Urostomy: Definition, Types, Care, Recommendations and Related Problems

It is an opening in your abdomen (belly) where urine leaves your body.

After your bladder surgery with a urostomy (ileal conduit), your urine will flow from your kidneys, through the ureters and ileal conduit, and from a small opening in your abdomen called a stoma.

Your stoma should be dark pink or red all the time. If your stoma looks gray, brown, or black, contact your doctor right away.

You will not be able to control the flow of urine from your stoma. You will wear a urostomy bag system (device) over your stoma to collect and hold urine.

There are a few different types of urostomy stomas. Your wound and ostomy nurse will tell you which type you have and answer your questions.

About your urostomy pouching system

A urostomy bag system has 2 parts: a wafer (the part that sticks to the skin) and a bag (the bag that holds urine).

With a 2-piece bag system, the wafer and bag are separate pieces that can be taken apart. With a 1-piece system, the wafer and bag are connected.

You will use different types of bag systems in the hospital and at home. This is because your stoma will get smaller as it heals. It usually takes 6 to 8 weeks for the stoma to reach its permanent size.

At the hospital

While you are in the hospital, you will learn how to care for your urostomy stoma and pouching system.

Most people use a 2-piece bag system and an extender called a low-pressure adapter while in the hospital. The low pressure adapter goes between the wafer and the bag to create additional space.

This makes it easier for your doctor and nurses to remove the pouch from the wafer and reattach it without pressing hard on your abdomen. It will help you feel more comfortable when your doctor checks your stoma.

At home

After you are discharged from the hospital, you will use either a 2-piece or a one-piece bag system. A home care nurse will visit you to help you continue learning how to care for your stoma and the pouching system.

You can use different pouching systems as your body heals and your stoma gets smaller. You will have appointments with an outpatient nurse.

They will look at your stoma with you, track how it is healing, and help you choose the pouching system and ostomy accessory products (products you can use in conjunction with your pouching system) that are best for your body.

Follow-up appointments

After you are discharged from the hospital, contact your doctor’s office if you need to speak with your WOC (Wounds, Stomata and Continence) nurse.

If your WOC nurse is not available when you contact your doctor’s office, your doctor’s office will send them your message and they will contact you.

Your first appointment with your outpatient WOC nurse will be 2 weeks after you are discharged from the hospital. It is also helpful to schedule follow-up appointments with your WOC outpatient nurse 2-3 months and 6 months after your surgery.

You should also contact your nurse if you have skin problems or have questions about your pouching system.

You may lose some weight when you first regain it after surgery. During the 3-6 months after surgery, you will likely regain some of this weight. During this time, you may notice some small changes in the shape of your abdomen.

These changes can make your bag system fit differently and uncomfortable. If this happens, contact your WOC nurse. They may recommend a bag system that is more flexible and moves with your body.

You may also want to choose a more flexible bag system if your bag system is uncomfortable when bending, twisting, or exercising. Your WOC Nurse will help you find the system that works best for your body and your activities.

Always contact your doctor’s office with your questions or concerns and to make an appointment with your nurse.

Placement of your bag system

Position your bag so that it points downward and can be tucked into your pants or underwear. You can also fold it, if you prefer.

Wear a belt or suspenders

You can wear a belt or suspenders on your pants when you are using your pouching system. If you choose to wear a belt, wear it above or below your stoma. If the belt is directly over your stoma, it can cause irritation, bleeding, or tissue overgrowth.

Preparing an emergency kit

Prepare a small emergency kit with a pre-cut wafer, a bag, and several gauze pads. Keep the emergency kit with you at all times so you can change your bag if it leaks.

Keep your emergency kit out of direct sunlight or heat.

Night drainage system

A night drainage system is a bag or bottle that connects to the bottom of your bag. It contains more urine than your normal bag.

It is important to use a nighttime drainage system when you sleep to prevent the bag from becoming too full. If your pouch gets too full, it may leak, or urine may flow back into your stoma and cause an infection.

Using a nighttime drainage system can also help you avoid having to get up at night to empty your pouch.

You will need to use an adapter to connect the night drainage system to your bag. The adapter will be included in your bag box.

Caring for your night drainage system

Every morning, empty the urine from the drainage bag or bottle into the toilet. After emptying the bag or bottle, flush the night drainage system. You can use warm water or a mixture of ¼ cup of white vinegar and 1 cup of water.

You can also buy cleaning products like the M9 ™ Crystallizer Cleaning System. After flushing the night drain system, allow it to air dry.

Replace your nighttime drainage system every 2 to 4 weeks.

If you have problems with your night drainage system plumbing, you can glue the connections between the night drainage system and your bag.

If you move around a lot while sleeping, wear a leg stabilizer or Foley® catheter bra. You can order these accessories when you order your supplies.

Leg drainage bag

A leg drainage bag is a bag that holds more urine than your normal bag. You may want to use a leg drainage bag if you are traveling or are unable to use the bathroom to empty your bag (for example, when you are playing golf or in a traffic jam).

Leg drainage bags may not be covered by your insurance plan. You can call your ostomy supply dealer to find out if your insurance covers leg drainage bags.

Leg Drainage Bag Care

When the bag is full, flush the urine from the leg drainage bag into the toilet. After emptying the bag, wash it. You can use warm water or a mixture of ¼ cup of white vinegar and 1 cup of water.

Replace your leg drainage bag every week, no matter how many times you use it.

Changing your urostomy pouching system

You should change your bag system every 3 to 4 days. If urine is leaking from your pouching system, change it right away. It is best to change your pouching system in the morning before drinking any liquids. Usually, less urine comes out of your stoma in the morning.

The first few times you change your bag system, you will be in your hospital bed. As you recover, you can begin to change your bag system wherever you are most comfortable. Many people like to stand in the bathroom in front of the mirror.

You can also remove your pouching system and clean around your stoma as part of your normal shower routine.

What to do if you see blood on your stoma?

Your stoma has many blood vessels and can bleed easily. It is normal to see a small amount of blood on the gauze or tissue when you are cleaning the stoma. The bleeding should stop on its own in a few minutes.

If you take a blood thinner or aspirin, you may bleed easier and for longer. Apply pressure to the stoma to help stop the bleeding.

Call your doctor if the bleeding does not stop after 10 to 15 minutes. You may need to go to the Urgent Care Center or local emergency room. Your doctor will tell you what to do.

Call your doctor right away if there is blood in your urine or if it comes from inside your stoma.

Showering with your urostomy

It is very important that you bathe every day. This will help keep your skin clean.

Its bag system is waterproof. Keep your pouching system on while you shower, except on days when you change your pouching system.

On days when you change your bagging system, you can remove the bagging system and shower without it, if you wish. Urine will continue to flow from your stoma while you bathe.

Shower as you did before your surgery. Do not use scented or oil-based soaps around your stoma.

Problems related to your urostomy

Contact your doctor’s office if you have any of the following problems:

Skin problems

If urine drips under your wafer, change it right away. Do not use tape to stop the leak.

If the leak does not stop after changing your wafer, contact your nurse. You may need a different system that fits better to prevent leaks.

Tell your nurse if you have any problems with the skin around your stoma (peristomal skin). The most common skin problems occur if your urine gets under the wafer or if you have allergies to your ostomy products.

Tissue build-up

A common skin problem is the buildup of tissue on the skin around your stoma. The tissue may appear grayish, purplish, wart-like, or have white spots. It can cause pain around your stoma.

Buildup occurs when your skin is exposed to urine all the time. If you have tissue buildup, call your doctor’s office to make an appointment with your nurse.

If you have problems with the buildup of tissue around your stoma, you may need to:

  • Cut or mold your wafer or get a different pre-cut wafer.
  • Use a different type of wafer.
  • Apply a barrier to your wafer (such as a Colly-Seel ™ disc, Coloplast Brava ® protective seal, or Coloplast Brava moldable ring).

You may also need to treat the skin around your stoma every time you change your pouching system.

To do this:

  • Mix ¼ cup of white vinegar with ¾ cup of water.
  • Soak a gauze pad in the mixture. Place the gauze pad on your skin for 20 minutes.
  • Rinse your skin with water.
  • Dry your skin well and apply a new wafer.

Allergic reaction

Another common skin problem is an allergic reaction. If you are allergic to one of the ostomy products you are using, you may have redness or bumps on the skin around your stoma.

You may also have itching, burning, or discomfort. If you think you are having an allergic reaction, call your doctor’s office. You may need to see a dermatologist (skin doctor).

Allergic reaction

If you have an allergic reaction, you will need to try a different brand of wafer and bag.

Eruption

If you develop a rash, tell your doctor or nurse. They will give you suggestions on how to treat it.

Urinary tract infections (UTI)

The signs and symptoms of a UTI are:

  • Urine that smells worse than usual.
  • Cloudy urine
  • Back pain.
  • Nausea (feeling like you are going to vomit) and vomiting (vomiting).
  • Loss of appetite
  • Temperature of 100.4 ° F (38 ° C) or higher (fever).

If you think you have a UTI, call your doctor’s office.

To avoid contracting an ITU
  • Drink 6 to 8 glasses of fluids every day. It is better to drink water.
  • Limit the amount of alcohol and caffeine you drink.
  • Use a bag that has an anti-backflow valve and use a nighttime drainage system. This prevents urine from settling on your stoma and causing an infection.
  • Empty your bag when it is ⅓ to ½ full.

You can also ask your doctor if you can take vitamin C (about 500 to 1,000 milligrams) and a sugar-free blueberry pill daily.

This will make the urine more acidic and can help prevent UTIs, decrease the smell (odor) of urine, and prevent skin damage.

Hernias

A hernia is when a loop of intestine (intestine) pokes through a weak muscle area. This causes a lump to form. Hernias often do not cause any symptoms. If you see a lump around your stoma, contact your doctor or nurse.

Tips to avoid getting a hernia

Often the abdominal muscle around your stoma is weak. To minimize the risk of developing a hernia, avoid constipation (straining to have a bowel movement), coughing a lot or very hard, lifting heavy objects, or straining.

It takes up to a year for the inside of your body to heal after surgery, so pay attention to how your body feels. If you feel pain during any activity, stop doing it. Call your doctor’s office if the pain does not go away.

Treat a hernia

If you have a hernia, your WOC nurse may suggest a hernia support belt. These belts are made to fit your body.

You can also wear a girdle or cycling shorts to support the hernia. If you use these, you will need to cut a hole for your urostomy bag.

Wearing a hernia support belt, girdle, or cycling shorts will not cure the hernia or prevent it from getting worse. However, they can make you feel more comfortable and pull on the bump to help your clothes fit better.

Hernias are generally not treated unless they become blocked, twisted, or cause pain or other problems.

Call your doctor immediately if you have:

  • Nausea.
  • Threw up.
  • Pain in your abdomen
  • Swelling in your abdomen

Traveling with your urostomy

Your travel decisions should not be based on the fact that you have a urostomy.

Here are some tips to help you manage travel with your bag system:

  • Bring extra supplies, in case you have trouble getting them while you’re away.
  • If you take a plane, train, or bus, take your supplies with you. Do not put them in your checked luggage. This will help you to be prepared if you are separated from your luggage.
  • Avoid driving a car for 4 to 6 weeks after your surgery, unless your doctor tells you otherwise. You can wear a seat belt loosely or place a small pillow over your stoma and under the seat belt. You can also use an ostomy seat belt protector. Check with your dealer or ask your WOC nurse for more information.
  • Discuss travel options with your WOC nurse. You may want to use a leg bag if you think you may have trouble going to the bathroom to empty your bag.

Preparation for medical exams

Always carry extra urostomy supplies with you. Many pharmacies and medical centers do not have urostomy supplies, and you may need an additional set.

Contrast scanned image

If you have a contrast scanner, bring an extra set of urostomy supplies, as well as a leg bag or night drainage system. For the scan, you will need to drink more fluids than usual.

This will help the contrast get out of your body, but it will also increase the amount of urine you make. Your pouching system may need to be changed if you have a leak because you are producing more urine than usual.

If you live an hour or more from the hospital, empty your bag before you leave. You may also need to empty it on the trip home or use a leg bag. You may also want to have a portable urinal or other container in your car in case of an emergency.

Chemotherapy

If you are receiving chemotherapy, please bring an extra set of urostomy supplies. Chemotherapy can make your body make more urine.

It can also make your skin more sensitive or change the way the wafer sticks to your skin. You may need to change your wafer more frequently during chemotherapy to protect your skin and prevent leakage.

Other procedures

If you have a procedure where the doctor or nurse needs to access your stoma, you may need to switch to a different type of pouching system.

For example, you may need to change from a 1-piece system to a 2-piece system. Your doctor or nurse will talk with you before the procedure.