Urostomy Care

GENERAL INFORMATION:

What is a urostomy?

• The urinary system is made up of the kidneys, two 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. The creation of 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). The bag is attached to the skin with an adhesive (substance that seals the pouch to the skin).
  
  
• 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.

What types of products are used for urostomies?

• Pouch: Pouches are used to collect urine that drains from the stoma. Urostomy pouches have a spout at the bottom of the pouch that is used to drain the urine from the pouch. There are a variety of sizes and styles of urostomy pouches. Most pouches are lightweight and odor-proof. Your ostomy nurse or caregiver can help you decide which type of pouch is best for you. The following is general information about types of urostomy pouches.
  
  
  • One-piece: A one-piece pouch contains the pouch and adhesive skin barrier together as one unit. The adhesive skin barrier is the part of the pouch system that is placed around the stoma and attached to the skin. When the pouch is removed and replaced with a new one, the new pouch must be reattached to the skin.
    
    
  • Two-piece: The two-piece pouch has two parts: an adhesive flange and pouch. The adhesive flange stays in place while the pouch is removed and a new pouch is attached to the flange. The pouch does not need to be reattached to the skin each time. The two-piece system can be helpful for patients with sensitive skin.
    
    
  • Reusable or disposable: A reusable pouch has a barrier (or faceplate) that is attached to the skin with cement or adhesive. The reusable pouch can be washed and reused. Disposable pouches have a skin barrier surface that is already prepared for being applied to the skin. The disposable pouch is thrown away after being used.
    
    
  • Pre-cut or cut-to-fit pouches: Some pouches have pre-cut openings that match the size of your stoma. Other pouches can be cut to fit the size and shape of your stoma. Cut-to-fit pouches are especially useful right after your surgery because your stoma decreases in size for about eight weeks.
  
  
• Night drainage system: The night drainage system consists of a large container and tubing that connect to the 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.

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 three to four days to prevent infection. Two-piece pouches should also be removed from the skin barrier and replaced about every three to four 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. Change 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 travels 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.
  
  
• 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.

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 66
  Fairview , TN 37062-0066
  P.O. Box 66
  Fairview , 37062-0066
  Phone: 1-800-826-0826
  Web Address: http://www.uoaa.org
  

• Wound Ostomy and Continence Nurses Society
  Web Address: www.wocn.org
  

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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