“Catheters are used in urological surgery and when other methods of managing urinary incontinence fail. Ten percent of hospital patients receive an indwelling urinary catheter at some time during their admission,’ and the use of such catheters results in significant morbidity and mortality.”1
“A leg bag is a smaller size urine collection bag for your urinary (Foley) catheter. The leg bag can be worn on your leg during times when you are out of bed to collect urine.”2
Being free of complications from many urological conditions is attainable by anyone. As we weave our way through our daily experiences with urine drainage bags and leg bags, we eventually learn simple tricks and tips to make life easier. Undoubtedly, the most important things to master are basic sanitation and proper use of your urine drainage and leg bags. But, first let’s take a look at a few basics:
A Foley catheter is a tube used in special circumstances for draining urine from the bladder when a patient cannot pass urine normally. A situation like this can arise post-surgery (Urological and/or Gynecological) or when a patient has urine retention due to blockage in the urethra or because of injury to the spinal cord. Although the catheter is usually inserted through the urethra, this is not possible sometimes. In these cases, and a mini operation is performed in the supra-pubic area to insert the catheter into the bladder. Whether the insertion is through the urethra or through the supra-pubic puncture, the process is called catheterization.
Once the catheter is in place and ready to drain, it is connected to a urine collection bag. There are two main types of bags:
- Leg bag
- Regular urine bag which is typically larger.
A leg bag is better when the patient is up and about because it is attached to the thigh and out of view while a regular urine bag is more convenient for use during sleep.
“There are two types of bags that can be attached to your catheter. The larger one has a longer tube and goes to a larger volume bag (right photo). This is the preferred drainage bag to use except when leaving the house and going into public. Because of its size, it drains the bladder better and may prevent your bladder from getting over-full, which can delay the return of normal bladder function. The other bag has a shorter tube and a smaller collection bag and can be strapped to your leg (leg bag, left photo). This allows it to be kept out of sight under loose-fitting pants or a long dress.
The larger bag must be used for overnight drainage since it holds more urine. Whenever the leg bag is used, it is necessary to pay close attention to its volume and not allow it to become over-full. If it gets too full, it will not drain the bladder well and urine will back up into the bladder delaying the return of normal bladder function. Poor bladder drainage also increases your risk of bladder infection.”3
How to attach or remove a leg bag
“The leg bag is attached either to your thigh or lower leg with Velcro straps or a mesh sleeve. Where you wear the bag depends on what feels comfortable for you. An special strap on the thigh should be used to help to secure your catheter. Leg bags come in three different sizes, holding 350ml, 500ml, or 750ml.”5
Whether you are attaching or removing a leg bag, proper hygiene is of great importance to prevent chances of contamination, which can lead to a myriad of urinary tract infections. Begin by washing your hands with water and soap for at least 15 seconds. The needed supply includes:
- A sanitized or fresh leg bag with straps or tape
- A large (regular) drainage bag
- Medical Gloves
- Alcohol swabs or pads
- White vinegar
- A clean towel.
When you are ready, drain the large (regular) urine bag. Regardless of the draining method your bag uses, avoid touching the tip of the outlet or letting it touch anything. Place the catheter-urine bag connection on a clean towel and then disconnect them as you pinch the open catheter end to prevent urine from leaking.
Next, place the removed urine bag on a clean towel. Remove the cover on the leg bag’s connection point and keep it for later use. Clean this tip with alcohol swab and then connect the Foley catheter to the leg bag.
Now fasten the leg bag to your thigh but be careful not to over-tighten. You can strap the catheter to your thigh; keeping it barely loose so that it does not tug on your urethra and bladder.
How to empty the leg bag
Since a regular urine drainage bag is larger than a leg bag, the leg bag will require drainage more often.
“This will need to be done many times a day as the bag fills up and becomes heavy. The frequency of this will depend on the size of the leg bag. Always wash your hands with soap and water first and dry hands well. Place the jug under the bag outlet tap and open to allow the urine to drain (avoid contact from the tap to the jug to reduce the risk of infection). When empty, close bag outlet tap and wipe with a tissue. Make sure the leg bag is placed back in a comfortable position for the patient (The urine will need to drain downwards into the bag and be secured so that it does not pull). Dispose of contents of jug into the toilet. Rinse out jug with warm soapy water and allow to dry. Wash hands with soap and water.”6
Empty the leg bag into a container or toilet when it is half full or a minimum of two times daily. Make sure that you understand how to open the spigot to empty the urine since different makes of leg bags use different draining systems. Once drainage is complete, close the cap and wash your hands. Take note and record the amount of urine drained if it is a recommendation from the healthcare professional. Also, a good tip would be to alternate legs to wear the leg bag, preferably after a shower.
“Don’t the leg bag or night bag get full. Empty the drainage bag when it is ½ to ⅔ full (at least every 4 to 8 hours) or when switching from one type of drainage bag to another. If you’re using a leg bag, you may need to empty it more often (like every 3 to 4 hours) because it’s smaller than the night bag.”7
How to clean the Leg Bag
The bags should be cleaned daily after changing from one to the other.
Use vinegar and water in the ratio of 1:3 to soak the bag for 20 minutes before rinsing it with warm water and hanging it to dry.
Bag replacement is usually recommended once a month, though it can sometimes vary. It is highly advised to follow their instructions.
“Collection bags should be washed with soap and water when they are exchanged. You may disinfect the bag and remove the urine smell by rinsing the bag with a distilled vinegar solution (1¼ cups white vinegar mixed with 2 quarts of water). Do not rinse the bag with water after using the vinegar solution. Your drainage bags should last 4-6 weeks under normal use with appropriate care. New bags can be purchased at medical supply stores.”8
A few more tips
- “Keep the collection bag lower than the level of your hips to prevent urine from flowing back into your bladder.
- The leg bag is smaller and you will need to empty it more often than your large collection bag.
- Unless told otherwise, drink 8 to 10 cups of non-caffeinated fluid each day.
- Clean your leg bag and large collection bag at least every other day.
- Clean each bag with a solution of vinegar and water that is 1 part vinegar and 3 parts water, unless told otherwise by a member of your health care team.
- Change your old bags to new bags every 2 weeks or more often as needed.”9
- Keep your body well hydrated to maintain healthy urine output as long as your healthcare professional gives approval.
- Avoid any mechanical damage to the catheter and urine bag.
- Avoid urine backflow by keeping the bag at a level below your bladder at all times. This also reduces the risk of infection.
See your doctor immediately if:
- Your urine has any abnormal smell or color
- Your lower back or bladder experiences pain
- You feel a burning sensation in your urethra
- There is discharge from your urethra.
- Redness, unwanted drainage or inflammation of the urethra and other signs of ill-health like nausea, lethargy, and urgency to pass urine many times. These symptoms may an indicate the presence of a UTI (Urinary Tract Infection).
“If you call your doctor, have the following information ready:
- Your temperature
- The amount and appearance of your urine
- Try to describe your problem as detailed as you can. For example, if the problem is pain, be able to tell your doctor where the pain is, what the pain feels like (sharp, dull, burning) and when pain occurs.”10
“Essentially, the bladder is like a muscle and it will eventually waste away if not used regularly. It has been demonstrated that after only 6 months on free-flow drainage using a leg bag, the bladder shrinks and ceases to function properly.”11
(1) Everyday Aids and Appliances: Urinary catheters. Belfield, P. British Medical Journal. 1988. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2545116/pdf/bmj00277-0034.pdf
(2, 9, 10) Leg Bag for Your Urinary (Foley) Catheter. James, A., & Solove, R. The Ohio State University Comprehensive Cancer Center. 2018. https://patienteducation.osumc.edu/Documents/leg-bag.pdf
(3, 4, 8) Bladder Catheter Care. Cardosi, R. Comprehensive Care For Women With Gynecologic Cancer. 2019. https://www.watsonclinic.com/uploads/Bladder_Catheter_Care.pdf
(5) Managing a urinary catheter. NSH Borders. Patient / Carer information booklet. 2019. http://www.nhsborders.scot.nhs.uk/media/383900/managing-a-urinary-catheter-patient-information-booklet-may-2016.pdf
(6) Procedure for Catheter Aftercare. NHS Wirral. 2010. https://www.wirralct.nhs.uk/attachments/article/19/NPC03ProcedureforCatheterAftercare.pdf
(7) When You Have an Indwelling Catheter: Care Instructions. Home Care, Alberta Health Services. 2017. https://myhealth.alberta.ca/Alberta/AlbertaDocuments/when-you-have-an-indwelling-catheter-care-instructions-printable.pdf
(11) Urinary Retention: Catheter Drainage Bag or Catheter Valve?. Virdi, G., & Hendry, D. Current Urology. 2015. https://www.karger.com/Article/FullText/442847