VOL: 97, ISSUE: 06, PAGE NO: 7
Joan McIntosh, RGN, is an independent research nurse, Elmdon, Essex
Female urinals enable women to manage the logistics of emptying their bladders in a dignified way, saving energy, reducing stress and enhancing their quality of life.
These devices can be an invaluable aid to daily living, both in and outside the home, helping users to maintain their independence and enabling carers to aid toileting without lifting. And for women with bladder urgency, they are a useful aid to continence.
In hospitals, using a female urinal can be less disruptive than using a bedpan. Female urinals also act as an important tool in managing severe, immobilising pain and helping patients with reduced mobility.
The designs of female urinals all take advantage of the fact that the urethra is at the front of the body and urine is projected forward under pressure. But because they differ from bedpans, which are deep and placed well back under the user, health care professionals and users often lack the confidence to select a suitable product and tend to underestimate their usefulness.
The case of a young woman I nursed many years ago who was dying of cancer illustrates how important urinals can be to patient care. Helping her on to a bedpan to empty her bladder disrupted her pain control, but the alternatives seemed equally inappropriate: catheterisation was too invasive and the use of pads too undignified.
She needed a receptacle that was shallow enough to be slipped or manoeuvred under her with as little disturbance as possible. Because of the nature of her condition, she also needed one she could use comfortably while lying down.
An appropriate female urinal could have met these needs, aiding pain control and preserving her dignity.
A growing number of female urinals are available in the UK. Between them they cater for the variety of postures in which women may need to use them.
For example, a woman with painful knees or hips may prefer to use a urinal while standing, rather than sitting on a toilet. Someone with extensive burns on her back may prefer a urinal she can use while lying on her side or face down, and a women with severe back pain may need a product she can use on her side.
The posture adopted by an unassisted user often depends on her functional ability, as does her ability to position and remove the urinal. Assessment should include the user’s ability to tilt her pelvis, separate her thighs, support weight on her hands and arms, lean or roll to one side, raise herself from a lying to a sitting position and take weight on her legs. Skilled assessment is therefore important to ensure that an appropriate product is selected (Box 1).
Many products are available but a recent series of national workshops identified health care professionals’ limited knowledge of the range and positioning of female urinals and their capacity differences (White, 1999).
Using a female urinal successfully largely depends on selecting a product that matches the posture of the user and her voiding volumes, and that is manageable in terms of the user’s or carer’s positioning and removal techniques (Box 2).
To have confidence in these products users need to be able to rely on them not to spill, but what that means in terms of their capacity can vary widely from person to person. For example, a woman with normal bladder function who has to wait for help to use a urinal will need one with a large capacity, but someone with urgency and frequency may find a low-capacity product adequate for her needs.
Most users fall somewhere between these two extremes.
Depending on the type of product being used, keeping the receptacle level may be important to maximise its available capacity. On a soft support surface, for example, the pressure of the user’s weight tends to form a slope that runs contrary to the direction of drainage, creating a risk of spillage (Fader, 1994).
If the urine volume in the receptacle is likely to approach the limit of its capacity, Vernagel powder can be used to stabilise the contents. This hydrophilic powder turns liquid into a gel, with a 7g sachet absorbing about 350ml.
Female urinals fall into two broad categories:
- Hand-held devices;
- Body-supporting devices.
Hand-held devices rest between the thighs and include dishes, jugs, bottles, two-piece small mouldings with drainage attached and one-piece small mouldings with a bag. Body-supporting devices rest under the thighs.
Dishes have a flat base and are shallow, compact receptacles with a cover that surrounds a roughly central opening (Fig 1). They are inserted under the user, in bed or in a chair, so that the start of the urinal opening is just under the perineal area.
Bottles are generally narrower than dishes. As the name implies, they have a hollow chamber with an opening shaped to fit the female anatomy. All bottles are suitable for use while standing and most can be used while the patient is in a chair, usually sitting forward. Several can be used while lying down and a few are suitable for use when patients are lying on their sides (Fig 2).
Small mouldings with drainage are designed to sit compactly between the thighs. They have a tube that connects to a detachable semi-disposable plastic bag, combining large capacity with compactness.
Some are cup-shaped, function as a funnel and require the user to stand or sit well forward (Fig 3). Others look like miniature dishes in that they have a flat base and are shallow, with a cover surrounding a roughly central opening.
The slimmest of these dish devices are particularly useful for seated users who have thigh spasms or contractures, which limit ability to separate the knees.
Provided capacity is adequate, a dish moulding may be emptied after use if the surface slope prevents drainage during use, thereby functioning as a receptacle in its own right.
A recent innovation is anatomically shaped small mouldings that drain directly into a purpose-made bag (Fig 4).
Jugs are deep and open receptacles (Fig 5). They can be used while standing and, as with other products that have been designed for such use, differ in the width of the stance required to accommodate them.
Body-supporting products are a more conventional concept for women, as they are designed to fit under, rather than between, the thighs.
One product is flat and shallow, designed for use on a chair or in bed (Fig 6). The other is a paediatric bedpan that doubles as a female urinal for use in bed.
If users cannot empty their urinals it is important that they are able to reuse them. Products can be reused without having to be emptied if they:
- Have a large capacity with non-spill features (Femupan);
- Drain during or after use (Femicep, Bridge Urinal, Bridge Urinal With Handle, Beambridge Lady Funnel, Portable Urinal);
- Can be made drainable after use by attaching a sheath and drainage bag over the handle (Female Urinal - Pan Type, Femupan);
- Lock the urine away with a non-spill adaptor (Spil-Pruf) or a polymer that absorbs liquid (Mini Potti, Pipinette Travel Kit);
- Have an opening that is large enough for a disposable gel pad to be inserted after the urinal has been used to mop up the contents. The pad is then discarded;
- Can be emptied easily into a bedside container (most products).
The user’s symptoms, circumstances (the lack of a helper) and environment (at home or away from home) create several logistical problems for women who have problems using a toilet. Female urinals can provide the solution.
The Continence Products Directory (Continence Foundation, 2000) details the full range of female urinals. Most perform well against the criteria of ease-of-use, comfort and safety from spillage as long as they are used correctly, in the appropriate posture for that product and within the limits of each product’s capacity and the capabilities of each user.
Continence advisers, occupational therapists and moving and handling advisers are particularly well placed to help nurses realise the potential of female urinals by advising them on this complex but useful product range.
The author has produced a comprehensive guide to the full range of female urinals on the UK market. Female Urinals: Handy Conveniences for Women is available from AJ Products, tel: 01763 838375. It costs £11.00, including postage and a laminated poster of most of the products.
A workshop on female urinals will be held by PromoCon 2001 in Manchester on April 5. Contact Debra Evans on 0161 834 2001 for details.