
• Drainage Bags
• Sheaths, Body Worn Urinals, and Other Devices for Men
• Devices for Women
• Devices for Bowel Incontinence
• Enuresis Alarms

Introduction

In this section we have brought together information on a number of specialised items, most of which should be used only on medical advice. They are:

• catheters to drain the bladder (here we include information about drainage bags and related items),
• devices for men including sheaths (also known as body-worn urinals) which are connected to a drainage bag,
• devices for women including vaginal cones to enhance pelvic floor exercises and devices worn vaginally to inhibit stress incontinence,
• devices for bowel incontinence to help with short-term control of leaks from the bowel, and
• enuresis alarms for adults and children who wet the bed.

Some of these items are available on prescription only (usually on the NHS), others are also - or only - available by mail order or over the counter.

Catheters

A catheter is a fine hollow tube which is inserted into the bladder to drain the urine away. It must be used on a doctor's advice only and is available on prescription. Catheters may be prescribed for temporary use - for example, following an operation - or for a longer time: some people use them for life. There are different lengths and sizes for children, men and women. Catheters can be used in two ways

An intermittent catheter is one which you insert into your bladder through the urethra several times a day, emptying the contents into the lavatory or a jug, and remove immediately after use. People are usuallys taught to do this for themselves. Some catheters are pre-lubricated for easier insertion.

An indwelling catheter stays in place for a prolonged period - if needed temporarily after an operation, maybe for some days or up to two or three weeks; catheters for permanent use will need to be changed about every three months.

Indwelling catheters are connected to a drainage bag which holds the urine. This is emptied as necessary, through a tap. There are different support systems for drainage bags: the bag may be strapped to your leg or worn in a special holder or underwear. You may prefer to have the bag supported in a pouch sewn on to your trousers or skirt.

An alternative to the bag is a catheter valve. You release this at regular intervals - it is very important not to allow your bladder to become overfull with urine. Again you may need to try several types for easy emptying and neatness under your clothes.

Tips

• Most companies that make catheters have free information booklets on how to care for yourself and your catheter.
• You can still have sexual intercourse with a catheter in your bladder. For further practical information, contact the Spinal Injuries Association or SPOD (the Association to Aid the Sexual and Personal Relationships of People with a Disability) at 286 Camden Road, London N7 0BJ (tel: 020 7607 8851).

Intermittent Catheters

Many patients use a clean, rather than sterile, technique and wash, dry and re-use each catheter for up to one week. Other people, particularly those with vulnerable kidney function and/or recurrent urinary tract infections (or cystitis), may be well advised to use a sterile catheter each time.

Catheters fitted onto a handle may help women with limited manual dexterity. Some are available with integral mirror to aid insertion.

Indwelling Catheters

There are two ways indwelling catheters may be used. They may be inserted into your bladder through your urethra (urethral catheter)r. Alternatively, they may be inserted through your abdomen (suprapubic catheter). Both are simple procedures which do not hurt, but may feel a little uncomfortable the first time. They are usually first fitted by a doctor or nurse; later, users and carers are often taught to change them as required.

Indwelling urethral catheters differ from intermittent catheters by having a small balloon at the inner end which is inflated once it is inside the bladde so as to keep the catheter in place. They will be provided for you by your nurse or doctor, who will be able to choose from a wide range of materials, arrangements of tips and eyes, and sizes of balloon.

Catheter Valves

For some people an alternative to using a drainage bag with a catheter may be to use a catheter valve. The valve fits onto the end of the catheter in the same way as a bag. The user's own bladder is thus used as the reservoir, preserving its natural function. The valve must be released every three or four hours to drain out the urine or there will be a risk of damage to the kidneys.

A valve probably works best for people whose underlying problem is difficulty emptying the bladder. Those with an overactive or unstable bladder may find that they experience leakage in between catheter releases.

Some valves allow direct connection to a drainage bag - i.e. the patient does not have to use the valve continuously, and the connection with the catheter does not have to be interrupted.

People with limited dexterity may find it worth experimenting with different valves as there are several varieties of release mechanism.

Drainage Bags

Drainage bags are for use with indwelling catheters or by men using sheaths. A bag full of urine is very heavy, so that the support system is important, and generally drainage bags have a small capacity. However, this is less of a problem for non-ambulant people, such as wheelchair users, who may prefer to use a large capacity leg bag (which will need emptying less often). Leg bag sizes therefore range from under ¼ pint (125 ml) to about 2 ¼ pints (1300 ml). They can be attached to larger bags at night or in hospital-type settings.

Bags are linked to the catheter (or for men to a sheath) by an inlet tube fitted with a non-return valve. The length of the tube will depend on the individual and where the bag is worn. Generally very short, or direct connection leg bags can be worn on the thigh with a catheter; medium inlet lengths are for wearing on the thigh with a sheath; long inlets can be used on the calf.

When a bag is to be connected to an indwelling catheter it should be supplied sterile. Bags to be used with a sheath do not have to be sterile.

Some bags have quilting or chambers to distribute urine more evenly around the contours of the leg and prevent urine from slopping around inside the bag as it gets full.

Types of Outlet Tap

There are different designs of tap for leg bags and catheter valves: for example, some have flip valves, others valves you twist or pull. Selection of an outlet tap which is easy to use is important. Tell your nurse which you think will suit you - think about the nimbleness of your fingers and your eyesight - and ask if you can try another type if the first you are offered is difficult.

Large taps with a very positive action may be useful but may be uncomfortable or even cause pressure sores. Some bags have an outlet tap which is also a connector for a night bag; others can be used with a separate connector.

Support Systems for Drainage Bags

There is a variety of ways of holding a urine drainage bag in place under clothing. It is important that, however the bag is supported, there is allowance for the weight of urine when the bag is full. This can make straps around the leg very tight or pull upon a sheath or catheter. The bag should be well supported to avoid this happening.

The simplest fixatives are leg straps - these are often packaged with the bag, but some are available separately. This may be useful if the preferred bag has a strap supplied with it that you find unacceptable or uncomfortable.

Again, you may adapt your own clothing to support a urine drainage bag. A pair of trousers or a skirt may have a pocket sewn inside with buttons and possibly an aperture for emptying the bag (above). People who wear trousers and a thigh bag may find a small Velcro-fastened opening in the trouser seam allows leg bag emptying without removing the trousers. While a few of these garments are commercially available, it is also possible to adapt almost any of the user's own garments in this way.

Extension Tubes

Some drainage bags have tubing which may be cut to the desired length. Alternatively, the desired positioning of the bag may be achieved by using a connection or extension tube.

Night Drainage Bags

Large capacity drainage bags (usually 2 litres/3½ pints or more capacity) are widely used in hospital settings and for overnight drainage for people at home. They are generally too large to disguise easily under clothing in the day time. They may be used with either a penile sheath or an indwelling catheter. Occasionally they are used in conjunction with a hand-held urinal.

Some bags have sophisticated features, such as drip chambers, detailed graduated measurements, anti-kink devices and urine sampling ports. The bag may have an outlet tap if it is to be reused. These bags are obviously much more expensive than simple unmarked non-drainable bags. The non-drainable bags are single use and must be thrown away when disconnected. Many systems now allow the connection of a large-capacity drainage bag to the bottom of a smaller leg bag which is being used during the day, so you do not need to worry about waking up to empty it. In this situation it is possible to use a simple disposable bag for overnight use. Where a bag is to be used in direct connection to an indwelling catheter, it should have a non-return valve and be supplied sterile. The bag has to be compatible with your leg bag attachment. Also it is important to use a night-bag holder so that the tap does not touch the floor - to avoid germs on the floor.

A variety of drainage bag holders is available. Some hang onto the side of metal beds, others are floor stands or can be used with a divan style bed.

Selection of large-capacity drainage bags will depend on the intended use. A consideration when the user will manage the bag is the type of outlet tap, which must be easy to use with simple distinction of the "on" and "off" positions.

Sheaths, Body-Worn Urinals and Other Devices for Men

Penile Sheaths

Men and boys may find a penile sheath offers advantages. A penile sheath - sometimes called a condom urinal or an external catheter - is a soft sleeve which fits over the penis to collect urine and is attached to a leg drainage bag.

The sheath may be self-adhesive, or you may need to use a separate adhesive. Sheaths are available in latex or non-latex materials and come in a range of sizes. It is very important that you are measured for the correct size and learn how to apply the sheath. Many companies have a free Helpline and provide a measuring or sizing kit. Most sheaths can be used once only, and most are available on prescription. They can be used during the day, at night or left on for 24 to 48 hours and then changed. Many men prefer this method to wearing pads, especially if they are travelling away from home.

Body-worn urinals

Body-worn urinals come in several designs depending on the type of leakage. They will provide a resort if you dislike or cannot use absorbent pads etc, or a penile sheath. Drip and diaphragm urinals are suitable for men with a moderate dribble. Pubic pressure urinals and penis and scrotum urinals are designed for men with a retracted penis. They drain into a legbag or (in the case of the drip urinal - illustrated) into its own reservoir. They are normally fitted by an experienced appliance practitioner, who can advise on the best type for you. They can be left on for longer periods and will last for several months if they are washed and stored according to the instructions. Most are available on prescription.

Tips about Sheaths and Body-worn Urinals

• Sheaths and body-worn urinals need to be the right size, to allow for natural movement of your penis, but not so loose that they might leak or fall off. · Sheaths with a bulbous outlet are less likely to kink.
• A self-adhesive sheath with an applicator is easier to manage if your fingers are not very nimble.
• A sheath is not suitable if the penis is very small or has become retracted. A larger shaped pad or a body-worn urinal is better.
• It is important to wash and dry your penis and surrounding area thoroughly before putting on a fresh appliance.
• Washing and drying urinals regularly will help to prolong their use.
• No appliance can be guaranteed to be 100% waterproof. Leaks are less likely if you follow the manufacturer's instructions.

Other devices for men

These include the penile clamp (which should be used with extreme caution, fitted by an expert and reassessed regularly), retracted penis pouches and urine directors.

For further information about these, please contact the Continence Foundation Helpline

Devices for Women

There is a variety of devices specific to women which should only be used under the supervision of a health professional. These include vaginal cones, electrical stimulators and biofeedback instruments to help with pelvic floor exercises.

They also include the following:

VAGINAL DEVICES

There are at least two devices that are inserted in the vagina and work by elevating the bladder neck and providing mild compression on the urethra or bladder outlet.

One - the Conveen Continence Guard - is made of medical-grade foam, is for single use only, and is available by mail order (it costs about £50 for a pack of 30).

The other - Contiform - which may be used for up to a month, is made of santoprene (widely used for medical purposes) and is available from some high street pharmacies at about £15

Contiform

For further information about these, please telephone the Continence Foundation Helpline

Devices for Bowel Incontinence

There are a few devices specifically designed as an alternative to pads to help you cope with leaks from the bowels. They should be used only under medical supervision.

The anal plug

This can be used by adults or children. It is a small foam tampon with a long string for easy removal. You insert it into the back passage in its compressed form as supplied. It then expands inside the body (the illustration shows it compressed and expanded) and can be left in place for up to 12 hours, though you will need to remove it for a bowel movement. The plug is useful when swimming or out on special occasions.

Used plugs can be disposed of with domestic waste but must not be flushed down the lavatory.

Not everyone finds a plug comfortable or effective. It is available on prescription.

The faecal collector

This is a bag with an opening which is cut to fit around the back passage or anus. A flange of flexible foam backed by skin barrier attaches to the skin around the anus. The bag can be emptied via the drainage outlet for liquid faeces, while a clamp can be used for more solid faeces.

The advantages over a pad include containment of odour. The bag will, of course, contain deflatus (wind) as well as faeces.

A faecal collector is unlikely to work well if the user is seated and there is a tendency for the bag to peel off the skin if the user is walking.

Faecal collectors are not cheap and are not available on prescription.

Enuresis Alarms

Adults as well as children (usually from the age of 7) who wet the bed will often find an enuresis - bedwetting - alarm useful. It is a device that prompts you to wake up when your bladder needs emptying and to hold on until you can get to the lavatory.

There are two types:

• a bedside alarm with a sensor pad that is placed under the bottom sheet, and connected to a control box placed by your bedside
• a personal or mini alarm with a sensor worn inside a slim pad or in Y-fronts by men. It is connected to a control box pinned to your night clothes.

Alarms are available with sound, flashing lights and vibrating signals. Most cost between £30 and £65, but they can often be borrowed from local enuresis clinics.

Advice on children's bedwetting is available from ERIC - the Enuresis Resource and Information Centre - telephone 0117 960 3060.