Managing Incontinence at sea

As a disabled solo sailor circumnavigating the waters of the UK and Ireland, one of the challenges I’ve had to deal with is managing incontinence at sea. I have good news: it can be done, and done well, even on a tiny boat. My specific issues relate to a spinal injury, but I’ve learned that in disabled sailing and racing community continence problems of various sorts are surprisingly common challenges.

In planning my Round Britain and Ireland sail working out how I was going to manage my continence loomed large in both the columns labeled ‘healthcare’ and ‘logistics’. In fact, it was probably the biggest predictable health related concern that I had. When I set out on the planning I was still waiting for the emplacement of a suprapubic catheter ¹. I had to plan on the basis of using intermittent self catheterisation² and incontinence pads. That combination helpfully enables me to explore some of the biggest challenges related to longer distance sailing with continence problems, and those problems aren’t disease related. Rather they are: storage, safety and waste disposal.

Storage

Small sailing boats are short on storage to start with, and they are also notorious for water getting places it should not. This is not a good combination. Incontinence pads are remarkably bulky items, and sterile items also tend to come in voluminous packing. Neither works at all well if they get wet during storage. The sort of pads that deal with severe incontinence absorb between 1 and 2 litres so they become a potentially bulky heavy mess if accidentally immersed. A point to note here is that continence pads are usually plastic wrapped. But most packaging is pre-perforated to make opening easier. This perforation can let in large amounts of moisture over time. So double wrapping them makes sense to preserve their effectiveness.

Safety

In terms of safety, the packaging associated with sterile items, and the super absorbent polymers pose a serious threat in the case of flooding because they can clog a strum boxes³ and pumps, effectively preventing bilge pumps from working. Storage hygiene in yachts is often poor and in major floods items as varied as food can labels, socks, and bedding often block pumps. However to reduce the risks as far as possible I took care to ensure that packs of pads were very firmly secured, and where possible double wrapped

The other issue is that the packaging of sterile products and continence pads themselves are made from highly flammable materials and can significantly worsen any developing fire. There are limited control measures for fire risk in a yacht the size of Trilleen, but I did take the precaution of keeping the stores at the extreme forward end of the yacht and away from all possible sources of ignition. This was calculated to increase the probability I would be able to escape in the event of an uncontrolled fire – something which every seafarer rightly fears.

Waste

Absorbent continence products can also end up resulting in very large volumes of waste. Except in specific cases, this is no more complex to handle than waste produced by caring from young children, but provision still needs to be made to land it and dispose of it appropriately. In Trilleen’s case I had provisionally allocated quite a lot of one cockpit locker for this purpose.

Fortunately, by the time I came to depart I had managed to switch over to using a suprapubic catheter, and while I still ended up requiring incontinence pads to manage bowel issues and small amounts of urine leakage this greatly reduced the concerns regarding storage, safety and waste disposal. The switch to indwelling catheterisation did however raise other issues, primarily the risk of infection.

Infection management

Many people affected by continence problems are also more prone to urinary tract infections and other more complex infections. These pose a very real risk to sailors operating in coastal or more remote waters. They can develop rapidly and be debilitating. Untreated they can lead to sepsis and death. At sea even the minor symptoms of pain, clouded thinking and sleepiness can be debilitating. Quantifying the degree of risk is surprisingly difficult, and in the sailing context needs to be assessed on a personalised basis. Some people with conditions which should predispose them to regularly get infected, only acquire mild infections rarely. Others living with conditions less associated with infections develop severe infections rather frequently.

In my view as a patient – not a medic – sailors with predisposing conditions who are likely to be more than 12 hours from an emergency department should carry a suitable, and preferably extensive, library of standby antibiotics and have worked out with their physicians the appropriate strategy for their employment.

 Rough weather and indwelling catheters

In rough sailing conditions sailors with catheters (or indeed other indwelling tube systems) should be aware that they are especially vulnerable. The tube systems linking the catheter to any drainage bag are vulnerable to being snagged and caught up. At best this can result in a sterile drainage chain being broken and urine leaking everywhere. At worst it could compromise the catheter itself by pulling on it with such force that the securing balloon causes tissue injury to the urethra or stoma.

1. A suprapubic catheter is a hollow tube placed through the wall of the abdomen into the bladder and secured there by a hydrostatically inflated saloon through which urine can drain freely. https://en.wikipedia.org/wiki/Suprapubic_cystostomy ↩︎
2. Intermittent Catheterisation or Self Intermittent catheterisation is the practice of passing a catheter – a hollow tube through the urethra to drain urine from the bladder at specific intervals during the day and night. After each occasion where urine has been drained the catheter is withdrawn. Intermittent catheters are typically more rigid than those used for indwelling applications. ↩︎
3. Strum Box: The strainer that fits over the intake end of the bilge pumping system. May actually be in the form of a metal box with perforated walls, but whatever its shape, its purpose is to keep shavings and other cloggers out of your bilge pump ↩︎