Life After Urostomy

What is a Urostomy?

During the most commonly performed urostomy surgery, called an ileal conduit, the surgeon takes a six to eight inch piece of the small bowel (the ileum) and makes it into a conduit (or pipeline) for urine. The remainder of the small bowel is reconnected so your bowel will function as it did before surgery. This process is similar to splicing a hose. The ureters (tubes that carry urine from each kidney to the bladder) are removed from the bladder and joined to the piece of ileum (small bowel).

One end of the piece of ileum that was removed is sewn closed and the other end is brought through an opening on the abdomen (belly). The part of the ileum you see on your abdomen is called the stoma. The stoma will probably stick out from the abdomen about 1 inch. This is where urine will now drain from your body.

A healthy stoma is moist and red or pink in color. The stoma has no nerve endings, so it will not hurt when touched. It is normal for the stoma to be large and swollen after surgery, however, it will shrink to a smaller size within a few weeks. You may see your stoma move slightly. This is a normal process that had helped push stool through your bowel and now helps drain urine outward and into the pouch on your abdomen.

Just like your gums bleed when brushing your teeth, your stoma may also bleed slightly. However, if your urine is cloudy, foul smelling, bloody, or you experience constant bleeding, contact your doctor immediately.

Urine flow will no longer be controlled since the stoma does not contain muscles. Urine will generally drain constantly since the conduit (or pipeline) does not replace the bladder or store urine. A pouch must be worn at all times to collect urine.

Urostomy surgery is performed to cure or alleviate symptoms of a disease. Your surgeon or WOC Nurse will explain the type of surgery you will or did have.

After the Operation

When you wake up from surgery, you will be wearing your first pouch. The pouch will be clear so the doctors and nurses can check your new stoma.

You will have an intravenous line (IV) dripping fluid into your veins. You may also have a tube that goes through your nose and into your stomach, keeping your stomach empty. Two small tubes (stents) coming out of your stoma will help keep the ureters open to drain urine. These stents may be removed before going home, or during your first doctor’s visit (after leaving the hospital).

In the beginning, your urine may be a little red or pink, however it should return to its normal (clear, yellow) color. It is perfectly normal to find mucus in the urine. This is due to the mucous membrane in the small bowel used to make the ileal conduit.

During the first few days you will only be given fluids to drink. Food will slowly be added to your diet as your bowel function returns to normal.

Urostomy surgery is a major operation, so it is normal to feel weak for a while. You may experience pain from the surgery, and medication can be prescribed by the doctor to help you feel more comfortable.

Going Home

When you get home, you should be able to resume the life you led before the operation.

Here is some helpful advice:

Obtaining Supplies:

Upon leaving the hospital, your WOC Nurse will provide you with information on how and where to get your supplies. Your doctor will write a prescription for your ostomy product supplier, as well as a list of the supplies you will need. Be careful not to store your pouches in direct sunlight or near heat. This may cause the barrier which attaches the pouching system to your skin to break down. If stored in cool temperatures, let the barrier return to room temperature before using.

Diet

Eating a well-balanced diet that can include your favorite foods is important to your health. Be aware that some foods cause an odor in urine including:

• asparagus 
• fish
• onions 
• garlic

These foods can still be eaten. However, you may become aware of an unusual odor. You should drink at least 8 glasses of fluid each day, unless you have to limit your fluids due to a medical problem. Be sure to drink extra fluids when exercising or sweating.

Urinary Tract Infections (UTIs)

UTIs can occur with a urostomy. Signs and symptoms of a urinary tract infection include:

• increased amount of mucus in the urine
• cloudy and strong-smelling urine
• fever
• confusion
• loss of appetite
• back pain
• nausea and vomiting
• blood in urine

 If you experience these symptoms, contact your physician.

Medication:

Some medications may change the color and odor of your urine. Your physician or pharmacist can advise you about this.

Bathing and Showering:

You may choose to bathe or shower with your pouch on or off. If you shower with your pouch off, choose a soap that is oil- and residue-free. These types of soaps will not interfere with the adhesion of the barrier.

Exercise and Sports:

Exercise is good for everyone, and this includes people with an ileostomy. Once your strength returns, you can enjoy exercise and activities as you did before the operation. Check with your doctor before exercising or playing contact sports. Special small pouches can be used when swimming and playing sports if desired.

Intimacy:

You should speak with your surgeon regarding any effects your surgery may have on sexual function. Your ostomy does not limit or prohibit sexual activity. Intimacy can play an important role as you take steps to resume the life you had before surgery.

Note: there are special products and accessory choices available for intimate moments.

Travel

Travel should not be restricted due to your ileostomy. Remember to pack all of your supplies for the journey, and make sure you have more than enough supplies for the duration of your trip. Keep your supplies where you can easily get to them. If you are flying, take supplies in a “carryon” bag in case you become separated from your checked luggage.

Supply Checklist :

• pouches
• barriers - if using a two-piece system
• soft paper towels
• wipes, 
• strip paste,
• powder or other accessories
• scissors (if using a cut-to-fit system) 
• stoma guide
• plastic bag (to discard pouch, if necessary)

Continuing Care

After surgery, it’s important that you begin enjoying life as quickly as possible. Your doctor or WOC Nurse is available to help with any problems or questions. Organizations are also in place to provide information and support for you and your family. Ask your WOC Nurse for information about local groups and chapters.

Diet

Unless your doctor has prescribed a special diet, you should not have to change your diet. Over time you will become aware of foods that produce more gas than others. Examples of some foods that can cause gas are:

• beer,
• dried beans,
• broccoli, cabbage,
• cucumbers, 
• carbonated beverages.

Products can be bought at the drug store or grocery store to reduce gas. Always check with your physician before taking medications. Some ways to decrease gas are by:

• eating slowly
• not talking with food in your mouth
• not drinking through straws
• not chewing gum

Odor

Some foods can cause more odors in your stool. They may include:

• fish
• cheese
• eggs
• beans
• cabbage family (i.e. onions, broccoli, brussel sprouts)

Experiment to see how they affect you. Liquid deodorizers, such as Coloplast® O.A.D.®, can be put in your pouch; taking certain oral medications can also help prevent odor. Your WOC Nurse can advise you of specific products available.

Constipation/Diarrhea

You may become constipated or have diarrhea, just as you did before surgery. If you become constipated, try eating more fiber (vegetables, fruits, and brans)and drinking more water. It is okay to take a mild laxative; however, check with your doctor first. If constipation becomes a problem, talk to your doctor or WOC Nurse.

If you become ill with a stomach virus, this can give you diarrhea. Treat it the same as before you had surgery, and remember to drink plenty of fluids – you might try a“sports” drink to replace fluids and electrolytes.

Bathing and Showering

You may choose to bathe or shower with your pouch on or off. If you shower with your pouch off, choose a soap that is oil- and residue-free. These types of soaps will not interfere with the adhesion of the barrier.

Exercise and Sports

Exercise is good for everyone, including people with a colostomy. Once your strength returns, you can enjoy exercise and activities as you did before the operation. Check with your doctor before exercising or playing contact sports. Special small pouches can be used when swimming and playing sports, if desired.

Intimacy

You should speak with your surgeon regarding any effects your surgery may have on sexual function. Your ostomy does not limit or prohibit sexual activity. Intimacy can play an important role as you take steps to resume the life you had before surgery. Note: there are special products and accessory choices available for intimate moments

Travel

Travel should not be restricted due to your colostomy. Remember to pack all of your supplies for the journey, and make sure you have more than enough supplies for the duration of your trip. Keep your supplies where you can easily get to them. If you are flying, take supplies in a “carryon” bag, in case you become separated from your checked luggage.

Supply Check list

• pouches
• barriers - if using a two-piece system
• soft paper towels
• wipes
• strip paste,
• powder or other accessories
• scissors (if using a cut-to-fit system) 
• stoma guide
• plastic bag (to discard pouch, if necessary)