Problems with Peeing in Drysuits

The need to pee while wearing a drysuit during dives has led to the development of techniques and devices that faclilitate urination. Male divers either use absorbent diapers, or a condom catheter attached to the penis that is connected to a plastic or rubber tube exiting the drysuit via a special bulkhead valve known as a “P-Valve.” Female divers also use diapers or devices like the Shewee Go or She-P, a latex or silicone cup held against external genitalia that drains urine via a tubing system identical to the condom catheter. P-valve systems come in two varieties: unbalanced or balanced. In the unbalanced version, a screw valve on the outside of the drysuit is opened for urinating, then closed afterwards. The balanced P-valve uses an additional chamber, inside the suit, to equalize the pressure inside the tubing with the ambient pressure.

Use of P-valves isn’t free of complications. Problems with their use include catheter squeeze, urogenital infections and pneumaturia, or the passage of gas or air in the urine. For the journal Diving and Hyperbaric Medicine, Richard Harris, a dive medicine physician in Adelaide, Australia, highlighted some cases, including one of his own. Before submerging into an Australian cave, he stood chest-deep in 44-degree water and opened his unbalanced P-valve to pee. At that moment, Harris distinctly felt cold water flow through the condom catheter into his bladder. Two days later, he began to feel malaise, followed by diarrhea and night sweats. The next day, Harris experienced painful and frequent urination. At the emergency room, he was treated intraveneously with the antibiotics cephalothin and gentamicin but when symptoms were slow to subside a week later, Harris was switched to norfloxacin for genital tract infections, with good effect.

A 49-year-old diver performed a 60-minute ocean dive to 23 feet, using a condom catheter connected to a balanced Pvalve. He attempted to urinate 25 minutes into the dive but immediately felt a sharp pain in his penis, forcing him to abort the dive. While ascending, he inflated his drysuit fully, which eased his discomfort somewhat. After exiting the water, he opened his drysuit to find the condom ballooned with urine, and a kinked tube. That night, he developed constipation, aches and general flu-like symptoms. He then developed a fever and the need to urinate frequently. He went to the hospital where he was diagnosed with a urinary tract infection and stayed for six days on intraveneous antibiotics.

Harris believes the UTIs were likely due to the drysuit tubing. After diving, the drysuit is stored and residual urine or water will stay in the P-valve tubing, a perfect culture medium for bacteria that leads to UTIs. Thus, the most important strategy for preventing urinary sepsis is adequate cleaning of the P-valve tubing after use and before storage. Syringing an antiseptic like chlorhexidine, or a solution of denatured alcohol and acetic acid, through the tubing can accomplish this.

Harris did an informal survey of other drysuit divers and found numerous episodes of UTIs, genital squeeze and pneumaturia experienced by both men and women. Therefore, this is a potentially serious problem that could lead to long-term health problem for those doing prolonged dives in drysuits. Education in cleaning and caring of P-valve devices should become part of technical diving training.

“Genitourinary infection and barotrauma as complications of ‘P-valve’ use in drysuit divers,” by Richard Harris; Diving and Hyperbaric Medicine, December 2009, pages 210-212. This article is a condensed version of the study and Undercurrent accepts responsibility for any errors made during editing.