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Urostomy management

Learning to take care of your urostomy may seem hard at first, but with practice and time it will become second nature, just like shaving or bathing.

Choosing a pouching system

Deciding what pouching system or appliance is best for you is a very personal matter. When you are trying out your first pouching system, it is best to talk with an ostomy nurse or someone who has experience in this area. There should be someone in the hospital who can get you started with equipment and instructions after surgery. As you are getting ready to leave the hospital, be sure you are referred to an ostomy nurse, a clinic, or a chapter of the United Ostomy Associations of America. Even if you must go out of town to get such help, it is worthwhile, as you want to get a good start and avoid mistakes. Even with help, you may have to try different types or brands of pouching systems to find the one that best suits you. (See the section "Getting help, information, and support.")

There a few things to think about when trying to find the pouching system that will work best for you. The length of the stoma, abdominal firmness and shape, the location of the stoma, scars and folds near the stoma, and your height and weight all must be considered. Special changes may have to be made for stomas near the hipbone, waistline, groin, or scars. Some companies have custom-made products to fit unusual situations.

A good pouching system should be:

  • Secure with a good leak-proof seal that lasts for 3 to 7 days
  • Protective of the skin around the stoma
  • Nearly invisible when covered with clothing
  • Easy to put on and take off

Types of pouching systems

Pouches come in many styles and sizes, but they all do the same job – they collect urine. There are 2 main types of systems available. Both include an adhesive part that sticks to your skin (called a faceplate, flange, skin barrier, or wafer) and a collection pouch.

  • One-piece pouches are attached to the skin barrier
  • Two-piece systems are made up of a skin barrier and a pouch that can be taken off and put back on the barrier

The skin barrier or faceplate of the pouch may need a hole cut out for the stoma, or it may be sized and pre-cut. It is designed to protect the skin from urine and to be as gentle to the skin as possible.

One-piece pouch Two-piece pouch

Each urostomy pouch has a drain valve at the bottom, so the pouch can be emptied as needed. It is a good idea to empty your pouch when it is about one-third 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.

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 while you sleep. Many people find a bedside drainage unit better than getting up during the night to empty the pouch. (This will be discussed later in the section called "Night drainage system.")

While you are in the hospital after your surgery, an ostomy nurse will talk to you about your personal needs and help you pick a pouching system. For some, this pouch is the type worn for a lifetime. Others will need to change to a new or different type of pouching system later on if they gain weight, grow (in the case of a child), or for other reasons. Do not keep using a recommended pouch if it is not working the way you need it to. Try different types until you find one that feels good, works well, and is easy to use.

Skin protection

The constant flow of urine from the stoma can irritate the nearby skin, so most urostomy pouches have protective skin barriers. Pouching systems come with either a pre-cut opening or they can be cut to fit your stoma size and shape.

Right after surgery the stoma is swollen, but it will shrink over the next 6 to 8 weeks. During this time the stoma should be measured about once a week. A measuring card may be included in boxes of pouches or skin barriers, or you can make your own template that matches your stoma shape. The opening on the skin barrier should be no more than 1/8-inch larger than the stoma size to keep urine off the skin.

Factors that can affect the pouching system seal

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 during the summer months in warm, humid climates 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 gain or loss will also 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.

Changing the pouch

It may be easier to change the pouch in the morning before you eat or drink anything. If this is not a good time for you, try to wait at least 1 to 2 hours after you have had fluids so that urine is not getting on your skin while you change the pouch. Some people find it helpful to use rolled tissues or paper towels to absorb dribbling urine from the stoma.

You will 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 is 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.

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 in 10 minutes or less. Remember that your pouch should be changed on a schedule that fits your routine. In other words, do not wait for it to leak to change it.

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.

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 (see "Ordering and storing supplies").

Emptying the pouch

Since bacteria grow quickly in urine, it is important to empty the pouch often, at regular times. A lot of urine in the bag also could damage the pouch seal.

During the day, you likely will need to empty the pouch 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. Try to empty it when the pouch is 1/3 to 1/2 full. 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.
  • Close the valve.
  • Dry the end of the valve with toilet paper.

Belts and tape

Adjustable belt

Wearing an ostomy belt is a personal choice. The belt attaches to the pouching system and wraps around your waist. Some people with urostomies wear a belt because it makes them feel more secure and it supports the pouching system, which can get heavy as it fills with urine. Others find a belt awkward and use tape instead. Tape can be put around the outside edge of the skin barrier like a frame, to help hold it in place.

If you choose to wear an ostomy belt, adjust it so that you can get 2 fingers between the belt and your waist. This helps keep you from getting a deep groove or cut in the skin around the stoma, which can cause serious damage to the stoma and pressure ulcers on the nearby skin. Belts should be worn so they do not ride above or below the level of the belt tabs on the pouching system. People who are in a wheelchair may need special ostomy belts. Supply companies often carry special belts, or an ostomy nurse can talk to you about making one yourself.

Night drainage system

At night the bottom of the pouch is connected to a night drainage system which will carry the urine away from the stoma while you sleep. This lets you sleep undisturbed. Gravity drains the urine to a bedside container. Your pouch will not get so full and heavy that it pulls away from your body, and your stoma will be protected against the build-up of strong urine.

Night drainage system

When connecting the pouch to the bedside drainage bag, leave a small amount of urine in the pouch before attaching the tubing. This keeps you from setting up a vacuum in the system. The bedside container should be vented and the tubing should be secured at the top of the bag or bottle with no more than one inch of it going down into the bag or bottle. If the urine backs up into the tubing it will stop drainage. The drainage container can be hung on the side of the bed, or put in another container on the floor. A wastebasket may be used for this purpose.

Clean the tubing and beside drainage collector every morning. Pour about 2 ounces of a vinegar/water solution into the emptied pouch that is attached to the night drainage system. (Use 1 part of white vinegar to 3 parts of water.) Let it run out of your pouch, through the tubing, and into the collection container. Then pour it out and hang up the night drainage system so it can air dry.

Last Medical Review: 03/17/2011
Last Revised: 03/17/2011