The catheter can be drained either continuously into a urine collection bag or one can use a catheter valve and drain the bladder intermittently. The advantage would be to use, for the patient, would be to use a catheter valve to drain the bladder and, in those circumstances then, they don’t have to wear a urine collection bag. But they do need good manual dexterity and they need to have good cognitive ability too.

Many people have a catheter because they are unconscious maybe, or they are undergoing surgery and you are having to monitor their urinary output under these circumstances. But if the bladder is being drained for somebody who’s developed retention of urine, then a catheter and a catheter valve was very much easier for the patient than having to wear a urine collection bag on the leg.

The catheter valve, it’s quite crude. But this is known as a flip flow valve and this fits into the end of the Foley catheter. And this can be just drained. The flip flow catheter can just be drained by turning this lever. That is the catheter valve fitted into the end of the Foley catheter, just like that. And it comes out and can be fitted into the end of the catheter.

The actual [suprapubic catheter] operation is done at the bedside. And I’m, you know, a bit flip about it. This bloke comes along with a local anaesthetic and a Black & Decker and drills in and chucks the, puts the tube in and away you go.

I mean, again it’s a, the operation is, well, you don’t see it to be quite honest. And you don’t feel it. And I never felt any pain regarding it. So you had an idea something was going on. I mean it wasn’t noisy or anything, so it wasn’t upsetting from that point of view. Obviously you’re a bit nervous about it because, you know, something’s being shoved in your body, which is unusual. I mean it’s not like putting an earring in or something like that.

But, you know, as I said, I’d made up my mind that this is the way I wanted to go. So maybe was prepared for the worst. And the worst was nowhere near what actually happened. I mean it was very, very simple. The catheter was put in, bags were put on.

I was given basically a list from a supplier of what was needed and I decided to go for, very quickly actually, for a flip flow because that actually gives you the benefit of being able to disconnect leg bags or night bags with ease. it’s like isolating part of your central heating system. I mean it was a very good thing to do.

Has it a valve you can close and open?

Oh, yes, a little valve. So you have the catheter, then this thing plugs in, which is about, it plugs into the end of the catheter. And you then plug your leg bag into it. I actually opted for a large-volume leg bag, which is three-quarters of a litre. Normally it’s only half a litre. But I did that because I decided very early on to take their advice and drink lots.

I only ever had a valve. Unless I was obviously admitted into the hospital with an infection, then they would make me put it on a bag so that they could measure the urine output and the colour of it and things like that.

But when I was at home having my usual, normal social life, I never had a bag on in case it burst or something.

So you could wear clothes without people noticing?

Yes, yes. I used to just tuck it down the side of my knickers or under my jeans or whatever.

I have a flip flow mainly because I was told as an in-patient that I should have one. That it was healthy to block off the catheter and actually let your bladder expand and to try and mimic that natural process. And then I know so many people that don’t know about flip flows, don’t use flip flows, and I think it would be interesting to know a bit more about flip flows.

I went to a conference as a user and we did a panel. And one thing that came up in conversation there as well, does a flip flow actually do anything anyway? The idea that the paralysed bladder has any elasticity, is it worth bothering with etcetera? And that was quite interesting and, to this day, I will always use a flip flow because if it stops my bladder shrinking, stops me having to have any surgery to correct problems that have happened as a result of not flip flowing, then I’d always rather err on the side of caution and use one. But there’s so many people I know that don’t use them.

Nobody’s mentioned one before.

Right.

So that’s quite interesting.

Yeah. Even people who went through the spinal unit with me, some of them weren’t advised about flip flows and some were. There didn’t seem to be any great consistency. And it would be interesting to understand a bit more about flip flows and whether they do actually do what I think and hope they might do or not.

I was always determined to be as independent and as normal as possible, to make as much recovery as possible. And some of the nurses started encouraging me to consider doing intermittent, using a flip flow valve on the catheter so that I would collect urine in my own bladder and then empty it.

They were reluctant, I have to say the doctors were not so keen on this in the hospital. I think maybe because of more infection rates, I don’t know. But they were a little bit resistant to this, but I was very keen because it made me feel like I was getting better, if that sounds that that my bladder was expanding and collecting urine. I could actually feel when my bladder was, it pleased me because I could feel that my bladder was, when my bladder was quite full. I didn’t have any leakage urethrally.

Did the nurses explain why they thought it was a good idea?

They thought it was a good idea for me because I was quite young and quite active and determined to sort of keep going.

I’m surprised the doctors didn’t think it was a good idea.

Just slightly more conservative I think. As it turns out I’m back on a leg bag. Because I came home with the, doing it with the flip flow and collecting it in my own bladder.

Oh I see, with no bag.

With no bag. I came home doing that, but that’s when I started getting infections. I had some UTIs when I was in hospital with reasonable regularity, but I suppose I was so busy doing physiotherapy, the whole routine was such that I wasn’t, I didn’t fall prey to infections in the same way. I didn’t have so much time to notice them if you like.

When I came home I was still doing the flip flow with the valve. I started to get infections and I could smell when the urine was, I could smell immediately when I had an infection. I took advice from the spinal unit who said well one thing to do is to go back to the leg bag.

Do you sometimes close it off using the valve even though you’ve got a bag?

No.

So it’s just on continuous drainage?

it’s on continuous drainage, yes. So when the infection, the urinary infections started to take hold after I’d come home, I fairly swiftly went back to using a leg bag strapped to my leg reluctantly. But I thought it would just be temporary. Unfortunately, I’ve remained with it. I think given my hand function, it’s probably a bit easier. it’s probably slightly easier for me to manage. it’s less, I feel more disabled with it and I feel less like a normal woman if you like. But maybe I’m just being a bit more realistic and accepting that the flip flow wasn’t really suited for me.