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.

Pant Hooks

There have been more than a few medical professionals, often from locations where the number of quadriplegics are far fewer, who assumed that catheterization can only be completed, entirely unclothed, while laying on a bed or stretcher. That is an unfortunate and unrealistic understanding by people who should, as much as they need to preserve people's lives, be aware of the need for quality and normalcy in those lives.

In the previous post I spoke of catheters and some of the options available. Aside from performing the task of catheterizing as mentioned in the linked post above, it can be quite simple with the appropriate piece of equipment. The photo is of the technology I devised and, once again, my dad built for me.

Very simply, a piece of welding rod tacked onto a large lock washer then covered with rubber or plastic hose. To each washer a length of desired material was secured. To use it, one hook is secured to the waistband of your pants and underwear while the other end is hooked to the frame of your chair to keep the clothing away from your body.

The red pant hook on the right is 16 years old and still going strong. It is starting to show signs of wear, despite re-taping the crimps that hold the bungee cord to the washer. The hook on the left is my newest iteration with a slight increased angle to the hooks so they hold more securely and the washers being joined by a precisely measured and tied length of paracord.

I don't know how many more years the original hook will last. I have one in my backpack that always stays with me, a spare in the drawer and another at my parents' house. So, when it gives way I will certainly have readily available replacements as well as the original hooks which can easily be re-tied with a new length of bungee cord or paracord.

Regardless of how long it lasts, I know that it has outlasted the original version conceptually thought up by me and fabricated by my occupational therapist while I was in rehab. The one she created was a composition of elastic waistband, coat hangers bent into shape, covered by hard plastic coating. The coat hangers were not covered in any protective material and punched holes in my clothing. As well, after just a few weeks of using it the elastic was already beginning to fray.

Men Versus Women

I know that the system works for me whether I am wearing sweatpants, sport pants, jeans or dress pants. I also know that the amount it is able to lower properly fitting clothing would not be adequate for a female quadriplegic. I understand that there are women who have chosen to have clothing modified with Velcro closures and others who simply need to take the time to lower their clothing far enough to get the job done. That is the extent of my understanding and if any of the female readers of this site wish to contribute technology, be it an actual device, modification or just information, it would be greatly appreciated.

Source: Custom-made by anyone who has basic welding ability. Many of the bungee cords you can buy now have plastic hooks that are much thicker and would reduce the concern of damaging clothing or skin. The difficulty might be in finding the appropriate length of cord so that the tension between pants and wheelchair frame is correct.

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!