Leg Bag

Last week we dealt with accessing the urethra entrance in order to drain it through the method of various types of catheters.

This week we will deal with collecting what is drained.

A popular method is the leg bag. Self-contained, light, reusable, easy to carry, durable and able to retain its contents until it is convenient to drain. This is my device of choice because of the resistance to leakage and the closed system that it creates when the funnel end of the catheter is connected to the universal connector on the hose of the leg bag. Different hose lengths are available, the one-way butterfly valve prevents liquid from flowing backwards out of the bag and the flip valve is fairly easy to open even with limited dexterity.

Leg bags are almost ubiquitous as the collection method for any permanent catheter such as an indwelling (Foley) or condom catheter. At night it can be hung over the side of the bed and by day the straps provided can be used to strap the bag to the user's leg or wheelchair frame. For use with intermittent catheterization the rubbery hose provides a good place to temporarily hang the bag over the side of a wheelchair while completing the catheterization process.

I am aware of people using pop bottles to collect urine, which has the advantage of being widely available, easily replaced, resealable and lightweight. However, it is not collapsible like a leg bag, requires some precise dexterity to align the funnel of the catheter and the opening of the pop bottle and is not a closed system while the urine is being drained. A few times in 16 years I have had a catheter disconnect from a leg bag or the valve get caught on my spokes and flip open, but I still feel a lot more confident about the security of my system than trying to aim a catheter into a pop bottle.

Extension hoses, not unlike the hose leading to the leg bag but longer, are another option that works quite well, is as compact as possible and instant to replace – leg bags require some assembly – but extension hoses require you to be near a toilet. For a short time I tried using them and just found that the control of the closed system of the leg bag was easier for me in the long run.

That is not an exhaustive list of the options available but some suitable options to consider if you are searching for a better bladder management system.

Source: Medical supply company.

Catheters

The topics posted this far have been fairly light. Nothing has been too terribly serious, deep or personal. This week begins a journey deeper into the realities of life with a spinal cord injury.

Most of the time when you hear someone who is not disabled talking about disability you will hear them use phrases such as, "They will never walk again." Or, when interviewing a person who is disabled that uses a wheelchair, will ask them something like, "What is the first thing you would do if you could walk again?" Seldom do they understand that the mobility is one of the lesser difficulties of a disability.

Hand function, normal urination, normal bowel function, normal sexual function – most of the disabled people I interact with place these far higher on the list than worrying about climbing a flight of stairs.

That said, I begin with bladder management.

The first step in the process is to access and drain the urine. Intermittent catheterization is just that, periodic insertion of a catheter to drain the bladder. Typically this is only available to persons with spastic paralysis. That is, people whose sphincter will remain tight without interference from a source such as a catheter. This is the type of catheter I use and it was a good day when I was informed about hydrophilic catheters. Prior to that I was using a standard rubber catheters that require lubrication applied to them externally. With hydrophilic catheters there is a coating on the outside of them that holds water making them very slippery right out of the package. They were a great help in reducing my issue with inserting the catheter, reducing infections and avoiding causing strictures. If the person develops incontinence over time, does not have spastic paralysis, or is recovering from bladder surgery a catheter such as an indwelling catheter or a condom catheter may be used.

An indwelling catheter is one that remains inserted for a period of time, with the help of a balloon that is inflated with saline solution once the catheter is inserted. These need to be changed on a regular basis, often accompany persistence urinary tract infections and some research shows that they may be a cause of cancer with long term use. One additional note about both types of inserted catheters, there are styles that have a special curved tip designed for easy insertion should a standard catheter be too difficult because of a narrow urethra or other restriction. These are called Tiemann catheters.

For males, an alternative to a catheter that is inserted is a condom catheter. Exactly as it sounds, it is a condom that is glued to the skin and has an opening at the tip with the appropriate fitting to attach to a urine collection device. These may be used by someone who does not have spastic paralysis or who has excessive leakage throughout the day. In the second case the sphincter may actually need to be cut so that the remaining spasticity does not cause the bladder to overfill and so that the bladder can drain entirely, which is best for preventing infection.

Next week we will look at accessing the area needed to catheterize.

Source: Medical supply companies.

On a side note, today's post marks the 16th anniversary of my injury. My, how time flies!