The choice of a legbag or nightbag is a very personal decision, and there are a number of factors that should come into this
Unfortunately many people are just issued with whatever bag happens to be the cheapest at the time, without any consideration of what their individual needs are. Many people are also not aware of the variety of choice available on the market. I hope that this article will help you find the most cost effective solution that will suit your needs. I would like to thank everyone who responded to my questionnaire, and who have given useful comments and suggestions.
Reliability vs Cost: Reliability of legbags is vitally important for a person’s dignity. Nobody should have to put up with the humiliation or inconvenience of a leaking or burst legbag. Normally the cost is directly proportional to the reliability of a bag, however sometimes it works out more cost effective to buy a more expensive, reliable bag that may, not only, last a lot longer than a cheaper bag but also provide peace of mind! From the survey we carried out, it appears that most people change their legbags between 2 – 4 weeks. The cheapest legbags that we found are the Romsons bags available from Supralatex, priced at approximately R6 per bag – depending on quantities ordered.
A number of people gave very positive feedback about the Urocare re-useable latex legbags, as expressed in this comment from John Crowley, a quad : “This is by far the best legbag option I know of. It comes in various sizes and shapes. There is a very good non-return valve, easily removed to clean and it is strong and durable can last up to two years or more with care.” These robust, durable latex bags are available from Clinical Emergencies for approximately R600 per bag. Many of the parts, such as the valves and connectors are replaceable.
Care of legbags also affects the lifespan.
It is recommended that two bags are used simultaneously. This way the bags can be alternated and cleaned and allowed to dry completely before being used again. Proper cleaning and hygiene is vital for preventing infections and it prevents the bag from starting to smell; it also keeps the valves and taps clean and leak free and prevents blockages in the pipes. The amount of water that each individual drinks will also affect the reliable lifespan of a bag as more concentrated urine results in more residues being left in the pipes and valves.
The type of drainage valve (tap) is an important factor for people with limited hand function. Valve security is also important in limiting leakages. When trying to make a bag last as long as possible it is usually the tap that is the weak point and starts to leak. There are four different types of taps that are available in SA, these are the T-tap, push-pull, twist and the lever.
The lever tap is the easiest for a person with limited hand function. The Bard, Conveen and Hollister bags have user friendly lever taps. Urocare have a very easy to use lever tap which fits onto their latex legbag, to which finger loops or a cross bar can be attached if necessary.
John Crowley reports that “the lever drainage valve is a must for quads who have some hand function and like to empty their own bags. Just hook your thumb in and press down. It’s also fairly easy to close again. Very good simple design.”
From user feedback it seems that the T-tap is the least reliable tap as it is the most likely to leak, it often leaves residual urine on fingers and it becomes stiff and difficult to use, thus limiting the length of time that a bag can be reused.
Emptying of the legbag:
For many quads, emptying the leg bag is a major headache, and the cause of much cursing. It is possible to import an electric tap opener at huge expense - however a number of creative quads have designed their own home made electric valves. Barry Newman, a quad, uses a stick with a hook on the end to open/close the bottom connection connected to the chair.
The problem with these options is that the tap is close to the person’s foot, and if they are unable to lift the bag to
be emptied into a toilet, then they must have access to a suitable place where the bag can be emptied. JP Lugt has another suggestion. He attaches a bed bag (night drainage bag) to the legbag and lays the bed bag on his batteries under his chair. The legbag then drains into the larger bed bag, and he only has to empty his bag once a day instead of always worrying
whether his legbag is full.
Other features to be considered when choosing a legbag:
Size and shape: Most companies have a variety of sizes available. Each person needs to find a balance between whether the bag can still be concealed when it is full and how often it needs to be emptied. The profile of the full bag is important as some bags still remain relatively flat while others bulge.
The most popular size for a legbag seems to be 750ml – generally speaking this needs to be emptied every 3-4 hours and it is small enough to be concealed inside a trouser leg. Some ladies prefer a 500ml bag which can be concealed under a skirt. The most common size for a night bag is 2000ml as for most people this can last through the night without having to be emptied.
The shape of a legbag is also an individual’s choice according to the length and width of their leg. Urendo Health Technologies have recently introduced a legbag which has three compartments which wrap around the leg.
Non-return valves – this is a small valve at the top of the bag where the urine enters. The purpose of this valve is to prevent urine from passing back up the pipe to the bladder when the bag is full, or if the bag is accidentally squeezed. This valve is very important for preventing infections, however unfortunately they can sometimes get blocked and limit the urine flow into the bag.
Length of valve discharge if the pipe is too short after the tap, it can result in frequent urine spills while emptying the bag. It is easy to slip a piece of rubber tubing over the end of the tap to extend this if it is too short.
Backing material – some bags , such as Coloplast, Bard and GRS, have soft, breathable, non-sweat material on the back of the bag for improved comfort.
Straps – there are a variety of straps available for comfort and ease of use, and others that are just cheap! It is important that the top strap should fit securely to prevent the bag sliding down the leg. The lower strap is less important
as this just prevents the bag from flopping around. If it is under trouser legs, the material usually secures the bag anyway. Many people leave off the bottom strap as it makes the bag easier to lift up onto the toilet bowl for emptying.
Sampling port - for people who are in hospital or who may need to give frequent urine samples, some bags have a sterile sampling port on the connector.
Pipe lengths + non-kinking pipes Most bags have a variety of pipe lengths available while others, such as the Coloplast bag, have a pipe which can be cut to the correct length, before the connectors are attached. It is important that the pipes cannot kink and thus cause blockages.
Sterile packaging - most legbags come in sterile packaging, for limiting infections. This is particularly important for hospital use and when the urine bag connects directly onto an indwelling catheter. For use with condom drainage, non-sterile bags are more than adequate if used with care.
Product support and availability are very important factors that affect the choice of bags. If availability is a problem, then contact the companies directly as many of them are willing to post or courier products. Companies often change the brands that they carry according to prices and availability.
Belly bag – this is a relatively new concept from Rusch Care, available through Thebe Medical. These bags can last up to a month, and although it is not the cheapest option, it can be very convenient. It is worn underneath the clothing, against
the stomach and has a soft belt that buckles around the waist to ensure that it remains securely in place. The pressure
from the bladder is more than sufficient to ensure that the urine flows through the catheter from the bladder into the bag. An anti-reflux valve prevents reflux of urine from the bag to the catheter. It has a volume of 1000ml which allows longer intervals between emptying. It can be used as both a day and night bag. Its position on the stomach means that it is within easy reach for emptying. It has a twist control drainage tap.
Night Drainage bags
Large capacity drainage bags, usually at least 2000ml, are used in hospitals and for overnight drainage at home. They are generally too large and cumbersome to be disguised under clothing during the day. They can be used on both a catheter and a urinary sheath and make use of the same attachment system as the legbags. Some bags are designed for single use, and have no
outlet tap. These bags should be immediately disposed of after use. These are low cost and can cost from as little as R2.00 per bag from Supralatex. Most people make use of a re-useable bag with an outlet tap. Where a bag is used in direct connection with an indwelling catheter, it should have a non-return valve and should be supplied sterile. It is also important to use a night bag holder to prevent the tap touching the floor and to ensure that the urine drains freely into the bag. Anumber of companies sell a simple frame which stands next to the bed to hold the urine bag.
For cost cutting ideas, this came from reader John Crowley: “Simple bed bags are available, but the best is just a converted bucket with a lid which is what I’ve used for many years. The easiest way is to get a nappy bucket or plastic washing powder container with built in lid. Cut a meter-length piece of tubing or plastic tubing from a conventional bag, leaving part of the bag/valve behind as an end anchor point. Then make a hole in the lid and slide the tubing through till the end catches.
The hole should be large enough to allow the tube to slide freely in or out when turning in bed but restricted enough to stop the end point from coming out. This works just fine with a little antiseptic and water in the bottom of the bucket. “
Also known as Urisheaths, Uridomes, external catheters, penile sheaths, condom drainage, etc. , it is a condom like sleeve which fits over the penis to collect urine, with a tube on the end which attaches to a drainage bag. These can be a good short term option for men who have no bladder control, and can be used very successfully in conjunction with intermittent catheterization.
They are generally not recommended for long term use due to a high risk of bladder infection and skin breakdown on the penis.
Skin care under the sheath is vital to prevent skin breakdown and infection. It should be changed every 24 hours and the skin washed and dried before the next on is applied. The correct size is very important for a secure fit, so that is does not fall off or leak.
It is also important to know what size you use if you are going to do a telephonic order. Sheaths with a bulbous outlet are less likely to kink which is important to prevent blockages. Some companies, such as Bard, Coloplast, Thebe Medical and Urocare have a disposable plastic applicator to simplify the fitting. Urinary sheaths are made of latex or silicon. Silicon has the advantage of being clear, which allows visual inspection of the skin, and to see if urine is draining freely. It is also hypoallergenic and odourless. Latex is cheaper but many people react to it.
Attachment choices include:
A self adhesive sheath which sticks to the skin to hold it in place, when used with an applicator is a good option for people with limited hand function.
For non-self adhesive condoms, a brush-on silicon adhesive can be used to stick it to the skin; this is available from Clinical Emergencies at R574 per bottle which usually lasts about 2 months. It is recommended that this is used in conjunction with elasticated, adhesive, fabric tape.
Double adhesive foam strips which are adhesive on both sides, and are resistant to urine and moisture. These are available from Clinical Emergencies, TechnoMed, Coloplast an GMS.
Single adhesive foam strips which can be wrapped around the outside of the condom to hold it in place.
Uriliner, sheath holder or posy, which is an elasticated fabric strip with a Velcro attachment, which is tightened around the end of the condom to hold it in place. Clinical Emergencies supply a simple Velcro posy for about R16.00. Lydia Holmes (wife of a paraplegic) has developed a low cost, reliable sheath holder which she has been selling for a number of years. This has a zebra stripe calibration sewn on as well as the Velcro and elastic to tighten it. The idea of the calibration is to assist patients to find the correct setting and use that over and over, thus eliminating the problem of incorrect fi tting
which could have disastrous consequences. The fabric part is laminated on to a foam base for comfort.
Options for ladies:
Unfortunately, due to a lady’s anatomy, there are not many options other than the catheters. The “Wee-Jon” and is a disposable urinal. It has a bag with a shaped opening which fits over the vaginal area. The bag has a gel powder in it, similar to modern nappies, which turns into a gel when wet. It can absorb approximately 600ml and although not an ideal solution, it is definitely worth experimenting with! It is on state tender so it should be available through government clinics and has a NAPI code so medical aids will pay on prescription.