Ileal Conduit Stoma

The ileal conduit a form of urinary diversion is usually performed after a urinary bladder that is afflicted by cancer is removed.

This surgery is a lifestyle change & needs mental adjustment & care of the pouches. This article has been written by Dr Manav Suryavanshi to help people manage their stomas & pouches well& accept the change that comes with this surgery in their lives.

Patients with ileal conduits will need to wear a pouch at all times. The first thing to be at ease with a change in life is to “Accept It”.

The pouch has a tap like plastic nozzle which is used to empty it from the bottom. The pouch has a limited capacity, so it is connected to the urobag through the nozzle at the bottom while the patient is asleep at night so that urine keeps draining continuously & patient does not need to get up & spoil his sleep. We also advise our patients to keep on emptying the pouch every 3-4 hours lest there is a lot of urine in the bag which causes the bag to come off& start leaking.

Acid urine is odorless and tends to have less bacteria. At Urofort Cancer care we recommend our patients totake vitamin C to keep the urine acidified. You can also drink cranberry juice (about two glasses a day) to keep your urine acidic. Citrus juicesdo not acidify the urine.

Acid urine keeps the skin around the stoma healthy as it does not allow deposition of alkaline salts on the skin in the area. If the stoma skin has a cauliflower-like appearance; it is due to alkaline urine.Acidification of urine can [prevent such complications. However, before taking cranberry juice or vitamin C,do check with Urofort Cancer care if your urine does indeed require acidification.

 

Urofort Cancer Care recommendations About Ostomies

People get accustomed to wearing the pouches for many days after first 4-6 weeks after surgery. However we advise that you should change the pouch every 7 days for reasons of hygiene.

• Any hint of discomfort mandates removal of the pouch.

• A skin irritation in its early stages can thus be detected.

• If the urine is leaking by the sides of the Change The Pouch. Do not try to apply more adhesive tapes or “patch it up”.

• Our enterostomal therapist should attend to a pouch that continually leaks& find one that fits better.

• If there is a great deal of itching around the stoma, this can be an allergy to the adhesive, urine or due to bacterial infection. Once again you need to see a specialist in stoma care.

 

Removing a Used Appliance

Patience is the key to correct removal of the appliance. One has to be gentle in removal of the flange or the skin tends to come off.Empty the appliance. One hand removes the appliance while the other hand supports the skin. Spend an extra 5 minutes at this time, than damaging the skin by hurrying through the removal. If adhesive paste has been used to apply the flange, apply the correct solvent with cotton to dissolve the paste from the edges of the flange & repeat as required to let the flange come off in small installments.The soiled appliance is then discarded.

 

Cleaning Around the Stoma

The skin around the stoma is washed gently with glycerin soap. Do not rub it. Make sure to rinse the soap completely. The skin must be dabbed dry & not rubbed with a clean cloth.Discharge from a stoma is a problem during this cleaning procedure. Lubricate a gauge piece with lignocaine jelly & place it at the mouth of the stoma to temporarily soak the discharge till the cleaning is completed. Do not forget to remove the gauge piece after the cleaning is done.

 

Applying a Skin Barrier

Many commercial products are available to protect the skin around the stoma. They come as a pliable gum (either as a pre-cut ring or as a sheet), paste, powder, spray, cream, or liquid; protect the skin right up to the stoma. Directions for each product will be on the container packing.

 

Putting On a Clean Appliance

The nozzle at the bottom of the appliance is closed. Peel away the sticking paper from the appliance seal and attach the appliance to the abdomen slowly and smoothly avoiding any air pockets. If an adhesive paste is used, a thin coat is applied to both the appliance faceplate and to the skin around the stoma. The paste is allowed to dry for few minutes before the appliance is attached. In the case of a two-piece appliance, the separate flange is adhered to the skin; the pouch is then secured to the flange.

 

Putting on a Tape

A porous tape such as transpore or micropore can be applied all around the edges of the appliance faceplate. Some people use multitail belts, 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. The tails are so arranged that they pass above & below the stoma, thus supporting the applied flange & pouch & preventing it from coming off.

Usually an ostomy is a life-saving surgery done in patients with malignancy. It allows one to resume their normal lifestyle wearing their pouches comfortably, eating the foods they like, engaging in activities and enjoying life.

 

Clothing

Neither are the pouches noticed nor is any special clothing required as the pouches lie flat against the abdomen.These pouches can be tucked underneath your shirts inside your underwear or between your underwear and your outer clothing.

 

Activities

Restrict your activity during the first 2 to 3 weeks after surgery. Do not lift heavy weights till your stoma heals( probablyupto 6 weeks). Once healed, you
 would be able do most of the activities you enjoyed before your surgery. Avoid contact sports. If your job includes hard physical labor modify your lifestyle & talk to your employer about making adjustments to your job responsibilities.

 

Relationships

Yourworry that people will have negative reactions regarding your surgery are unfounded. People will never know that you are wearing a pouch, unless you choose to tell them.

 

Urofort Cancer Care

The Urofort Cancer Careis a support address for people who have had ostomy surgery. This is an endeavor to care for our patients after their surgery has been done, to make their lives simple, comfortable& as normal as possible. Discuss all the issues & difficulties you have with Dr Manav Suryavanshi. This will help us help you & also help us help ourselves becoming better by the passing moment to help our patients better & better.