Managing with Products and Devices

There are many devices and products that collect and hold urine. They help manage urinary retention and urinary incontinence. With urinary retention, your bladder does not completely empty. With urinary incontinence (UI), you have urine leakage that you cannot control.

Products and devices can help men and women of all ages. For some people, they are the only way to manage bladder problems. These devices can also give older and disabled persons more freedom.

Indwelling Catheters

Foley Catheter
Foley Catheter
Image: Blamb/

Suprapubic Catheter
Suprapubic Catheter
Image: Blamb/

A catheter is a flexible tube placed in your bladder. An "indwelling" catheter stays in your bladder all day and night. There are two types of indwelling catheters. Indwelling "Foley" catheters are placed in your urethra. Indwelling "suprapubic" catheters go above your pubic bone through a small surgical cut in the belly. With both types, a balloon holds the tube in your bladder. They both also drain urine into a bag outside the body.

A health care provider will place the Foley catheter in your urethra. The catheter can be managed by home care nurses when used long term. A urologist places the suprapubic catheter with minor surgery.

A Foley catheter should only be used for less than 2 years. If you need an indwelling catheter for a longer period of time, you should consider a suprapubic catheter. Because the suprapubic catheter is only in the bladder, there is less risk of bacteria growing (because it is away from the vagina and rectum). That means less risk of urinary tract infections, especially in women.

Both Foley and suprapubic catheters need to be replaced with a new catheter at least once every month. This also lowers the risk of infection. Both catheters can cause complications if used for a long time. Bladder, testicle (males), and kidney infections, bladder stones and bladder cancer can occur. Foley catheters can cause permanent damage to the urethra.

Foley and suprapubic catheters should be taped or strapped to the upper thigh or lower belly. This lowers the chance of injury if the catheter is tugged accidentally.

Catheters are made from latex with Teflon coating or silicone. The choice depends on a person's allergies and the health care provider's preference. Some catheters are coated with antibiotics to prevent infection. There is debate about whether this works.

Indwelling catheters vary in shape, tube size and tip. They are sized using the French (Fr) scale. Size 14 Fr is the most common size. A balloon is inflated once the catheter is inserted. This keeps the catheter from falling out. The balloon is usually filled with about 2 teaspoons of sterile water.

External Collecting Systems

For men, there are external collecting systems called condom or Texas catheters. These special condoms are rolled over the penis. They are kept in place by adhesive or straps. The condoms have holes at the tip. A tube goes from the hole to a drainage bag. Urine from incontinence collects in the drainage bag. Newer condoms are usually silicone. They come in sizes, with a sizing guide.

This device may be hard to use if you have problems with finger dexterity. A caregiver or family member would need to apply the condom catheter. Adhesive pouches may be better for men whose penis has retracted (drawn back).

An external collection device for women funnels urine from a pouch through a tube to a collecting device. These must be stuck to the outside of the labia. They are rarely used as the labia do not form a good water tight seal, so urine leaks.

Urine Drainage Bags

Both indwelling and external collecting devices are connected to drainage bags. They collect urine coming out of the bladder. Drainage bags come in different sizes. Overnight bags hold 1500 to 2000 milliliters (1.5 to 2.0 liters) of urine. These are large and cannot be hidden.

A leg bag is a smaller drainage bag. It holds 500 to 800 milliliters. It allows more freedom of movement. It can be hidden under clothing. It can be strapped to the thigh or calf. A new type, called the Belly Bag, is strapped to the belly. Drainage bags work by gravity. So they should be strapped somewhere below the bladder.

When choosing a bag, make sure the strap is not too restrictive or tight. The valve that drains urine from the bag should be easy to open.

Drainage bags can be cleaned and deodorized. Soak 20 minutes in a solution of two parts vinegar and three parts water.

Catheters for Intermittent Catheterization (IC)

Intermittent catheterization is also called "in and out" catheterization. It is also called "clean intermittent catheterization" (CIC). Because it is clean you don't need gloves and sterile preparation.

A catheter is inserted in the urethra 3 to 5 times a day. After you empty your bladder, you remove the catheter and throw it away. You or a caretaker can insert the catheter. You don't have to wear it all the time. This lowers the chance of infection. And these devices don't have a balloon like the indwelling catheter.

Older men and women can perform CIC and should be on a routine schedule. The amount of urine in the bladder should be 15 ounces or less. Catheterization may be needed four to five times a day. Most healthcare insurances and Medicare will pay for 4 catheters a day (120 a month).

Most IC catheters are straight. Some (called Coudé catheters) have a curved tip. It may be easier for a man to advance a curved tip past the prostate gland. Catheter lengths are 6 inches for women and 12 inches for men.

You can get catheters and other supplies, such as lubricant, packaged together. These packages are helpful if you need to use the catheter at work. Catheter supply companies deliver catheters and other supplies by mail.

Absorbent Products

Absorbent products such as pads and adult diapers are available for incontinence. There are many designs. Some pads or panty liners have adhesive strips that attach to underwear. There are also undergarments, adult briefs and protective underwear. There are guards and drip collection pouches for men.

These products all absorb urine leakage and they help protect the skin from urine accordingly, they keep urine from wetting clothing. Pads can be disposable or reusable.

Absorbent incontinence products are designed to absorb and hold urine. Feminine hygiene pads are designed to absorb blood, not urine. The advantage of using incontinence products is that the surface area is closest to the urethral opening, which is above the vaginal opening. The pads are super absorbent and they cause less skin irritation and fewer rashes. Reusable pads are made of cloth with a rayon or polyester core and helps urine absorb.

When choosing a product, consider ease of use. Consider whether you need to remove outer clothing to change the device. Also consider absorbency, the liner, and the materials. For example, outside coverings made of plastic may irritate skin. Cost is also a concern for many people.

Toilet Substitutes

Portable devices can be very helpful if you cannot get to a regular toilet. These devices include commode seats or bedside commodes. There are also bedpans and urinals.

A bedside commode is placed close to the bed. It is easy to use at night or on a floor of the house with no bathroom. When choosing a commode you should consider its height and weight, how easy it is to empty, seat type, and cost. A soft surface may be more comfortable.

There are also raised seats (toilet raisers) that can help you get up and down from a regular toilet on your own.

Bedpans are usually not very effective or comfortable. Special fracture pans can help if you are recovering from surgery and can't get out of bed.

Urinals (plastic jug-type devices) are useful if you cannot move easily. You urinate into these devices directly. They can help when restrooms are not accessible. They are also useful when traveling. And they are an option if you are confined to a bed or chair. Most urinals, such as the newer spill proof ones, are easier for men to use. Urinals for women are not as easy to use.

Skin Care Products

If you are using incontinence devices or products, you may need skin care. Over time, urine leakage can cause skin breakdown, rash and redness. Urine on your skin can lead to bacteria growth and infection.

Soaps, skin products, topical antimicrobials, cleansers and skin barrier products can all help if used properly. Frequent washing with soap and water can dry out your skin. Rinses or cleansers made to remove urine may be better for washing the skin around the urethra.

Disposable wipes or wash clothes rather than toilet tissue may help keep your skin healthy. Moisturizing creams, lotions or pastes keep the skin moist. They seal in or add moisture. Barrier products protect the skin from contact with moisture. They lower friction from absorbent incontinence products.