Urostomy Care

WHAT YOU SHOULD KNOW:

• The urinary system is made up of the kidneys, ureters, bladder and the urethra. The kidneys produce urine and the urine travels through the ureters (tubes) to the bladder where it is stored. The urine then leaves the body through the urethra. A urostomy is a surgical procedure in which the urine bypasses the bladder. The urine leaves the body through an opening in the abdomen called a stoma instead of leaving through the urethra. During surgery, your bladder may be left in place or it may be removed.
  
  
• To create a passageway for the urine to travel from the ureters to the stoma, a portion of the colon is used. A portion of the colon is cut and the main colon is then reconnected for normal bowel function. The ureters are detached from the bladder and attached to the portion of colon that was cut. The end of this portion of the colon is then brought to the surface of the abdomen to allow the urine to leave the body. The urine drains into a watertight pouch (bag). A urostomy is needed when the bladder does not work properly due to certain health conditions. Some of these include bladder cancer, neurologic (brain and nerve) conditions, birth defects, and inflammation of the bladder.

AFTER YOU LEAVE:

Medicines:

• Keep a current list of your medicines: Include the amounts, and when, how, and why you take them. Take the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency. Throw away old medicine lists. Use vitamins, herbs, or food supplements only as directed.
  
  
• Take your medicine as directed: Call your primary healthcare provider if you think your medicine is not working as expected. Tell him about any medicine allergies, and if you want to quit taking or change your medicine.

Follow-up visit information:

Keep all appointments. Write down questions you have about having a urostomy. This will help you to remember to ask these questions during your next visit. Your stoma may change over time depending on things like gaining or losing weight. Caregivers will measure and check your stoma and ostomy. Bring your ostomy equipment with you to your appointments and any time that you have to go to the hospital.

How do I care for the skin around my stoma?

A good time to check your stoma and the skin around it is when you change your pouch. The stoma should always be pink or red and moist (wet) looking. Because your stoma has many small blood vessels, it may bleed when it is cleaned and wiped. Do not worry about a little bleeding unless the bleeding does not stop. As swelling goes away, your stoma size should get smaller and should be its normal size about eight weeks after surgery.

• The part of your urostomy pouch that sticks to your abdomen is called a skin barrier. It is important that the skin barrier opening for your stoma fit closely (not closer than one-eighth of an inch) up to the stoma. Use the stoma-measuring guide that comes with your urostomy supplies to check the size of your stoma. As your stoma gets smaller, you will also want to cut the skin barrier opening smaller. Urine can leak through the opening onto your skin if the opening is too large. The urine may then cause your skin to be red and irritated.
  
  
• Red skin may also mean that the skin barrier was left on too long. It is always important to learn why the skin around your stoma is red or irritated. Talk to your caregiver about what to do to prevent and treat red and irritated skin.

How do I change my pouch?

The amount of time that your pouch stays tightly on your abdomen depends on many things. These include the size and shape of your stoma, the shape of your abdomen, and the type of pouch you use. One-piece pouches should be removed and replaced about every 3 to 4 days to prevent infection. Two-piece pouches should also be removed from the skin barrier and replaced about every 3 to 4 days. Ask your caregiver how often you should change the skin barrier from a two-piece pouch. The following is general information about how to change your pouch:

• Urine flows out of the stoma continuously. It may be best to change your pouch in the morning before you have anything to drink. The amount of urine that drips from the stoma will be less during this time of day.
  
  
• Wash your hands with soap and water. Empty the urine from the pouch into the toilet. Gently remove the pouch by pushing the skin down and away from the adhesive skin barrier with one hand. With the other hand, pull the pouch up and away from the stoma.
  
  
• Clean the skin around the stoma with warm water. You may also use soap but do not use soaps that have oil or perfumes. Pat your skin dry.
  
  
• While changing your pouch, hold a gauze roll, tampon or a piece of clean cloth over your stoma. This will soak up the urine and keep your skin dry. Do not insert gauze or tampon into the stoma.
  
  
• Use a pouch that has an opening that is one-eighth of an inch larger than the stoma. Center the pouch over the stoma and press it firmly into place on clean, dry skin.
  
  
• Place the old pouch in another plastic bag to be thrown away if the pouch is disposable. Set your reusable pouch aside to be cleaned later. Close the spout at the bottom of the pouch you have just applied.
  
  
• To clean your reusable pouch, rinse the pouch in warm water. Soak the pouch in a mixture of three parts water to one part white vinegar for 30 minutes. Rinse in lukewarm water and air dry the pouch away from direct sunlight.

How do I empty my pouch?

You will probably need to empty the pouch about every 2 to 4 hours. Empty your pouch when it is about one-third full. You may need to empty your pouch more often if you drink a lot of fluids. The following is general information about how to change your pouch:

• Sit on the toilet with the pouch hanging between your legs. You may also sit on a chair next to the toilet with the pouch opening aimed into the toilet.
  
  
• Point the opening of the pouch into the toilet and open the clamp that keeps the pouch closed. You may see mucous in the urine, which is normal. Mucous is normally produced in the colon. Because the urine travel through the colon to leave the body, mucous gets mixed with the urine.
  
  
• Close the clamp on the pouch. Wash your hands with soap and water.

What are some problems that can happen with my stoma?

• Skin problems: Your skin may become very red, sore and weeping (always wet). Your skin may become irritated if you do not have a tight seal around your stoma and urine touches your skin. Keep a watertight seal around your stoma. Keep the skin around your stoma clean and dry to prevent skin problems.
  
  
• Urinary crystals: Urine should be acidic. If it is not acidic, urinary crystals may form on the stoma or skin around the stoma. Urinary crystals look like white, gritty particles and may irritate the stoma or cause it to bleed. To prevent urinary crystals, keep the skin around your stoma clean. You can also make your urine more acidic by taking vitamin C. Applying a vinegar compress to the stoma for a few minutes when you change your pouch may also help to reduce the crystals. To make a vinegar compress, mix equal parts of water and white vinegar. Talk to your caregiver about what you can do to treat and prevent urinary crystals.
  
  
• Stoma retraction: Retraction happens when the height of the stoma goes down to the skin level or below the skin level. Retraction may happen soon after surgery because the colon does not become active soon enough. Retraction may also happen because of weight gain. The pouching system must be changed to match the change in stoma shape.
  
  
• Peristomal hernia: Peristomal hernias occur when part of the bowel (colon) bulges into the area around the stoma. Hernias are most obvious during times when there is pressure on the abdomen. For example, the hernia may be more obvious when sitting, coughing, or straining. Hernias may make it difficult to create a proper pouch seal. The hernia may be managed with a hernia belt. Changes may also need to be made to the pouching system to create a proper seal. Certain people may also have surgery to correct a peristomal hernia.
  
  
• Prolapse: A prolapse means the bowel becomes longer and protrudes out of the stoma and above the abdomen surface. The stomal prolapse may be caused by increased abdominal pressure. Surgery may be done to fix the prolapse in some people.
  
  
• Stenosis: A stenosis is a narrowing or tightening of the stoma at or below the skin level. If your urine squirts out instead of flowing freely, you may have a stenosis. The stenosis may be mild or severe. Surgery may be done to correct the stenosis.

How will a urostomy fit into my lifestyle?

• Diet: You do not have to follow a special diet after a urostomy. Drink at least 8 (eight-ounce) cups of liquids each day. You may choose to avoid eating certain foods as they may give your urine a strong odor. Some of these foods include asparagus, cheese and eggs. Vitamin C may help to decrease urine odor.
  
  
• Bedtime:
  
  
  • During the night, you can use a night drainage system. This system consists of a large container and tubing that connect to your regular pouch. The container and tubing are connected to the bottom of the pouch with an adapter. The large container holds more urine than the regular pouch. This system can be used during the night so that you do not have to get up several times to drain the bag.
    
    
  • To keep the tubing from kinking, run the tubing down your leg and over the foot of the bed.
    
    
  • To keep the night drainage system clean, rinse the container and tubing with cool water each day. Once a week, clean the container and tubing with three parts of water and one part white vinegar.
  
  
• Work: You can go back to work when your caregiver says it is OK. You may need special support to prevent a hernia if you work is heavy labor, such as lifting or digging. You may need an ostomy belt over the pouch to keep it in place if you move a lot at your job.
  
  
• Exercise: Exercise is very important. Talk to your caregiver about an exercise program once you feel stronger. Together you can plan a program that works for you. It is best to start slowly and do more as you get stronger. Exercising makes the heart stronger, lowers blood pressure, and helps keep you healthy. Your body and mind should feel better after exercising. Walking, jogging, bicycling, and swimming are good exercises. Talk with your caregiver before playing contact sports. Empty your pouch before playing sports.
  
  
• Swimming: You should always wear your pouch while swimming. Empty your pouch before getting into the water if you swim. You may put waterproof tape strips over the edges of your skin barrier to protect it.
  
  
• Relationships:
  
  
  • You may feel anxious, nervous, or scared when you first start to care for your urostomy. You may not like the way your body looks. You may feel like you are no longer in control of your body. These are normal feelings. Talk to someone close to you or to your caregiver about these feelings.
    
    
  • Learning to live with a urostomy may be difficult for both you and your spouse. Together you can find ways to live with this change in your life. It will take time for you to feel better after surgery. If you had an active sex life before urostomy surgery, it can be the same after surgery. You cannot hurt your stoma by having close body contact. Be sure to empty the pouch before having sex.
  
  
• Traveling: Always carry extra urostomy supplies and pouches with you when traveling. Take enough supplies for your trip because you may not be able to find what you need while traveling. Contact your local ostomy group or ostomy nurse for help. They may be able to give you a list of ostomy caregivers in the area you are visiting.
  
  
  • If you fly, pack your supplies in your carry-on luggage not your checked suitcase because luggage is sometimes lost or delayed.
    
    
  • If you drive, do not put your supplies in the trunk or glove compartment. This can cause your supplies to get hot, melt and not stick well. Keep your ostomy supplies in the coolest place in the car.

What ostomy supplies do I need?

You will need a pouch, skin paste, and cream to protect your skin. Ask your caregivers what ostomy supplies you need, and how to get them.

Where can I find support?

You may feel embarrassed, anxious, or worried because you have a urostomy. These feelings are common. It will take time for you to get used to your new body image and body function. Talk about your feelings with your caregiver or with someone close to you. Ask your caregiver about support groups for people with a urostomy or to arrange for an ostomy visitor. Such a group or person can give you support and information. Contact the following for more information and support.

• United Ostomy Associations of America, Inc.
  P.O. Box 512
  Northfield , MN 55057-0512
  Phone: 1- 800 - 826-0826
  Web Address: http://www.ostomy.org
  

• Wound Ostomy and Continence Nurses Society
  15000 Commerce Parkway
  Mount Laurel , NJ 08054
  Web Address: www.wocn.org
  

CONTACT A CAREGIVER IF:

• You have a fever.
  
  
• Your urine is bloody and has a strong odor.
  
  
• The skin around your stoma is red and irritated and you do not know what to do.
  
  
• You have nausea, vomiting, pain, cramping, or bloating.
  
  
• Your urine habits change, such as having little or no urine.
  
  
• You have an unusual change in stoma size and color.
  
  
• You have questions or concerns about your urostomy, medicines, or urostomy supplies.

SEEK CARE IMMEDIATELY IF:

• Your stoma is bleeding and you cannot stop the bleeding.
  
  
• You feel weak and unable to do your usual activities.
  
  
• You have bad abdominal pain.

Learn more about Urostomy Care (Discharge Care)