Important points to consider

• Hand control difficulties vary between people, or from day to day for an individual.
• The type of hand control difficulty you have will affect which products you can use; for example, you may have difficulties with only one hand and look for products that can be managed single-handedly. This may present less of a problem than if both hands are affected.
• Different products require different hand control skills; for example, a sheath is light but thin and small. Good finger control is necessary to open packaging and put on the sheath.
• A hand held urinal may have quite a chunky handle for easy grip but require strength to lift it when full.
• Sometimes, it is not obvious where the problem with using the product will be! For example, you may be able to put a product on but not be able to cleanly remove and dispose of the product after use.

Product suggestions

Pads

• Pull-up style pads which are similar to pants tend to be easier to manage. However, you do have to remove lower clothing in order to get them on. If you find changing lower clothing difficult then pull-up style pants may not be suitable for you.
• The methods for securing some pads need reasonably good hand control. For example, the mesh stretch pants used to secure some larger pads can roll up like tights and be fiddly to pull into place.
• To secure larger pads, try using lycra based pants which may be available as part of a normal underwear range.
• The adhesive tabs used in disposable diaper style pads or safety pins used to secure some more traditional washable products require good finger control.
• Pad manufacturers often provide guidance and tips on how to apply pads in different positions.
• T-shape pads are designed to be easy to put on. The belt can be secured in place while sitting and this will hold the pad in place as you stand and put the pad in place.
• Marsupial or pouch pants can be useful. You or a helper can ‘pre-load’ the pants with the pad so they are ready for you to use.

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Female devices

These devices can be difficult to manage if your hand control is poor. They are quite small and have to be carefully inserted (into the urethra or vagina). A steady hand is required to ensure precise positioning without increasing the risk of damage to the skin or the introduction of infection.

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Male devices

• Male devices vary in the level of hand control required to use them. Some male devices require fine hand control; for example:
  • putting on a sheath which has to be rolled over the penis
  • managing the straps of a body-worn urinal
  • connecting devices to a urinary drainage bag
• Penile compression devices have a closure mechanism that requires good grip for use.
• Men might find body-worn urinals that are secured in place with a garment (similar to a jock strap) easier to use than one with straps. A helper could be asked to set up straps on a body-worn urinal so you can pull it up over your legs and body into place.

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Catheters

• Indwelling catheters are suitable if there are no alternative products to suit you and you are unable to use the toilet safely.
• Aspects of catheter management can be difficult if hand control is limited. For example:
  • Connecting and disconnecting the drainage bag
  • Managing leg bag support mechanisms (straps or bag holder)
  • Managing the tap on the drainage bag
• Tubing connections are designed to be hard to disconnect for security in the system and you may need help with this aspect of catheter management.
• Try using a leg bag support garment or holster to support your leg bag. These may not be as fiddly to use as straps that have to be fed through holes in the leg bag and tend to twist.
• There are various designs of drainage bag tap - it is worth trying a few to work out which you find easiest to use.

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Faecal devices

• Some faecal devices, for example, anal plugs are small and require careful placement to avoid discomfort and damage to the skin.
• Anal plugs are removed by gently pulling on a string. This might be difficult if your finger strength is poor.

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Toileting aids

• Toileting aids such as hand held urinals vary widely in the ease with which they can be used. Some have relatively large handles specifically designed for people with limited hand control. Urinals made from soft plastic may be easier to grip (ref 27 Vickerman 2006).
• Urinals can be hard to manage when full as they are heavy. Some urinals can be connected to a drainage bag so urine empties directly from the urinal during use.
• If your hands are shaky and spillage is a concern, look for urinals with non-return valves. Some men prefer to use a wide necked female urinal as it requires less precision to put it in place. Try using super absorbent powder which solidifies the urine thereby reducing the risk of spillage.

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Tips from products users

• Mesh pants catch very easily on nails, rings, watches and bracelets - try removing these if possible.