Caring for a Urostomy

As you learn more, you may have questions about caring for your urostomy. This section has many tips that come from others. But remember, no two people are alike. There’s no one right answer, only suggestions and ideas for you to try. 

Emptying and changing the pouching system

You’ll be taught how to change and empty your pouching system before you leave the hospital. You don’t have to use sterile supplies. For instance, facial tissue, toilet paper, or paper towels can be used to clean around the stoma instead of sterile gauze pads.

Emptying the pouch

The urostomy pouch has a drain valve at the bottom, so it can be emptied as needed. Since bacteria grow quickly in urine, it’s important to empty the pouch often, at regular times. A lot of urine in the bag also could damage the pouch seal. It’s a good idea to empty your pouch when it’s about 1/3 to 1/2 full.

During the day most people need to empty the pouch about as often as they used the bathroom before they had urostomy surgery or other bladder problems – for many people, this might mean every 2 to 4 hours, or more often if you drink a lot of fluids. Children may have to empty more often because their pouches are smaller. Follow these steps:

• Sit as far back on the toilet as you can.
• Place a small strip of toilet paper in the toilet to decrease splashing.
• Hold the bottom of the pouch up and open the valve.
• Gently empty the contents right into the toilet. You can put some toilet paper in the toilet first to help avoid splashing if needed.
• Close the valve.
• Dry the end of the valve with toilet paper.

At night a piece of flexible tubing can be attached to the drain valve on your pouch. This allows the urine to flow into a bigger bedside bag or drainage bottle while you sleep. Many people find a bedside drainage unit better than getting up during the night to empty the pouch. (This is discussed further in "Using a night drainage system.") 

Changing the pouch

Different pouching systems are made to last different lengths of time. Some are changed every day, some every 3 days or so, and some just once a week. It depends on type of pouch you use.

Your pouch should be changed on a schedule that fits your routine. And it's best to have a regular changing schedule so problems don't develop. In other words, don’t wait for it to leak to change it. It may be easier to change the pouch in the morning before you eat or drink anything. If this isn’t a good time for you, try to wait at least 1 to 2 hours after drinking fluids so that urine doesn’t get on your skin and supplies while you change the pouch.

You’ll want to find the best position for putting on your pouch – sitting, standing, or lying down. The position you use should allow you to see your stoma and be easy for you to be in when making a change. Some people stand facing the toilet so the urine dripping from the stoma falls in the toilet. When changing while sitting in a wheelchair, it’s helpful to slide your buttocks toward the front of the chair and lean back a little. Using a mirror may help you center the pouch over the stoma.

Before changing your pouch, clean your hands well and put all your supplies on a clean surface. Clean pouches decrease the chances of germs (bacteria) getting into your urinary system. Bacteria can multiply quickly even in the tiniest drop of urine. These germs may travel up the ureters and cause a kidney infection. Bacteria can also cause foul-smelling urine. Some people find it helpful to use rolled tissues, paper towels, or tampons to absorb dribbling urine from the stoma.

You don’t have to use sterile supplies – the stoma and nearby skin are clean, but not sterile. But keeping all your supplies clean and organized will save you time and money. Always have at least 2 complete pouches, one on your body and one ready for your next change.

At first you may find that changing your pouch can take up to 30 minutes. With time and practice you may be able to change it faster.

Factors that can affect the pouching system seal

The pouching system must stick to your skin. It’s important to change it before it loosens or leaks. The length of time the pouch stays sealed to the skin depends on many things, such as proper fitting, the weather, skin condition, scars, weight changes, diet, activity, and the shape of your body near the stoma.

Here are some other things that may affect how long a pouch sticks:

• Sweating will shorten the number of days you can wear a pouch. Body heat, added to outside temperature, will cause skin barriers to loosen more quickly than usual.
• Moist, oily skin may reduce wearing time.
• Weight changes will affect how long you can wear a pouch. Weight gained or lost after urostomy surgery can change the shape of your abdomen. You may need an entirely different system.
• Physical activities may affect wearing time. Swimming, very strenuous sports, or anything that makes you sweat may shorten wearing time.

Protecting the skin around the stoma

The skin around your stoma should always look the same as the skin anywhere else on your abdomen. But urostomy output can make this skin tender or sore. As you get stronger and get better at handling your equipment, skin irritation may become less of a problem. Here are some ways to help keep your skin healthy:

Use the right size pouch and skin barrier opening. An opening that’s too small can cut or injure the stoma and may cause it to swell. If the opening is too large, urine could get to and possibly irritate the skin. In both cases, change the pouch or skin barrier and replace it with one that fits well.

Change the pouching system regularly to avoid leaks and skin irritation. It's important to have a regular schedule for changing your pouch. Don't wait for leaks or other signs of problems, such as itching and burning.

Be careful when pulling the pouching system away from the skin and don't remove it more than once a day unless there’s a problem. Remove the skin barrier gently by pushing your skin away from the sticky barrier rather than pulling the barrier from the skin.

Clean the skin around the stoma with water. This can be done in the shower or tub. Pat the skin dry before putting on the skin barrier or pouch.

Watch for sensitivities and allergies to the adhesive, skin barrier, paste, tape, or pouch material. They can develop after weeks, months, or even years of using a product because you can become sensitized over time. If your skin is irritated only where the plastic pouch touches it, you might try a pouch cover or a different brand of pouch. A stoma nurse can offer ideas if needed. Pouch covers are available from supply manufacturers, or you can make your own. You may have to test different products to see how your skin reacts to them.

Shaving hair under the pouch

Having a lot of hair around the stoma can make it hard to get the skin barrier to stick well and may cause pain when you remove it. Shaving with a razor or trimming hair with scissors is helpful. Extreme care should always be taken when doing this. It’s recommended that you dry shave the skin around your stoma using a stoma powder, since soap and shaving creams have lotions and oils that may cause the skin barrier not to stick. After shaving, rinse and dry the skin well before applying your pouch.

Spots of blood on the stoma

Spots of blood are no cause for alarm. Cleaning around the stoma as you change the pouch or skin barrier may cause slight bleeding. The blood vessels in the tissues of the stoma are very delicate at the surface and are easily disturbed. The bleeding will usually stop quickly. If it doesn’t, call your ostomy nurse or your doctor.

Eating restrictions

It's important to know your kidney function isn’t changed by urostomy surgery, and the urinary tract and digestive tract are separate systems. There are usually no eating restrictions after urostomy surgery. However, if your kidneys have been damaged, your doctor may have you watch your protein and salt intake. Sometimes foods and medicines may cause urine odor or change the color of your urine.

The pH balance in urine may also change and can be checked by your doctor. Urine pH is a measure of how acid or alkaline it is. Knowing the urine pH is important.

• When the food you eat is used by the body, it leaves a mineral residue called ash. This ash can be either acidic or basic (alkaline) depending on the type of food. Most fruits and vegetables give an alkalinized ash and tend to make the urine alkaline. Meats and cereals usually lead to an acidic ash residue.
• Unless you are told otherwise, your urine should be kept in an acid state. Drink cranberry juice in place of orange juice or other citrus juices (these tend to make the urine more alkaline), and take vitamin C daily (check with your doctor first). Some of the acid ash foods include: most meats, breads and cereals, cheese, corn, cranberries, eggs, macaroni, nuts, pasta, prunes, fish, and poultry.
• Urinary crystals on the stoma or skin are caused by alkaline urine. The crystals look like white, gritty particles. They may lead to stoma irritation and/or bleeding. Proper cleaning, keeping your urine acidic, and careful fitting of the skin barrier will help prevent urinary crystals.
• To help reduce urinary crystals, you can make a vinegar compress and apply it to the stoma for a few minutes when the pouch is changed. To do this, soak a bath cloth or small towel in a mixture of equal parts of water and white vinegar and hold the moist cloth on the stoma.

Bathing

You can take a bath or shower with or without your pouch in place. If you don’t wear a pouch, keep in mind that urine may keep draining out into the shower or tub. It’s best to only use water while cleaning the skin around your stoma. If you do use soap, be sure to rinse your skin well. Soap will not irritate your stoma, but it might interfere with the skin barrier sticking to the skin. Don’t use bath oil around the stoma – it can make it hard to get the pouch to stick.

If you bathe with your pouch off, be sure your skin is cool and dry before you put on a pouch. Otherwise the heat from a hot bath or shower can keep the skin warm and make you sweat under the barrier, this makes it hard to get a secure seal.

When you should call the doctor

You should call the doctor or ostomy nurse if you have:

• A cut in the stoma or injury to the stoma
• A lot of bleeding from the stoma opening (or a moderate amount in the pouch that you notice several times when emptying it)
• Bleeding where the stoma meets the skin
• Bad skin irritation or deep sores (ulcers)
• An unusual change in your stoma size or color
• Fever or strong urine odor (may be a sign of a kidney infection)

Ordering and storing ostomy supplies

Supplies may be ordered from a mail order company, from a medical supply store, or from a local pharmacy. If you want to order supplies online. For additional help ordering, try contacting the product manufacturer, check your local phone book’s business pages, or check the Internet (try searching for “ostomy supplies”).

• To order pouches, skin barriers, and other ostomy products, you’ll need both the manufacturer’s name and the product numbers
• Talk with your ostomy nurse about reputable dealers who can supply you with what you need 
• Before ordering your supplies, check with your health insurance to be sure that they work with the company in question 
• Compare prices when using mail order and the Internet (remember to include shipping costs)
• Keep all your supplies together on a shelf, in a drawer, or in a box in a dry area away from moisture and hot or cold temperatures.
• Order supplies a few weeks before you expect them to run out to allow enough time for delivery. DO NOT stockpile supplies – they can be ruined by moisture and temperature changes.