Schuma 6 - Manfred Sauer UK

Transcription

Tutorial
for
Continence Systems
This manual is printed on recycled paper in our own printing shop our contribution to the environment.
April 2002 (7)
Authors: Günther Udri, Manfred Sauer
Translated by Danièle Petton
Revised and extensively adapted for the UK by Barry Kaighin
Günther Udri, born in 1944, has had paraplegia since 1962 following a road accident. He is a graduate in
industrial management and was a tutor at the Rehabilitation Foundation in Heidelberg, Germany, until 1991.
Since then he has been working as a customer advisor and deputy manager at Manfred Sauer GmbH.
Manfred Sauer, born in 1944, has had tetraplegia since 1963 after a diving accident. In 1965 he began to develop
and market urinary sheath drainage systems. In 1976 he launched Manfred Sauer GmbH, now a firmly established
business enjoying a large market share in sheath drainage systems.
Barry Kaighin, born in 1961, has had paraplegia since 1988 following a road traffic accident. After working in the
computer and record industries Barry became part of the international Manfred Sauer team being involved in
product development and is currently the Sales & Marketing Director of Manfred Sauer GmbH (UK branch).
Barry also lectures on continence and disability awareness issues in universities, hospitals and healthcare
conferences around the UK & Ireland and has presented to professionals in Sweden, Holland and Germany.
Unit KG/D, KG Business Centre, Kingsfield Way, Northampton NN5 7QS
Tel. 01604 588090 Fax 01604 588091 E-mail: [email protected]
Confidential Helpline: 0191 291 0166
On our Web Site you will find the latest information about our products, useful hints and tips
for managing a continence problem. There are many links to other related sites,
as well as the opportunity to win £25 for your story serious or funny
about your experiences living with a continence problem home or abroad.
Our Web Site can be accessed from any of the following World Wide Web addresses:
www.manfredsauer.co.uk www.legbags.com www.urinarysheaths.co.uk
Preface
Due to the high demand for our tutorial, we have produced this revised and updated edition to reflect
the latest developments and changes to our system.
The tutorial is intended for our product consumers and healthcare professionals. In many of the
consultations with our customer advisers we have noticed the need for a general comprehensive
explanation of bladder function and dysfunction. For this reason we have included an article on the
subject.
The advice in the tutorial will not answer all of your questions. Do not hesitate therefore to speak to
your customer adviser. All our customer advisers use our products and would be happy to share their
experiences and help you with any queries.
Any comments or suggestions you have as a result of your own experiences are welcome and may
be used in future editions of this tutorial or in advisory consultations.
Lobbach, April 2002
Manfred Sauer
I never realised how much my bladder controlled my life until I started controlling my bladder. The
advice I had from the Manfred Sauer Helpline has completely changed my life and given me the
confidence to socialise again! SB Newcastle 1997
You are not alone, as many as 1 in 3 women and 1 in 9 men experience incontinence at some
period in their life. The aim of this tutorial is to briefly outline certain aspects of urinary incontinence, offer solutions to enable people to make informed decisions to achieve full continence
with confidence. This means you are in full control being able to choose where and when you
go to the toilet, by managing your continence problem. Advice given here is general and should
in no way be seen as a substitute for professional urological investigation which may uncover
underlying problems that need medical intervention.
Note: Throughout this tutorial we have used the word urinary sheath to refer to urinary condom.
Self-adhesive urinary sheath is also used throughout this tutorial to refer to a urinary sheath with
its own self-adhering adhesive film bonded to the sheath.
© MANFRED SAUER GMBH
www.manfredsauer.co.uk 1
List of contents
About Incontinence & bladder paralysis
Introduction .................................................................................................... 4
Function of the healthy bladder ..................................................................... 4
Incontinence ................................................................................................... 6
Reflex incontinence ........................................................................................ 6
Treatment possibilities ................................................................................... 7
The limp bladder ............................................................................................ 8
Stress incontinence ........................................................................................ 9
Urological diagnostics ................................................................................... 9
For Men: Benefits of the sheath drainage system ......................................... 9
For Women: What are the alternatives? ....................................................... 10
Reusable or disposable pads for men & women ........................................ 10
Recommended reading ............................................................................... 11
Glossary of terminology ............................................................................... 12
Tutorial
The principle of an up-to-date sheath drainage system .............................. 14
Criteria for choice .................................................................................... 15
Urinary sheaths ............................................................................................ 16
Latex urinary sheaths .............................................................................. 16
Synthetic urinary sheaths ........................................................................ 17
Urinary sheath adhesion .............................................................................. 19
Routine care of the skin for ideal urinary sheath adhesion .................... 19
Preparing the skin ................................................................................... 20
SAUER skin adhesive ............................................................................. 20
Latex-based skin adhesive ..................................................................... 21
Synthetic adhesives ................................................................................ 22
Applying a urinary sheath with a separate liquid skin adhesive ............ 23
Re-adhering an urinary sheath ............................................................... 24
Points to remember when adhering with synthetic adhesives ............... 24
Adhesion in spite of abrasions ................................................................ 25
Removing adhesive remains ................................................................... 25
Double sided adhesive tapes ................................................................. 26
Self-adhesive SAUER p-sure sheath ............................................................ 27
Applying the self-adhesive sheath .......................................................... 28
Connecting the sheath to the leg bag .................................................... 30
2 Helpline: 0191 291 0166
Removing the sheath .............................................................................. 30
Self-adhesive drip Funnel type urinary sheaths ....................................... 31
KIC System ................................................................................................... 32
How it works ............................................................................................ 34
Urinary Leg bags .......................................................................................... 37
Bendi bags .............................................................................................. 37
The Bendi Bag features .......................................................................... 38
Putting on the Bendi leg bag .................................................................. 40
SAUER Comfort leg bags ....................................................................... 41
Features to note when putting on Comfort leg bags .............................. 41
Discreet Thigh Bag ................................................................................. 42
Leg Bag drainage problems ................................................................... 43
Special orders of the SAUER leg bags ................................................... 44
Inlet tube lengths and outlet taps ........................................................... 44
Sterile Leg bags ...................................................................................... 45
Cotton cover ............................................................................................ 45
Waist belts for ambulant people or children ........................................... 45
Outlet taps ............................................................................................... 46
Swing tap ........................................................................................... 46
Sliding tap .......................................................................................... 46
Emptying urine drainage bags ............................................................... 46
Connecting Bed bags .................................................................................. 47
Partial incontinence ...................................................................................... 49
SAUER Drip urinal for men ..................................................................... 49
URIbags Male & Female discreet pocket sized urinals ...................... 50
Skin care and protection .............................................................................. 51
Preventox ................................................................................................ 51
Problems ...................................................................................................... 52
Urinary sheath dosnt adhere for 24 hours ............................................. 52
Skin redness ........................................................................................... 55
Penile retraction the solution? .............................................................. 55
Alternatives .............................................................................................. 56
Keeping kidneys and bladder healthy ......................................................... 57
Bladder training ....................................................................................... 58
Useful tips about living with a urine drainage system ................................. 60
Aids to catheterisation .................................................................................. 63
Key word index ............................................................................................. 64
Useful contact numbers and Website addresses ................ inside back cover
Bladder paralysis
About incontinence and bladder paralysis
Introduction
The following tutorial on incontinence is mainly addressed to people with neurogenic bladders and
more specifically spinal injuries, but it will also be of interest to people with a whole range of other
conditions. The quality and length of life of people with spinal injuries and many other conditions that
affect continence depends on maintaining a healthy bladder and healthy kidneys. It is therefore
important to be aware of the basic functions and damage that can be done to the urinary tract. This
information will compliment advice from your doctor or specialist nurse and enable you to take
responsibility for your own health. A glossary of terminology appears on page 12 & 13 for your
reference.
The function of a healthy bladder
Bladder function can be divided into two phases. First, there is a permanent filling and retaining
phase, where urine, produced in the kidneys is stored in the bladder over a period of several hours.
This process is involuntary and there is no noticeable build-up of pressure in the bladder (intravascular pressure).
As soon as the bladder is filled to a trigger point which will differ from person to person, a message is
sent to the bladder centre (the sacral miction centre) and from there to the control centre in the brain
both involve the spinal cord (see Fig. 1). The information is then registered as a urinary urge only, as
the bladder still has an adequate reserve capacity left.
As soon as the time and place for voiding the bladder is reached, a signal runs in the opposite
direction and releases a voluntary voiding phase (micturition). If necessary, one can release urine
without having a urinary urge.
The command to micturate starts a very complicated procedure. The bladder muscle (the detrusor)
contracts increasing the pressure in the bladder. In males, the pressure within the bladder can reach
approx. 50 cm H2O. An extremely complex, but very finely harmonised autonomic mechanism
ensures, practically simultaneously, that the bladder neck opens, the external sphincter relaxes and
the muscles of the pelvic floor give way to free passage of urine. Both the bladder muscles and the
sealing mechanism (sphincters) must work well together (Detrusor-Sphincter-Synergy), so that the
urine can freely flow through the urethra.
4 Helpline: 0191 291 0166
Bladder paralysis
The following points are vital to assure trouble free micturition:
The nerves between the bladder, the lower bladder centre and the brain must be intact so that
the nerve impulses can be passed on.
The bladder must be intact.
The inner and outer sphincters must stand up to the bladder pressure.
kidney
(Ren)
brain/
upper
bladder
centre
renal pelvis
(Pyelon)
spinal cord
ureter
lower bladder
centre
command
to the
bladder
bladder muscle
(detrusor)
command
from the
bladder
neck of the bladder
(inner sphincter)
prostate
bladder
outer sphincter
(Sphinkter externus)
urethra
Fig. 1 The diagram shows bladder drainage by
the central nervous system
Fig. 2 Urinary tract (male)
Bladder paralysis
Incontinence
As soon as a disorder occurs at one stage of the process, incontinence is the likely result. Incontinence means unintentional loss of urine. The control over bladder voiding is disturbed through some
cause or another.
Apart from urinary incontinence, there is also bowel incontinence which is not covered here (for
organisations that can provide further information see useful contact numbers and website addresses
on inside back cover see our own website for the very latest list of links to such organisations at:
www.manfredsauer.co.uk).
There are various types of incontinence, dependent on where the defect or disorder occurs or why it
occurs:
Stress incontinence: see following pages.
Overflow incontinence: Loss of urine caused by loss of bladder muscle function see limp
bladder paralysis.
Urge incontinence: Normal filling of the bladder, with an inability to hold back urination once the
desire to void is felt. The Urge Syndrome is the combination of frequency, urgency and nocturia.
Reflex incontinence: see following pages.
The forms of incontinence described here are those that are mainly the result of neurogenic bladder
conditions such as spinal cord injury and Multiple Sclerosis.
Reflex incontinence the spastic bladder
The main reason for this form of incontinence is damage to the spinal cord in the pathway between
the brain and the lower bladder centre. This damage can be caused by trauma such as spinal injury
with paralysis, or may be the result of illness (e.g. multiple sclerosis) or congenital condition such as
in spina bifida. The signal that the bladder is full arrives in the lower bladder centre but cannot be sent
further. This first signal can sometimes be faulty as it does not always relate to the filling of the
bladder, but can also be released through other stimuli. This gives rise to the command occuring too
early or too often. Because the brain cannot intervene, a short circuit in the lower bladder centre
occurs, and this causes a reflex, spastic and unintended often unnoticed release of urine.
In more favourable cases, the bladder fills well, the interior bladder pressure is raised moderately,
and the reflex activity leads to a residual-free bladder voiding several times within 24 hours. This is a
well balanced reflex bladder.
6 Helpline: 0191 291 0166
Bladder paralysis
Further improvement is possible by triggering this reflex through bladder training (tapping, triggering-off or knocking). In this case the individual can decide when to void the bladder (see bladder
training on pages 58 & 59).
Unfortunately, such cases are rare and an unbalanced reflex bladder is more common. This occurs
when the finely balanced relationship between inner bladder pressure and the sealing mechanism is
disturbed (Detrusor-Sphincter-Dys-Synergy). The pressure caused by the reflex action of the bladder
does not lead to opening of the sealing mechanism but to contraction. This results in the bladder
(muscle) working even harder to try and overcome the contraction. Bladder pressure is raised once
again, and this can lead to the following problems:
increased amounts of residual urine
dilation of the bladder wall (diverticle, pseudo-diverticle)
reflux of the ureters and kidneys
reduction in the capacity of the bladder
infiltration of urine into the internal male genitals
advanced reduction of kidney function
All of the above increases the existing risk of infection.
For people with a spinal cord injury above the level of T/6 there is the added risk of complications that
many healthcare professionals outside the specialist area of Spinal Injuries may not be aware.
Depending on the severity of the problem, the affected person experiences cramps and varying
degrees of related disorders of the autonomic nervous system, ranging from unbearable outbreaks
of sweating, flushing of the face, neck and shoulders and goose pimples, to dangerously high blood
pressure in spinal cord lesions above the T6 level Autonomic dysreflexia or hyper-reflexia which, if
unchecked, can lead to fits, a cerebral haemorrhage (stroke) and death (From Spinal Injuries
Association Moving Forward, April 1995).
In addition, the people concerned cannot even help themselves, because the triggering or knocking
of the bladder increases the symptoms and dangers.
Treatment possibilities
It is the aim of every treatment to reach a nearly residual-free drainage, with as low as possible inner
bladder pressure. For the treatment, there are two possibilities, either the reduction of drainage
resistance or the reduction of activity of the bladder muscle. Depending on the case, the two
methods can be combined.
Bladder paralysis
Depending on the severity of the case, drainage resistance can be reached by the following
methods:
relaxed sitting position (in a wide sense a relaxed body)
intermittent self-catheterisation
slitting the sealing mechanism (sphincterotomy)
enlarge the bladder by positioning a section of the bowel into it (augmentation cystoplasty)
The over (hyper) active bladder muscle can be treated by medication such as oxybutynin. These
drugs increase bladder capacity by diminishing unstable detrusor contractions, but all may cause
dry mouth and blurred vision and in extreme cases may precipitate glaucoma. For some time now, in
cases of over active reflex voiding, it is possible to improve the capacity function and bladder voiding
through surgery. The nerve routes that convey the level of the capacity and provide the reflex are
severed (Deafferentation). The nerve routes that register the activity of the bladder are then attached
to electrodes. A low pressure reservoir in the bladder is guaranteed through deafferentation, and the
bladder can be voided willingly. This means that urine can accumulate in the bladder for a few hours
without being disturbed by involuntary reflexes, yet can still be voided voluntary at any time. This
large-scale operation is often referred to as a Bladder Pacemaker, Sacral Anterior Root Stimulator
(SARS), or a Brindley Operation. This however is a major operation taking up to 4 hours, with
recovery time up to one month. The operation involves cutting certain nerves which may reduce the
option open to the individual as new medical advances are made. There are new treatments in
magnetic resonence currently being developed which may eventually replace this SARS operation.
Seek specialist advice to determine if you are suitable for such an operation and its potential
advantage/disadvantage on your lifestyle.
The limp (Acontractile) bladder
When the damage to the spinal cord lies below the area of the lower bladder centre (T12), the reflex
nervous system is also damaged, so the bladder has no muscle tone and doesnt contract to empty
automatically. This causes a limp bladder, which leads to high quantities of residual urine and
increased risk of infection. As a result, stimulating the bladder is impossible because the micturition
reflex cannot be released. It is possible to attempt to void the bladder through careful application of
pressure, but this can cause the inner bladder pressure to rise dangerously.
In this situation, residual and pressure free drainage can be achieved through intermittent selfcatheterisation.
8 Helpline: 0191 291 0166
Bladder paralysis
Stress incontinence
Even when the bladder is emptied at regular intervals without the application of pressure and with no
resulting residual urine, it does not mean that continence is guaranteed.
The muscle tone of the sealing (sphincter) mechanism can give way or be damaged by earlier
surgery so that loss of urine may occur even through minimal strain. Bladder strain resulting in the
involuntary release of either small or large amounts of urine can be caused by changing position in
the wheelchair, or even by sneezing or coughing.
If this form of incontinence cannot be treated with medical aids, there remains the possibility that a
false sphincter the Scott sphincter can be implanted.
Urological diagnosis
This summary clearly shows that bladder function is extremely complicated, so while we hope that
these notes will be of use to you in your own self-monitoring, it is essential you do this in conjunction
with regular consultations with your specialist and continence adviser.
For Men: Benefits of the sheath drainage system
Although treatment surgical or otherwise can attain significant results, full continence is seldom
achieved. The problem is how to deal with partial incontinence or in the case of someone who is fully
continent but with impaired mobility, to reach the toilet in time? For men, the urinary sheath is still the
best solution, both in practical terms and peace of mind against uncontrolled reflex voiding, because
it enables you to lead a full social life. Only someone in this position can appreciate the benefits
both freedom and confidence that a urinary sheath drainage system can provide.
The sheath drainage system is a solution for people with neurogenic bladders such as spinal injuries,
Multiple Sclerosis etc. in the sense that other therapies do not always lead to continence with
confidence.
For men that have had various prostate treatments or removal, some incontinence usually remains to
a greater or lesser extent. Experience shows that the sheath drainage system is a satisfactory
solution in most cases.
Unlike permanent catheters or disposable/reusable pads which are still widely used, it is clear that
the sheath drainage system causes fewer problems when dealing with incontinence due to old age,
such as skin care issues with pads and recurrent infections with catheters. For medical staff, this
Bladder paralysis
means re-thinking current urinary care methods using permanent catheters or nappies, and going
for the sheath drainage system as an alternative.
For Women: What are the alternatives?
Assuming a full urological investigation has ruled out pelvic floor exercises as a method of achieving
full continence the choices women have are limited to:
intermittent catheterisation
urethral or suprapubic permanent catheterisation
relying on urinals (see URIbag F & URIfem described later in this tutorial)
bladder training may be possible in some cases (described later in this tutorial)
Sacral Anterior Root Stimulator (SARS) or a Brindley Operation. (see treatment possibilities
earlier).
Reusable or disposable pads for men and women
These are basically specialist nappies for people over the age of 4 years old working on the principal
of soaking up any leaks as efficently as possible whilst trying to keep the layer next to the skin as dry
as possible to avoid irritation. Odour and social confidence will always be a problem with this type of
continence management. Unfortunately they are often the first choice by some healthcare professionals as it is easier to pad a person up than investigate the underlying reasons for the continence
problem. However, they are not the ones expected to wear the pads! We believe this should be the
last resort as pads certainly do not inspire social confidence and can lead to all sorts of skin problems
and sores, particularly when the person has little or no sensation, as may be the case with conditions
such as spinal injuries. These products are not available on prescription in the UK and each local
health authority has a different policy on supplying pads to people in the community. Where you live
may be the difference between being supplied with as many pads as you require or just one pad to
last the whole day!
Lobbach, October 1998
Günther Udri
10 Helpline: 0191 291 0166
Bladder paralysis
Recommended reading
For the general public:
Moving Forward The Guide to living with Spinal Cord Injury published by the Spinal Injuries
Association (SIA). The guide is about helping people with spinal cord injury regain their independence.
(SIA contact details at the end of this tutorial) A4 binder also available on CD ROM
Promoting Continence and Product Awareness free booklet on products produced by Promocon &
Ricability (Available dirrectly from Promocon contact details at the end of this tutorial)
Childrens Continence Products free booklet on products for children produced by Promocon &
Ricability (Available dirrectly from Promocon contact details at the end of this tutorial)
For the Healthcare Professionals:
Nursing for Continence C Norton, Beaconfield Publishers, Beaconfield
Clinical Handbook for Continence Care B Roe, K Williams, Scutari, London
Incontinece - Abrahams P, Khoury S, Wein A 1999 Health Pub Ltd Plymouth
Promoting Continence Getliffe and Doleman, 1997 Bailliere Tindall
Good Practice in Continence Service published by the Departmant of Health April 2000 is available
on the internet: www.doh.gov.uk/continenceservices.htm
Contact the Continence Foundation (contact details at the end of this tutorial) for an updated list of
publications, papers and fact sheets and useful addresses for Patients, Carers and Relatives.
Bladder paralysis
Glossary of terminology
Autonomic Dysreflexia .................. Spinal Injuries only. A sudden life-threatening surge in blood
pressure. In Tetraplegics and paraplegics with lesions of T6 or
above, an overfull bladder is the commonest cause to trigger this
reaction. Once the cause is removed, i.e. bladder emptied, the
danger is over.
Autonomic nervous system .......... The part of the nervous system responsible for the control of bodily functions that are not conciously directed.
Continence Adviser ...................... Specialist nurse or physiotherepist with expert knowledge on helping people with continence problems. A referal from a doctor is
not normally required. Contact through the Association of Continence Advisers or Continence Foundation helpline (see inside
back cover for details) or local doctors surgery/clinic.
Detrusor ........................................ Bladder muscle
Dys-synergy .................................. The forces working against one another (see synergy)
Incontinence ................................. Involuntary loss of urine
Intermittent self-catheterisation .... Emptying of the bladder by passing a special catheter into the
bladder. Once the bladder is emptied, the catheter is removed.
Intravesical .................................... Pressure within the bladder
Micturition ..................................... Emptying of the bladder
Neurogenic ................................... Pertaining to the nerves
Pseudo diverticle .......................... Widening of the bladder
Reflux ............................................ Flowing back of urine from the bladder into the ureters and kidneys
Residual Urine .............................. Measure of a post-micturition, urine (whats left in the bladder after
emptying)
Sacral miction center .................... Lower bladder centre in the transitory area between the thoracic
and lumbar vertebrae
12 Helpline: 0191 291 0166
Sphincter ...................................... Sealing muscle (inner and outer)
Suprapubic catheter ..................... Permanent catheter which will be passed into the bladder through
the abdominal wall. Requires a minor outpatients surgical procedure to initially fit. There is evidence that points to them being less
prone to bladder infections than ureathral catheters. Also prefered
by many people who have an active sex life
Synergy ......................................... The working together of forces (see dys-synergy)
Ureatral catheter ........................... A permanent catheter which will be passed into the bladder
through the urethra (the usual channel for urination)
Trauma .......................................... Injury through force e.g. an accident
The principle of an up-to-date urine drainage system
14 Helpline: 0191 291 0166
oo
Criteria for choice
For Men
Urinary sheath type
Latex urinary sheaths
Synthetic urinary sheaths
Funnel type urinary sheaths
Urinary sheath attachment
Skin adhesive, adhesive tape
Self-adhesive urinary sheaths
For Men & Women using a urethral or suprapubic catheter
Drainage tubes
Flexible and discreet
Variable length (can be shortened as part of the prescription service in the UK)
with adapter to connect to any urinary sheath or catheter in the UK
Inlet tube non-return valves
4 eyelets on entry into bag to ensure clear flow prevents reflux of urine
Leg bags
Capacity, shape
Material, leakproof
Straps
Soft material with anti-slip properties
Wide enough to comfortably secure leg bag without damaging skin
Closures
Swing tap with easy close security band
Sliding tap
Attachment to overnight bag
Will fit any UK night bag with supplied connector
Groups aimed at
Wheelchair user
Ambulant people and children
People in bed
(ladies go to page 37 to skip the following section on urinary sheaths)
Tutorial
Urinary sheaths
We have the largest range of sizes and material choices of urinary sheaths in the UK (latex, synthetic
and self-adhesive see page 27).
Latex urinary sheaths
Composed of natural rubber (ammoniac based) and
chemical substances (e.g. sulphur) for vulcanisation
and to help prevent ageing. To optimize skin tolerance,
these substances are almost completely removed by
centrifugation (in the finished product).
Special features of our latex urinary sheaths:
Thinner, highly elastic latex film. The extremely high elasticity allows for large amounts of spontaneous urine without putting the adhering surface under strain. Only thin latex film will adapt to
the skin to improve adhesion.
The urinary sheath tip is double-dipped to prevent tearing but is still elastic enough to enable a
residue free drainage, so no fluid is able to collect, unlike when stiffer material is used.
Our urinary sheaths come in 11 different sizes: the better the fit the safer the adhesive contact!
Talcum powdered to prevent sticking together and also to make removal easier.
Every urinary sheath is inflated with approx. 10 litres of air to test its tear resistance, check for
small holes, thin areas and sticking.
Different latex mixtures
We offer our latex urinary sheaths in 2 diffferent thicknesses to match individual skin types.
Standard latex urinary sheaths Original
These urinary sheaths are manufactured from natural rubber, and are practically chemical free due to
centrifugation. Since this makes them suitable for nearly all skin types, they are our standard.
Order no. 53.xx 11 sizes from 1840 mm individually checked yellow inspection ticket
16 Helpline: 0191 291 0166
Urinary sheaths
Extra-thin latex urinary sheaths D
A special feature of these urinary sheaths is the extra thin latex film to make them fit like a second
skin. Recommended when standard urinary sheaths do not adhere adequately, perhaps because of
penile retraction. The resistance to tearing in the nipple area is less than in standard urinary sheath,
but is still sufficiently resistant to tearing if handled with care.
Order no. 53.xx.D 4 sizes from 2640 mm individually checked green inspection ticket
Synthetic urinary sheaths
These urinary sheaths are made of synthetic material,
for those allergic to latex. Otherwise they have the
same advantages as the latex urinary sheaths.
The dipped connecting tube is part of the urinary sheath.
It fits our leg or bed bag with or without a universal
adapter.
Suitable for fixing with practically all skin adhesives and
double-sided adhesive tapes. However, in case of
proven allergy to latex, latex based skin adhesives
cannot be used, only double-sided adhesive hydrocolloid tapes or the synthetic based skin adhesives are
suitable.
When using the skin adhesives, make sure that you do not use too much adhesive and, before
unrolling the urinary sheath, allow the solvents in the adhesive to air a little. Otherwise there is a risk
that the solvents weaken the synthetic urinary sheath film, or worse dissolve. This would result in
holes, or the urinary sheath would start to tear in the adhesion zone.
Order no. 56.xx 11 sizes from 1840 mm individually checked pink inspection ticket
Tutorial
Storage
Urinary sheaths and other latex products can be stored at room temperature in closed cartons in dry
conditions for up to 2 years.
Inspection ticket
Each urinary sheath package contains an inspection ticket.
The information on this ticket will help to locate the cause of
any complaint. Therefore please retain it until you have used
all the products covered by it.
Tape measure
This is to determine the exact size. There are 11 different
urinary sheath sizes to choose from, ranging from 18 to 40
mm in diameter.
To measure, put the tape measure in the middle of the
penis. If the urinary sheath is fixed to an erect penis
(which presents a better contact area for the adhesive
area than a flacid penis), it should also be measured
under these conditions.
Choosing the right urinary sheath
First of all, determine the size of the urinary sheath you need using the tape measure. To begin
with, try the standard latex urinary sheath. If you experience any problems with the standard type,
we suggest you consult your continence systems adviser to discuss which urinary sheath or
adhesive products are best suited to you.
18 Helpline: 0191 291 0166
Urinary sheath adhesion
Choice of adhesive product is the decisive factor for ensuring that your urinary sheath is reliable and
secure.
There are 3 options:
Skin adhesive We are still convinced this is the most reliable method. Unlike for the selfadhesive sheath, you can still determine for yourself the quantity you want, where you want to
put it and over what area, avoiding any red marks etc.
Double-sided adhesive tapes if you are allergic to latex, avoid latex based skin adhesives.
Instead, use adhesive tapes or latex-free skin adhesives. Adhesive tapes can be very useful
where there is inadequate skin area for adhesion. Some people consider the use of adhesive
tape to be a cleaner solution than skin adhesive. However, because of the thickness of the
tape it is not possible to get as secure and comfortable fit as with a separate skin adhesive.
Integrated adhesive layer on self-adhesive sheaths. This is certainly the most convenient option
but our experience shows that it is not as reliable as a separate liquid skin adhesive.
Recently on the UK market there have been a variety of sheath applicators that are mainly aimed to
appeal to the carer, to enable sheath application with very little contact to the genital area. In our
experience these are just gimmicks and interfere with rather than aid reliable sheath adhesion.
There are always new developments in urinary sheath adhesion either in our own laboratory or from
other manufacturers. Ask your continence systems adviser for further details.
Routine care of the skin for ideal urinary sheath adhesion
To obtain optimal adhesion and prevent skin irritation when using skin adhesive, follow these
guidelines:
Try to maintain normal skin moisture (not too dry and not too greasy).
Refrain from using greasy soaps, shower gels, bath oils and body lotions, etc. (they reduce
good adhesion).
Never adhere a urinary sheath directly after a bath as the skin will be waterlogged. If possible
delay sheath adhesion for 15 to 20 minutes. If this is not possible, use a skin protecting film like
our Preventox wipes or fluid (see page 51)
Tutorial
We do not recommend skin preparations containing solvents as they dry out the skin and cause
irritatation.
The above guidelines also apply to double-sided adhesive tapes or self-adhesive Funnel type
urinary sheaths, unless special manufacturers recommendations advise otherwise.
Preparing the skin
Meticulous hygiene and constant observation of skin condition are essential when preparing the skin
for adhesion. For extra skin protection, use Preventox (see page 51).
SAUER skin adhesive
Liquid skin adhesive gives the best adhesion between skin and
urinary sheath. Unlike the self-adhesive sheath, users can determine for themselves how much skin adhesive to use, the width
of the adhering area and the size of the buffer zone.
All our skin adhesives are designed for direct application to the
skin and are CE marked
For over 30 years, SAUER skin adhesive has been a success in
the use of urinary sheath drainage system and offers solutions
for all types of skin conditons.
The efficiency of adhesion varies according to the composition of the skin adhesive used.
The water resistance of the skin adhesive allows you to wear the urinary sheath in the bath or
when swimming without impairing the adhesion strength. However, staying a long time in a hot
bath, may reduce the adhesion strength.
The skin friendliness is achieved by adding skin agents to the skin adhesive. This makes
round-the-clock wear possible.
The removal of the urinary sheath when using a latex adhesive (see page 25) does not usually
leave any residue on the skin since the urinary sheath and the skin adhesive complement each
other. Synthetic adhesives and sheaths (including silicone self-adhesive sheaths) tend to leave
a residue after the sheath has been taken off. This should be removed with a non-alcohol based
adhesive remover or ideally soaked off in the bath or shower.
The tube with pipette applicator allows simple and clean application of the adhesive.
20 Helpline: 0191 291 0166
Latex-based skin adhesive
Composition is based on current dermatological
knowledge. The basic materials provide adhesion
while the additional materials care for the skin. This
combination makes round-the-clock wear possible
without occurrence of skin problems. All are available on prescription in the UK.
Components
Basic materials:
Effect
Mastic crepe ....................................... Adhesion
Heptan ................................................ Viscosity
Additional materials: Lanolin (clear) ..................................... Replenishes oils in skin
Zinc oxide ........................................... Skin protection
The standard skin adhesive can be used without problems in almost all cases, and provides
absolutely reliable adhesion.
Order no. 50.01 Original
Because the condition of your skin can change, it may sometimes be necessary to use another
adhesive combination, either for a short time or for longer duration.
For the rare cases of lanolin allergy, we dispense with the lanolin.
Order no. 50.03 lanolin free
By reducing the additional materials that care for the skin, adhesive strength is increased.
Order no. 50.05 50 % or Order no. 50.00 Pure
If you dont want to do without the skin caring agents, adhesive strength can be increased through
resin.
Order no. 50.20 2 % or Order no. 50.22 12 %
Tutorial
Synthetic adhesives
In case of latex allergy or when adhesion strength is not adequate with a latex skin adhesive, we
advise a silicone or synthetic skin adhesive. These adhesives are generally stronger and therefore
more abrasive to the skin. Use them only when you have serious adhesion problems.
At the moment, we offer 2 synthetic adhesives. Their adhesive procedure is described on page 24.
SAUER skin adhesive Synthetic
Contains no latex or silicone. Available on prescription in the UK.
Order no. 50.36-2 in a tube with a pipette applicator
Order no. 50.36 in a glass bottle with a brush applicator in the lid
U-Bond skin adhesive
Silicone liquid adhesive. Comes in a glass bottle with a brush applicator
in the lid. Not available in a tube. Not available on prescription in the UK.
Storage of adhesives
At room temperature for approx. 2 years. Avoid direct sunlight or leaving the top off the bottle which
allows the solvent in the adhesive to evaporate which thickens the adhesive making it difficult to
apply.
Choosing the right adhesive
We cannot know which adhesive is the best for you, as each skin type reacts differently. First try
the proven Original adhesive. If you are not getting satisfactory results and application has
been correct (see next page), then try an alternative.
We recommend that you try any new adhesive product on a neutral area of skin such as the
inside of your wrist or the back of your hand to ensure that there are no allergic reactions. When
using adhesives with stronger adhesion strength, always check your skin condition carefully!
We suggest you talk to one of our continence system advisers by calling our helpline on
0191 291 0166.
22 Helpline: 0191 291 0166
Applying a urinary sheath with a separate liquid skin adhesive
If possible, do not apply a sheath within 15 to 20 minutes of having a bath or shower. This is because
the skin gets waterlogged after washing, which can affect the adhesive bond. An erection is not
absolutely necessary for adhesion, but if one can be manipulated, we recommend that you adhere
the urinary sheath to an erect penis as this gives a flatter surface for adhesion and
prevents the urinary sheath pinching.
Pull over the protective cloth supplied with all our urinary sheaths to ensure that no
pubic hair interferes with the urinary sheath adhesion. The hole in the protective
cloth is 1 mm smaller than your urinary sheath size.
First unroll the urinary sheath 46 cm (buffer zone), then apply to the penis and
unroll hold as in the diagram. If an erection is not possible stretch the penis
slightly by pulling.
With the other hand apply the adhesive in a ring in the middle of the penis shaft, so
that one can vary the adhering area if any skin defects are present. Apply as little
adhesive as possible but make sure that there is enough. Too much adhesive
builds up a film which will prevent firm contact between the skin and the latex. This
can cause the urinary sheath to slip or stick together.
Spread the adhesive well with the side of the nozzle of the tube (or brush if using a
bottle adhesive) or with your finger (dont glue your fingers!) a band of adhesive
23 cm wide is enough. Important: There must be a uniform ring of glue all around
the penis. Do not allow the glue to dry. The heptan evaporates when spread, thus
stopping bubbles forming underneath the urinary sheath.
While the right hand unrolls the urinary sheath over the adhesive, the left hand
should stretch the penis slightly. The urinary sheath should be pressed on tightly.
Longitudinal folds and bubbles can be stroked away (lateral folds are less dangerous). Inspect the area after 1 minute again, and if necessary, press again.
If necessary, to avoid pressure marks or if the penis retracts during micturition
(emptying the bladder), the remaining rubber ring behind the adhering area can
be removed by cutting into the ring or by tearing. The cut should be made around
the urinary sheath to prevent tearing. When cutting or tearing, hold the urinary
sheath on the adhering area.
Tutorial
If a sheath is not secure for a 24 hour period the likelyhood is that:
you need a stronger adhesive
the sheath is too large
there is a problem with penile retraction
a combination of the above
Please consult our helpline for advice.
Re-adhering an urinary sheath
If on inspection you find that the urinary sheath has not adhered in one area, you can re-adhere this
spot by sliding the clean nozzle of the adhesive tube under the urinary sheath and squeezing a small
amount of adhesive onto the area.
Points to remember when adhering with synthetic adhesives
The adhesion strength is particularly strong. If your skin is delicate, we recommend you use some
skin protection before applying the sheath (like Preventox wipes Order no. 50.50 or the Preventox
fluid roller Order no. 50.58. Both are available on prescription in the UK)
You can unroll the urinary sheath over the adhesive area as soon as you have spread the adhesive.
If you need more adhesive, we recommend you leave the adhesive to air for a few seconds (up to 1
minute) so that the solvents can evaporate. This will give you better and lasting adhesion.
If using U-Bond adhesive (Order no. 50.37 not available on prescription in the UK).) and the standard
latex urinary sheath (Order no. 53.xx) together does not give good results, we advise you use the
extra-thin latex urinary sheaths (Order no. 53.xx D).
Remove carefully all adhesive residue with some adhesive remover pads (Order no. 50.38, not
available on prescription in the UK). You should remove the residue after a shower or after a wash so
that any remaining greasy materials (such as soap) are also removed from the skin at the same time.
Opening and closing the bottle of adhesive often, can cause the solvents to evaporate and make the
adhesive thicker. If the adhesive becomes too thick, use a thinner (Order no. 50.39 is the thinner for
the silicone adhesive Order no. 50.37, not available on prescription in the UK).
24 Helpline: 0191 291 0166
Adhesion in spite of abrasions
With a little practice, you can even adhere a urinary sheath over small wounds. It is important to cover
these small sores with a protective dressing such as a hydro-colloid dressing that does not interfere
with the action of the adhesive. Hydro-colloid dressings are available from your doctor. It comes in
various thickness. Just cut the necessary size and protect small skin abrasions.
It is always advisable to consult your doctor before using any new product - Particularly if you are
unsure what caused a skin abrasion or sore.
On pages 5256, we list possible causes why a urinary sheath does not adhere 24 hours.
Removing adhesive remains
As a rule, the latex adhesive comes away from the skin if you remove the urinary sheath carefully by
rolling it off. On no account should you remove adhesive remains with solvents, acetone or similar
substances because this will disrupt the natural oil balance of the skin and may cause chapping and
cracking, which leads to inflammation.
You can either wash adhesive remains or rub it off with your fingers. If a thin grey film remains, dont
worry, glue on top of it and it will come off by itself. Non solvent based adhesive remover pads are
available (Order no. 50.38, not available on prescription in the UK).
Avoid bringing skin adhesive into contact with clothing because it is very difficult to remove. If the
adhesive does come into contact with clothing, use nail varnish or solvent based cleaning agent on
the clothing. Always check the clothing manufacturers label.
Tutorial
Double-sided adhesive tapes
Double-sided tapes are often used for elderly, bed-ridden
people and those in intensive care units. They also help in
cases of a retracted penis, for children and where there is
inadequate skin area for adhesion.
We offer 2 alternatives:
Tape made of lightly elastic foamed polyethylene, with
adhesive surfaces on both sides (Order no. 50.04). This
tape spreads and increases the diameter of the penis, so
you may order a urinary sheath one size larger.
Tape made of very elastic skin friendly material, and also
used as a hydro-colloid dressing (Order no. 50.14). Can
even be used to protect small skin abrasions, always
check with your doctor first.
Storage: Keep in a dry and dark place at room temperature.
Application
To prevent pubic hairs being trapped under the tape, we suggest you apply the
protective cloths supplied with all our urinary sheaths. If an erection can be manipulated, tapes can then be applied making sure they do not cut into the penis shaft.
Apply tapes to dry skin in a spiral overlapping fashion.
Unroll the urinary sheath 46 cm, apply and carefully roll over the tapes. Press
lightly all around.
For the hydro-colloid tape, we recommend applying pressure with the hands for
about 30 sec. so that the warmth of the fingers increases the adhesive strength.
Removal: Remove after 24 hrs by rolling off together with the urinary sheath.
If the glands of the penis is significantly wider than the shaft of the penis we know
of a product called Urifix that can be used as a washer behind the glands to
prevent urine pooling. Urifix is a co-hesive tape available on prescription in the UK
that will only stick to itself. It can also be used to protect small abrasions and sores.
26 Helpline: 0191 291 0166
Self-adhesive sheaths
Self-adhesive SAUER p-sure sheath
(available in the UK from the Autumn 2002)
After years of development, we have added our selfadhesive sheath (perhaps more acurately described as
a self-adhering sheath) to our range of products in the
UK. It offers the same advantages as our latex urinary
sheath (see page 16): 11 sizes, high elasticity material
which gets thinner towards the end. Double-dipped tip,
100 % individually checked.
In addition, our self-adhesive sheaths have other features that make them easy to handle and
comfortable to wear:
Synthetic material. The sheaths and skin adhesive are latex-free. This prevents the irritations
and allergies that can occur with latex, although true latex allergies are very rare. More often it is
impurities in some manufacturers latex sheaths and adhesives that cause skin irritations.
Self-adhesive film which allows you to put the sheath on quicker and more easily. This guarantees a reliable adhesion between the sheath and the skin.
Dipped connecting tube. This is part of the sheath. The connecting tube fits our leg and bed
bag with or without a universal adapter.
Order no. 97.xx 11 sizes from 1840 mm individually checked blue inspection ticket
Tutorial
Applying the self-adhesive sheath
Tip
To practice putting on the sheath, just ask for what
we call a small thumb size, which is a self-adhesive sheath with a diameter of 22 mm. You can then
follow the steps described below and find out how
to overcome unrolling problems, prevent longitudinal folds and see where the adhering area starts.
Pull over the protective cloth so that the pubic hair
does not get glued together and make the adhesion
process more difficult.
Unroll the sheath at least two folds before you start
applying (with small penis, you may have to unroll 3
times). This is to get a buffer zone between the penis
and the dipped tip of the sheath and the correct
position of the adhesion area. If the sheath is difficult
to unroll, we suggest that you stretch the connecting
tube gently.
Put the sheath on the foreskin (if uncircumsized)
without smoothing the foreskin back and carry on
unrolling until you come to the end of the talcum
powdered zone. The unrolled part of the sheath should
be roughly in the middle of the penis.
Pull over the protective cloth
at least 2 x
Unroll at least two times
When unrolling further, you come to the adhesive
zone. From the start, make sure that you unroll the
sheath evenly. To make the unrolling easier, you can
also stretch the connecting tube.
Stretch the connecting tube and put the
sheath on the foreskin (if uncircumsised)
28 Helpline: 0191 291 0166
If the sheath is unrolled unevenly towards one side,
it may stick and then almost impossible to unrol
further.
Unroll the sheath further
correct!
wrong!
Avoid any folds in the adhesive zone. The adhesive
part is about 3 cm wide. The remaining 2 cm of the
sheath is uncoated.
Check the position of the sheath, then press it carefully around and against the penis.
To avoid pressure marks, or if the penis retracts
during micturition, you can remove the remaining
rubber ring behind the adhering area by cutting into
it or pulling it right off. To prevent tearing, make the
cut around the sheath. When cutting or tearing off,
hold the sheath to the adhering area.
Press the sheath all around
Tutorial
Connecting the sheath to the leg bag
Always fit the sheath, then attach the leg bag to the
leg (adjusting the length of the inlet tube if necessary) before connecting the sheath to the leg bag.
This helps to prevent any twists from when the
tubing was coiled being transferred to the sheath
and restricting the drainage path.
Connect the outlet tube of the sheath to the inlet
connector of the leg bag and press all around gently. This connection can be made easier by wetting
the plastic connector before the connection.
To make sure that the inlet tube does not slide away
from the connecting tube of the sheath, you can roll
the end of the connecting tube over. This puts more
pressure on the inlet tube and prevents it from
sliding out.
Dont push the inlet tube further in than the connecting tube of the sheath because you may damage
the tip of the penis.
Connect the inlet tube with the
connecting tube of the sheath
SAUER leg bag will attach to the sheath
without need for universal adapter making adjusting inlet length casier and connection discreet.
correct!
wrong!
Roll the connecting tube over
for more security
Removing the sheath
Roll off the sheath from the back without pulling hard to avoid any risk of damaging the skin. Ideally
this should be done in the shower or bath to reduce trauma to the skin.
30 Helpline: 0191 291 0166
Self-adhesive Funnel type urinary sheaths
Apart from the SAUER Comfort plus self-adhesive sheath
already described, several manufacturers produce different
types of self-adhesive urinary sheaths in the UK. As these are
made of heavier and thicker material, we call them Funnel
type urinary sheaths. Shorter than the SAUER Comfort selfadhesive sheath, the tip has a less elastic Funnel which
allows fluid to pool at the tip of the penis, particularly for
wheelchair users or people who spend most of their time
seated.
They are generally only available in 3 to 5 sizes, as opposed
to the 11 sizes of SAUER Comfort self-adhesive urinary sheaths
offered. Obviously these are only leak-proof when the circumference of the penis and the circumference of the urinary
sheath match perfectly. If the circumference does not match,
longitudinal folding can occur and ultimately the urinary sheath
will become detached.
Because of the different
radius of the tube outlet
you will need a leg bag
with a universal adapter.
The thickness of the rubber cannot adapt to the anatomy as
well as a SAUER thinner latex or synthetic urinary sheath.
The rigid construction of these Funnel type urinary sheaths prevents buffer zone formation. This
means that when you void large quantities of urine, the urinary sheath does not expand like our thin
latex or synthetic urinary sheaths. This puts more pressure on the adhering area, which means the
urinary sheath may become detached (blow-offs or blow-outs).
Application is easy: apply the urinary sheath over the penis through unrolling and apply light
pressure on the adhering area.
apply and unroll
press well
remove by rolling off
Tutorial
KIC System
The bridge between the urinary sheath drainage system and the self intermittent catherisation.
KIC stands for Kondom (condom in English)+Intermittent Catherisation.
We have developed this system for people who are incontinent between catherisation intervals, or who achieve
continence only with medication which they cannot or will
not tolerate because of side effects. Always seek medical
advice before changing any prescription drug regime.
KIC is also suitable for those who may have used a urinary
sheath for many years but start to experience repeated
urinary tract infections (UTI) due to a high residual amount
of urine left in their bladder after voiding. Bladder scanners or urodynamic investigations by specialist healthcare
professionals can determine such situations. The specialist may recommend intermittent catheterisation at least
twice a day, first thing in the morning and last thing at
night to ensure the bladder is completely drained. This
would require at least 2 sheaths a day and cause unnecessary trauma to the skin.
The KIC System allows for repeated ISC without disturbing the adhesive area of the urinary sheath and the subsequent trauma to the skin. Performing ISC through the
outlet tube of a used standard urinary sheath or even a
transparent one is not recommended due to the increased
likelihood of introducing infection into the urinary tract.
In the KIC System, we have a removable connector instead of a fixed tube to connect the leg bag. The connector can be removed from the urinary sheath
using the special sheath expander tool, the sheath can then be pulled over the penis shaft so that the
penis tip is left free for disinfecting and catheterisation. Then, the urinary sheath can be restored to its
original position and connected to the existing drainage system. This procedure can be repeated any
number of times.
With the KIC System, you only need one urinary sheath per day this not only protects the skin, but
it can also save the NHS several thousand pounds per sheath user per year.
32 Helpline: 0191 291 0166
KIC System
Cleaning and disinfecting
KIC sheath expanders and KIC connectors are easy to clean with common disinfectants (no special
sterilization is required). Just follow the disinfectant manufacturers instructions.
KIC System components
KIC sheath expander is made of sturdy plastic material and can be used for several
months.
KIC sheath expander
KIC urinary sheath has a reinforced outlet
which can be stretched but always goes back
to its original shape. The hole does not tear
when handled with care. As with all our urinary sheaths, there is a choice of 11 sizes (18
40 mm). An extra thin version is also available
for cases when penile retraction is a problem.
KIC urinary sheaths with
embossed perforation
The KIC connector replaces the connecting
tube of the urinary sheath. This allows you to
separate the leg bag inlet tube from the urinary sheath. In order to allow the sheath expander tool to expand the outlet of the sheath
over the tip of the penis for access to catheterizse.
KIC connector with
connecting tube
Tutorial
How it works
Hold the KIC urinary sheath between
thumb and index finger, pull the open
end of the KIC sheath over the disc of
the connecting tube, and ensure that
the connecting tube is correctly aligned.
Push on the outer sleeve of connecting
tube and screw into place.
Pull the KIC sheath and the connecting
tube to check connection. Then, apply
KIC sheath as usual.
34 Helpline: 0191 291 0166
KIC System
To loosen the connection between the
KIC sheath and the inlet tube of the leg
bag, remove the connector from the
KIC sheath.
Insert the closed prongs of the sheath
expander into the hole on the end of
the KIC sheath.
Expand the hole at the end of the KIC
sheath by closing the scissor handles.
Move the sheath expander and KIC
sheath towards the body over the tip of
the penis as much as you can, so that
the glans is free. If penile retraction is a
problem when the bladder is full, you
can gently close the prongs of the
sheath expander to prevent the shaft of
the penis retracting prior to catheterisation.
Tutorial
Disinfect + Catheterise
Remove any adhesive remains to
prevent any inflammation of the
glans or foreskin. Disinfectants or
adhesive residue can have an adverse effect on adhesion strength.
Remove any residue left over from
catheterisation and bring the sheath
expander and KIC sheath back over
the tip of the penis, away from the
body.
Close the sheath expander by opening the scissor handles, and then remove the sheath expander.
Re-connect the KIC sheath to the connector and ensure that the connection
is secure by pulling.
36 Helpline: 0191 291 0166
Urine bags
Urinary leg bags
All SAUER leg bags are manufactured in our factory on a high-frequency welding machine. They are
made of PVC which is still the only material which allows the manufacture of bags of such high quality
for the medical field. However we are constantly looking for alternative greener materials that are
kinder to the environment.
Bendi bags
These leg bags with the leg hugging shape have been developed specifically for wheelchair users or
people who spend most of their time in a sitting position. They are specially adapted for those in the
sitting position. They are very comfortable to wear, as well as flexible and secure. All of our leg bags
can be tailored to individual requirements such as inlet tube length and type of outlet tap.
High capacity. Holding up to 1.3 litres (1300 mL), these give you more independence on long
journeys and at work without the worry of having to find accessible toilets. It halfs the number of
times the wheelchair user or their carer has to empty their leg bag. There is also a 0.7 litre
(700 mL) bag for wheelchair users who do not require the extra capacity or are of smaller build.
Bendi Bags can be worn comfortably on the inside or outside of either leg. Inlet tubes can be
adjusted to individual specific requirements. The bags are inconspicuous, securely fastened
above the knee with an extra wide soft woven strap with silicone non-slip backing. A choice of
outlet sliding or lever action outlet makes for easy drainage.
Comfortable to wear. This is due to the textured PVC which allows the skin to breathe and does
not stick or cause sweating. For increased comfort, use a SAUER washable cotton cover is
available.
Every bag is individually tested for leaks and functionality.
Choosing the right leg bag
In our catalogue, we described the features of the different types of leg bags in detail and we also
help you to choose the best leg bag for your needs. We suggest you also talk to our continence
systems adviser who can give you valuable advice.
Tutorial
The Bendi Bag features
Ê Inlet connection
Option of a smooth or stepped universal adapter. We advise smooth adapters for connection to
urinary sheaths and stepped adapters for connection to urethral and suprapubic catheters.
Ë Inlet tube
Is very soft and flexible to avoid dragging on sheaths or catheters, but will not kink. There is a short
(12 cm) and long (20 cm) standard inlet tube length. However should these sizes not be suitable,
we can customise inlet tube to your specific requirements as part of the prescription service in the
UK to suit all body sizes.
Ì 4 way welded inlet into bag
Allows for a smooth flow of urine, even with leg bags which do not lie flat.
Í Reflux valve
Prevents the return of urine, for instance during physiotherapy sessions.
Î Strap Eyelets
Allow the straps to be fastened according to individual need, thus giving a more secure fitting.
Ï Outlet Tap
This enables you to empty the leg bag with a swing tap or a sliding tap, without any mess:
the swing tap is good for people with limited hand movement and can even be modified to close
itself with a security band that also helps prevent accidental opening.
the sliding tap is particularly secure to prevent accidental opening although there is some
evidence to suggest that this type of tap increases the risk of transmitting infection.
Ð Textured PVC material
This is very strong and has a textured surface to avoid sweating or sticking to the skin.
Ñ Welding
The inlet into the bag, the reflux valve and the outlet tap are welded to the PVC. Double welding
makes it the most secure bag on the market.
These features apply to all SAUER leg bags.
Straps: An extra wide 38 mm (1½") soft woven elasticated top leg strap is available on all prescription
SAUER leg bags for extra comfort and security with a non slip silicone backing.
38 Helpline: 0191 291 0166
Urine bags
Ê Inlet connection ...
... without universal adapter connects directly to SAUER sheaths
Ë Inlet tube
Welded valve Ì
Ñ Welding of inlet valve
... with smooth universal adapter
Í Reflux valve
Strap eyelet Î
Î Strap eyelet
... with stepped universal adapter
Textured surface of the PVC Ð
Double welding Ñ
Ñ Double welding of the outlet tube
Outlet tube with swing tap Ï
Ï Outlet tube with sliding tap
Tutorial
Putting on the Bendi leg bag
Decide whether the leg bag is to be worn on the left or the right leg.
Please take note of the directions for use supplied with the Bendi
Bags for details of attaching the leg bag to the strap.
Place the leg bag on the leg and if the inlet tube is too long, its
length can be adjusted. Pull the leg strap through one of the higher
punched holes (eyelets) in the leg bag. The bag has several holes
for the leg straps, enabling the position of the leg bag to be
adapted to individual leg shape (e.g. sitting position).
We have designed the leg bag so that the top leg strap is placed
above the knee. This eliminates any risk off cutting off the circulation because you dont have to fasten the strap as tightly as a calf
bag strap. It also means that the leg bag does not slip down when
full.
Ensure the elastic of the undergarment you wear does not restrict the flow of
urine. Men who wear Y fronts can pass the urinary sheath or catheter through
the slit in their underpants to enable free drainage.
Only after attaching the leg bag to your leg and fitting the catheter or urinary
sheath should the two be connected. This avoids any coiling of the leg bags
inlet tube from when it was packaged, twisting the sheath or catheter.
To ease making the connection between the leg bag and the catheter or urinary
sheath tube, wet the connector tube of the leg bag slightly or spray with a
disinfectant. When attaching the catheter or urinary sheath, please ensure that
twisting does not occur.
Check the position of the tubing several times during the day to ensure that the
drainage path is clear, especially after physiotherapy or after changing position
(e.g. getting into a car or transferring from bed to wheelchair, etc.).
If necessary, you can secure the inlet tube to the leg by using a second leg strap
(see picture on page 41).
40 Helpline: 0191 291 0166
Urine bags
SAUER Comfort leg bags
These new 600 mL capacity rectangular leg bags have the same
quality features as the Bendi Bags, leg hugging leg bags (strong and
textured PVC, welding, reflux valves, outlet tap, etc.).
Because of their shape, they can be used by able-bodied people as
well as wheelchair users and children, and they can be worn either on
the left or right leg.
The main characteristics are:
Capacity. Available in 0,6 l. They are intended for people who do
not usually have problems finding accessible toilets to empty the
bag. They are squarer than the majority of similar capacity leg
bags, making them particularly suitable for people of smaller build.
The long inlet tube can be customised to fit all body sizes. This
means you can wear the leg bag either on the thigh or on the
lower leg. The bags come in 3 standard inlet tube sizes. Direct
inlet, 15 cm inlet and 45 cm inlet. Any other length can be made
for you on request.
They are available on prescription in the UK, sterile or non-sterile, each with a glued universal adapter. For the 15 cm and 45 cm
inlets, we also supply a loose adapter to allow the inlet to be
shortened to individual requirements. Longer inlet tube lengths
are available on request. We offer smooth or stepped push-on
adapters. This allows a perfect fit to all urinary sheaths or catheters currently available in the UK.
Universal adapter:
smooth or stepped
The backing of the leg bag is a natural cotton fleece, which is
velvety smooth for extra comfort against the skin. The leg bag is
coated on one side only and remains transparent on the other
side.
Features to note when putting on Comfort leg bags
You can wear the Comfort leg bags either on the thigh (direct or short inlet tube version) or on the
lower leg (longer inlet tube). When worn on the thigh, they can also be worn on the outside.
Tutorial
We cannot give a general description on how the leg bag should be worn, so we recommend you try
the different options to find out the best solution for you.
Our extra wide 38mm (1½") non-slip top strap secures the Comfort leg bag into position. Each
prescription pack has one wide top strap, one narrow bottom strap, 10 leg bags and a connector to
attach a night drainage bag to the outlet of the leg bag. To find out more about other ways of securing
the leg bags, please ask your continence systems adviser.
Discreet Thigh Bag
These unique leg bags have a capacity of 0.45 litre (450 mL). They are
available with direct inlet tubes in the centre of the bag or in the
opposite corner to the outlet tap (ideal for suprapubic catheter users).
You can wear them easily on the thigh under short clothing, shorts or
swimming costumes. You can also wear them when dealing with
partial incontinence (see page 49).
The Discreet Thigh Bag can be worn in different ways:
Strapped on the outside or the inside of the thigh using our
narrow straps threaded through the eyelets on the top or bottom
of the bag for wheelchair users. The eyelets on the side of the
bag are generally for use by ambulant people using our wide leg
bag strap.
Place the bag in our 100 % washable cotton cover and secure it
on the inner or outer thigh with our 38 mm wide Velcro strap.
Simply tucked into the wearers underclothes or swimming costume, or laid across the top of the thigh (and kept in place by
clothing).
Variations
inlet tube
straight
diagonal
adapter
smooth
stepped
outlet
swing tap
sliding tap
without
straight inlet tube
42 Helpline: 0191 291 0166
diagonal inlet tube
Urine bags
Leg Bag drainage problems
If the leg bag is not put on properly, drainage problems can occur the urine does not flow directly
from the urinary sheath or catheter into the leg bag.
Possible reasons may be:
the urinary sheath or catheter is trapped beneath the elasticated leg of the under garment
clothing is too tight
the tube is too long or kinked
the leg bag is not secured properly
the leg bag is not positioned correctly
the leg bag contains air
Tutorial
Special orders of the SAUER leg bags
We have designed our range of products for bladder incontinence care to cover every need. We are
always looking for a better solution or trying to develop something for any person not covered by
current range of products.
Therefore, if you have any problems or questions regarding our standard range of products, please
call us. We can advise you fully and try to find the best solution for your specific requirement. If we do
not have a product that suits your specific requirements, we are always happy to recommend other
products available on the market that may suit you.
.1
5c
e. g
All our leg bags can be produced with any inlet tube length. To adjust the
inlet tube length yourself, simply cut the inlet tube to the required length
and use one of our push-on smooth or stepped connectors (available
from our helpline). For people who find our standard inlet tube lengths
unsuitable or are unable to adjust the inlet themselves, we offer a free
inlet tube cutting service. Once you have determined the inlet tube
length, notify our customer helpline and we will cut and glue the inlet tube
for you at the factory giving you a wash and go solution out of the box.
Customers who use a catheter and need non standard inlet tube lengths
require a customised sterile bag which takes about 12 weeks to get
through the sterilisation process. However, once we know your requirements, we will keep enough of your required size in stock to ensure you
never run out. Alternatively, individually sterilised connectors are available on request for catheter users who wish to shorten the inlet tubes
themselves care must be taken to ensure as clean a technique as
possible to avoid introducing infection into the system.
m
Inlet tube lengths and outlet taps
How to measure the length
of the inlet tube
We can customise your leg bag in the following ways:
shorten or lengthen inlet tubes (see picture on the right)
fit different adapters stepped, smooth, urine sample ports
fit outlet tubes instead of a swing or sliding taps.
44 Helpline: 0191 291 0166
Urine bags
Sterile Leg bags
All of our leg bags are available sterile or non sterile. For a sheath user with no history of infections
living in the community, a non sterile leg bag is perfectly adequate and also saves the NHS a
considerable amount of money (it costs the manufacturer over 40p to pack each leg bag in a special
gas permeable pouch and sterilise it a waste of money and resources for the majority of sheath
users). Anyone with a permanent indwelling or suprapubic catheter should use a sterile leg bag as a
matter of routine as the catheter is a way into the body for bacteria and every possible effort should
be made to ensure infection risk is kept to a minimum. Catheter users are also recommended to
attach a night bag to the bottom of the leg bag with the supplied connecting tube rather than
disconnecting the leg bag from the catheter every night. Your specialist continence healthcare
professional is the best person to advise on the regime that best suits your clinical situation.
Delivery time: Please note that there is a delivery time of approx. 14 days for any special non
sterile orders and up to 3 months for sterile ones. A minimum quantity of 6 boxes must be placed
for non standard sterile inlet tube lengths. The alternative is to order an the adjustable inlet tube
version of the leg bag that comes with separate sterile connectors so the inlet tube can be
shortened as required.
Cotton cover
Some users find the direct contact of the leg bag against the
skin uncomfortable. We offer a cotton cover. This is made of
skin-friendly cotton, can be used frequently and is washable.
Waist belts for ambulant people or children
The waist belt ensures that the distance between the urinary
sheath and the leg bag remains the same and prevents any
pulling on the urinary sheath and the adhesive area.
It is recommended particularly for
ambulant people
small adhesive surfaces
use in small urinary sheath sizes or by children
Tutorial
Outlet taps
Swing tap
The benefits of the swing tap are:
Easy operation, even with restricted finger movement
A positive action that moves through 90 degrees and makes
it easy to determine whether it is open or closed
Security band to help prevent accidental opening and aid
closing
open
closed
Sliding tap
easy operation by pushing back and forth
greater security against unintentional opening
the open or closed position is easy to feel just by touching
the slight bump on the side
Emptying urine drainage bags
Leg bag: Never allow air to enter your leg bag through the
outlet tap. Always leave a small amount of urine in the bottom of the bag. This increases the suction in the system
(creating a partial vacuum) which helps drainage and prevents a build up of urine in the buffer zone of the urinary
sheath. It also minimises airbone contamination in the bag,
which is particularly important for catheter users.
It is also possible to empty the bag without getting fingers or
clothes wet. After emptying, push the tap upwards to allow
the urine in the tap outlet to flow back into the bag. This,
however, does carry the risk of introducing airborne contamination into the bag.
46 Helpline: 0191 291 0166
Urine bags
Bed bags: Non drainable (without a tap). Empty the urine
through the inlet tube into the toilet if the bag has no nonreturn valve.
If you are in a hurry, cut
the corner off to enable
quick drainage.
Connecting Bed bags
For urinary sheath users the sheath is not removed but the leg bag is replaced by a bed bag.
Catheter users should attach the bed bag to the
bottom of the leg bag with the supplied connecting tube rather than disconnecting the leg bag
from the catheter every night. This prevents the
introduction of bacteria into the closed drainage
system of catheter and leg bag.
Important:
The bed bag must hang below the person!
Bed bags are mass produced and often seem to
leak. Using our waterproof night bag cover
(Order no. 70.52) can solve this problem as well
as disguise the contents of the bag from visitors.
Alternatively, many people rest the nightbag and
its stand in a bowel just incase it does leak.
Night bag cover
Tutorial
For people that pass over 2.0 l of urine overnight. To save changing bed
bags during the night, it is possible to connect 2 cheap disposable 2.0 l
night bags to a sheath or catheter at the same time by using a Y
connector (Order no. 62.10) thus making it unnecessary to change the bags
at night.
You can also leave the leg bag connected and add a bed bag to it. To do
this, you need a short coupling tube (Order no. 55.38 included in every UK
Drug Tariff Pack). Attach the coupling tube to the adapter of the bed bag
and the outlet tap of the leg bag (wet the coupling tube to ease the
connection). The outlet tap of the leg bag remains open so the urine can
flow through the leg bag.
Y piece
Please note:
The bed bags, which generally have a long inlet
tube (100 cm) which is coiled for storage. The tubes
therefore have to be stretched slightly by pulling
them between your index finger and thumb while
applying slight pressure. This relieves the tension
and reduces the risk of the urinary sheath twisting
or the catheter pulling.
When changing position in bed, check position of
the urinary sheath and inlet tube, to prevent twisting and avoid outflow problems.
48 Helpline: 0191 291 0166
stretch the tube
Partial incontinence
Partial incontinence
SAUER Drip urinal for men
Is an alternative for partial incontinence when only small quantities of urine are an issue (for instance after prostate removal).
For wearing under a swimming costume or for short periods of
time by people who would normally use a urinary leg bag. In the
latter case, the bladder should be emptied before using the drip
urinal (see bladder training). Ideal for men who have a suprapubic catheter but still leak a little through the urethra.
The connecting tube of the urinary sheath can be closed with a
swing or a sliding tap. Using a stopper is not so easy and the
process of emptying is not so hygienic as using an outlet tap.
Only SAUER sheaths are suitable for this purpose, stiff Funnel
type urinary sheaths are not elastic enough to hold any significant volume.
URIbags Male & Female discreet pocket sized reusable urinals
URIbags are ideal for use by:
Anyone that cannot get to the toilet in time.
Emptying a urinary drainage bag or urostomy bag
(use male version)
Wheelchair users, due to its small dimensions it can
be easily placed and removed without the worry of
spillage as with traditional bottle urinals.
If you perform Intermittent Self Catheterisation (ISC)
Small children in the car, camping, sailing, flying,
coach trips ... the list is endless
There will always be a time when it is not possible to find
an accessible toilet particularly for wheelchair users. In
our experience it is always better to be prepared for such
bag stored in
tube when
not used
ready for use
Tutorial
circumstances which is why we would recommend the
URIbag as a backup continence solution for everyone
regardless of their impairment because it takes up very
little room when not in use. Wrap the URIbag in a typical
supermarket plastic carrier bag (wheelchair users should
ensure the bag has handles that can be suspended over
the pushing handles of the chair) so once it has been used
it can be carried around discreetly until somewhere suitable is found to empty it. After use the URIbag should be
rinsed in running cold water. In the case of heavy use the
URIbag can periodically be rinsed with soapy hot water
(e.g. once a week). As with all natural latex products keep
out of direct sunlight, do not store wet for more than a few
days and do not use chemicals to clean.
bag stored in
tube when
not used
ready for use
URIfem Female Urinal for use lying down or in
a half-sitting position
Is a reusable female urinal that is ideal for use in bed and
differs from other designs because it is very narrow and
the method of positioning the urinal in order to use it
ensures minimal disturbance. Many women may not actually be incontinent but due to mobility problems cannot
get to the toilet in time during the night. The URIfem is
made of durable polycarbonate that can be sterilised using any typical solution such as Milton or in a steam
steriliser up to 130 degrees.
There are many reusable female urinals on the UK market
(14 at the time this tutorial was printed) each having different merits. The general consensus of opinion is that women
should try several to see which suits their individual requirements. Contact your local continence adviser who
may be able to offer a trial of selected urinals to help you
make up your mind. When choosing any urinal to be used
in bed (particularly on a soft mattress) or in a seated
position always ensure there is sufficient depth in the
container to remove the urinal after use without spillage.
50 Helpline: 0191 291 0166
Skin care and protection
Skin care and protection
Meticulous hygiene is essential, especially for those who wear urinary sheaths, catheters and
perform intermittent self-catheterisation, to prevent bladder infections and fungal infections around
the groin area.
Preventox
Is a skin protection fluid. It builds a protective film, which is elastic and
allows the skin to breathe and is designed to protect the skin from
adhesive products such as urinary sheaths and ostomy products.
Effect:
Disinfects and cleans through high alcohol content.
Protects the skin by coating the skin with a breathable film (like a
spray dressing, especially when used with a spray or roll-on bottle).
as a single wipe
Increases the adhesive action of the skin adhesive, adhesive tapes,
self-adhesive sheath and ostomy products.
Note: Do not apply Preventox to broken skin as it has an alcohol base
a hydrocolloid tape or dressing is best to protect broken skin under a
urinary sheath always consult your specialist nurse or doctor in such
cases. However, you can use Preventox to treat skin redness.
Preventox comes in various forms:
as single wipe (Order no. 50.50) available on prescription in the UK.
as a roller that is used like an underarm roll-on deodorant. This is
particularly suitable for use by people with restricted hand movement (Order no. 50.58) available on prescription in the UK.
in a bottle with
applicator
spray head
if required
in a bottle with an applicator (Order no. 50.52); you can add a
spray head (Order no. 50.53) to this and operate it by finger pressure.
Before trying any new product that comes into direct contact with the
skin such as adhesives and skin protecting film, we recommend you try
it out on a neutral area of skin (such as the inside of your wrist) to ensure
you have no allergic reaction.
in a roll-on
bottle
Tutorial
Problems
If you have any questions concerning our products, or if any problems arise during use, please do
not hesitate to contact us. We have found a quick call is often sufficient to solve many small problems
and complaints. Our confidential Helpline is staffed by people who have personal experience of living
with and managing continence problems.
Confidential Helpline: 0191 291 0166
Below and on the following pages we have listed the most common problems and our suggested
solutions.
Urinary sheath dosnt adhere for 24 hours
Possible cause
Possible solution
Adhesive and/or urinary sheath do not meet
individual needs
- Change the adhesive type and/or urinary
sheath
- Ensure you have the correct size urinary
sheath and check that penile retraction is not
a problem. If the penis is retracting when the
bladder is full or during voiding of the bladder, use the extra thin urinary sheaths (see
pages 17, 24, 55)
Urinary sheath sticks in buffer zone
- Check the pH of urine
- Drink more water
- Change urinary sheath type
- Use less skin adhesive.
- Move the adhesive further down the shaft of
the penis
Slight skin secretion, extreme sweating e.g.
caused by medication for urinary tract infection, spasms, or acidity, etc.
52 Helpline: 0191 291 0166
- Ask your doctor for an alternative medication
Problems
Possible cause
Possible solution
Skin irritation caused by use of adhesive for
several years
- Change urinary sheath and/or adhesive type
always test a new product on a neutral area
of skin such as the inside of your wrist to ensure no allergic reaction.
- Try to go without a urinary sheath for a period
of time
Medications with large amount of vitamin E
Medications or cream containing cortisone
Perspiration in hot weather
- Try to avoid extreme heat. Use a skin preparation fluid like Preventox to increase the adhesive bond
Skin too damp because the sheath has been
applied too soon after a bath or shower
- Wait at least 15 minutes after a shower or
bath before applying the sheath. Use a skin
preparation fluid like Preventox
Liquid soaps, foam baths, oil based products,
talcum powder
- Use unscented soap do not use other toiletries on the skin
Skin abrasions, fungal infection
- Consult your specialist nurse or doctor a
hydrocolloid tape or dressing is best to protect broken skin under a urinary sheath and
generally does not affect the adhesion of the
sheath. Anti fungal creams & powders are
available from your local pharmacy. However,
if in doubt, always seek medical advice.
Use of adhesive remover pads
- Wash off any remover pad residue
Tutorial
Other factors that can affect urinary sheath adhesion include:
Diabetes: the characteristics of the urine caused by this condition can have a negative effect on the
strength of the adhesion.
Spices, Food: we have noticed that the use of strong spices or certain food like curry, chilli,
horseradish, garlic and also beer yeast can reduce the strenght of the adhesion, in some cases.
We have even heard that a change of diet from meat eater to non-meat eater can affect the strength
of the adhesion for a while.
Skin redness
First of all, try to find out whether the reason for the redness comes from a urinary tract or fungal
infection, soap, medication, or some other cause.
Possible cause
Possible solution
After using adhesive for the first time, because the skin is not accustomed to it
- Occurs very rarely goes away after a few
days. Adhere further up the penis shaft
- Vary the adhering zones this is not possible
with self-adhesive urinary sheaths
Urinary sheaths due either to the talcum
powder or to the material the urinary sheath is
made from i.e. latex, synthetic polymer or
silicone
- Use a urinary sheath made from a different
material. If you are not using a SAUER
sheath, try our standard latex or extra thin
latex sheaths. Alternatively try our synthetic
sheaths. There are also silicone urinary
sheaths available on the UK market Call our
helpline for free advice on: 0191 291 0166
Removing adhesive residue with solvents
- Refrain from using solvents there are adhesive remover pads available in the UK without
any solvent base Call our helpline for free
advice on: 0191 291 0166
Allergy to lanolin in the skin adhesive
- Use adhesive without lanolin content Manfred
Sauer has 8 different skin adhesives available
on prescription in the UK so you can be sure
to find a suitable adhesive for all types of skin
54 Helpline: 0191 291 0166
Problems
Possible cause
Possible solution
Skin irritations, abrasions, mycotic infections
- Always consult a specialist nurse or doctor to
check there is no underlying problems
Allergy to latex in the adhesive or in the urinary sheath
- A true latex allergy is quite rare. Usually it is
the impurities in the latex or talcum powder
used that cause people allergies. Manfred
Sauer latex products are made of the highest
quality medical grade latex. If the problem still
persists, use a latex free adhesive and synthetic or silicone urinary sheath
Some devices and pharmaceuticals used to
treat erectile dysfunction can cause irritation
to the skin e.g. vacuum pumps, penile injections, penile suppositories and viagra.
- Always consult a specialist nurse or doctor to
check there is no underlying problems.
Vacuum pumps if used responsibly may
cause a little redness the first few times they
are used. With any pharmacuiticle drug an
allergic reaction is always possible.
See Skincare and protection, page 51.
Penile retraction the solution?
This is often a problem for elderly men and people with a strong detrusor-Sphincter-Dys-Synergy
when the urine flows. It can be so extreme that there is no part of the penis visible to attach a sheath.
Depending on the severity of the phenomanon, you can take the following action:
Empty the bladder as much as you can before putting on the urinary sheath (for example,
through self catheterisation or expressing, tapping or triggering, see pages 58 & 59)
Use the correct size urinary sheath (Manfred Sauer has 11 sizes to ensure a perfect fit)*. If the
retraction is severe, use extra-thin latex urinary sheaths which are identified by the letter D at
the end of the product code e.g. 53.26 D.*
Use a SAUER Comfort self-adhesive sheath and remove the remaining ring once the sheath is
properly fitted (see page 29)
Intermittent Catheterisation and, if necessary, extra urinary sheath supply (see also the KIC
System, page 32)
Tutorial
Some clients tell us they exercise their penis regularly with a vacuum pump and, as a result, get
a bigger adhesion area. A vacuum pump can also be used to stop the penis from retracting and
generating an erection which is maintained by constriction rings at the base of the penis when
the vacuum device is removed. Once the urinary sheath has been fitted* the constriction ring
can then be removed.
Implantation of a penis prothesis this requires specialist surgery discuss this procedure with
your urology consultant.
* Once the urinary sheath is properly fixed, you must cut off the remaining rubber ring behind the
adhering area and, using a skin adhesive, glue any remaining parts of the sheath to the skin (see
page 23). The extra-thin urinary sheath fits like a second skin and retracts with the penis rather than
being rolled off.
Alternatives
As a rule, Original latex urinary sheath and skin adhesive are sufficient to ensure reflux-free drainage.
If individual circumstances lead to unsatisfactory results, consider the following alternatives:
Preventox (skin protection) .................................................. see page 51
Other latex based urinary sheaths (extra-thin D type) ...... see page 17
Synthetic urinary sheaths .................................................... see page 17
Other latex-based adhesives ............................................... see page 21
Synthetic adhesive .............................................................. see page 22
Double sided adhesive tapes .............................................. see page 26
SAUER Comfort self-adhesive sheath ................................. see page 27
Contact the Manfred Sauer Helpline for free advice on
Tel: 0191 291 0166
e-mail: [email protected]
If we do not have a solution to your problems,
we will make every possible effort to refer you to somebody who can.
56 Helpline: 0191 291 0166
Bladder training
Keeping kidneys and bladder healthy
To keep the kidneys and bladder in good health, it is vital to maintain disciplined self-monitoring
procedures.
Always remember:
Fluid intake drink enough water to produce 1.52 litres of urine daily. Ideally the urine should
be a light straw colour.
Urinary output keep a record of
- Voiding intervals
- Quantity due to bladder capacity and residual urine
- Appearance: cloudiness
concentration
odour
as a sign of infection
- pH There are test strips (litmus paper) available to establish the pH of your urine. The urine
should test with an acid value somewhere between pH 56. To increase the acidity, there are
medications you can take or try the natural products available such as rosehip tea, natural
blackcurrant juice, cranberry juice, cranberry juice concentrate tablets and Vitamin C tablets.
It should be noted that high concentrations of acidic substances can cause indigestion and
even ulcers in extreme cases.
If any irregularities occur, consult your doctor and increase your fluid intake drink tea and plenty of
water to stimulate your urinary flow. Many doctors allow consumers who are willing to take control of
their bladder management to have a stock of antibiotics (chosen by the doctor based on their
infection history). Rather than wait for an appointment to see a doctor or get a specimen of urine
analysed, they can then start a course of antibiotics immediately after taking a specimen. It is
important to be responsible in the use of antibiotics and always get a specimen analysed to monitor
exactly what is going on.
To prevent bladder infection, there is a whole range of medications as well as homeopathic products.
Cranberry juice or cranberry capsules/tablets and vitamin C are reported to help prevent bladder
infections as they make the urine more acidic and thus less hospitable for bacteria. Consult your
continence specialist for details of such treatments.
Sudden headaches could be a sign of increased bladder pressure or even infection. Do not try and
self-diagnose consult your doctor or urology specialist for advice.
Tutorial
Bladder training
Depending on your medical condition you may be suitable for bladder training. Many ladies have to
rely on this form of bladder management as they may not wish to be permanently catheterised and
find the use of pads distasteful and intermittent catheterisation difficult in the real world. You should
discuss the type and scope of bladder training (also known as triggering) with your consultant or
urology specialist, after completing a urodynamic examination.
If your doctor advises you carry out bladder training, men are advised to do it whilst wearing a sheath
drainage system and women with a suitable absorbant pad. Bladder training helps:
decrease dependancy on a sheath drainage system
increase and perfect the automation of the bladder
reduce distention of the bladder
reduce the amount of residual urine
Intervals for bladder training
Even people who have partial or no sensation learn to notice changes in their bodies which act as a
sign of a full bladder. These signs are important for people who rely on bladder training or intermittent
catheterisation to manage their bladders. Such signs are:
goose pimples on your back, arms, face or forehead
sweating in specific places such as at the hairline on your forehead
pins and needles, itching on the back of your arms
feeling of pressure/tension in the head
Muscle spasm in legs and abdomen
You can organise the intervals between training by these signs. If no signs occur, you should perform
bladder training every 4 hours (except during the night).
Risks
The unbalanced pressure of the bladder (Detrusor-Sphincter-Dys-Synergy) can increase through
bladder training and cause long-term damage to the bladder tissues and ultimately damage the
kidneys. See also pages 6 & 8.
58 Helpline: 0191 291 0166
Bladder training
Intermittent Catheterisation
You can prevent these risks linked to bladder training by intermittent catheterisation. The catheterisation ensures a pressure and residual-free bladder drainage. If you cant or dont want to perform this
procedure yourself or have it done by a carer throughout the day, you should do it at least twice a day
(morning and evening). Wheelchair users should take their feet off the footrests and push their pelvis
as far forward as possible in order to straighten the urethra as much as possible before passing the
catheter.
Performing bladder training
You can use individual stimuli to release the reflexes
(the trigger mechanism) by:
Knocking on the bladder
Stimulating the skin on the abdomen, the external genitals, or the inside of the thigh
Rectal manipulation (stretching of the anal
sphincter)
Make sure you are in relaxed position!
When sitting: Push the pelvis as far forward as
possible
When lying: Lie on your side with your knees
bent
Those with a limp bladder paralysis should empty the bladder by intermittent catherisation. Pressing
with your hands on the bladder can cause long term damage.
Tutorial
Useful tips about living with a urine drainage system
Essential supplies - Small bag
We advise anyone who wears a urinary system to carry a small bag in case of an emergency. This
bag should contain:
Urinary sheath Users
2 urinary sheaths
1 tube of skin adhesive which you have already tried for adhesion quality if you are not using a
self-adhesive sheath.
1 leg bag to save space, we advise a discreet thigh bag
1 small plastic bag with an elastic band if the outlet tap starts dripping, you can put the plastic
bag around the tap and fasten it with the elastic band.
If the urinary sheath starts leaking
The urinary sheath may start leaking while you are wearing it, e.g. a small hole appears. After drying
the spot, spread some adhesive over it (see reference to the small bag) and glue some of the urinary
sheath film together. This should last until you are able to change the urinary sheath in a quieter
place.
Ureathral/Suprapubic catheter users
Syringe to empty balloon of old catheter to enable its removal if it gets blocked
Spare catheter and accessories required to fit the catheter in case the existing one gets blocked.
Most people or their carers can be taught how to fit a catheter. To rely on calling out a healthcare
professional should your catheter get blocked in the middle of the night or when on holiday may
not be practical
Catheter valve or spare leg bag should there be a problem with the leg bag you are wearing.
Techniques for people with limited finger movement to apply a urinary sheath
Many tetraplegics do not have the third hand needed to slide the urinary sheath into the connecting
tube. You can solve this problem by using a piece of tubing.
60 Helpline: 0191 291 0166
Useful tips
From the inlet tube of a bed bag, cut a piece of approx. 30 cm long (with or without adapter). You can
re-use this piece time and time again. Slide this piece of tubing (side of the adapter when used) into
the connecting tube of the urinary sheath. To make the tubing slide easier, just wet the tubing or
adapter slightly at the point of entry. Hold the end of the tubing with your teeth just above the penis so
that you can unroll the urinary sheath with the two balls of your thumbs.
When you have finished with the adhesion procedure and waited for a while (about 5 mns), blow the
urinary sheath through the piece of tubing to check that:
the adhesion is secure
the urinary sheath does not leak
You can then remove the piece of tubing and slide the connecting tube of the urinary sheath (wet
slightly also) into the inlet tube of the leg bag.
The whole procedure takes place while you are sitting with the leg bag ready to be fitted and your
trousers undone. To help this procedure, Rolli-Moden trousers have an extra long zip that extends
into the gusset.
There is a video (Order no. 99.921) which illustrates this procedure.
Adhesion with continual incontinence
Continual incontinence means that urine drips constanly through the urethra. As a result, the
adhesion area is always damp and this always leads to a reduction of the adhesion strength. You
should therefore void the bladder by bladder training or catheterisation beforehand. The few
remaining urine drops can be stopped temporarily by holding back the penis. Then, there is enough
time to dry the skin and go through the adhesion procedure.
The SAUER Comfort self-adhesive sheaths can help in this instance as the adhesion procedure is
shorter. These sheaths are put on the penis tip, then unrolled and adhered at the same time.
Emptying the urine bag while away from home
This is the situation: you want to empty while in a car, at the office or on a plane whithout attracting
everybody elses attention.
Before leaving home, slide a latex coupling tube (Order no. 55.38) into the inlet tube of a bed bag.
You then put them into a non-transparent plastic bag. You can also use the connecting tube of a
urinary sheath as a joint (simply by cutting the connecting tube from a urinary sheath).
Tutorial
To empty the leg bag, slide the coupling tube into the
outlet tap of the leg bag and open the tap. As soon
as the leg bag is empty, close the outlet tap and
remove the coupling tube. To make sure that the bed
bag is leakproof, you can either tie or bend the inlet
tube and move the (blue) cap of the bed bag adapter
over the knot. Later, you can put the bed bag into the
plastic bag and dispose of it.
You can also empty the leg bag into the URIbag (a
pocket sized urinal that folds away into a small case).
The URIbag which takes up hardly any room when
empty can hold up to 1.1 litres (almost 2 pints). The
URIbag has a cap which closes securely, thus ensuring no leaks when full. You can then empty in an
appropriate place at your convenience.
Taking leg bags off temporarily
From time to time (e.g. in the bath or sauna), you may want to remove the
leg bag from the urinary sheath and leave it off for a while. Although leg
bags are fitted with a non return valve, it is possible that when lying flat for
sometime, a small quantity of urine comes out of the inlet tube.
There are two ways of dealing with this. Often, it is enough to stand the
inlet tube up against a wall. The second alternative is to close the system
you add a latex coupling tube to the inlet tube and then join it to the
outlet tap. You can order individual coupling tubes (Order no. 55.38) or,
even simpler, cut the connecting tube of a urinary sheath.
The last 100ml who needs socks?
If you choose to wear a leg bag that is drained at the ankle, it does not mean you have to wear socks
with long trousers in hot weather. A good tip is to turn the outlet tap assembly upwards and tuck it
inside the lower leg bag strap snugly so it is fixed in this position. This effectively gives you a
reserve tank of about 100mL. So if you forget to keep a watch on how full the bag is getting, you
can untuck the tap assembly which gives you that little bit of extra capacity and time to find
somewhere to empty the bag.
62 Helpline: 0191 291 0166
Useful tips
Aids to catheterisation
Many people have to perform Intermittent Self Catheterisation (ISC). This process can seem very
invasive and quite daunting to people new to the procedure. However, rest assured with practice it
will become part of your daily routine and need not cause any discomfort or distress. Please seek the
advice of your urology specialist nurse or doctor as to the appropriate product for your medical
condition and training on the dos and dont of catheterisation. We have developed several devices
to make the process of catheterisation easier to perform.
Leg Dividers: Divide and hold the legs
apart, particularly suitable for ladies that
may have a problem catheterising due to
uncontrollable leg spasm or find it difficult
to find the entrance to the urethra. Two
versions are available. Inflatable divider
has a mirror and can also be used in the
shower to wash between the legs if leg
spasm is a problem. Simply inflate to required size/firmness, deflate to store in
pocket or handbag for transportation. The
metal version also has a torch and is often
used by healthcare professionals in clinics to teach ISC and permanently catheterise people with extreme leg spasm.
Push
Inflatable Leg Divider
Metal Leg Divider
Cath-Hand: Was developed by one of our customers with tetraplegia (C5/6). It is strapped to the
wrist/forearm and enables anyone with poor grip and finger dexterity to perform ISC by a gently
flexing of the wrist, can beused with hydrophilic catheters that when wet are very slippy to handle.
Left & right hand versions are available. The Cath-Hand can also be used to pick up other objects
about the house.
open
closed
The jaws can be roughened.
Exact adaptation using a hair-dryer.
The hand-lifting muscle is tensed,
the catheter is kept in a firm hold.
Index
Adhesive removal pad ............................................ 2
Drainage problems .................................................. 2
Adapter .................................................................... 2
How to choose a leg/bed bag ................................ 2
How to choose a urinary sheath ............................. 2
Cotton layer ............................................................. 2
Adhesive procedure .............................................. 22
Adhesive remains .................................................. 24
Adhesive tapes, double sided .............................. 25
Adhesion in spite of abrasions ............................. 23
Allergies ..................................................... 16, 20, 21
Solutions to non-tolerance .............................. 15, 40
Application of leg bags ......................................... 28
Bed attachment ..................................................... 34
Bed bags ......................................................... 33, 34
Bladder training ..................................................... 42
Catheter leg bags .................................................. 29
Urinary sheath adhesion ....................................... 17
Urinary sheaths, synthetic ..................................... 16
Drainage ................................................................ 13
Drainage problems ................................................ 29
Drip urinal .............................................................. 35
Emptying ............................................................... 33
Latex urinary sheaths ................................ 14, 15, 16
Leg bags ............................................................. 35 ff
64 Helpline: 0191 291 0166
Non-tolerance .......................... 15, 16, 21, 38, 39, 40
Partial incontinence ............................................... 35
Uroclean ................................................................ 36
Preventox ............................................................... 36
Problems, causes, treatments .................. 37, 38, 39
Re-adhesion .......................................................... 23
Redness of the skin ................................... 23, 36, 39
Removal of adhesive remains ............................... 24
Self-adhesive urinary sheaths ......................... 16, 26
Self-adhesive Funnel type urinary sheaths ........ 26
Skin adhesive and alternatives ....................... 20, 21
Skin composition .................................................. 18
Skin protection and skin care ......................... 19, 36
Sliding tap ............................................................. 33
Sport bag ............................................................... 30
Storage ...................................................... 16, 21, 25
Swing tap ............................................................... 32
Synthetic urinary sheaths ...................................... 16
Tape measure ........................................................ 16
Taps ................................................................ 32, 33
Thigh bag .............................................................. 30
URIbag ................................................................... 50
Urine bags ........................................... 27, 30, 33, 35
Waist belts ............................................................. 31
Useful contact numbers and Website addresses
Spinal Injuries Association For people with spinal cord injuries Tel: 0800 980 0501
and their families. The SIA also produce a very informative monthly www.spinal.co.uk
newsletter
Spinal Injuries Scotland For people with spinal cord injuries Tel: 0141 314 0056
and their families living in Scotland
www.sisoniline.org
Association for Continence Advice Organisation for healthcare Tel: 020 8692 4680
professionals with a special interest in the standards of available www.aca.uk.com
care and management of continence
Continence Foundation A national resource centre for Tel: 020 7831 9831
information, education and research for bladder and bowel www.continence-foundation.org.uk
problems
Multiple Sclerosis Society For people living with MS wanting Tel: 0808 800 8000
general information and practical advice
www.mssociety.org.uk
Multiple Sclerosis Research Trust (MSRC)
Tel:: 0800 783 0518
www.msrc.co.uk
Association for Spina Bifida & Hydrocephalus (ASBAH)
Tel: 01733 555988
www.asbah.org
PROMOCON National resource for continence product information
Tel: 0161 832 3678
www.promocon2001.co.uk
Incontact User led support group for people with bladder and Tel: 0870 770 3246
bowel problems. They run a network of local groups, helplines www.incontact.org
and pen pals to provide information and support
Royal Association for Disability and Rehabilitation (RADAR)
Tel: 020 7250 3222
www.radar.org.uk
Disability Now monthly newspaper with latest disability news
& reviews published by Scope
Tel: 020 7619 7317
www.disabilitynow.org.uk
Disabled Parents Network Disabled people have the right to Tel: 0870 241 0450
have children and should be properly equiped, supported and www.disabledparentsnetwork.org.uk
resourced for each stage of parenting
Awear National resource for advice on clothing matters for Tel: 0115 953 0439
people of all abilities
www.awear.org.uk
ERIC is a charity that provides advice and information on bowel Tel: 0117 960 3060
and bladder problems to younger children, teenagers, parents www.enuresis.org.uk
and professionals
Rolli Moden Fashion clothing for wheelchair users owned by Tel: 0049 6226 960 203
Manfred Sauer GmbH
www.rolli-moden.de
Continence Systems
Neurott 7 74931 Lobbach Germany Tel. +49 6226 960 100 Fax +49 6226 960 010
MANFRED SAUER GMBH (UK Branch)
Unit KG/D KG Business Centre Kingsfield Way Northampton NN5 7QS
Tel. 01604 588090 Confidential Helpline: 0191 291 0166 Fax 01604 588091
E-mail: [email protected] Website: www.manfred-sauer.co.uk

Schuma 6 - Manfred Sauer UK

Transcription

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