Mastering The Condom Catheter (Well, sort of...)

Earlier this month, I took Bob to see the urologist because his overactive/neurogenic bladder symptoms had worsened. Suddenly, Bob is peeing every 15 minutes or so. And this is problematic, to say the least, especially if we are not at home. This problem was also keeping poor Bob up all night long.

So I tell the urologist all of this plus the fact that he's only peeing about a "thimble full" at a time. The urologist gets out the big scope that they use to look inside a bladder. The minute he inserts the scope, Bob starts to pee. I mean, really pee. Pee is shooting up, around that scope, like a fountain.

And this is not a "thimble full" but seems to be the entire contents of Bob's bladder. And there's nothing protecting Bob, his clothes or the wheelchair except a little blue "chuck" that the nurse had laid over Bob's lap.  Now, the chuck is getting soaked, Bob is getting soaked, his pants and wheelchair cushions all soaked.... in fact, the urologist himself is getting a bit soaked.

The urologist doesn't seem to even mind, he just says, "Hey, look! He's peeing!" He says this as if he's absolutely delighted about this shower of pee. Then he adds, "And it smells really, really good!"

Okey dokey. Though this does make me wonder just what kind of doctor would want to devote his entire career to working with pee....

The urologist tells us that Bob's bladder "looks good", there's no obstructions though the prostate is a bit enlarged, but not so much as to cause a worry, and the only thing he can see is that Bob's bladder has a "decreased capacity" from the last exam, meaning it's shrunk....

We leave the urologist's office soaked with pee and armed with a new medication and a prescription for condom catheters and a referral for a home health nurse to "teach me" how to use them.

Now, I have long resisted such a thing as condom catheters. Mainly, because I've always thought that if Bob's brain is ever going to rewire and control his bladder, he needs to actually try to control his bladder. But after more than two years dealing with this, I finally gave in. I mean, I am really tired of spending all our time in the men's room whenever we go out. And it's not only that, but every time he has to urinate it's a BIG emergency. It becomes a mad, frantic dash to the nearest bathroom with Bob practically in tears and me, pretty much killing myself trying to get him there in time. So my idea was to get some external condom catheters to use when we go out, and maybe we could actually go out a little more. You know, do something fun? And also for at night, so Bob can get some sleep. But not to use them 24/7 at home. That way, Bob's brain can still have a chance to "rewire".

Anyway, the home health nurse arrives but she's under the impression that she's here to set up a feeding tube pump. I tell her that we already have a feeding tube pump and it's all set up and I've been using it for over two years, and that she's supposed to be here to "teach me" how to put on a condom catheter.  And that's when she tells she has no clue how to do that. She's never applied a condom catheter to a patient in her entire nursing life.

Then she says, "In fact, I've never even put a regular condom on a guy. Have you?"

When I tell her that it's been long time and in another life since I've done anything like that, she asks Bob, "Do you know how to put condom on?"

Bob says, "Um.....um.... Huh?"

"Well," the nurse says, "I did put on condom on a banana once. In school. Can't be that hard." So she opens the "free sample" packet we got from the urologist and finds the directions. She reads these out loud. They are:

1. Open package.

2. Unroll sheath over penis.

3. Connect connector to drainage tubing.

"Sounds simple enough," she says, then opens the package containing the drainage bag and shows me how to connect the tubing of the bag to the tube on the condom catheter, which she knows how to do because this, she says, works just like a Foley catheter. Then she says, "You want to practice putting the condom on me?" And she holds up two fingers.

I kid you not. She actually wants me to put a condom catheter on her fingers.

Which I decline. By now, I am thinking, this whole darn thing is rather ridiculous, because, you know, I can read directions too. And I certainly do not need to practice putting a condom on her fingers.

The nurse packs up her stuff and leaves but not before telling me that if I have any trouble with this procedure, just google it. She's sure there's probably some good how-to videos on You Tube.

All righty. So now, I'm on my own.

I don't know if you've ever seen a condom catheter, but it pretty much looks like a regular condom with a spout at the tip. You unroll it, as the directions say, just like a regular condom, i.e. "unroll sheath over penis". The spout attaches to the tubing of the drainage bag, so that when the person pees, it goes straight down the spout and into the tube and into the bag.... Which is a great idea, in theory.

The problem is getting the darn thing on to begin with.

The big difference between putting on a regular condom and a condom catheter is that when a regular condom is used, the recipient, um, rather rises to the occasion. Not so with a condom catheter. In fact, the effect is quite the opposite. So instead of being like putting a condom on, say, a banana, it's more like trying to put a condom on a blob of jello.

You can imagine the problems this causes.

So, I've been tearing my hair out trying to get this condom catheter on. It's rather like wrestling with a large fat worm. A very flaccid, wiggling, large fat worm, at that. And just when you think you've got the thing on the tip, sort of perched there like a little stocking hat, and you start to "unroll the sheath", the condom will spring back at you, like shooting a rubber band. I tell you, it sometimes takes me twenty minutes to get the darn thing on him.

And yes, I've googled it. Unfortunately, all those You Tube videos show a nurse applying a condom catheter on a plastic manikin.  Easy that. When you're working with hard plastic.

After three days of this struggle, I woke up one morning with my legs aching like you would not believe. And I thought, what the heck did I do? Because I couldn't remember, you know, falling or running into anything. Then, I noticed two large bruises on my upper thighs. But still, I could not remember how I sustained this particular injury. Later, when I was leaning over the hospital bed, wrestling once again with the fat wiggling worm, I realized that, not only was my back killing me, but my thighs were pressing hard against the bed rail in that exact spot those bruises appeared. Who knew this would be such dangerous work?

Then, the other day, while again wrestling with the fat wiggling worm, Bob looked at me and said the magic words: "pump it up". And I about slapped myself on the forehead, because why didn't I think of that? You see, Bob has a penile implant, this device was put in years ago after radiation treatment for cancer caused a myriad of problems. But, personally, I only know the basics of its operation and Bob, being now one-handed, can't do it himself--it's two handed job. So back to google and praise the lord, there are directions. And I manage to pump him up, get that condom catheter on, and pump him back down. Still no easy feat, as you are sort of feeling around in the dark for certain implanted buttons and gizmos---but better than wrestling the worm.

Yesterday, we went to see Bob's primary care doctor. I was glad to see that Bob handled wearing the condom catheter just fine. I was worried it might be uncomfortable. And it was nice to just sit in the waiting room without running to the men's room every 15 minutes.

Oh, and I did give that primary care doc a piece of my mind about the Foley catheter incident. He said, "Well, let's take it out right now." That's when I told him that wouldn't be necessary, as the thing was already gone -- and the guy actually laughed. He was so shocked, he actually laughed right out loud. I tell you, he now knows better than to mess with me.