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Patient advice Leaflet following a Formation of Urostomy/ileal conduit

The following guidelines will make care of your Urostomy/Ileal Conduit easier. Keep this information at hand for quick reference.

A Urostomy/Ileal Conduit is formed surgically when part of the bowel (often the ileum) is used to divert the urine from your kidneys through an opening in the abdominal wall. The part of the bowel that is brought onto the surface of the skin is called a stoma. Body waste can then exit the body through the stoma and be collected externally using a drainable appliance.

A Urostomy is a permanent measure.

The Urostomy is sited on the Right hand side of your abdomen, midway between your hip and umbilicus. However the siting of the stoma is discussed along with the stoma care nurse in order to determine the best position for the individual patient.

There are many reasons why you might require a Urostomy, but it is usually performed in order to improve your current condition. It will be discussed with you by your consultant and Stoma care nurse the reasons for this.

It is important to remember that because a stoma is without sphincter muscles, there is no control over when bodily waste leaves the body. This is why a stoma appliance is required to collect this waste.

The stoma should be red and moist in appearance and similar to the texture of the inside of your mouth. A Urostomy tends to have a small spout and protrudes slightly. There is little or no sensation to the stoma; however because it is a vascular area then it not unusual for the stoma to bleed slightly when cleaning it. Initially following surgery the stoma will appear quite swollen. This usually takes around 4-6 weeks to shrink to its expected size.

The Urostomy will start to function straight away as it has been performed as a bypass. It will always produce a mucus due to the lining of the bowel.

Helpful Hints

  • Eat a well balanced diet including vegetables and fresh fruits. Eat on a regular basis. Drink at least 6 to 8 glasses of fluids per day.
  • Eat slowly and chew your food thoroughly. Avoid chewing gum, smoking and drinking through a straw, as this may help to reduce gas.
  • Eating yoghurt or peppermint preparations may help to reduce gas.
  • Certain food may cause the urine to turn red, such as beetroot, re fruit and re fruit drinks. Some medications can also change the colour of your urine and cause odour.
  • There are certain foods that can cause more odour than others. Foods such as asparagus, baked beans, broccoli, cabbage, cauliflower, eggs, fish, onions, garlic can cause strong odours for some people. Although your pouch is odour proof, if you eat these types of food you may notice a stronger smell when changing your pouch. If this causes any concern, you may wish to limit these foods in your diet.
  • Drinking cranberry can help to keep the urine odour free and prevent urine infections. If on Warfarin ensure you check with your doctor before taking.

Applying the pouch system.

Equipment Required

Tissues/Wipes
New Appliance
Bowl of warm water
Scissors
Disposal bag
Any accessories required, e.g. adhesive remover, protective wipes/sprays etc Measuring device/template

Ensure you have all your equipment close at hand when preparing to change your appliance.

  1. Wash your hands prior to starting the procedure
  2. Stand or sit in a position which is more comfortable for you. You can use a mirror if this is easier for you. Remember that you must try and keep the skin around the stoma wrinkle free to help form a good seal.
  3. As you are using a drainable system, empty the contents into the toilet first.
  4. Have the disposal bag close to hand or place the bottom of the appliance into the disposal bag.
  5. Remove the appliance. Peel the adhesive off the skin with one hand while exerting gentle pressure on skin with the other. Adhesive remover sprays can also be used. It is important to remember that if you get hairs growing close to your stoma, you may trim them off with a safety razor or scissors. This can help in the removal process.
  6. Wash the stoma itself and the skin around the stoma with warm water or cleansing lotions provided by the stoma companies that are unperfumed and mild. Your stoma may bleed a little when being washed; this is normal. Rinse and dry well. It is essential to ensure the area is prepared well prior to a new appliance being applied.
  7. Ensure you check your stoma for any changes, e.g. size
  8. If the stoma has shrunk ensure the flange is cut to the appropriate size. The appliance should be cut very slightly larger than the stoma in order that effluent cannot cause skin damage.
  9. 8/ A protective barrier wipe can be applied to skin around the stoma at this point and allow to dry.
  10. If using a 1 piece system fold the flange/appliance slightly over in half. Remove backing from the flange. Place the bottom half of the folded flange up towards the base of the stoma. Once you have placed the appliance in the correct position unfold the other half of the flange over the stoma. Ensure you use your finger tips to secure the base around the stoma, as this will be the area where any effluent will hit first therefore it is essential that this is secured first. You can then move out to secure the rest of the base.
  11. Place your hand over the stoma and the pouch for a minute or so. The heat from your hand can help the appliance stick to your skin.
  12. As you are using a drainable system, we would advise you to change your appliance on alternate days or if any leak is detected. If you have a 2 piece system, the base plate should be changed on alternate days and the detachable bag can be changed if required or when the base plate is changed.
  13. Ensure you dispose of all used items in a plastic disposable bag which is tied and then placed in a domestic waste bin.

Bathing/Showering

  • You may shower or bathe with your pouch on or off. Remember that your stoma may function during this time.
  • Although you don't necessarily have to change the appliance once you have got it wet it is advisable to ensure that you dry it off (using a hair dryer, towel).

Sexual Relationships

It is important that you give yourself time to recover following surgery and adjust to the changes that you are undergoing personally. Sexual activity is one of our normal functions and having a stoma should not prevent this activity. It is understandable that you may have concerns but talking through them with your partner can help improve communication and understanding. For men it is possible that they can experience some difficulty with erection and ejaculation, as the nerves and blood supply involved with sexual function lie close together and may be bruised during any pelvic surgery. If this remains a problem please discuss with your consultant or stoma care nurse.

  • Change/Empty appliance prior to commencing sexual activity.
  • Secure the bottom of the bag upwards with tape or wear a Stoma cap
  • Remember sexual activity will not harm the stoma
  • Any position that is comfortable for you both is suitable for sexual activity.

Going away from home

  • Ensure you take a small bag containing a supply of wipes, new system x2, small spray bottle of water and disposable bag. If travelling abroad ensure you keep these in your hand luggage.
  • If travelling on an airplane, book an aisle seat to help allow you the ease of going to the bathroom.
  • Obtain an Ostomy Travel Certificate from your Stoma Nurse or local stoma Association. This will assist you when travelling through customs and airport security. If there is any reason to explain your stoma products.

Dietary Advice

After formation of your Urostomy you will continue to digest and absorb all nutrients normally through the small bowel. In the case of a Urostomy no bowel has been resected it has just been used to act as a diversion. For most people, a Urostomy has very little effect on diet and you should be able to eat whatever you like.

However there are certain aspects regarding your diet that you should follow in order to help aid your digestion.

It is important to remember to drink plenty of fluids each day, approximately 1.5-2.0 Litres over 24hrs.

Meal pattern

Developing a pattern in your eating regime can be beneficial in managing your stoma more effectively.

  • Take your time eating your meals and chew your food properly.
  • Avoid heavy meals and snacks prior to bedtime.
  • Avoid alcohol and caffeine drinks prior to bed time.
  • Initially following surgery you will find that smaller meals will be tolerated easier but ensure you can eat regular, smaller meals in order to gain an adequate intake./li>

As with any operation, but in particular with bowel surgery, you may find it takes longer for your appetite to return to normal. It is a good idea to reintroduce food gradually, starting with a nutritious diet that is easy to digest.

Foods that can cause Odour

Alcohol, Cauliflower, Asparagus, Fish, Brussel Sprouts, Cheese(certain types), Cabbage, Eggs, Onions, Garlic, Baked Beans, Spices, Certain Medications, Vitamins

Foods/Medications that can cause the urine to be coloured

Beetroot - Red coloured urine
Red Berries – Red coloured urine
Red Fruit Drinks – Red coloured urine
Senna - Brown/Yellow coloured urine
Warfarin - Orange coloured urine
Some anti-depressants – Blue/green coloured urine
Antibiotics - Reddish/Brown coloured urine

Exercise following surgery

Having a stoma should not prevent you from exercising or from being as physically active as you were before. It is important that you allow some time for recovery and build up gradually. Contact sports could potentially have some implications however this should be discussed with your specialist or stoma nurse and they will advise as to whether it is advisable.

Arranging your supplies.

Your Stoma nurse will arrange your supplies prior to your discharge through Fittleworth Healthcare. You will be given enough supplies to see you through until your supplies arrive. The prescription will be arranged through your GP and the company. This is usually within 24-48 hrs. Your supplies will include wipes, disposal bags and your actual stoma appliance. You can order additional accessories if required such as Adhesive spray remover, barrier wipes, barrier rings, deodorant sprays etc.

Useful Addresses

Urostomy Association
Central Office
18 Foxglove Avenue
Uttoxeter
Staffs ST14 8UN

Tel: 08452412159 or 01889563191
Email: www.uagbi.org

Debbie Johnson
Stoma Care Nurse

Tel: 07732769093
Email: debrajohnsonwhittton@msn.com