Managing of Bladder Dysfunction with Products and Devices
Devices and products are used to contain or collect urine and are part of management of bladder dysfunction, particularly in persons with urinary retention or incontinence. Bladder dysfunction can result in urinary retention, which is when the bladder does not empty urine adequately, and urinary incontinence (UI), which is the involuntary or unwanted leakage of urine (See Table 1). In many persons with bladder dysfunction, products and devices offer the only option in the management of bladder dysfunction. Products and devices can be beneficial to both men and women of all ages and can allow older and disabled persons more independence.
Catheters are an integral part of managing bladder dysfunction in persons with both urinary retention and UI. An indwelling urinary catheter consists of a flexible tube placed in the bladder (either via the urethra or a suprapubic opening), which is held in place with a balloon and attached to a drainage bag. A urethral catheter is usually prescribed by a urologist and, if used long term, managed by home care nurses. A suprapubic (above the pubic bone) catheter is another type of indwelling catheter that is inserted by the urologist during a surgical procedure.
A urethral catheter (also called a "Foley" catheter) should only be used short term (two to four weeks) in persons with urinary retention. A catheter left in the bladder for an extended period of time can cause complications, such as infection and bladder stones. It is felt that a suprapubic catheter should be used in persons who need to have a catheter for more than two years. Because this catheter is inserted in the bladder above the pubic bone, there may be less contamination from fecal material (stool), which may mean less infection, especially in women.
In both men and women, if a catheter is used long term, it can cause injury to the urethra (the tube that carries urine from the bladder to the outside) and to the base of the bladder. Injuries occurring include tearing of the urethra or swelling of the urethra and scrotum. Anchoring the catheter to the upper thigh or lower abdomen using a strap can prevent these injuries.
Indwelling catheters are made from latex, Teflon coated or silicone. The choice of the catheter depends on a person's allergies and the doctor's preference. In an attempt to prevent infection, some catheters have been coated with antibiotics but there is debate if these catheters have any effect on decreasing infection.
Catheters vary in shape, size of the tube or internal diameter, catheter tip, and are sized according to the French (FR) scale, with size 14 being the most common size used. A balloon is inflated once the catheter is inserted preventing the catheter from falling out. The balloon size is either 5 mL (which contain 10 mLs) or 30 mLs, the later commonly used in catheters inserted following a surgical procedure.
External catheter systems
External catheter (condom) systems, referred to as penile sheaths and used to be called "Texas catheters", are used by men with UI. These types of catheters are rolled over the penis and kept in place by adhesive or straps. When incontinence occurs, the urine is collected in a drainage bag that is attached to the catheter. The material of newer sheaths is more likely to be silicone than latex. There are adhesive urinary pouches that are similar to ostomy appliances that may be more appropriate for men whose penis has "retracted." If the man has difficulty with hand and finger dexterity and manipulation, the ease of application and removal may be an issue with this type of collection device. A caregiver or family member would need to apply the catheter.
Since there are several sizes of condom catheters it is suggested that a measuring or "sizing" guide supplied by manufacturers be used when choosing a catheter.
There is an external collection device for women, which funnels the urine via a pouch to a tube and collection device. These devices require careful application so that the pouch "sticks" to the outside of the labia preventing urine from leaking around the device.
Urine drainage bags
Both indwelling and external condom catheters are connected to drainage bags, which act as a reservoir for urine drained from the bladder. Drainage bags used overnight are called bedside bags and hung over the side of the bed during the night. These bags hold 1.5 to 2 liters of urine and they should be emptied at least every four hours.
A leg bag is a smaller drainage bag that allows the person more freedom of movement. This smaller bag (capacity is 500 to 800 mLs) can be attached to the calf and concealed under clothing. Though most persons find the thigh the easiest place to strap a leg bag, the bag can also be strapped to the calf. A new type of bag, called the Belly Bag, is strapped onto the abdomen. When choosing a leg bag, the person should note the type of strap so that it is not too restrictive or tight and make sure the valve that drains the urine from the bag is easy to open. Drainage bags can be cleaned and deodorized by filling the bag with a solution of two parts vinegar and three parts water and letting it soak for 20 minutes.
Intermittent catheterization (IC) involves the regular introduction of a catheter to empty the bladder and is often referred to as an "in and out" catheterization. The catheter is removed after the urine is drained so the person is "catheter-free." Research has shown that by keeping the bladder empty and catheter-free, the chance of infection is less. Intermittent catheterization is performed using a "clean" technique (CIC). This means that the person performing the catheterization cleans the catheter with soap and water or boils the catheter after use and reuses the catheter for at least 7 days and then it is discarded. Most insurers pay for 4 catheters a month. Using this technique does not increase the chance of developing a urinary tract infection.
Age is not a deterrent to performing CIC; however it is important that the person insert the catheter to drain urine from the bladder on a routine schedule, usually several times a day as prescribed by the doctor or nurse. As a general rule, bladder volume should not exceed 12 ounces. Depending on a person's usual output, this may mean catheterization should be performed as often as four to five times a day.
There are two main designs of these types of catheters, polyvinyl chloride (PVC that is made from vinyl, hydrophilic that become slippery when water is applied to the surface of the catheter.
As with indwelling catheters, the catheter tip configuration is also important when choosing a catheter for CIC. Most catheters are straight, but using a curved tip, or Coude, can make it easier for a man to advance the catheter past the prostate gland. The lengths of these catheters are either 5 inches (for women) or 12 inches (for men).
There are also products that contain the catheter and other supplies such as lubricant all in a "self-contained" system that are helpful in persons who work on a daily basis and need to perform IC to drain their bladder while at work.
Absorbent products are available for persons with incontinence. They include a variety of designs such as pads or panty liners that have adhesive strips allowing for attachment to underwear; undergarments and protective underwear that are pulled on like regular underwear; guards; drip collection pouches for men; and adult briefs. These products absorb urine leakage thus decreasing exposure to the skin from urine wetness and preventing urine from saturating clothing. They can be either disposable or reusable. Additional products such as under pads can be used to protect the bed and furniture.
Absorbent incontinence products are designed specifically to absorb and contain urine. Other products such as feminine hygiene products are designed to absorb blood, not urine. The advantage of using incontinence products is that the surface area is closest to the perineum. It contains a super absorbent polymer that absorbs any leakage preventing urine from contacting the perineum, which in turn will cause less skin irritation and rashes. Reusables are made of cloth material with a rayon or polyester fiber core that aid in urine absorption.
When selecting an incontinence absorbent product, persons should consider the ease of use, especially if outer clothing needs to be removed when changing a saturated pad, and the absorbency of the product. Additional considerations include the make-up of the product in relation to the outside covering (plastic can promote skin breakdown) and the inside liner and the absorbing material. Cost is also a concern for many people.
Portable devices that substitute for a regular toilet can be very helpful for persons who have difficulty accessing a bathroom. There are two general categories: commode seats, or bedside commodes; and hand-held devices, such as a bedpans or urinals.
A bedside commode can be a godsend for a person with incontinence or a caregiver. It is placed close to the bed for easy use at night or on the floor of the house that does not have a bathroom. When selecting a commode, the person should consider its height and weight, ability to empty commode contents, cost and the type of seat (a soft surface may be more comfortable). Persons who are able to access their own bathroom may find using a raised seat (referred to as toilet raiser) helpful when getting up and down on their own.
Bedpans are generally not very effective or comfortable, but a "fracture pan" can be helpful for a person recovering from surgery who is unable to get out of bed.
Urinals are useful for persons who have severe mobility restrictions, particularly when visiting places with inaccessible restrooms, when traveling, or if confined to a bed or chair. The design of most urinals favor men, especially newer spill-proof ones that were developed for persons undergoing rehabilitation. Urinals for women are not very successful in collecting urine during voiding.
Skin care products
Skin care, in certain cases, is necessary when using any device or product for bladder dysfunction. If urine leakage is exposed to the skin for a long period of time, skin breakdown, rash formation and redness can occur. Furthermore, the presence of excessive moisture from urine can contribute to growth of bacteria that can lead to skin breakdown and infection.
Proper uses of soaps, skin products, topical antimicrobials, cleansers and skin barrier products, are all important in skin care management. Since frequent washing with soap and water can dehydrate the skin, a perineal rinse or cleansers that are formulated to remove urine may be a better method for washing the perineal skin. The use of disposable wipes or wash clothes rather than toilet tissue may be better for keeping the skin healthy beneficial to the skin. Moisturizers preserve the moisture in the skin by either sealing in existing moisture or adding moisture to the skin. Moisturizers can be creams, lotions or pastes. Barrier products protect the skin from contact with moisture and decrease friction from absorbent incontinence products.
Information provided by the American Urological Association.