There are several different types of catheter – condom, intermittent, urethral and suprapubic. Which one is used depends on the severity of a person’s condition and symptoms and how long the catheter is needed. Different types of catheter can be used at different times depending on a person’s changing needs. An indwelling catheter is used when all other types of treatment have failed. The best alternative to it – a condom catheter or intermittent self catheterisation – is usually considered first.
External catheters are the least invasive for draining urine and are available as penile sheath catheters for men (condom catheters). Here, men talk about their experiences of using a condom catheter. Because this website focuses on the experiences of people living with a long-term indwelling catheter and intermittent self catheterisation, a condom catheter – if used at all – was usually used only in the short-term. When it became clear that an indwelling catheter would be more suitable, the condom catheter was no longer used. Condom catheters are a good way of collecting urine in men who have no urinary retention or urinary obstruction and can use their hands well enough to be able to use the catheter themselves. With condom catheters, the risks of damaging the urethra and of infection are less.
The external catheter or condom catheter is useful because it avoids having to pass a catheter through the urethra. It is only applicable in males, but it is a condom which is rolled onto the penis and it has an adhesive surface to it which maintains it itself in position. So that is the condom fitted onto a penis and the end of the condom is drained into a leg bag.
Now this is of value in some elderly patients who are troubled with incontinence when they are in bed. But the problem is that in elderly men the penis retracts and the condom comes off. Or sometimes the condom can twist around and then it fails to drain and urine then builds up behind and washes the catheter, the condom off the penis. So there are problems with maintaining a condom catheter in position. If it can be maintained in position that’s very good.
But then there are other occasions when sometimes men develop an allergy to the adhesive on the condom, and they get a serious skin reaction. So there are always problems with every type of appliance that you do use. But it is useful in some cases.
A condom catheter is a urine storage device that can be used to treat short-term incontinence in men. It consists of a flexible sheath that fits over the penis just like a condom. The condom catheter is rolled onto the penis and attached to it using double-sided adhesive, a jockey-type strap or a foam strap. The catheter is connected to a tube that drains the urine into a drainage bag. Condom catheters are available in many sizes. Leg bags also come in different sizes and can vary from brand to brand.As the bag fills, it becomes heavier. Condom catheters are available in latex and silicone. Latex rubber can cause problems for some people with allergies. A condom catheter and leg bag should cause no problems in normal daily activities. John Y, a 77-year-old man with a neurological condition called spastic tetraparesis, started using a condom catheter when he found he had to pass urine urgently. A urologist [a doctor who specialises in urinary tract problems and the male reproductive organs] later recommended an indwelling catheter.
John is a retired medical practitioner. He is married and has three children. Ethnic background/nationality: White British.
I’m 77 and I retired just before my 63rd birthday because I was having neurological problems, largely to do with my legs. At that time I didn’t have any urinary problems at all. But the disease I’ve got is progressive and my arms are affected. My legs got more and more bad, weak, till I became wheelchair bound about four, five years ago. And my arms are beginning to be affected now too.
About two years ago I was aware that I was having to strain to pass water. I did try and mention it to my GP but he didn’t take it seriously at the time. And I said, “Perhaps I’ve got retention with overflow.” And he pushed me in the tummy and said, “No, you haven’t.” And I think he may have missed a chance at that point to spot that something was going on.
Anyway I used to control my, I used to have urgency micturition [urination] which was a great problem. So I started wearing a Conveen during the day and a leg bag. And this meant that it didn’t matter where I was. If I had to pee, I could just pee and it went into my leg bag.
Could you talk about that in a bit more detail, the advantages and disadvantages of having that?
Well if I had been able bodied I could probably have just run to the loo. But because I was wheelchair bound, there was no way I could deal with it. And when I got about 200, 250 in my bladder, the reflex would set and I had to pee. And that was why I wore a Conveen.
If I was going out for an evening, I used to fluid restrict myself a bit so that I knew the bag wouldn’t be a problem. And this particular night, about thirteen months ago, I did fluid restrict before I went out.
When I came back my wife said, “Oh you haven’t passed much urine in this bag, you’d better drink some water.” And I said, “Well actually I think I’ve got some in my bladder and I haven’t been able to pass it.”
So I was aware then that there was a problem. And I did something a bit stupid. I tried to drink myself out of it. I thought well I’ll drink lots and see whether or not I can pass any urine and I didn’t. I got progressively more and more distended and then I did manage to pass some, I passed about 900ml.
But by the time the emergency doctor came, even despite that he said I’d probably got another six or seven hundred still in my bladder. And he initially said, “But as you’ve passed 900 shall we just wait a couple of hours and see if you can pass some more?”
This is your GP?
No, this was the emergency doctor. He was a GP but it was an emergency thing. And I think that was a mistake really. I think I should have had a catheter in at that point.
But anyway three hours later I phoned him up and said, “Can you come and do it?” And he said well he was busy with something but he’d got a nurse by his side who was experienced and he’d send her.
She came and she put a urethral catheter in, and I had that in for a couple of days. I consulted with the GP and I said I’d like to be referred to an old friend, who was a urologist I’d known for years. I went to see him and he was very concerned about how much I’d distended my bladder because he said, we reckoned I’d had more than 2000 in it at one stage.
This is a urologist?
A urologist. And he said, “Oh I don’t think it will recover at all. I will investigate you if you want but I think, with you being in a wheelchair, the simplest thing to do is
Badg and Martin tried condom catheters when they were first spinally injured. Badg spent 7 months in a spinal injury unit and, after being given a urethral catheter first, nurses tried to see if he could manage with a condom catheter instead. He found, though, that for him it caused the onset of mild autonomic dysreflexia.This is a potentially life threatening condition that needs immediate medical attention. It occurs when the blood pressure in a person with a spinal cord injury above T5-6 becomes excessively high because of the over-activity of the autonomic nervous system. The most common symptoms are sweating, pounding headache, tingling sensation on the face and neck, blotchy skin around the neck and goose bumps. The symptoms may not all appear at once and their severity may vary.
Badg is a married IT consultant. He is self-employed and has two children. Ethnic background / nationality: White British.
Approximately 17, it could have been 18 years ago, I was trimming the hedge at the bottom of the garden. I fell off the steps, broke my neck, C6/7 incomplete. I finished up at the spinal unit. I had seven months in there.
I had an indwelling catheter while I was lying down on traction. I stayed with that and then started to experiment with that, or the nurses in the spinal unit did. We tried, because I was incomplete, it’s a slightly reflex bladder and slightly not. So we did have a go at condom drainage but it doesn’t work very well. It makes me slightly dysreflexic, but only just very slightly.
So then I was offered a suprapubic catheter, which was not an easy decision at the time, not knowing what it was going to be like, which you never will till you’ve got it. I just talked to other people about it. Everybody I’d met seemed fairly happy, except the guy on the bed next door who had a terrible problem with blocking all the time with any catheter.
The main disadvantage of condom catheters is irritation if attached too tightly. Penile ulceration, scarring and penile tissue loss can result. Dislodgement and leaking can also be a problem. Making sure the tubing is either taped to the leg or strapped so it will not move around can solve the problem of dislodgement. The catheter tape and adhesive can make some people sore.
Charles, who had multiple sclerosis since 1986, started using intermittent self catheterisation (ISC) in 2005 when he found it hard to control his bladder. In 2009, he developed brachial neuritis, which limited the use of his hands so ISC became more and more difficult. When he damaged his urethra while trying to self catheterise, he had to go into hospital. He tried using a condom catheter but said ‘you need the right penis for it’.
Charles was a computer engineer before he retired. He is married. Ethnic background/nationality: White British.
They also tried me on sheath catheters, on basically a condom drain rather than using a bottle.
Can you talk about that for a bit?
Well, the sheath catheters are a good idea but I think you need, to be blunt, you need the right penis for it.
The right penis for it. I think you actually need to be, you can’t really have a foreskin with that sort of thing.
Does it get sore?
No, it’s not that. It’s just that if you put it on, then the foreskin moves around a bit and it comes off. And it wrinkles and it doesn’t stick very well. So you actually get, the problem is it will crinkle up and leak. And so it, for me, wasn’t a success.
For other people I believe it worked okay. But I tried it for a good two, three weeks. But I should think in that period I probably had, in the bed, four accidents. You know, especially at night.
Then it was decided that, I think, to put me forward that I should have a suprapubic catheter.
Was that because sometimes you were leaking when you weren’t using the bottle and you couldn’t control the urine flow?
I think, yes, I was on inco sheets, which were the sheets on the bed all the time, just in case. I mean I was still on the oxybutynin and the Desmotabs [medications] in hospital and I’d got beyond that. You know, I had a problem.
So I needed a collection method of urine, otherwise I would be wearing nappies or something like that all the time.
Stuart said he hadn’t met anyone yet who’d been able to get on with a condom catheter. He felt that such a catheter was ‘a non-starter’ for him personally because he had very little use of his hands after a spinal injury.
Stuart is retired. He is separated and has 3 adult children. Ethnic background/nationality: White British.
For nearly 37 years there have been no changes to the Foley Catheter. And the alternatives to it, such as the Conveen or intermittent catheterisation, that one is a non-starter for somebody like myself whose hands don’t work.
With regards to the Conveen, I’ve yet to meet anybody who has had a long term success story with that, either because of the irritation from the glues that are used to attach them, or from the variation in size of penis during the day, trying to keep them on at whatever the state of play is. And so of all of the alternatives, the suprapubic is much the most favourable, but does create a lot of infections.
Infection is a risk with condom catheters too. Peter Y, who’d had a spinal injury after breaking his neck in a car accident, used a condom catheter for over 30 years. He then changed to a urethral catheter around 2003 after several infections and urinary retention.
Peter manages the 21st Century Catheter Project website and is single. Ethnic background/nationality: White British.
From 1969 till about 2002, I used a condom. In fact two or three different kinds in that time, and connected to a leg bag. And I remember going for the first ten years with no infection.
I had a period of stress at that time and got an infection. And I also had some difficulties with some relatives who had chicken pox who came very close to me. And, although I’d had chicken pox as a child, the side effects I got from that went straight into my kidneys in that I blew up like a balloon and my water balance was completely shot. Those were minor issues afterwards in that I did recover quite well and was still using a condom in 2002/3. And so I got a long time using that system.
Then I had, this is a recurring theme, I had another quite big period of stress in my business life because I have, although I’m in a wheelchair, I have worked all my life more or less, not immediately after the accident but very quickly afterwards. As a result, I found I wasn’t passing water during the day. I was passing water at night, fairly filthy looking stuff, but I wasn’t passing it during the day which was yeah, is bizarre.
So I went to my GP and it actually took nine months to refer this to a consultant at the local hospital, which was too long. And I was feeling pretty groggy by the time the urethral catheter went in.
Most of the men we interviewed who used a condom catheter did so before having an indwelling one, but Kenneth started using a condom catheter after having had a urethral catheter for 8 years. He’d been diagnosed with prostate cancer in 1994 and became incontinent after the surgery. In 2002 medical staff found it impossible to insert a new catheter and he now uses a condom catheter. He has learnt about it through trial and error.
Kenneth was an engineer and surveyor before he retired. He is married and he has two grown up children. Ethnic background/nationality: White British
You had the catheter for about eight years, you said?
And then finally what made you decide not to have one anymore?
I didn’t decide. My body decided, it decided it for me. It just rejected the catheter. Every time it was put in, it wouldn’t go in, it was rejected. So then it was suggested that I tried a Conveen. Which, I haven’t looked back since.
And how do you get on with the Conveen? Do you find that quite easy?
Fine, yes. Change it every day, wash at night and, as I say, change it every day. And absolutely superb. Don’t look back.
How often do you actually have to empty that? Does it drain into a bag?
No, the Conveen is attached to the end of the penis and then it’s attached to the bag. The bag lasts a week, washed out every day. The Conveen I change every day in the evening when I have a shower.
You put a new one on?
Yes. I have tried it going longer but it’ll do two days if necessary. Three days, then you run the risk of the adhesive breaking down and it comes away.
Do you find the skin gets sore at all?
Occasionally. The worst thing of course is, if you’re not careful when you put it on, you get blisters on the end, which is painful. But then you just have to put up with it, don’t you?
And does that drain into a bag that you strap to your leg again?
Yes, just the same as with a catheter.
And how high up the leg would you position it?
Just below the knee.
So that works quite well?
Yes, just top strap there, bottom strap there.
I think your doctor will tell you what size is required. And the only advice I can give is cleanliness. Wash every day. Do not miss, it doesn’t matter how tired you are at night, wash, get it clean, keep it clean. I should think that is half the battle of being healthy. But you must, and I can’t emphasise it enough, keep clean.
And what about everyday life with a Conveen? Do you have the same problem that you can’t go for very energetic walks?
Or is it easier?
No, it’s not easier.
Because you’ve got the bag there?
You’ve got the bag there and if you’re not careful, a long walk would cause a blister.
At the end of the penis?
Yes. So therefore you do short walks. And, as I say, you’ve just got to be careful that the tube doesn’t twist when it’s on the end. Because if the tube twists against the bag, it stops the wee coming through and it’ll rub as you walk.