Are urinary sheaths recommended if bed bound?

[JDM625]

FIL is bedbound following a stroke. He was seen by the continence nurse initially and wears pads. He has had recurrent UTI's, which I suspect are caused from sitting in a filthy pad until the next carer arrives.

Would a urinary sheath/conveen help reduce the UTI's? For clarity, I'm not referring to a internal catheter.

It would certainly be better for his skin. They can come off sometimes if moving around. I would certainly discuss the options with his continence nurse.

Reasons for recurrent UTIs are complicated and generally not to do with being on a pad.
Older men are often prone to UTIs due to not emptying their bladder fully when they wee due to having an enlarged prostate.

UTIs are often overdiagnosed in the elderly as well by putting every dip down to a UTI - really you need confirmation of every one with growth on an sample, not just seeing something positive on a dip.

My experience of conveens is that they fall off, a lot. They are great for the skin not being wet but bad for the skin on the penis due to the glue.

I'd suggest having a conversation with the continence nurse again about your concerns.

Convenes are not always great. They often fall off or move out of place. They can also cause sore areas on the penis that can be painful and hard to heal.

I don’t think a pad would cause UTIs. How is he drinking? Did he have a catheter in hospital?

how many visits is he having a day? Is there faecal incontinence between the visits?

A compromise can be convene at night but not during day as more pad changes. But first he needs to trial whether it works for him as often does not.

Thanks everyone. I'd missed the replies.

To answer questions:
Other than briefly, during the initial stoke 18mths ago, no, FIL has never had a urinary catheter inserted since.
He wears pads, is bed bound and has 4x carer visits a day. They don't have a down stairs toilet. He isn't hoisted to open bowels on a commode- because they don't even have a commode! He sits in a filthy pad until the next carer arrives. If he opens his bowels in the evening, he could be waiting 12hrs till the next visit and MIL is unable to change him herself. 🙁

The A&E discharge summaries I've seen say 'suspected UTI'. I've asked MIL if a sample was actually sent to the lab, but she never knows. I've asked her to contact the continence nurse multiple times for a review or give me the number and I'll call them- but it seems to fall on deaf ears. Until the following week when he is rushed to A&E again!

The local authority does assessments to see what’s needed. They will supply a commode. He can’t go on like this. I’d be phoning then and telling them he urgently needs help.

Thank you. I agree, but what if he wants to open his bowels when the carers aren't there to hoist him onto the commode? I would buy a commode, but unless he can plan his poo to be hoisted in time to be sat on it, I doubt it would help.

I've tried his GP surgery and hospital team. MIL has the continence team details 'somewhere'! She had no organisation, diary, phone book of numbers etc which is another infuriating thing. And no, no dementia or memory issues with her!

Does he have the sitting balance to be able to tolerate being on a commode? Usually someone would only be discharged to be bedbound if they are not able to sit out into a supportive chair, or if their home does not have enough space for them to be hoisted out safely.
As you said, OP, even if he was suitable for a commode your MIL would not be able to safely transfer him on and off it.
Please do have a chat with the continence team. As a bed bound man sadly he will be prone to UTIs. Hydration is really important.

@delightfuldweeb Does he have the sitting balance to be able to tolerate being on a commode?

No. Only if he was strapped in securely somehow to prevent him falling out. He has little core strength now and still thinks he can walk/run/play sports! He was very active prior to the stroke. Thank you.

this sounds like he needs to be in a care home really with carers available 24/7. He can’t be left in soiled pads for hours. Never mind the UTIs but his skin will break down and he will get big wounds if this continues. Carers 4 times a day are not appropriate for this situation.

It doesn't sound like a commode would be suitable sadly and if he wants to continue living at home 4 (double handed?) Calls is the most he will get.
This means that there are times people are waiting for care.
The same issue would arise even if they had a live in carer
I've never found convenes to be very useful either.

UTI's are difficult to treat mainly due to lack of fluid being drunk and not fully emptying the bladder often as has been said due to the prostrate.
sadly it sounds like you MIL is not able to cope with his toiletry needs maybe other things too
to be honest with his needs he may be better having residential help

My DF had a conveen when living with me at end of life. The nurses caring for him told me that the key to success with a conveen is making sure the size is correct. One of their team members was always referred to as the conveen queen as she was the expert fitter!