My uncle is now totally bedridden, and having given up on bottles and the like are learning to use a sheath catheter, which looks like a condom with a tube which drains to a bag. It seemed to work ok, but I took it off for an hour today to let his skin breathe, allowing him to revert to his old method of 'catching the dribble' with a towel. All seemed fine until I decided it was time to change the mattress pad and refit the sheath. He waited until I had rolled him one way, put the new pad underneath, then rolled him the other way so that he was aiming nicely at the new, clean, dry pad and decided that it was a good time to piddle as he'd been 'holding on' for an hour. Aaaaaaaarggghh! I'm rapidly discovering that a sense of humour is more important than anything else in this caring lark...

On a more serious note, does anyone have experience with long-term use of external sheath style catheters? I get the feeling that taking them off for an hour or two will help keep his skin healthy, but I don't want him piddling as I'm trying to change him every time, and he's rapidly getting past the stage of being able to understand what he needs to do to make my life easier. Is it possible to have one in place permanently? How often should I change them? Daily, or twice daily, or once every two days, or what?

Heehehehehe Im so cracking up Olivia Im sorry I got a visual from you tryin to put this thing on him
Read this with a grin on your face cause this is the ONLY time Im goin into this detail!
Ok step 1, all fingers (gloved of course) pointed towards the penis in a circular holding pattern the width of the penis, gently push the skin and pop that puppy outta that hole
Have you ever seen a penis ring? Well kinda the same concept hold the base with your forefinger and thumb (OMG Im actually writing this in black and white! LMAO!)
Im blushing here already!
Sumbunny better not razz me lol
It does (hack cough OMG) *clearing throat* stiffen it up a bit to roll it up then you attach the tape around about twice then partially on the penis that should hold it but if hes pulling it off I think your best bet would be to go for depends if this is not staying on.

Well at least its 1am and not 1pm

Putting a bed-pan under the bag is a good idea! I have two little kiddies backpacks hanging off the bed rails, one each side, and put the catheter bag inside. I find it easiest to unplug one side and switch it over to the other when I roll him from side to side or when I need to change the bag.

I'm going to try to explain the problem I have putting the sheath on, too, in case anyone has any tips for me. BG, you said you 'roll it on like a condom'. If you imagine trying to roll a condom onto the finger of a gloved hand, the problem I have is that I have the glove but there's no hand in it, if you see what I'm getting at. It's like shoving the finger tip of the glove into the end of the sheath, grabbing it through the rubber and stretching it so I can unroll it along the finger. It's the only way I can think of to get the thing on! My other half suggested viagra, but I think that might be a bit extreme. Any advice gratefully received...

The sheaths I can buy here are supposed to be self-fixing, but there's no sticky anywhere on them and they tend to come off, so I've been taping them on with micropore tape, when we finally managed to find any! It might just be the 'no hand in the glove' syndrome causing problems, but are there any alternative ways of keeping the things on, or is micropore the best? I use inch wide tape and try to wrap it just over thre-quarters of the way around, though it's been tempting on occasion just to wrap it round and round a few times when he's been a bit too keen on pulling the things off. We struggled for a while with the wrong sort of tape which was too narrow and it didn't work well at all, and was difficult to take off, and then we found narrow micropore, but we didn't really stop the things falling off until we found the inch wide stuff.

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We're also learning that it's absolutely essential that the tube that carries the urine away runs downhill every bit of the way

Yes! Absolutely! The cath bag should always be below the body I usually hang it on the bottom rail of the hospital beds and also place a bed pan under the bag just in case of leakage these new monstrosities SUX with the knob (you have to turn it) I dont see them as often now but theres always someone who either doesnt know how to do it or forgets to clamp the tubing (try having that happen with a UTI! OMG STENCH!)
The urinal issue I usually clean it before end of shift and hang it on the railing or someplace in arms reach for the person so they can use it during the night but considering hes altered Id just tell him its cracked and toss it and you cant get a new one.
Theres an ointment for the sheath but honestly Iv used it a couple times and chucked it I roll it on like a condom it hasnt failed yet but thats just me its a little slippery for me to use with gloves thats why I dont....Im all thumbs an Lord knows I dont want ANYONE thinkin Im spendin too much time down there with a patient been there done that ONCE that was enough, try tellin someone hang on just a lil longer its almost there...oooppps gotta tape now

Haaahaaa MB got me lol

I'm making up another order for stuff and I think I'll try a few lotions to go with the creams as you're right BG, a thinner lotion would be easier to apply and absorb. My supplier has Eucerin, too! I'd never heard of it, but it's going on the list...

I'll keep an eye on the tubing to make sure it doesn't cause problems. I'm using completely the wrong sort of tape to hold everything in place at the moment as I can't find any of that nice papery easy-to-get-off-without-tearing-the-skin sort, but I've ordered some from ebay. I hope it turns up soon as uncle is excelling himself at pulling everything off at the moment and I'd be happier taping him up with something that's not so likely to cause problems. He got the tape tangled up in his hair 'down there' yesterday and he wanted me to give him a pair of scissors to trim it off, so I managed to persuade him let me shave it off instead. I dread to think what would have happened if I'd let him loose with the scissors.

We're also learning that it's absolutely essential that the tube that carries the urine away runs downhill every bit of the way - there is no pressure behind it to push it over any uphill bits, no matter how minor. We now have a bag set up on each side of the bed and swap the connector according to which way he is facing.

I tried BG's tip about using the urinal flat on the bed, too. It worked! But there is a problem. Uncle now has it in his head to use the bottle again, and I get summoned at any time of day or night to find the bottle for him while he helps by tearing the sheath off ready. Aaaarggggghhhh! Two steps forward three steps back seems to be the order of the day. And night. I think tonight we're going to try the sheath-urinal underneath a nappy, and not use the bottle at all today in the hope that he forgets it again. With luck the nappy will help keep the sheath and tubing in place, and if it comes off the nappy can take over. Maybe I'll get some sleep like that.

I did think of asking for tips about putting the sheath on, too, but I'm not sure how many obscenity laws that would break. I seem to be using a 'pinch and stretch' technique at the moment, which makes me wince but uncle and my other half both assure me that it's ok and that it doesn't hurt to do that.

I send my other half in to buy the sheaths from town, and we've run into a rather amusing potential problem. The trade name for them is 'Urinar', which seems harmless enough but it's also the Portuguese word for 'to pee', which means that when he walks up to the counter and says in rather bad Portuguese that he 'would like urinar' he's going to find himself escorted out of the shop in short order. I must remember to keep an empty box in the car...

This message has been edited. Last edited by: Olivia,

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ol sorry hun Im not really shy penis penis peeenis neener neener neener

BG!!! You said "neener"!!!

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The strange thing about his skin is that most places it it like paper, but on his penis it seems perfectly normal

Sorry it took me so long to get back your quite welcome hun Im giggling a little because I should have clarified this a bit more the penis is not what I was referring to in this case its the tubing actually (here we go again talkin penises in the daytime lol)
lol sorry hun Im not really shy penis penis peeenis neener neener neener
Ok enough of my sense of humor already *smackin myself on the hand*
The tubing can rub on the legs causing skin tears.
From the sound of it your doing a good job hydrating the skin thats almost exactly what I do only after I do the warm water sponging I use a thinner lotion that absorbs quickly then a thicker one like Eucerin or other to "seal' the moisture in.
Do the same with his feet this is really a sign of dehydration.
The Dementia symptoms might be lessening due to feeding and hydrating him I see this all the time.
When Dementia symptoms get worse the first thing to check for is UTI's, med changes or dehydration in most cases dehydration ranks the highest as the culprit of worsening symptoms.

That's fine by me, Bobcat! Even I'm not quite laughing this morning as I had to give a laxative yesterday and I've been up since six 6am up to my eyeballs in poop. Plus up at 1am when the catheter mysteriously lost three pieces of tape without trace, came detatched from both uncle and the tube, and found it's way onto the floor.

On the plus side, if I get him fully 'pooped-out' by lunchtime, I get to leave my teenage son in charge for a few hours and get taken out for lunch :-)

I am going to move this entire thread to Daily Challenges unless there is an objection. Very important info is being shared here and I doubt that folks looking for info would check here, in "We Laugh to Survive".

Hello,Olivia....Yes, we have to laugh every chance we get.And when we can laugh,,,We do..

Let me know what you think.. There is real info about various catheters, pros and cons.

Thanks to Olivia for asking,,,and starting the conversation.

I will wait a while, and I hope to get an agreement. Personally I think this is a bigger issue that "Laugh".

BG - you're a godsend. That's exactly the kind of advice I've been searching for! I'll try using the urinal like that tomorrow when the sheath is off and see how it goes. When he tried it the day he fell it was a total disaster, and of course at the time we had no waterproof mattress cover or bed-pads or a bed we could raise the head on or anything, but now we're a bit more organised perhaps we should try again.

The strange thing about his skin is that most places it it like paper, but on his penis it seems perfectly normal. I've no idea why that should be - perhaps he spent years wearing shorts with no shirt and exposed his skin to the sun too much? His back is the worst - I wash it down daily with a little warm water, no soap, on a soft cloth, just patting it gently to dampen it, then pat it dry with a towel and ever so gently rub E45 cream into it, which is the preferred hydrating cream in the UK as far as I can tell. I order stuff online from a UK supplier as I can't find anything as good here in Portugal, and what there is costs about four times the price.

He's eating better now, and even taking a spoonful of cod liver oil, but for the first few weeks after he fell he hardly ate anything and the skin on his feet became incredibly flaky, shedding what looked like scales almost every day. They seem to be improving slowly, but they absorb cream at an alarming rate. The skin on his shins is incredibly papery, too, and I dab a bit of baby oil on them as I'm terrified to put enough pressure on it to rub cream in.

The dementia seems to be lessening, and he's become generally much calmer and even a little withdrawn, though he was always a loner. For several hours today he's turned the sound on the television right down, which is unusual for him, so he could sleep more peacefully.

I also dug out my emergency supply of cranberry juice which I keep in case I get a UTI and gave him a cupful. It's never failed to clear me up, so I thought I'd give him a dose 'just in case'.

Olivia what kind of urinal do you have?
I deal with this all the time if you spread his legs slightly and lie the flat side between his legs you can get the penis to the mouth of the urinal and there shouldnt be a problem with spillage.
If his skin is paper thin then Id be very cautious about using a sheath cath Im dealing with one such case right now that has the worst case of thin skin Iv seen to date and anything rubbing will cause the skin to "tear" *still beating myself up for the first day there*
Please please hydrate that skin anyway you can its heartbreaking to see this happen.
Accidents do happen *trust me I was protecting a known spot and I think IMHO being overly cautious* take it from me dont go overboard yet be careful I dont want you to beat yourself up over this

I'll do that, MD, as soon as we've managed to find a suitable doctor that he's prepared to talk to.

We're pretty certain that the decline is related to the fall a few weeks ago though. He's already had 7 known strokes, the first 15 years ago, and three years ago he decided to let nature take it's course and stopped all medications except aspirin.

Over the last six months or so he's had several episodes where he's woken up curled up and cold as ice with his feet black (he had frost bite in them many years ago when he was shipwrecked and they still turn black if the circulation slows down) and has been constipated a day or two later. I've never made much of an issue of these little episodes, just fussed him and warmed him up and, once I figured out the pattern, slipped him a laxative.

He's been getting steadily weaker and weaker and barely able to walk but six weeks ago he managed his 4-30 morning wash (we never did figure out why, but he always washed at 4-30 in the morning) and then went outside for a smoke and collapsed on the way back in. At the time we thought it was just a fall, but he never regained the ability to stand, and one of his legs is pretty well useless now. If you ask him about it he says it hurts where he bumped it, and I think it did at first, but he still can't use it six weeks later and the 'pain' seems to wander mysteriously around his leg and only be present if I ask him about it. So now we think that the fall was caused by, or maybe triggered, another stroke, which has left the leg unusable and triggered the dementia.

He does however seem to be slowly getting the hang of not pulling the catheter off, and his skin is showing definite signs of improvement, so I think we're finally getting everything under control.

Olivia, I suggest that you have his urine tested & cultured to see if he has a urinary tract infection. His sudden decline is quite typical of a UTI in elderly folks. It is not unusual for him to not have any fever or symptoms other than the deepening dementia and more urinary incontinence...

Many blessings for all that you do for him!

Thanks for the input! It's going to be a hard decision and, as I'm learning, I seem to make a decision one day and then have to change it again the next. He's had seven strokes over the last fifteen years but it's only for the last six weeks that he's been totally bedridden, and only for the last couple of those weeks that he's shown any signs of dementia, but to my mind he seems to be deteriorating fast now. His skin is like paper, and the battle to preserve it started the day he could no longer get out out bed to use a pee bottle. He, like many old men, is 'shrunk' so finds it impossible to use a bottle lying down, and he has an enlarged prostate which means that he piddles very frequently and in small amounts. We started off quite successfully using a collection of small towels to catch the piddle as it came, but he leaked too much over-night. So we diapered him at night, but his skin very soon deteriorated as he would piddle, albeit in small amounts, almost as soon as I put one one. We coped, just about, until a week or so back, coincinding with when the first signs of dementia kicked in, and he seemed to lose the ability to reliably use the towels, so there was an almost constant supply of piddle spreading over his already paper thin, red, and breaking skin. The sheath catheter has turned all that around and his skin is now improving rapidly.

He's a stubborn old thing, and since moving in with us four years ago has been most insitent on not seeing a doctor, and there are no visiting nurses where we live. He's made me promise that if ever I can't cope with him I'm to send him back to one of the seaman's missions in the UK, most of which are now closed, and none of which are geared up to deal with anyone in his conditionn. I doubt he would survive the journey, and in any case I do honestly feel that the next stroke is likely to take him out completely and want to do my best to keep him as happy and comfortable as possible until that happens. He sleeps almost continuously, but takes his sheath catheter off several times a day - I think he just fiddles with it in his sleep - so I don't think an internal catheter is going to work just yet. I'm going to try to find a private, English speaking doctor (we're in Portugal) who will come out to advise as I'm starting to feel a little out of my depth and he's fading so fast. Hopefully his new-found dementia and short-term memory will mean he won't hold it against me for too long.

Olivia, this is a tough call because it opens the door to many problems. While sheath type catheters are (arguably) less likely to promote UTIs, they have to be positioned on the cleaned skin very carefully to prevent irritation. An indwelling catheter may be easier for you to maintain, but they promote UTIs bigtime. This, of course, is assuming that your uncle doesn't pull at it or remove it, which REALLY skyrockets the incidence of UTIs.

I prefer diapers with extra padding because, although they must be changed more frequently to prevent skin breakdowns, the urethra is not constantly irritated as with catheters.

My mom came home from the hospital with an indwelling Foley catheter. The UTIs became more frequent and virulent. It irritated her and she removed it many times. Finally, I did not have home health reinsert it and we went to diapers. It was a challenge to keep her skin in reasonable condition, as she was always wet, but the UTIs were fewer... A good barrier cream is essential! I just wish she had been started with diapers and had a Foley as a last resort. I think she'd have had far fewer UTIs and hospitalizations.

Hello Olivia welcome in
THere are others here who have used them on their LO's I deal with them at work and while its an easy method to deal with (removing cleaning etc) I really do prefer the indwelling cath's but thats just me.
You have to be extra cautious with this style like you said airing it out is a good thing you have to keep the penis completely clean as its a breeding ground for yeast so in other words always pull back the foreskin and clean around the...well you know *chuckle* I think Im being a little graphic for daytime eyes
If he can handle the indwelling Id go with that just make sure you keep the tubing clean ie use the same precautions and if you have visiting nurses then they can change them out every 3-4 weeks or PRN
Look for further advice on this matter first though as this is my own opinion
Again welcome in to ECO