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. Part of the ureters may also be removed. A small segment of the small or large intestine is used to create the channel (a urinary diversion).

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 a WOCN after your surgery.

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

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. Noncontact activities, such as swimming, hiking, camping, and tennis, should be no problem. If you had an exercise routine, talk to your doctor about when you can restart it and whether it is possible to participate in contact sports, such as football, karate, and basketball, which could result in injury to the stoma.

Your work should not be affected. 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. You should drink 8 to 10 glasses of fluid each day to help decrease the chance of kidney infection.

Many of the problems relating to intimacy may be more emotional than physical. You may be concerned with ability, body image, and what others think. Talk to your doctor, counselor, or a therapist for help coping with any problems concerning intimacy or your self-image.

You will probably be able to wear the same clothing. Tight clothes will not hurt your stoma. If you have trouble hiding your ostomy pouch, or if it shows through your clothing, your WOCN may have suggestions.

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

You want to keep your quality of life, and understanding how to care for your ostomy will help you live comfortably with it.

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.

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 usually 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 Treating skin irritation section below.
• 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 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.