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Urostomy Bag Leakage
Dear All:
My dad had a radical cystectomy on June 6th – he now has no bladder or urethra usage, only a stoma. Operation went well, and he has been home for nearly 2 weeks now.
He is quite depressed at the mutilation he has suffered, but what depresses him more is the repeated failure of the urostomy bags – they keep leaking from the circular adhesive that forms a ring around the stoma. The longest any bag has lasted is about 3 days, and sometimes only 1 day; this is without any sort of strenuous activity (or even showering).
The leakages USUALLY occur at night, an unpleasant way to wake up, making me wonder if he is sleeping the “right” way, whatever that may be. He has tried slleping in a lounge chair, but often goes to sleeping straight on the floor, finding this more comfortable. Leaks occur both ways.
We have tried to reinforce the edges of the bags with 1st aid tape, this MIGHT have had some limited success at forestalling the inevitable leakge.
My questions of anyone with the knowledge and kindness to answer:
1.Is leakage a comon early problem, possibly owing to swelling or stoma size? His stoma is just under 25 mm, ovoid, right side of abdomen.
2. Any recommendations on bag brands – I think adhesion is key to happiness with these bags. He has used bags from Hollister that the hospital provided, and recently tries one from Assura (with a “light convex” stoma cover). Both have leaked, though we have tried the Assura only once so far ( it looked sturdier and more thoughtfully designed, though).
3. Is sleep position important in this? He doesn’t roll onto the bag, of course, but I wonder if an optimum position exists (side with bag? On back?, etc).
4. Finally, removal of bags sometimes seems to disturb the healing of the stoma area, precipitating some bleeding – will this stop after some time goes by?
5. Also, we usually clean off the skin prior to fresh application by washing lightly with Ivory soap (leaves no film), followed by further cleaning with Isopropanol. Is this OK?
Many thanks to anyone with any ideas – and if you know some other point(s) that are helpful.
SC
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16 Replies
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hi, what is put Put it on heavy and let it sit overnight??
Thanks
adhesive on the pouch.
I use Torbot, but I know there are others. Put it on heavy and let it sit overnight. -
Thangarajan, have you tried the leg bag attachment to your pouch. This will give you 2 or 3 hours.
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One great tip I received on leakage: One day before changing pouches, put adhesive on the pouch.
I use Torbot, but I know there are others. Put it on heavy and let it sit overnight. I got this from a
person that had both a urostomy and colostomy. I haven’t had a leakage problem since. Nobody I know in the stoma community has ever heard of this method. Give it a try and good luck! -
I am 78yrs,had aileal conduit surgery 35days ago.&am recovering .Am almost back to normal-no dependency from my family members.
I am facing two discomforts
1) Urobag leak as being discussed in the post.
I have been doing all trial&error method and learnt to see that the ‘sagging’of the bag is minimised -by putting the Urobag into a special pouch stitched at the inside of my shirt(serving 2purposes-to house the bag —to hide my stoma bag ).
During sleep I have contrived a device which keep the nylon connector and the tubing to have the natural gradient so that the urine flows constantly to the night drainbag without bulging the staain bag.
THE PROBLEM YET TO BE ADDRESSED IS:-
My stoma bag gets filled up in 50 to60 mts.I am scared to venture into any travel which takes more than an hour.
I am on a carpool and cannot carry my Night drain bag.I cannot afford to employ a driver who demands skyhigh.
CAN ANYONE IN THIS HELP ME TO ALLAY MY FEAR . -
Dear SC, Experiencing exactly the same thing as your Father. Specifically requested an experienced home care nurse familiar with my set up like your Father. Nurse didn’t know as much as my wife and I and I continued to have leaks. Received a referral to a medical supply company specializing in urostomy. The owner, a nurse quickly identified my problem and why the leaks were continuing. We had been using a single bag application & applying it while lying prone. Nurse said it should be applied either standing or sitting and not prone. She applied a 2 piece bag type explaining it would be more secure. She said reason for my leaks was the wrinkled skin in this area not allowing the single piece bag to fasten securely. As my abdomen heals and gets stronger the wrinkles will tighten up. Works great now. I wanted to connect a larger bag to my pouch for sleeping. Check with 2 other medical supply businesses who did not have a clue for the transition piece needed. This nurse had exactly the transition needed. My surgery was on July 26th so I am still learning. With leaks you cannot have any piece of mind. This is my first time on the forum and don’t know if I could give you the contact for tis nurse but she would be happy to talk with you. For me, an Angel in disguise. Good Luck for your Father.
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There is also another wonderfully helpful site for those with ostomies and it is http://www.uoaa.org. There are so many experienced people there who are willing to offer suggestions and advice. However, be aware that people there have different types of ostomies: colostomies, urostomies, and one more kind that escapes me right now. You can read without signing up but it is free to sign up and ask questions.
My Dad is 84 now and had some trouble with his “appliance” at first but now seems to have it down to a science in the 4 years he’s had his urostomy. He changes twice a week and hooks up to a bottle overnight. I think my Mom actually does the change for him, but he says he only lets her so she will feel “needed”. He tells me he can easily do it for himself. He uses an Eakin seal to fill in the gaps that seem to come with bellys and uses Hollister two-piece appliance.
Companies will send you samples of their products to try. Just call them and ask. I think it must get easier with practice, especially if you find the right product for you (which might change down the line.)
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Hi JDON
I get the feeling that the uro doesn’t give a hoot about your problems now that they have got your money. Not nice of me but sometimes I just feel like they blow me off.
I change my wafer in the morning when the stoma is less active. As I said before I let the water run on the stoma and use soap to clean it. I clean the area before with an adhesive remover pad because I also use a
Eakin Seal on my wafer. After I get out of the shower I use the skin barrier to make a good seal and then I use a gauze pad to wipe it dry. I feel this works good for me. I also sit on the toilet when I am doing this. I don’t know if things are different for a man or not. I hope this will help you. I also feel that no one seems to help with any information, we are on our own with the help of this site. The people here are just wonderful. Good luck
Babsiebob
Dx 4-28-08
pT3a no mo
Rc with Ileal Conduit on 6-09-08
2nd surgery on 6-27-09 for ureter leak
Renal failure on 7-01-09 nephy tube and then stent on 7-09-09
so far so good -
My biggest initial problem changing my wafer/bag was keeping the area around the stoma dry. The stoma continued to discharge and, of course, a good adhesive bond can’t be obtained on a wet skin. I finally found that I could press down just below stoma or “pinch” the skin together from both side of the stoma using my two hand. This usually, but not always, exhausts the urine about to discharge and gives me a few minutes to get things installed on dry surfaces. I have always stood while doing this.
One needs to do this quickly of course so I prepare and lay out everything I will need BEFORE HAND. The step-by-procedure I use:1. Squeeze out as much urine as possible.
2. Dry the wafer area thoroughly with a pad of toilet tissue.
3. Scrub the area thoroughly with an adhesive remover “wipe”.
4. Wash the area with one end of a gauss pad dipped in water.
Dry the area with the dry end of the pad.
5. Dry again with a pad of toilet tissue.
6. Apply a coating with a “protective barrier” wipe. I THINK this reduces itching and such. BUT there is a third type of wipe which improves the adhesive bond. BUT the info on the packaging is VERY obscure and it is difficult to determine which type of wipe it is.
7. Fan the area until it is VERY dry. Apply wafer and bag.I agree totally that the training of follow-up caregivers is very poor. They do not discuss available products or how to use them. (I spent hours with a catalog with hundreds of products trying to decide what I needed.) Most only want to take your pulse and blood pressure (which I didn’t need a nurse to do) and get back on the road.
One problem that still concerns me is bleeding from the stoma.
It is usually slight but can be enough to concern me. I asked my urologist about this but he seemed uninterested.JDON
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If I were to point to a failure in the medical system it would be in follow-up in training & technique with the ileal conduit bag. I had 2 appointments with my Wound, Ostomy, Continence Nurse (CWCN, BSN, RN). He had me lay down so of course I could not see how he was doing the cleaning etc. Of course I was ill prepared to deal with cleaning and changing technique. Then I was discharged and had to do it myself! Much STRESS, many 4 LETTERED words, loud shouting- about a month before I found this site.
I believe the ileal conduit system is so simple and straightforward that many of our members don’t come here very often. SO I’m urging you old-timers to recall your difficulties back when you first had to learn technique- share with us dumb newbies. I bet I’m not the only one who does not have a loving caregiver to do it. Everything is reversed in the mirror! {groan}
I just had an appointment with my new CWCN Nurse and looked thru the catalogue of seals and bags available. Thousands ! AMAZING!
I fell asleep last night watching film clips and reading threads I had googled. I’m 9 months in and just now getting a handle on what works for me. It seems like it is a very individual thing where what works best for one doesn’t work for others. Trial & error seems to be part of the process. This is not easy for me and other grouchy old men (& women).
Thank you rolsen64 RONI
I’m 70, retired heat/air contractor. After 4 months of keymo ileal conduit (IC) surgery removed bladder & prostate May 2010 -
I change my bag twice a week and I shower when I take it off. It feels so good to have the warm water on that skin. I also use dial soap on the area. It will help with the skin irritation too. You also might use an Eakin seal on the wafer. That works good for me. Good luck
Dx 4-28-08
pT3a no mo
Rc with Ileal Conduit on 6-09-08
2nd surgery on 6-27-09 for ureter leak
Renal failure on 7-01-09 nephy tube and then stent on 7-09-09
so far so good -
I’ve showered just before changing the bag. I wondered about showering with bag off. That sound great. I’ll try it. But have a minor skin infection which I should solve first. My ostomy nurse and Hollister are trying the convex and something without the tape edge. It might be that I’m sensitive to the tape. I should get some samples in a day or 2. The convex with the belt certainly gives me a better seal. I was very negative about the belt when my ostomy nurse put it on but because I am pretty active the belt (and convex bag)seem to maintain a better seal.
I’m 70, retired heat/air contractor. After 4 months of keymo ileal conduit (IC) surgery removed bladder & prostate May 2010 -
SC …
I had an ileam bypass urostomy 2 years ago. Six months ago I started having frequent bag failures …within hours a couple of times. I tried using paste with no success. I then contacted my supplier and they recommended the convex wafers. I have tried one and it worked. (I am now trying to use up my remaining flat wafers).
I could never determine why the sudden failures started especially since I was doing nothing different when they started. I am physically very active. My urologist suggested the weight of my leg bag tube but he could suggest nothing else.
Home care nurses usually have very little experience with urology devices and the one I had during the recovery from my operation knew essentially nothing. I would not go there for help.
I don’t believe the way I sleep was a factor. Since my bag is on my right side, I try to sleep on my left side to lift the bag as much as possible to improve the flow to my overnight bag which is attached to the rail low down at the foot of my bed. The head of my bed is also raised about 4 inches for another problem.
I have also tried, fairly unsuccessfully, to empty my bag every 1 1/2 hours. I believe a very full bag may increase the pressure on urine trying to escape through the opening around the stoma. I usually manage to remember in two hours or so.
You mentioned swimming. I haven’t done it but showering with my bag on has never seemed to affect the seal.
My biggest treat these days is showering with the bag/wafer removed.
I hope some others on this site have more insight into this problem. One doesn’t care to have another accident in the packed stands of the Titans football stadium.
JDON -
SC
Where is your dad? Does his ET want him to just try different appliances on his own, or is she helping him with suggestions? Is it possible to see another ET who might have a better grasp on what is needed for ileal conduit urinary diversions? Regrettably, all ETs do NOT have a lot of experience with urinary diversions.
I’m having a devil of a time accessing this give and take – please email me at rolsen64@aol.com so I can email or call you direct.
Best,
Roni -
Thank you rolsen, he does have a nurse who comes by to check on his progress, and orders him samples of products to try out. He says she told him to just keep trying different pouches, since different adhesives behave differently on individuals.
I do take your point on allowing “airing time” for the stoma – I’ve wondered how skin could stand the constant exposure to urine.
SC
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Urinary diversion, part 2
Since it is imperative to insure a constant flow of urine away from the stoma, and to keep urine from backpuddling around the stoma, the appliance needs to be connected to a long thin tube that drains into a collection jug at night or when lying down for a few hours. The tube and jug need to be cleaned daily with a germicidal solution. The reusable appliances also need to be cleaned in a similar manner when changed, typically every three to six days. Many people find it is easier to change an appliance in the morning before drinking liquids, and it also helps to bend over a few times to help expel urine from the conduit. A wall mirror and a dissolvable paper guide strip (the ½” paper strip fits inside the faceplate opening) make it easier to center the appliance over the stoma. Of course, it is important to always have a backup appliance ready and available at all times.
Please feel free to email.
Best,
Roni
rolsen64@aol.com
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