International Consultation on Incontinence

Continence Product Advisor

International Continence Society

Sheaths

Sheaths are a commonly used male device. They are designed to collect urine as it leaves the body. Some men prefer them to pads 12 which they consider to be unacceptably feminine 3

Click on How to use a sheath for guidance.

Click on the purple tabs below for more information about sheaths.

More likely to suit you if...

Less likely to suit you if...

  • You wish to avoid using pads
  • Using a device (as opposed to a pad or catheter) is acceptable to you
  • You wish to avoid the inconvenience of frequent pad changes
  • You have found indwelling catheters to be uncomfortable (sheaths tend to be more comfortable than indwelling catheters)
  • You have had a problem with infection with indwelling catheters (sheaths are associated with less infection than indwelling catheters)
  • You have good hand control
  • You have good memory and mental function
  • You have skin damage on or around the penis
  • Urinary tract infection is a major concern for you
  • You or your helper are unwilling or unable to fit the sheath

Top Tips

  1. A good barrier product can be used before wearing a sheath. It helps to protect the skin. (Thank you for your tip - some skin protectors can also interfere with sheath adhesion so please check FAQs)
  2. 15 2
  3. Sheaths tend to fall off, not just a matter of fitting the right size as penis is often a different size when applying sheath to later in day (i.e. semi-erect when applying, but much smaller when out in the cold).
  4. 1 0
  5. Use a catheter retainer strap, it stops the sheath kinking and blowing off – place over junction of sheath and bag
  6. 1 0
  7. I was given some sheath samples without any instructions. I found useful guidance on the internet (youtube)
  8. 1 1
  9. Use skin protector wipes (available from sheath manufacturers) this may help protect the skin and improve adhesion.
  10. 0 0

Sheaths are secured to the penis with an adhesive and they can be divided into two main designs:

One-piece sheaths have an integral adhesive and are simply rolled over the penis

Two-piece sheaths have a separate double-sided adhesive strip or use an adhesive spray. The adhesive is applied to the shaft of the penis and then the sheath is rolled over the penis and adhesive, and secured in place

  • One-piece sheaths are generally more popular than two-piece sheaths as most men find them easier to use45
  • Sheaths are sometimes called condom catheters, uridomes or external catheters and are similar to contraceptive condoms. They fit over the penis and are mostly ‘self-adhesive’ although other forms of securing sheaths are available.

  • Sheaths are usually connected to, and drain into, a urine drainage bag most commonly attached to the leg. Other methods of supporting the drainage bag are available.

  • If leakage is very light it may be possible to use a catheter valve or spigot connected to a sheath.

Important features:

  • Material: Sheaths are usually made from latex or silicone rubber. Most men prefer silicone sheaths over latex ones 5 especially if latex sensitivity is a problem. Also, silicone is transparent allowing some visualisation of the skin without removing the sheath. However, this is not a substitute for periodic removal of the sheath and direct inspection of the skin.

  • Size: Sheaths are supplied in a range of lengths and sizes. Most companies supply them with diameters in the range of about 20-40mm (in 5-10mm increments). This variation ensures that you have a sheath which is the correct size for you – this is very important for comfort, safety and effective containment of leakage.

  • Applicator: Some sheaths come with an applicator which is intended to assist helpers put the sheath on. In trials, men have reported that applicators can be difficult to use 5 However, applicators on newer designs of sheaths are untested and may be easier to manage.

  • Anti-kinking / twisting features: Some sheaths come with features intended to improve drainage by reducing kinking and twisting at the distal end of the sheath near the connection to the drainage bag.

  • Anti-blow-off features: Some sheaths come with features intended to reduce the likelihood of ‘blowing off’ at high urine flow rates such as can occur at the beginning of the urine flow. For example, the distal end of the sheath may be thickened and bulbous to stop the internal walls sticking to one another between urine flows. Silicone sheaths are less likely to blow off 5

  • Connection to the drainage bag: Some sheaths come with features intended to increase the ease and security of connection to the drainage tube; for example, a push ring or ridge at the end of the outlet tubing.

  • Features for penile retraction: Retraction of the penis is quite common amongst older men and those who have had treatment for urological conditions e.g. prostate surgery. Shorter length sheaths with wider adhesive bands are designed to enable sheaths to be secured where penile length is reduced.

  • Drainage bag support: Body-worn urine drainage bags are usually secured to the leg (leg bag) or suspended from a waistband (sporran).

  • Alternatives to drainage bags: If leakage is very light or only during particular activities (e.g. swimming), some men connect a catheter valve (similar to a tap) directly to the sheath. See Catheter valve for more information. A spigot may be used as an alternative to a catheter valve. The sheath contains any drips which are drained from the sheath when the catheter valve is opened or spigot removed. This system works best with sheaths that have a concertina design at the end so there is space to hold the urine until emptying.

  • Other sheath designs have been developed over the years; for example, using a non-adhesive collar to keep the sheath in place. Such devices are not commonly used 6

  • Sheaths are a popular and effective alternative to absorbent pads for many men 1 They are perceived to be a more masculine product than pads, and to offer less restriction to activity and greater comfort than indwelling catheters 7 They are liked for their ability to keep urine away from the skin 8910 (as it is channelled straight into a collecting device), and they are generally suitable for men with all degrees of mobility, including wheelchair use.

  • Many men are unaware that sheaths exist and health care professionals are often reluctant to fit them, which may be due to embarrassment on the part of both the health care professional and the consumer. However, the potential benefits are worth overcoming the embarrassment; specialist continence nurses are more likely to have the knowledge and skills required to be able to discuss sensitive issues with you and fit a device with the best chance of it functioning successfully.

  • Men report that using a mix of products gives them the flexibility they need in different circumstances/ during different activities 2 For example, you may find that wearing a sheath when you are going out and an alternative product, such as a pad, when you are at home is a useful combination. It is worth trying different combinations to see which works for you.

Some key pointers for successful use…..

  • Men have reported that staying in place and not leaking, comfort and ease of use are the most important aspects of sheath use11 An effective sheath should stay in place for an acceptable length of time (usually up to 24 hours). It should be leak free, comfortable to wear, easy to apply and remove, avoid skin damage and channel urine effectively into a urine drainage bag.

  • The key to successful sheath use is appropriate selection and fitting; if you can fit the sheath easily then it is more likely to successfully stay in place than if fitting is difficult9. It is generally accepted that the selection, fitting and monitoring of sheaths and their accessories, especially leg bags12 is best done by a health care professional with expertise in these products. This is considered to reduce the risk of complications (see ‘Are there any disadvantages to using a sheath?’ in FAQ’s below).

  • Good genital hygiene and ensuring a good free flow of urine through the sheath (by checking and releasing twisting of the sheath) is important for skin health and to prevent urine pooling in the sheath, which could lead to bladder retention or bladder tract infection13

  • Men often find that one brand of sheath works better for them than another, even though they may appear very similar10. Try more than one design / brand until you are confident you have a sheath that works well for you.

  • ‘Try before you buy’ - manufacturers of sheaths may send you free samples in the post for you to try. Look out for advertisements in magazines and on the internet.

Some potential problems….

  • Sheaths are less suitable for men with short penile length or penile retraction which men can experience after treatment for urological conditions e.g. prostate surgery. However, there are specialist sheaths designed to overcome this problem which are shorter than the standard sheath length and with a wider adhesive band.

  • Recently a new style of sheath has been developed that attaches just to the end (glans) of the penis. This may be useful if you have a retracted penis. Click on [Devices for penile retraction](http://www.continenceproductadvisor.org/products/maledevices/devices forpenileretraction) for further information.

  • Sheaths may also be unsuitable for men who are confused, considered psychologically vulnerable or have decreased sensation through spinal cord injury 121415. Tugging at the sheath may result in disconnection or increase the risk of bladder tract infection 16 and decreased sensation may result in a lack of awareness of damage occurring to the skin.

What are sheaths made of?

  • Sheaths are made from a variety of materials including latex, silicone rubber or other synthetic polymers.

  • Care is needed as some people have an allergy to latex; although this is uncommon and is usually confined to skin reddening and irritation, more severe allergy could occur. Bear in mind that you may not know that this is the case until you try latex products and you may also develop a latex allergy over time when using latex products.

  • Silicone products are transparent and some men prefer this as they can see the condition of the skin on the penis and the glans under the sheath.

I have bowel leakage, can I use a sheath?

  • Sheaths – which are designed to contain bladder leakage - are unlikely to be useful for you if you have both bowel and bladder leakage. If you have very light bowel leakage you may be able to wear a small pad that doesn’t interfere with your use of the sheath. However, using larger pads may make it difficult to position the sheath and the drainage bag tubing properly.

  • It may be possible to wear a sheath at the same time as a faecal collecting device. Click on Faecal devices for information about these products.

Will I have difficulty putting them on or taking them off?

  • Men with good use of their hands usually find sheaths easy to manage. One piece sheaths are generally easier to use than two-piece sheaths.

  • Some sheaths come with applicators which some men find useful but many find fiddly. It may be down to personal preference.

  • Prior to applying a new sheath, wash the penis thoroughly with soap and water and ensure it is dry. Make sure any old adhesive is removed.

  • Special skin wipes or barrier cream can be used to protect the skin but make sure you allow the skin time to dry and the cream to be absorbed before putting the new sheath on. Avoid petroleum based products e.g. Vaseline, which can damage the sheath. If you are having difficulty with adhesion, try not using your usual protective product for a while or try a different product.

  • Leave a small gap at the end of the sheath between the glans penis and the join with the drainage tube to avoid rubbing/hurting the end of the penis. However, be aware that too large a gap may increase the risk of the sheath twisting or kinking, which might impede free drainage of the urine into the drainage bag 17. You may have to practice with a few sheaths until you get the positioning right.

  • Sheaths are usually designed to be used for up to 24 hours. Some brands may be suitable for longer wear times – you are advised to follow the manufacturer’s instructions about this.

  • Generally, if you have used the sheath for the whole day it should come off easily and you can wash away any residue of adhesive. It can be uncomfortable to remove the sheath if the adhesive is still very strong. You may find it more comfortable to remove the sheath gently whilst in the bath or bathing the penis in warm soapy water.

  • If the adhesive sticks to pubic hair it can be uncomfortable. Some men choose to remove or trim hair from this area before using sheaths.

Click on How to use a sheath for guidance.

Will they take up much storage space in my home?

  • Sheaths do not take up much storage space; they may come in boxes of 30, say, to provide a month’s supply, based on using one new sheath per day. They are easy to carry when away from home 2

How should I dispose of a used sheath?

  • Sheaths can usually be placed in a small bag/nappy sack and disposed of in the normal household waste.

  • Contact your local waste collection service to find out about any specific local requirements.

  • If you are staying away from home you will need to plan in advance how to dispose of products discreetly although men find sheaths easier to dispose of than pads especially when away from home 2

Click on Travel for tips from sheath users when away from home.

How much do sheaths cost and where can I buy them?

  • The cost of sheaths varies according to the country you live in, so it is not possible to give an exact price range.

  • They can be purchased through various retail outlets, for example, supermarkets, chemists or directly from the manufacturer by phone or on the internet.

Click on Worldwide to find out how to obtain sheaths where you are.

Are there any disadvantages to using a sheath?

Although sheaths can be useful devices, they are associated with some complications and there are some disadvantages to their use:

  • Sexual activity may be limited by use of a sheath and a pad may be more useful at times for this reason.

  • Intermittent catheterisation – sheaths may also prohibit intermittent catheterisation. However, it may be possible to catheterise through the distal end of the sheath – having disconnected the drainage bag tubing/catheter valve - if the urethral meatus can be visualised and clean insertion achieved. This practice should be discussed with your health care practitioner. Sheaths specially made with a removable end, for intermittent catheterisation are available.

  • Failure of the device to stay in place and therefore contain leakage 81518 - you can reduce the risk of disconnection of the sheath from the penis or the drainage bag tubing by careful fitting of the sheath and securing of the drainage bag and tubing with appropriate straps or a Leg bag support garment. A drainage bag heavy with urine will pull down on the sheath if not properly supported. Try supporting the drainage bag higher on your leg (even on the thigh) for added security. Use tubing support straps to secure the drainage bag tubing close to your leg; this will reduce the risk of it getting caught or tugged and may also make it less visible under clothing.

  • Skin damage (trauma or allergy) 19 can occur through use of sheaths. This risk can be minimised by removing the sheath periodically (according to the manufacturer’s instructions) and by keeping your penis skin scrupulously clean (with unscented soap and water). Use silicone sheaths (particularly if latex allergy is a problem) and regularly examine the skin (especially on the underside of the penis).

  • Compression damage - problems with compression can occur if the sheath is too tight19 Ensure the sheath is the correct fit according to the measuring guide supplied with the sheath. If there is any swelling of the portion of the penis which is inside the sheath, the sheath is probably too tight and should be removed immediately.

  • Infection - urinary tract infection can occur in association with sheath use 2021 (although to a lesser extent than with urinary catheters 22 as can skin infection or polyps 1823. The risk of infection can be reduced by preventing the sheath or drainage tubing from kinking, thereby ensuring free flow of the urine from the bladder into the drainage bag. Try using products with an anti-kink function; see ‘What are sheaths?’ above. Some drainage bags have anti-kink tubing. Regular, thorough genital hygiene is also important for reducing the risk of infection.