the deal on condom catheters and post prostatectomy urinary incontinence

A popular search that ends  up on my site is “condom catheter.”  Here’s a primer and then a story about my experience with one.

 A condom catheter is a condom like device that is more sturdy  than a regular condom and has a spout at the tip that in turn  can be attached to  a bag, usually a leg bag that can  be strapped to one’s leg. The  advantage of a condom  catheter is that you don’t have to  wear  diapers. If a  post prostatectomy patient leaks only a small  amount then  the diaper is the better option. If there is profuse  leakage in which the patient is changing diapers often then sometimes the condom cath is better. For me my incontinence was profuse and diapers did not lend itself to working. I tried it but, changing diapers all  day became old quickly. Dr.   Patrick Walsh states in his  book that using a  condom catheter makes one lazy. That you become dependent on just catching the urine  and not actively using your sphincter  muscles, Kegeling, etc. I am not of that camp. I think that the return to continence has no rhyme or reason. Your  body just has to  figure  it out ,i.e.” Okay external sphincter, the prostate is now gone and you have to man  up and begin  puckering more  now…you have a more important and emphasised role  in me being dry. Get to  work.” Just like children, sometimes they listen  and sometimes they don’t. And as  always they  do  it on their timetable not yours.

• Not everybody can wear one. If the male has a  prominent suprapubic  fat  pad…a good seal that the part closest to the abdomen is not possible and the condom will just roll up and slip off.
• There are several  kinds.  In the old days the condom would roll on and then one would wrap a tape like strap at the base to hold it on. These were problematic because  the only thing holding the condom on is at the base and you would have to  do the strap so tight that it either was uncomfortable or might restrict blood supply. (I saw a  male patient this past week who was a  paraplegic and had used this type for years. The reason I saw him was for necrosis of the  skin  of the penis beyond the strap  he  was using. This is uncommon but does happen. He  will need  skin grafting the entire penis  circumferentially.)
• Probably the best one out today is the one that the entire  inside of the condom  is sticky, so there is adhesion to the skin of the penis throughout its entire length and is no strap. You put it on and then  squeeze the entire thing and it seals.  This is the kind I used and it worked out quite  well.
• They come  in  different sizes, mostly a diameter or girth  thing not a  length  thing, and this is important in the condom working well without leaking. Length is important in that this helps the condom stay on, i.e. there is more area for the condom’s adhesive to stick.
• A thin person, no suprapubic fat  pad and a penis with some length works better for a  condom catheter than an obese patient with a  penis with little  length. The condom  catheter is very discriminating my friend.
• They can be expensive as you would use one to three per day dependent on showers, etc.
• I would take my off for sleep, because a lot of incontinence stress  in nature. By that I mean it is worse when  you are upright and moving around.
• Whether a condom cath is best for you will depend on what you can tolerate, the degree of your leakage, your anatomy, if your skin can tolerate the glue that is used, and your attitude and  preferences about the management of leaking urine.

From “The Decision”

I was totally incontinent for about three months. I initially thought that diapers would manage the problem, but even the most absorbent brand would last only 45 minutes without getting heavy and beginning to sag down between my legs. I went back to work with a full patient load 11 days after my surgery. It quickly became apparent that a diaper alone would not work. Going back and forth to the restroom in between every four or five patients got old very quickly. I then tried the technique of adding an absorbent liner inside the diaper and only changing that, but the liner was cumbersome as well, and still I had to dispose of and replace it several times a morning. I soon found that the only thing that would let me have freedom from all the paraphernalia related to diapers was a condom catheter. We used to joke as urology residents, saying, “I’m going to go empty my leg bag,” instead of saying we were going to go to the restroom. There were residents who would take condom catheters from the urology clinic and put them on at baseball games so they could drink beer without the inconvenience of going to the stadium restroom. I ordered several types to try out (I won’t tell which size I ultimately used) and actually got along quite well with them. The ones I used were like a condom with sticky glue on the inner surface. As you roll it on, it sticks to the skin and forms a water-tight seal; the end of it has a spout that connects to a tube and a bag that attaches to a leg, hence the term “leg bag.” I could wear this under my scrubs and no one knew I had it on. I worked in the office, operated, and even taught youth Sunday school with this set-up undetected. This system malfunctioned and popped open only once. This soaked the pant leg of the scrubs I was wearing, but no one saw it and I was able to correct that quickly with a new pair of scrub bottoms. There was an ever-present fear that it might leak at an inopportune time, but that never happened. I had told very few people that I had had my prostate removed, so hardly anyone knew that I had a “leakage” issue and was wearing a leg bag. I would be speaking to a patient about what they should do for their prostate and answering questions about incontinence, all the while wearing my leg bag. It was an odd time; I elected not to tell patients about my situation. I bet in those three months of wearing protection that I must have treated hundreds of patients with prostate issues. “What would you do if it were you?” they would ask as I could feel my leg bag filling up. The bag holds about a pint, so I could feel it getting heavy and bulging the scrubs at the calf level of my leg. If you let the bag get too full, then it begins to pull down on the tubing, which in turns pulls down on the condom, which pulls down on the… You get the picture. With time, as I am sure it is with most inconveniences that patients endure, all of the issues associated with the condom catheter became second nature, just part of my life.

I would take off the condom before my shower and then jump around to see if the leaking had improved, and each morning for those three months, I was disappointed. Following the shower, I would dry the area to perfection and then carefully roll on my condom catheter and begin the process of hooking everything up. I had a routine that took about 15 minutes. On one particular morning, some of the skin of my “you know what” was very irritated and little blisters were all over the skin, particularly where urine would contact inside the condom. The condom catheter’s glue made taking off the condom a very unpleasant experience, as it would pull at the irritated areas of skin and open the blisters as well. It was very painful to take off the old and miserable to then put on the new. I remember being quite depressed by my situation that morning, more so than usual. As if it were not bad enough to be leaking all the time, now my system for dealing with it was also problematic. The thought of wearing this contraption all day, considering all the movement and discomfort that this entailed, also added to my despondency. The other issue was that if the skin kept getting irritated, I would not be able to use the condom catheter and would have to go back to diapers. I was pondering my plight and was just about “situated” when my wife entered our master bath. I was stooped over in order to connect the rubber straps of the bag to my calf and looked up at her. She looked at me oddly and with what I perceived as a look of concern. I thought that maybe she had detected my frustration and slight depression. I remember being disappointed that my true feelings might have been revealed, as I had been trying to down-play to my family the pathetic “urinary” situation that had become my life. By the way she peered down at me I was sure she was going to ask, “Is everything O.K?” She then said,” John, I think I see a black hair on the tip of your nose.” Somewhat relieved, as I connected the last leg strap, I said, “Thank you dear.”