URINARY TRACT MANAGEMENT IN SPINAL CORD INJURY:
URINATION AND THE URINARY TRACT IN SCI: CATHETER-FREE VOIDING WITH EXTERNAL
If your physician recommends a trial of becoming catheter-free:
Most people with a spinal cord injury don't have normal control
of urination even when they empty their bladder well. Men usually wear an
external condom collecting device, called an external catheter. As yet, there
is no external device for women, so they usually wear diapers.
External Catheters - An external catheter is a device that
collects urine after it is outside the body. It helps to keep you dry. There
are many kinds on the market; be sure the one you use is best and safest
for you. You will also need Elastikon tape and scissors, soapy washcloths,
wet washcloths, and a towel. Change the external catheter daily to prevent
skin irritation. There are two methods of applying an external catheter:
To apply with tape:
Wash entire genital area well with soap and water. Retract foreskin and wash
well, rinse and dry well; bacteria tend to collect here.
Check the skin of the penis for redness or abrasions. Allow skin to air.
Skin prep applied to penis will protect it from moisture.
If uncircumcised, pull the foreskin toward the head of the penis. This prevents
the tourniquet effect which can cause swelling, sores, and possibly gangrene.
Roll the external catheter upward until the entire penis is covered (make
sure there is at least two inches between the head of the penis and the end
of the condom).
Place a pre-cut piece of Elastikon tape around the external catheter directly
below the rolled edge at the top of the external.
Wrap tape around the penis so that tape ends meet and stick together. Do
not overlap tape. This allows for penile erection and proper circulation.
Do not stretch tape tightly.
Clip ring at the top of the condom to prevent tourniquet effect. Some external
catheters stay better if the tape is spiraled (your nurse will demonstrate).
Connect the external catheter to the drainage bag.
To apply with adhesive:
Follow the first 3 steps of applying with tape. Then apply tincture of benzoin
or skin cement to help keep external on. It is a good idea to clip pubic
hairs around the base of the penis.
To contain the adhesive, make a drape from a paper towel by tearing a small
hole in the center and placing it over the penis.
Spray the shaft of the penis with adhesive. Let it dry until tacky (about
30 seconds) then continue with steps 4-8 for applying the external catheter
If you have trouble keeping an external in place, use skin prep to adhesive
or (if you use tape before rolling condom on. Skin prep also protects skin.
If you use a Texas catheter, save the plastic pieces. You can make your own
external catheter using the pieces and a condom.
Check the external frequently to be sure it is draining freely and is not
on too tight. Call your doctor if a sore deeper than top layer of skin occurs
on penis, or if you cannot apply external below sore.
If an irritation or a sore occurs from an external catheter, you may be able
to apply the external catheter below the sore, or you may need to leave the
external catheter off for a few days until the sore heals.
- External catherers are also available with self-adhesive which do not require any additional products.
The following figures demonstrate two types of external catheters,
as well as two ways of applying the tape.
Diapers: - If waterproof (incontinent) panties are used:
Wash the skin well and dry thoroughly before putting in fresh liners. Be
sure to wash and change liners frequently.
If any skin soreness occurs from the urine, air your skin as much as
- Applying diaper rash cream may also be effective in protecting the skin.
TIMING LIQUID INTAKE
Some patients learn how to stay comfortably dry by timing their
intake of fluids with urinating. For example, drinking less liquid before
going out decreases the amount of urinating while you are out. It takes times
to experiment with drinking liquids to learn how long it takes for the bladder
to fill so that you can stay dry.
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