Having difficulty with the external catheter - any tips?

A fellow caregiver asked...

Our 80 year old father had a serious stroke. We tried to use an external catheter and a drainage bedside bag overnight, so that we can have some sleep, since he needs to urinate up to 5 times a night. Unfortunately, we have a problem putting on the external catheter (the condom-like one). The one we use is with an adhesive tape. Also, sometimes he has a problem of a retracted penis. Could you please provide some tips how to apply the mail external catheter, so that it stays on and does not form an air-bubble at its tip. Thank you!

Expert Answer

Jennifer Serafin, N.P. is a registered nurse and geriatric nurse practitioner at the Jewish Homes for the Aged in San Francisco.

As I read your letter, I was thinking to myself about all the times I tried to use those external male drainage devices, and how much trouble I had with them. This is probably why we do not use them much anymore in health care settings. The external device you are using (which looks like a condom that is hooked up to a drainage bag) is difficult, because it falls off and can leak.

My thoughts on how to help this include: 1) Use a skin prep pad prior to applying the condom so that it sticks better and forms a better seal. This will also help protect his skin, as the adhesive in the tape can be irritating. This should be available in a medical supply store. 2) The "bubble" you speak of in your letter forms when the tube or condom kinks up and does not drain properly. Frequent checks of the tubing will help it to drain better, which will prevent the bubble. 3) For a retracted penis, the application of the device gets more difficult. Make sure he is lying flat, and try and grasp the penis to make it as upright as you possibly can before applying the device.

Alternatives to try instead of using the external device include: 1) Prop a urinal between his legs, with the penis placed inside the opening. However, this won't work well if he is moving around alot in bed at night. 2) Or, have him use a urinal on his own if he can instead of getting up and trying to use the bathroom. He may need more than one, especially if no one is around to empty them. You can leave them on his bed or at his bedside.

My last thought: Your father has pretty severe symptoms of urgency, which may be due to BPH (enlarged prostate), his stroke, or something more serious like urine retention and even prostate cancer. You should have your father evaluated for his frequent urination at night (called nocturia) to see if there are any alternatives (like meds or a procedure) that can help him. Even if you could reduce his nocturia by one to two times a night, that might make all the difference. I would recommend making an appointment with a urologist to have your father evaluated if he hasn't been already.