 Patients should be seen by the wound care or ET nurse and have a dietitian

referral for new dietary needs related to the ileostomy or colostomy (Registered
Nurses Association of Ontario, 2009).
 The ostomy bag may become filled with gas from the intestine and may let out
a “farting” sound that is usually quiet, but uncontrollable. Patients may “burp” the bag
through the opening at the top in a two-piece system by opening a corner of the
ostomy pouch from the flange to let the air out. Dietary restrictions may also help
decrease the amount of gas produced by the intestines (Ostomy Canada Society, n.d.).

UROSTOMY CARE

A urostomy is similar to a fecal ostomy, but it is an artificial opening for the urinary
system and the passing of urine to the outside of the abdominal wall through an
artificially created hole called a stoma. A urostomy is created for the following
reasons:

 Bladder cancer
 Cystectomy
 Trauma/surgery
 Incontinence
 Painful bladder/overactive bladder
 Congenital abnormalities
 Conversion of continent urinary diversion to incontinent stoma
 Neurological conditions and diseases
 Spinal cord injury
 Chronic inflammation of bladder
 Interstitial cystitis
 Radiation damage
 Inability to manage a continent urinary diversion or a neobladder

A urostomy patient has no voluntary control of urine, and a pouching system must be
used and emptied regularly. Many patients empty their urostomy bag every two to
four hours, or as often as they regularly used the bathroom prior to their surgery.
Urostomy pouches (see Figure 10.9) have a drain at the end, and the pouch should be
emptied when one-third full. The pouch may also be attached to a drainage bag for
overnight drainage. Patients with a urostomy are more at risk for urinary tract
infections (UTIs) and should be educated on the signs and symptoms of such
infections (Perry et al., 2014).

Figure 10.9 Urostomy pouch

Checklist 88 describes how to change a urostomy pouch.

CHECKLIST 88: CHANGING A UROSTOMY POUCH/APPLIANCE

Disclaimer: Always review and follow your hospital policy regarding this specific skill.

Safety considerations: 

Urine flows continually from a urostomy; thus, applying a pouch is more challenging than
applying a regular ostomy.
A stent is usually placed in the stoma post-operatively to prevent stenosis of the ureters. The
stents are usually removed in the hospital or at the first physician visit.
Sterile technique must be used when changing a urostomy pouch on a new urostomy. Always
follow agency policy.
Since bacteria grow readily in urine, it is important to empty the pouch regularly and use a
pouch with an anti-reflux valve to prevent backup of urine into the urostomy.
An ostomy belt may be used to hold the pouch in place.
A urostomy pouch should be changed every three to seven days, depending on the supplies
used. It is best to change it before it leaks.
It is best to wait one or two hours after drinking fluids to change a urostomy appliance.
Sterile supplies are used in acute care with a fresh post-surgical urostomy. A patient in the
community may not use sterile supplies, but strict adherence to proper hand hygiene is required to
prevent infections of the bladder, kidney, or urinary tract.
Never place anything inside the stoma.
Bacteria can rapidly replicate and cause an infection. Educate the patient on the importance of
proper hand hygiene and keeping supplies clean.
Factors that affect the pouching system include sweating, high heat, moist or oily skin, and
physical exercise.
Always treat minor skin irritations right away. Skin that is sore, wet, or red is difficult to seal
with a flange for a proper leakproof fit.