Using Male External Catheters

Overview
They say "unless you pee, you aren't drinking enough." That's good advice for people engaged in endurance events. Dehydration is the risk. And, it's truly a serious issue. Pilots, drivers and riders who allow themselves to become dehydrated may become disoriented and make judgmental errors that lead to incidents and accidents.

Several urinary relief systems have been used over the years and some prove the adage that "necessity is the mother of invention." Glider pilots, for example, have been fond of ziplock bags filled with absorbent material. Somehow these pilots manage to fill those bags while flying their aircraft and then they either keep it in the cockpit with them until they land, or they shove it out the side window to land who-knows-where. If you are partial to this method, then we suggest you consider doing it right. Use TravelJohn Personal Urinals. They are much more absorbing, better smelling and more compact than anything else you may be using. And, they are designed for either male or female use. Also, we suggest a little social consciousness when disposing of used bags.

Today, men are beginning to use external catheters designed for extended use. The essential item is a male external catheter (MEC), which connects to a relief tube. The vehicle operator does nothing special when the time comes. He just lets go like a bird in-flight. There is no distraction from the more important matter of operating the vehicle safely.

What is a male external catheter?
A male external catheter is a condom-like device with an opening designed for attaching to a urinary relief tube. The inner surface is coated with an adhesive to secure the MEC and prevent leakage. A MEC designed for extended use will also have an annular flap at the tip with a small central opening. The purpose of this flap is to prevent leakage up the sheath of the MEC. Over time, standing urine irritates the skin and can even cause blistering. The flap is an effective preventive measure. Extended use catheters may be used all day, but are not reusable.

What are the options for routing the relief tube?
That depends on the type of vehicle you are operating. This is where creative thinking may be needed. Obviously, you will want to secure the exit tube so that it cannot not come loose and spew urine into or onto unwanted places. Of greater importance, the exit tube must never become entangled with turning machinery, such as wheels and gears, so as to snatch it away while you are attached. At least one glider pilot is known to have routed his exit tube to the usual point on his main-gear door, where it was poorly attached. When he landed... well, you get the picture.

Another issue is privacy. If people never mill around when you connect and disconnect and you operate out of sight then a short, flexible (latex) tube from the catheter may may be all you need. Unzip your fly and connect to the exit tube in the crotch area. However, if you operate in full view, then a MEC connection tube that exits your pant leg at your ankle may be a better choice. This obviates the need to unzip, but still requires connecting and disconnecting. Onlookers are not likely to be drawn to whatever it is you are doing at your ankle. However, it's a good idea to have a ready answer for those really curious onlookers who are slow on the uptake. Glider pilots might simply say "you know, you're not really a part of the bird until you are plumbed into it."

A further issue is whether or not you want to use quick disconnect, shutoff couplings for the attachment from the MEC tube to the vehicle exit tube. They prevent drainage and allow quicker connecting and disconnecting. But you may prefer a simple plastic union fitting with tapered ends that push into the two tubes. If you go for couplings, then your vehicle may have a flat surface where a connection is appropriate. In that case, a bulkhead coupling-body can be installed. The concealed side connects to the vehicle exit tube. To hook up, you merely push your connection tube coupling-insert into the bulkhead coupling-body and it latches together.

Another option is to use a collection bag strapped to one leg, as wheelchair occupants do. This gives you mobility and obviates the need to connect to a vehicle exit tube. You may be a passenger or you may be operating a vehicle not equipped for urinary relief. The down side is that you have a limited capacity and a full 32 oz bag on you leg is a considerable weight. You will need to walk slowly with a full bag strapped to your leg. You will need to make a b-line to a place where you can dump the contents. Fortunately, the bags are designed with a dump valve at the bottom, near your ankle. Even out in the open, you can simply kneel down, tilt the valve dump tube away from your shoe and open the valve. Unless someone is standing over you, it will not be obvious what you are doing. A casual onlooker may think you are praying. If a bathroom is available, you can plant your shoe on the rim of the toilet and dump the bag in complete privacy.

Another option is to use a collection bag with its dump tube connected to the vehicle exit tube. You may be wondering why anyone would want to do something so redundant. One answer is that you might be operating in freezing conditions and the vehicle exit tube could freeze. That would be very bad unless you had an emergency capacity at hand, or at leg as it were. Another answer is that you might be traveling in a gaggle so that you would not want to trail urine whenever the need arises. A collection bag acts as a buffer, allowing you to dump the contents at more socially acceptable times.

Finally, if there is a chance that the vehicle exit tube could be holding residual urine at the end of the day, you will want to blow it out. For that, you will need a short blowout tube that you can connect to the vehicle exit tube for that purpose.

Special Considerations
As with any system, a MEC urinary relief system requires some getting used to. Everything may not necessarily work flawlessly at first. Problems can be avoided and improvements made by practising before you enter a competition. Modifying your system and methods may be needed. Here are some suggestions:

• Skin Irritation
  Urine on the skin over time can cause burning and even blistering. So, care should be taken to select a MEC designed to minimize this problem. Extended Wear MECs sold by OneOnTheGo.com are cleverly designed with an annular flap that prevents urine from flowing back up the sheath. You can see this clearly in the image on the right. This flap really is very effective. However, even the small exposed area can become irritated over time. A little petroleum jelly offers good protection, but you must be careful to ensure that your supply is sterile. Otherwise, you will be be inviting a nasty urinary tract infection.



• About the adhesive
  The adhesive on the inside of the MEC is very well designed for the job. However, there is one problem that may have occurred to you. It loves hair and that can be very painful. This can be minimized with care, but if you are going to commit to this system, you should remove the problem hair. Removing the MEC is best accomplished by pulling the edge of the MEC outward as much as possible. The skin then pulls away easily.



• About size
  OneOnTheGo.com offers male external catheters in three sizes, designated medium, intermediate and standard. The diameters are 30 mm (1.2"), 35 mm (1.4") and 39 mm (1.5"), respectively. You will not find an ideal size. If the MEC is too loose, then the adhesive does its thing and seal the folds reliably. But if it is too small then it will not go on easily, it will be uncomfortable and it may restrict urine flow. Better too large than too small. However, you should be realistic when choosing a size. Don't let your ego cloud the issue. OneOnTheGo.com recommends ordering a few individual MECs before ordering in quantity.



• Back flow
  Some people wonder "what keeps urine from flowing back up the connection tube from the collection bag?" The answer is that the inlet to the bag has a one-way, flap valve to deal with this. So there is no need to worry about whether the leg bag is too high. The image on the right shows the inlet to the leg bag, but the valve cannot be seen because it is inside the bag. This valve is so effective that you can blow the bag up with air and it will not leak down.



• Blockage
  The collection bag inlet valve can be a problem. After the inlet valve is wetted by the first use, it becomes very effective and there is a tendency for the bag to suck a vacuum. This will collapse the end of the MEC. As a result the inner surfaces stick together and block flow until they slowly unstick with usage. Uncomfortable pinching may also occur. Annular ridges in this area of the MEC help, but sometimes the ridges need some help. Small, circular key rings solve the problem nicely. If you have a problem with this, you can place a 1/2" ring into the foremost annular ridge and a 5/8" ring in the aft ridge. These will stiffen the ridges and prevent them from collapsing. Remember to retrieve the rings before discarding the used MEC.
  
  One last thing that can cause blockage. If the connection hose puts a significant torque on the MEC, it can twist the soft tip tube. This will restrict the out flow. When this happens, the MEC will swell like a balloon and threaten to break loose. You will know when this happens and stop the flow. In time it will leak down. After that, you will use the relief system with great caution. The solution is to take care when attaching the connection hose, so that it does not twist the MEC.



• Cleaning
  It is important to clean the connection tube and bag after every use. If you don't, black stuff that is impossible to get rid of will grow. Use hot water. A little bleach helps.



• The connection tube inlet fitting
  After much use, the inlet fitting on the connection tube might easily slip out of the tube. Normally, you should replace the connection tube after extended use. However, you can fix this problem permanently if you wish. Tape can be used to hold the inlet fitting to the tube. But it will become ragged in time. As seen in the image on the right, the joint can be permanently strengthened by stretching a larger piece of tubing over it. Another technique is to push the tube beyond its limit onto the fitting, then roll the end of the tub back onto itself. This will increase the tightness of the fit for a sure grip.



• Old equipment
  With use, the leg bag will stiffen. After a year of use, it may begin to leak where the outlet valve connects into the bag. So, you should replace the bag annually and carry a spare with you. They can be hard to find when you need them.



• Leg straps
  The leg bag is held in place by elastic straps that go around your leg and attach to buttons on either side of the bag, above and below. The elastic tends to slip loose, so you will need to find the right length and then stitch the elastic together to prevent this. (See the image with a strap above.) In time these will become dirty and will weaken. OneOnTheGo.com sells replacement straps.



• Outlet valve modification
  Don't throw away the inlet tips from discarded collection bags. You can use them to create a tapered connection for the outlet valve. This will make connecting to the vehicle exit tube easier. The fitting is just a little too small for the opening. So a little vinyl tape is needed for a tight fit. The image on the right shows this modification.