A urostomy is a surgical procedure that creates a new pathway for urine to exit the body, typically after the bladder has been removed or bypassed. This diversion results in an opening on the abdomen, called a stoma, through which urine drains continuously into an external collection pouch or appliance. Routine changes of this urostomy bag are necessary to maintain the health of the skin surrounding the stoma, known as the peristomal skin. Since urine contains irritating waste products, a secure, well-fitting pouch is fundamental to preventing skin damage and potential infection.
Essential Preparation and Timing
Success in changing a urostomy bag requires careful preparation of both supplies and timing. It is recommended to gather all materials first, including the new pouch system, a measuring guide, small scissors, a disposal bag, and clean cloths or gauze pads. Accessory items like barrier rings, protective seals, adhesive remover spray, or a skin barrier wipe should also be set out if they are part of your routine.
The ideal time for a change is when the stoma is least active, typically first thing in the morning, before consuming any liquids or food. Changing the appliance at this time minimizes the flow of urine, allowing for a cleaner and more secure application of the new barrier. Before starting the removal process, you must empty the existing pouch completely into the toilet through its drainage tap or valve.
Removing the Used Appliance and Skin Care
Once the pouch is drained, the used system must be removed gently to protect the peristomal skin from trauma. Using an adhesive remover spray is beneficial; spray it lightly over the barrier and, while pressing down on the skin, slowly roll or peel the edge of the wafer away. The technique is a “push/pull” motion, where you push the skin away from the adhesive rather than pulling the adhesive straight off, which helps prevent skin stripping.
After the old appliance is removed, visually inspect the stoma and the surrounding skin. A healthy stoma should appear moist and pinkish-red, similar to the inside of your mouth, while the peristomal skin should resemble the skin elsewhere on your abdomen. Note any signs of irritation, such as persistent redness, burning, itching, or skin breakdown, as these indicate a potential problem with the appliance fit.
The stoma and skin should be cleaned using only warm water and a soft cloth or gauze pad, gently wiping away any mucus or urine deposits. If soap is used, it must be a mild, oil-free variety, as residues can interfere with the new barrier’s adhesion. Once cleaned, the skin must be patted completely dry, as a moist surface will prevent the new appliance from forming a secure seal.
Applying the New Urostomy System
The most important step for preventing leaks and skin irritation is ensuring the new wafer is precisely sized and applied. If the stoma is still changing size (common in the first six to eight weeks post-surgery), it must be measured with the provided guide. The opening cut into the adhesive wafer should be no more than one-eighth of an inch (about 3 millimeters) larger than the stoma, creating a snug fit that prevents urine from touching the skin.
For a two-piece system, the wafer is prepared by cutting the opening and applying accessory products like a barrier ring or paste to fill in skin creases. Barrier rings, which are moldable hydrocolloid seals, are stretched and pressed directly around the stoma base to create a watertight gasket against the skin. With the backing peeled off, the new wafer is carefully centered over the stoma, starting from the bottom and pressing firmly outward to smooth wrinkles.
Once the wafer is in place, applying gentle pressure with the palm of your hand over the entire surface for five to ten minutes helps the adhesive bond. The warmth from your hand activates the hydrocolloid adhesive, improving its initial tack and security. If using a two-piece system, the new pouch is snapped onto the wafer, and the drainage tap must be checked to ensure it is securely closed before you stand up.
Monitoring and Troubleshooting
A properly applied urostomy system is designed to remain secure for three to seven days, depending on the product type and individual activity level. However, the appliance must be changed immediately if you feel a burning sensation or notice lifting or seepage around the edges, as this indicates urine is contacting the skin. Leaking is the primary cause of peristomal dermatitis, and persistent leaks often signal a need to reassess the stoma opening size or to utilize accessory products like barrier strips or convex systems to improve the seal.
After the change is complete, the used appliance should be sealed in a disposal bag and placed in the regular trash according to local guidelines. If you notice the stoma is a color other than pink or red (brown, gray, or black), contact a healthcare professional immediately, as this may indicate a lack of blood flow. For ongoing issues with persistent skin irritation, a specialized Stoma Nurse or physician can evaluate your technique and recommend specific products, like stoma powder or a different appliance type, to address the problem.