Aids and Appliances for Urinary Incontinence

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1 Aids and Appliances for Urinary Incontinence Alison Stubbs, RGN, Clinical Specialist for WyMedical Ltd Tel Abstract Functional incontinence, where toileting has become problematic due to reduced mobility, can often be resolved with the use of some of the many aids and appliances now available. Over the years there have been many developments on aids such as hand held urinals to promote continence and appliances to contain urine, most of which are available on the drug tariff but are not necessarily well known or widely used. Key Words Handheld urinals, aids and appliances, urinary incontinence. Incontinence is both distressing and debilitating, it can lead to depression, prevent a person from leaving the comfort of their home and cause conflict between the individual and the carer. Incontinence is a major contributory factor of admission to a residential or nursing home with it being second to dementia in leading to the move and up to 40% of the residents of a nursing may suffer with urinary incontinence. (DOH, 2000) Functional incontinence can be a problem not only to the sufferer but also the spouse or carer by placing additional pressures with increased cleaning and washing. Sufferers often end up with having to wear incontinence pads or having a catheter inserted to be able manage their problem as these are often the more popular choices. However, there have been many advances with regard to the development of aids such as hand held urinals to help promote incontinence; and appliances to contain urine, the majority of which are available on prescription but are often overlooked as a way of managing the problem. This article is aimed to introduce some of the aids and appliances available. Aids for Promoting Continence Hand held urinals Hand held urinals are designed to be used by the sufferer or carer and are therefore smaller than traditional urinals or bed pans. They are invaluable for those who have impaired mobility and are unable to transfer or get to the toilet. The different designs available from companies cover the needs of those who are chair or bed bound. When considering which urinal may be best suited for the individual the following should be considered.

2 The position in which the urinal is going to be used, some are better when lying down whilst others when sitting. The dexterity of the person who will be using it. The clothing and accessibility- ability to get the urinal into position for example drop fronted pants for women who are chair bound make the use of a urinal much easier. The flow of urine and the amount of urine being passed- it is essential that the system selected is able to cope with the fluid. Ease of cleaning the urinal. Some of the hand held urinals have been designed to be attached to a urine drainage bag, this provides the advantage of the urinal being able to be used for multiple voids for instance overnight or where a carer is only visiting periodically throughout the day. Absorbent gel is also available on prescription, this can be added to the urinal prior to use and prevents spillages when removing the urinal after use. If using a gel it is imperative that the design of the urinal is one which can be cleaned easily to remove all traces of the gel. Hand held urinals often take time to perfect the usage and initially there may be some problems with leaking or misplacing the urinal. Advise the user to try and become accustomed to using the urinal when the bladder is not over full to gain confidence and to allow time to adjust to the right position. Encourage them not to give up and to place a towel or washable protective pad underneath them until they master the technique. There are several different handheld urinals available either on drug tariff or to purchase and it is worth contacting either the continence service or manufacturers for further advice. Picture 1 URIfemfemale Urinal from Manfred Sauer. This urinal is ideal for use in bed and can be used either laying down or semi-recumbent.

3 Picture 2 Pictured left is the Beambridge Saddle urinal designed in a wedge shape to enable it to be pushed down into the mattress to get it into position under the lady. Pictured right is the Bridge Urinal from Beambridge, this is designed to be used either in a bed or chair and can be attached to a drainage bag as pictured. Funnels/ Urine Directors Some men suffer from the penis retracting into the body or a poor flow of urine and present with soiling of their clothes as the urine flows down the front of the scrotum. If there is still some length of penis, a urine director can be tried to direct the urine away from the body into the toilet bowl. If the gentleman is not ambulant a drainage bag can be joined to the end of the funnel and used in a sitting position. If the penis is totally retracted or there is evidence of an enlarged scrotal area or hernias, a large plastic household jug can be used and the gentleman should be advised to place the penis and scrotum into the jug so the urine is collected. Funnels/ urine directors are also available for women and can be particularly useful when the stream of urine sprays outwards; they can also be used directly into the toilet or attached to a drainage bag. Picture 3 Beambridge Medical male and female urine director/funnel.

4 Pocket/ portable Urinals Discreet pocket sized urinals have been developed to enable those with functional incontinence or for those suffering from urgency to lead a more normal life and they can be used either standing or sitting. Toilets are not always accessible to wheelchair users and portable urinals prevent having to carry around cumbersome urinals and can be easily emptied down a drain if a toilet is not available. Pocket urinals can be placed discretely in a pocket or handbag and once used can be placed in a plastic bag until they can be emptied in a convenient place. Pictured above- the Unomedical UnoComfor portable urinal- designed not to spill and can hold up to a litre making it ideal for multiple voids but it is not available at present on prescription. Pictured below- the Manfred Sauer URIbag male and female versions. Appliances for containing urine. There are many different appliances available for men to contain urine, although one piece sheaths have become the most popular device there are many other products available on the drug tariff. Many of which can be tailored to meet the preferences of each individual and their level of incontinence by selecting different combinations of the systems available. When deciding which appliance may be the most suitable the following should be considered.

5 Mobility- some appliances are less suitable for people who are very active. Manual dexterity- some appliances have straps and fastenings. Eyesight- good eyesight may be easier when fitting an appliance although the option should not be ruled out as it may be possible to fit the appliance by feel. Personal preference- some people may want something which can be removed easily during the day. Degree of incontinence- there are different systems to suit the level of leakage. The flow of urine. Penile length. Leg Amputation can reduce the choice of some body worn products. Stoma- a stoma site may be affected by the straps of a body worn appliance. Allergies to latex. Personal choice. Body worn Appliance Systems Not everybody wishes or needs to wear a drainage system for the whole day or may have difficulties keeping a sheath in situ due to penile retraction. In these incidences it may be worth looking at a body worn appliance. Body worn systems comprise of different parts, some involve belts and straps whilst others are pant-like garments with a stoma like bag. For men whose penis retracts making a sheath unsuitable, a pubic pressure device provides gentle pressure at the base of the penis against the pubic bone to prevent the penis from retracting. These systems rely on tension from belts and straps which need to be firmly applied and can take time for the skin to adjust to wearing the appliance for any length of time. These systems have evolved over the years and have become less bulky and it is worth seeking advice from a nurse specialised in fitting body worn appliances to ensure the system will be suitable for the problem and to provide specialist advice. If the gentleman has an enlarged scrotal area due to hernias, hydroceles etc then the penis is likely to retract or may even be totally retracted. In these incidences the above mentioned body worn systems are not recommended due to the nature of the straps and the level of tension required.

6 The Hollister retracted penis pouch (pictured left) can be used effectively to manage problem. The flange area can be cut to the diameter of the penis and the penis placed into the bag and then stuck to the skin area around the base of the penis. To enable a greater drainage capacity and to prevent the pouch pulling the skin it is best to attach a leg bag to the end of the bag. If the penis is partially retracted or the shaft of the penis has become sore from wearing one piece sheath then it is worth trying the Bioderm from Clinimed (pictured below). The Bioderm is an external urine drainage device which sticks to the glans of the penis with thin hydrocolloid petals and tape, this can then be attached to a leg drainage bag and left in situ for up to 3 days. With all aids and appliances References Department of Health (2000) Good Practice in Continence. London: DoH Manfred Sauer, (2005) Tutorial for continence systems. Manfred Sauer (UK) Ltd. Northampton. Stubbs A (2007) The successful management of urinary sheaths. Continence UK 1(2): 16-20