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What are the most common urostomy stoma problems?

It takes time adapting to life with a urostomy. Learning about the changes happening to your body and coping with how your new stoma functions can feel overwhelming. Lean on family and friends to help you through your recovery, your stoma care nurse will be there to support you too. It is useful to know about any urostomy stoma problems you may encounter and how to deal with them.

Here is our guide to the most common problems and how you can overcome them.

What is a urostomy?

A urostomy is surgery which allows urine to leave your body through a stoma, after removal of a diseased or damaged portion of your urinary tract. With a urostomy, urine flows through your stoma as it is produced, so you will need to wear a stoma pouch on the outside of your body. A urostomy is freely refluxing, meaning the urine can travel in either direction. All urostomy bags have a non-return valve which prevents the urine from flowing back and pooling around the stoma, reducing the chance of urinary tract infections (UTI). All urostomy bags have a choice of tap or soft bung to allow you to drain the urine out of the pouch and into the toilet.

Leakages from urostomy bags

Unfortunately, those with urostomies may experience leaks at some point as the urine is a liquid it can be tricky to manage. There can be several reasons why your urostomy bag might leak. Here are some of the most common reasons:

  • Your urostomy may need re-sizing as your stoma may have changed shape and size and therefore the aperture might be too large or even too small. It needs to be a snug fit around your stoma.
  • The urostomy stoma may sit in a dip or crease on your stoma. Applying stoma paste and trying washers, can help the adhesive adhere better to the skin.
  • Make sure the flange area around your stoma has a good seal and the bag is applied correctly. Take a few minutes after application, to smooth around the edges and check for any wrinkles bag using your fingers.
  • Sometimes the skin around the urostomy can get quite damp and moist so make sure you spend the time drying the skin well before applying your next pouch.
  • Some urostomies can be flush to the skin or even retracted in appearance, which can cause your stoma bag to leak. Speak with your stoma care nurse as you may benefit from a convexity product.

Keep the skin around your stoma clean

The skin around your urostomy is known as the peristomal skin. It is important for all ostomates to keep this area healthy, by keeping it clean and dry. If the skin around the stoma becomes sore or irritated, it has more chance of developing an infection. Change your stoma appliance at least once to twice per week and check your skin on a regular basis. Do not wait until it leaks as urine can harm the skin.

Symptoms of a urinary tract infection (UTI)

Unfortunately, urinary tract infections (UTI) can still occur following urostomy surgery as your body is still vulnerable and infections to the urinary tract may still develop. Some UTIs can lead to kidney infections, which can make you feel quite unwell. Drink plenty of liquids as fluids will help keep the urine more acidic.

Here are some of the classic signs and symptoms you may feel with a UTI:

  • Dark and cloudy urine
  • Mucus in the urine increases
  • Urine become strong in odour (smell)
  • Abdominal (stomach) pain
  • High temperature (fever)
  • Back pain (where your kidneys are located)
  • Blood in the urine directly from your stoma or in your pouch
  • Loss in appetite
  • Nausea and/or vomiting
  • Feeling fatigued

If you are experiencing the above symptoms with your urostomy, contact your stoma care nurse or your GP. Your GP may ask you for a urine sample so that your urine could be tested for bacteria to diagnose a UTI.

Drink more water

Try to drink 6-8 glasses of water each day. Water helps your kidneys do their job of flushing out body waste. It can reduce the bacterial concentration in your urine, which may lower your chances of developing a UTI. If you notice your urine looks a darker yellow or orange colour then you are likely to be dehydrated, so try to make a conscious effort to drink more water. Avoid drinking caffeinated drinks as they can dehydrate you, switch to decaffeinated where possible. Limit your alcohol consumption too as again, this can be dehydrating.

Mucus build up

As your surgeon has used a small part of your bowel to create a stoma, your urostomy may produce mucus. It looks white and sticky and can commonly be mistaken for a sign of infection, but it is all perfectly normal. Mucus can often be more productive in the first few weeks and months, following surgery and then the amount slowly reduces. If the amount of mucus increases, and/or if your urine

changes colour and has a strong odour, it may signal that you have a urinary tract infection (UTI).

It is wise to speak to your stoma care nurse if this occurs.

What are urinary crystals?

Urinary crystals on the stoma, on the skin around your stoma or at the top of your stoma bag are linked to alkaline urine. These crystals look like white, gritty particles and may lead to stoma irritation or bleeding of the stoma. Try to drink plenty of fluids to keep your urine more acidic. These are crystals can also occur when you have a poorly fitted barrier, so take the time to make sure the barrier fits properly or try a mouldable skin barrier, which will provide a more customized fit.

There are some home remedies and ointments which can be used, so again speak to your stoma care nurse if this occurs.

Getting a good night’s sleep

Your urostomy bag will continue to collect urine and require emptying through the night. To save you from getting out of bed every few hours to empty your pouch, many people prefer to use a night drainage bag, which is simply a larger bag. You will need to use a urostomy bag with an anti-reflux valve which can be connected to a drainage bag at night.  The night drainage bag attaches directly to the drainage end/tap of your stoma pouch on your stomach. It can then collect up to 1-2litres of urine during the nights whilst you sleep.

Foods which can affect the smell or colour of urine

Although you do not have to avoid certain foods it is good to be aware that certain foods can affect the smell of your urine. Such as fish, onions, garlic and even asparagus. You may also find that beetroot can often colour your urine a pinkish shade and can also affect your stools as well.

For more help on urostomies, visit the Urostomy Association.

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