The ileal conduit is performed when the bladder has to be removed, most often because it is cancerous. People who have ileal conduits have to wear a pouch at all times. It is emptied from the bottom. Most pouches cannot hold enough waste to last through the night, so it is necessary to connect the pouch to a bedside container, to be able to sleep through without having to get up to empty the pouch. Just as for colostomies, there are literally hundreds of different pouches that can be used to collect the urine as it passes out of the stoma.
People who have ileal conduits are often asked to try to keep their urine slightly acidic. Acid urine does not have an odor and tends to have less bacteria. Your enterostomal therapist or physician may recommend that you drink cranberry juice (about two glasses a day) to help keep your urine acid. Another method for acidifying the urine is to take vitamin C. Citrus juices, which are rather acidic when you drink them, do not acidify the urine.
Additionally, acid urine helps to keep the skin around the stoma healthy because it will not deposit urine salts (usually alkaline salts) on the skin in the area. Sometimes the skin around the stoma can have a rather cauliflower-like appearance. This is usually from alkaline urine. Therefore, acid urine has many benefits for people who have ileal conduits. However, before deciding to drink cranberry juice or take vitamin C, be sure to check with your doctor and enterostomal therapist to be certain that the urine does indeed require acidification.
What You Need To Know About Ostomies
Although people with ostomies are able to wear pouches comfortably for up to a week at a time, there are certain things that everyone with an ostomy should know about.
If the pouch is uncomfortable in any way, remove it. Sometimes impending skin irritation can be detected when the pouch is just slightly uncomfortable. If the pouch is leaking (the feces or urine is not going into the pouch but rather around the appliance), change the pouch. Do not try to "patch it up." If you do have skin irritation, see if you can detect what is causing it. A pouch that continually leaks should be attended to by an enterostomal therapist or nurse specialist who can help you find one that fits better, If there is a great deal of itching around the stoma, this can be an allergy to the adhesive, to the special items used to protect the skin, or to overgrowth of bacteria. Once again, a specialist in stoma care can be of help in clearing up these skin conditions.
Removing a Used Appliance
This is done gently to protect the skin around the stoma. First the appliance is emptied. Then, while one hand removes the appliance, the other hand supports the skin around the stoma. If cement has been used to adhere the appliance to the skin, the correct solvent is applied with a cotton-tip applicator to the area at the edge of the appliance; when the cement has been dissolved in that area, the loosened section of the appliance is eased from the skin. This process is repeated as necessary. The soiled appliance is set aside.
Cleaning Around the Stoma
A shower, bath or sponge bath with warm water cleans the area will. The skin is washed gently, not rubbed. If mild soap is used, it must be rinsed off completely. The skin is then blotted completely dry. If the stoma continues discharging during the cleaning process, a tampon or a pill bottle the size of the stoma can catch any waste.
Applying a Skin Barrier
Many ostomates rely on some kind of commercial product to protect the skin around the stoma. These products, which come as a pliable gum (either as a pre-cut ring or as a sheet), paste, powder, spray, creme, or liquid, protect the skin right up to the stoma. Directions for each product will be on the container.
Putting On a Clean Appliance
If there is an opening at the bottom of the appliance, it is closed. The ostomate slowly peels away the backing paper from the appliance seal as he/she attaches the appliance to the abdomen carefully and smoothly, with no air pockets. If cement is used, a thin coat is applied to both the appliance faceplate and to a circle of skin around the stoma slightly larger than the area the faceplate will cover. The cement is allowed to dry for several minutes before the appliance is attached. In the case of a two-piece appliance, the separate faceplate is adhered to the skin; the pouch is then secured to the faceplate.
Putting on Tape
A porous tape can be used-picture-frame fashion-around the edges of the appliance faceplate. Some ostomates use a belt, which is put on around the hips at the level of the stoma, loosely enough so that two fingers can be slipped between belt and skin.
For most people, an ostomy is a life-saving surgery which allows one to resume the lifestyle to which he or she is accustomed. Over a million people are wearing their pouches comfortably, eating the foods they like, engaging in all kinds of activities, and enjoying life.
The United Ostomy Association is a nationwide group of people who have had ostomy surgery. They meet regularly in every major city of the United States. After your surgery, you may want to meet people who have had the same type of surgery. Along with your doctor and enterostomal therapist, the United Ostomy Association can be a source of invaluable aid in helping you adjust to your ostomy and master some of the concerns which you are bound to have.
Read Care of Colostomies and Ileal Conduits: Part 1 of 3
Read Care of Colostomies and Ileal Conduits: Part 2 of 3
Editor's Note: This article was authored by Victor Alterescu, RN, ET.