Having a urostomy means you will encounter a range of unique stoma challenges – some of which are similar to those with other types of stomas and others which are exclusive to urostomies. It’s essential to understand what urostomy problems that may arise and what you can do about them. In this guide, we explain the most common urostomy problems and how to spot, prevent, and treat them.
Urostomy problems
Click to skip directly to a section:
- Urinary Tract Infections (UTIs)
- Mucus
- Urine pH balance
- Bleeding or discharge from urethra
- Painful skin
- Urostomy bag leakage
- Hernias
Urinary Tract Infections (UTIs)
A urostomy puts you at greater risk of developing a UTI, which can lead to kidney problems. This is caused when bacteria enter your urostomy, ureters, or kidneys. The main way of preventing this is to drink plenty of water every day and empty your pouch regularly.
Symptoms of a UTI include:
- Dark or cloudy urine
- Strong-smelling urine
- Increased frequency of urination
- Fever
- Back pain located around the kidneys
- Nausea
If you experience any of these symptoms, contact your GP as soon as possible. You may be put on antibiotics to treat the UTI.
UTIs can cause you to pass stones. If you do, save it so that your GP can send it to be analysed.
Mucus
Mucus may look like threads in your urine or you might notice a white, sticky substance on your stoma when changing your urostomy bag. This happens because ileal conduits are made from a piece of your bowel, which naturally produces mucus. This is common immediately following surgery and should decrease over time. Some mucus is completely normal and should not be a cause for concern, but if you are noticing significantly more mucus than usual, ask your stoma nurse or GP about it.
Some foods can stimulate more mucus production, as can certain medications. It could also be a sign of a UTI if combined with other symptoms as discussed above.
Overproduction of mucus could also be caused by irritation or minor injury to your stoma. If your stoma bag baseplate is not cut to the right size or is not aligned properly, it may rub against the stoma and cause this. This might be accompanied by leakage which we explore later.
Urine pH balance
Urine can either be acidic or alkaline. Diet is a major factor that can determine the pH of a person’s urine. After a urostomy, it is recommended that you try to keep your urine acidic, as this can help prevent infection and urinary crystals. You can do this by consuming any fruit juice (particularly cranberry juice) or live yoghurt. Alcohol can increase the alkalinity of your urine.
Bleeding or discharge from the urethra
If your urethra has been left in place and your bladder removed, you should speak to your doctor if you experience bleeding from the urethra.
If your bladder has been left in place, you may experience discharge. This can become infected, in which case you’ll need to go on antibiotics. You may need regular bladder washouts. If the problem persists, women may be offered a small operation to make an opening from the bladder through the vagina to drain the fluid. Men may need to have the bladder removed.
Painful skin
Possibly the most common problem stoma patients encounter is sore skin. There are many causes of this, including:
- Urine on exposed skin (when your urostomy bag leaks – see below)
- A poorly fitted bag
- Sensitivity to the stoma products you are using
- Folliculitis (usually caused by shaving)
- Not removing your appliance gently
It’s important to strike a balance between changing your urostomy bag often enough to monitor your skin’s condition, whilst not changing it so often that your skin becomes irritated. It changes from person to person, but around 3 days is a good benchmark to aim for.
Treat any skin irritation before it escalates by using a barrier film product like StoCare Protect between bag changes. Use a medical adhesive remover like StoCare Remove to safely remove your appliance.
Read our full guide to peristomal skin protection
Urostomy bag leakage
Urostomy bag leakage problems can be one of the most frustrating problems for urostomy patients. They occur when urine does not enter your bag as it should and sits on the surface of the skin or leaks onto nearby clothes or bedding, for example.
Common causes of leaks include overfull pouches, poorly fitted bags, incorrect template sizing, damaged pouches, and skin conditions that prevent proper adhesion.
To prevent urostomy leaks:
- Ensure your pouch fits properly with the hole cut to the correct size – no more than 2-3mm larger than your stoma.
- Empty your pouch regularly – try not to let it get more than half full.
- Check your pouch for signs of wear or damage, and ensure it has a good seal to your skin; replace it if needed.
- Keep the skin around your stoma clean and dry. If you develop a leak, remove the bag immediately and wash your skin.
If urostomy bag leaks persist despite proper fitting and care, speak to your stoma nurse about alternative products or accessories that might help, such as a stoma seal.
Read our full guide to stoma leakage
Hernias
Stoma surgery can weaken the muscle that was cut, making it susceptible to a parastomal hernia. This is when part of the intestine, tissue or other organ pushes through the abdominal wall near a stoma, creating a bulge. This results in swelling around the stoma, which can get bigger over time. This can make it harder to fit your urostomy bag properly.
Parastomal hernias are a common complication for people who have a urostomy and rarely cause complications. However, you should contact your stoma nurse if you suspect you have one, especially if you are experiencing pain. They will assess how serious it is and advise you on how to manage it. They may suggest that you wear a support garment (such as a belt, pants, shorts, or girdles), which may be available on prescription.
Read our full guide to peristomal hernias
When to seek help
Your urostomy should not hinder your quality of life or cause you anxiety, stress or pain. If you experience persistent issues, don’t hesitate to contact your stoma nurse or GP. Many problems can be resolved with simple adjustments to your routine or products, but some may require medical attention.
Your stoma nurse is your best resource for troubleshooting problems and can provide specialist stoma advice tailored to your individual situation. They can also arrange for you to try different products or accessories that might better suit your needs.
The Urostomy Association is a charity specifically set up to support people with a urostomy and they have lots of useful resources.
You may also want to explore Colostomy UK’s comprehensive information (for anyone with any type of stoma, not just colostomies), including a 24-hour stoma helpline.
If you are a medical professional and are interested in finding out more about how StoCare products can help your patients or requesting a repeat sample order, please email info@rhodespharma.co.uk.
Although all our articles are written alongside qualified medical professionals, this information is for guidance only and does not replace advice given by your healthcare team.
