Urostomy Care

Topic Overview

A urostomy is an opening in the abdomen created by a surgical procedure (radical cystectomy) to allow urine to flow to the outside of the body. This may be needed when a diseased or damaged bladder has to be removed. The urostomy (or ostomy) creates an opening that is called a stoma.

Wound, ostomy, and continence nurses (WOCNs) are available in some medical centers to help you learn how to care for your ostomy. Talk with your surgeon about meeting with an ostomy nurse after your surgery.

It takes time to adjust to having a urostomy. But with time after surgery, you will be able to work, participate in sports and physical activities, be intimate with your partner, and resume your social life.

Immediately after your surgery, activities such as driving and lifting will be restricted to allow the stoma to heal. After 2 to 3 weeks, you should be able to resume normal activities. With your pouch in place, you can still swim, hike, camp, and play tennis. Contact sports may cause injury to the stoma or may cause the pouch to slip. But check with your doctor about how to be safe while being active, whether it is playing sports or doing your exercise routine.

As your strength returns, you will likely be able to return to work. The only types of work that you may not be able to perform are those that require heavy lifting or physical contact. Talk with your doctor to learn about any occupational limitations you may need to know about.

Usually you will have no dietary restrictions and foods can be enjoyed as before. Be sure to drink plenty of fluids each day to help reduce the chance of kidney infection.

A urostomy can affect a man's ability to have sex (usually just for a short time). Usually a woman's sexual ability isn't affected. If you are concerned about sex, your body image, and what others think, talk to your doctor, counselor, or a therapist. He or she can help you cope with problems concerning intimacy or your self-image.

You will probably be able to wear much of your same clothing. You'll want to avoid tight clothing that might cause problems with the drainage tube. And wearing looser pants can make it easier to conceal the pouch. Cotton knit or stretch underpants can provide support and keep the pouch secure. Your ostomy nurse will be able to help you with more clothing ideas.

You can continue to travel. Empty or change your ostomy pouch before beginning your trip. When traveling by plane, bring extra ostomy supplies in your carry-on baggage, not checked baggage. If traveling by car, store your supplies in a cool place.

Caring for your ostomy

When you have an ostomy, urine leaves your body through the stoma instead of the urethra. Since there is no muscle around the stoma, you are not able to control when urine passes out of your body. An odor-proof plastic pouch (ostomy pouch) surrounds the stoma to collect the urine and is held to your skin with an adhesive. Pouching systems may be one-piece or two-piece.

Understanding how to care for your ostomy will help you live comfortably with it. An ostomy nurse is a great support. He or she will help you learn to manage your ostomy so you can get back to a normal life. This will include learning how a pouch system works and how to replace your ostomy pouch. Your nurse will also give you tips on how to treat and prevent common problems, such as irritated skin.

Pouching systems

• In a two-piece system, the pouch and barrier (sometimes called a flange or wafer) are separate. The pouch contains a closing ring that attaches it to the barrier. This is generally a snap ring, similar to those found on food storage containers. The barrier fits around the stoma and sticks to your skin.
• In a one-piece system, the pouch and barrier are a single unit.

Both two-piece and one-piece pouches can be either drainable or closed. These systems also contain a special valve or spout that adapts either to a leg bag or to a night drain tube connected to a special drainable bag or bottle.

• Drainable pouch. Place toilet paper in the bowl to prevent splashing. Sit down with the pouch between your legs. The pouch is held shut with a clip system. Simply unclip it and allow its contents to fall into the toilet. Clean the end of the pouch with toilet paper and reclip it.
• Closed pouch. Unsnap the pouch from the barrier and dispose of it. Do not flush it down the toilet. Putting the pouch in a Ziploc bag reduces odor. You then need to attach a new pouch.

Replacing your ostomy pouch

If you have a drainable pouch, you usually need to replace it every 4 to 7 days or whenever there is a leak in the pouch or itching or burning under the barrier. If you have a closed pouch, replace it when it is one-third to one-half full.

• Prepare the new pouch and barrier. Cut an opening in the new barrier slightly larger than the stoma. You may also have a precut barrier. If you have a two-piece system, snap the pouch to the barrier. Remove the paper backing from the barrier so that the adhesive is exposed. You may need to put some skin barrier paste on the barrier if it does not stick well to your skin.
• Remove the old pouch and barrier. Remove your old pouch by peeling away the barrier and gently lifting the pouch while pressing down on the skin below the pouch. Be sure not to irritate the skin as you remove the barrier and pouch. If the pouch is sticking and difficult to remove, use an adhesive remover underneath the barrier. Dispose of the old pouch and barrier.
• Clean your skin. Clean your skin and stoma with a wet washcloth or wipe. You may use soap; if you do, rinse well. Allow your skin to dry and check your skin and stoma for signs of irritation. See the section below on treating skin irritation.
• Measure your stoma, if needed. After your surgery, the size of your stoma may change. Your doctor may want you to measure it and will give you a measurement guide to help you do this.
• Put on the new pouch. Position the opening in the barrier around the stoma and apply the sticky side to the skin. Press down until all edges are sealed. If your pouch is open-ended, attach the clip.

Treating skin irritation

The stoma is normally pink to red. Call your doctor if your stoma:

• Has a pale color.
• Is dark red or purple.
• Has moderate to severe swelling.
• Has moderate to heavy bleeding.

If the skin under your pouch is red, irritated, or itchy, you need to treat your skin. Follow these steps:

1. Gently remove the pouch.
2. Clean the skin under the pouch with a wet washcloth.
3. Dry the skin.
4. Sprinkle ostomy protective powder on the skin and then blot it off.
5. Reattach or replace the pouch.

Ostomy supplies

Ostomy accessories may include:

• Curved (convex) barriers, which better conform to some abdomens.
• Ostomy belts, which help support the pouch.
• Pouch covers, which conceal the pouch.
• Skin barrier paste, which fills in folds or skin irregularities of the abdomen to form a better seal.
• Skin wipes or powders, which protect the skin under the barrier and around the stoma.
• Tape, which supports the barrier and is used for waterproofing.
• Tape remover, which cleans adhesive off the skin.