An indwelling catheter, like the Foley catheter, serves the purpose of urine collection. It can be connected either to a urine collection bag for continuous drainage or to a catheter valve, providing the option to open and close it as needed. In the case of free drainage, urine constantly flows from the catheter into a drainage bag.

Two types of bags are commonly used with catheters: a leg bag designed for daytime use and a larger night bag intended for nighttime use, especially during sleep.

What are types of Urine Collection Bags?

Leg Collection Bags

Large Capacity urine collection bags

Leg collection bags are commonly referred to as "Body-worn urine bags." These bags are typically made of plastic, with some featuring a fabric backing for added comfort against the skin. They have a tube emerging from the upper side of the bag, which connects to the funnel end of a catheter or sheath. Located at the bottom of the bag, there is a small tap or valve that allows for easy emptying. Leg bags can be worn discreetly under clothing and are often unnoticeable. They are usually secured to the thigh or lower leg, but some bags are designed to be worn around the waist. Leg urine collection bags are versatile and can be used at any time, although they are particularly beneficial during the day, as they allow for ease of movement. At night when a larger capacity is required, it's possible to connect a large capacity bag to the body-worn bag. In this setup, the valve of the smaller body-worn bag is left open, enabling urine to flow into the larger bag. This system is commonly referred to as a "link" system.

Leg bag collection is commonly attached to the leg using straps, and they can also be kept in place against the leg with an elasticated sleeve or suspended from a waistband. There are special garments designed to securely hold the bag in place, such as support garments or straps. To establish a secure connection, the tapered plastic fitting at the end of the collection bag tube should be firmly pushed into the funnel end of the catheter or sheath. Ensuring a secure connection is essential to prevent accidental disconnection of the collection bag tube. Proper support for the collection bag is crucial. A bag that becomes heavy with urine can exert downward pressure on the catheter or sheath, potentially leading to disconnection or damage to the bladder neck. Using additional straps to secure the drainage tubing close to the leg above the bag can help reduce this risk. Positioning the collection bag lower than the bladder is essential to take advantage of gravity for the free flow of urine. When seated for extended periods, this can be facilitated by securing the collection bag below the knee.

Some men who wear a sheath might choose to use a leg collection bag on specific occasions, like when they are outside or on the go, while opting for pads (instead of the sheath and bag) when at home or in bed. For those using a catheter, a catheter valve can be used during times when a collection bag is not desired. The collection bag can be connected to the catheter valve to maintain a closed link system and can be removed when not needed, offering flexibility and convenience.

How to choose a Leg bag for collection?

The choice of urine collection bag varies from person to person and often depends on personal preferences. The most important factors rated by users of collection bags are typically ease of emptying, comfort, and confidence in the bag's leak-proof performance. These factors play a crucial role in selecting the right collection bag for individual needs:

Capacity: Leg collection bags come in various sizes, ranging from 250ml to 1000ml. Smaller bags offer more discretion under clothing but require more frequent emptying. Larger bags are more noticeable under clothes and become heavier when full, making them potentially harder to keep in place. To accommodate different needs, individuals might choose to use various bag sizes for different situations, such as smaller bags for outings and larger ones at home. It's essential to maintain a closed drainage system when using these bags with a catheter.

Ease of emptying: One common challenge with leg collection bags is the emptying process, which is facilitated through a tap at the bottom of the bag. Users often emphasize the design and functionality of these taps. Issues such as difficulty operating the taps and accidental openings that lead to urine leakage are among the most frequently reported problems by users. When selecting a leg collection bag, it's advisable to explore different options to identify the one that best meets your needs. Consider various factors when making your choice:

• Ease of opening and closing the tap.
• The likelihood of accidental opening of the tap.
• Convenience in emptying the bag without getting your fingers wet.
• The bulkiness and visibility of the tap under clothing.
• The comfort of the tap against your leg.

Comfort: Comfort is influenced by various factors, including the type of collection bag, the method of securing it in place, and how it's connected to the catheter or sheath. Typically, body-worn collection bags are constructed from materials like polyvinyl chloride (PVC), polyvinylidene fluoride (PVDF), or polyethylene, which can lead to perspiration and, in some cases, chafing due to friction between the bag and the skin. This can impact comfort for users, and addressing these comfort-related issues is essential for enhancing the overall experience of using these bags.

Large Capacity Urine Collection Bags: Large capacity collection bags, commonly known as night bags, are designed for overnight use and can hold significantly more urine compared to body-worn collection bags. They are typically positioned away from the body, either on a floor stand or a hanger that attaches to a bed or chair frame. These night bags come in various sizes, with capacities ranging from 2000-4000mls (approximately 3.5-7 pints). Some night bags are single-use and feature a tear-off portion or single-use tap for emptying the urine before disposal. Others are reusable and equipped with a drainage tap similar to that of body-worn collection bags. Reusable night bags can typically be used for 5-7 nights before they need replacement.

While glass and plastic (PVC or HDPE) bottles are also available for high-volume or overnight urine drainage, they are less commonly used. These bottles are reusable, and the manufacturers recommend specialized urological appliance cleaners.

Large capacity urine collection bags, like night bags, are typically utilized by individuals who are immobile or spend extended periods in bed. These bags are designed to accommodate a larger volume of urine and are well-suited for overnight use. However, they can also be used during the day by those in wheelchairs. In such cases, the collection bag can be directly connected to the catheter or sheath without the need for an additional body-worn bag, providing convenience and efficient urine drainage. Large capacity urine collection bags are particularly valuable for managing significant volumes of urine. They can be used on their own or in conjunction with a body-worn bag, creating a practical "link system." This system is especially advantageous during the night, as it eliminates the necessity for frequent emptying of smaller bags. To implement this system, the large collection bag should be directly connected to the tap of the smaller bag, with the tap left open to allow urine to flow from the smaller bag to the larger one. This approach minimizes the need for repetitive connections and disconnections between tubing and the catheter, thereby reducing the risk of infection.

How to maintain hygiene and Infection Control?

Maintaining proper hygiene and infection control is crucial for individuals using both body-worn and large capacity urine collection bags.

Infection prevention is of utmost importance for those using these bags, particularly when combined with an indwelling catheter. It's essential to understand the difference in the use of a urine collection bag with a sheath and with an indwelling catheter:

• An indwelling catheter is inserted from outside the body into the bladder, potentially providing a pathway for bacteria to enter. To reduce the risk of infection, the catheter and collection bag should function as a closed, one-way drainage system. The connection between the catheter and collection bag must be watertight, and collection bags are equipped with non-return valves to prevent urine from flowing back along the catheter into the bladder. This setup minimizes the risk of infection because there is little to no opportunity for air or external liquids to enter the bladder.
• On the other hand, a sheath is an external collection device. Men who use sheaths benefit from the natural defence against external infection provided by the urethra, which is continually flushed as urine exits the bladder. Men using sheaths change their own sheaths and collection bags as needed. Even in this case, maintaining good hygiene practices is important to prevent infection.

Collection bags are designed with various features aimed at reducing the risk of infection:

• A non-return valve at the point where urine enters the bag prevents the backflow of urine up the tubing when the bag is moved by users or caregivers.
• Bags with the tap and outlet tube widely separated are considered most effective in preventing contamination of the leg bag spouts.
• The end of the connection tube of a large capacity bag usually has a dust cover. When the large collection bag is disconnected from the tap of the body-worn bag, such as in the morning, the connector of the large bag should be cleaned, and the dust cover should be replaced. The tube should be coiled, covered, and stored with the bag off the floor, making it ready for reuse. These practices help maintain hygiene and reduce the risk of infection.
• Usage of anti-reflux or anti-backflow valve in a urine collection bag is a one-way valve designed to prevent urine from flowing back up the drainage tubing into the catheter or sheath and potentially into the bladder. This valve helps maintain a closed and sterile system, reducing the risk of infection and preventing urine from re-entering the patient's body. It is especially important in cases where patients use indwelling catheters or sheaths, as it ensures that urine only flows in one direction, from the body into the collection bag, and not the other way around. This feature is essential for maintaining good hygiene and reducing the risk of urinary tract infections.

Empowering patients to make informed decisions and offering ongoing support as they navigate their options can lead to an improved quality of life and increased confidence in managing their healthcare choices. This patient-centred approach ultimately enhances the overall well-being of individuals as they take control of their health and future.