Looking after your internal urine pouch
During surgery to remove your bladder (cystectomy), your surgeon might make an internal pouch to hold urine. This operation is called a continent urinary diversion, or a mitrofanoff.
On your tummy (abdomen) you have a small hole called a stoma. To pass urine, you pass a thin tube (catheter) into the stoma. The catheter goes all the way into the internal pouch. This allows you to control (be continent) when urine comes out. You don’t have to wear a bag to collect urine, as you would after a urostomy.
You will need to learn how to look after your stoma and pouch. The nurses will show you how to:
- empty urine from your pouch
- wash out your pouch
After your operation
After your operation, you have a thin tube (catheter) in the new opening on your tummy (stoma). This drains your urine. You have the catheter while your body heals. It is in place for about 6 weeks after your operation.
You go home with the catheter in place. The nurse will show you how to care for it.
After this time you’ll come back into hospital. Your doctor or nurse will remove the catheter. Your stoma nurse will then teach you how to empty your pouch and wash it out.
How to empty your urine pouch
You empty urine from the pouch by putting a catheter into the stoma. This is called self catheterisation. Your stoma nurse shows you how to do it.
How often do I empty my pouch?
To start with, you empty the pouch every 2 hours or so. As the pouch gradually stretches, you empty it every 4 to 6 hours during the day.
What you need
To empty your pouch you need:
- a disposable catheter
- lubricating gel
- a container to drain urine into, or access to the toilet
- gauze / tissues
You may also want a mirror to begin with to be able to guide the catheter into your stoma.
At first, you might drain the urine into a container. This is so that your nurse can keep a record of how much urine you are passing each time. After a while you can drain the urine straight into the toilet.
Draining the pouch
You don't have to worry about keeping everything free from germs (sterile) when you self catheterise. But try to be as clean as possible. You want to keep the risk of introducing an infection as low as you can. It’s best not to touch the end of the catheter that you are going to put into the stoma.
To empty your internal pouch you should:
- wash your hands
- open the catheter packaging
- open the gel
- take out the catheter and moisten the blunt end with water or gel (unless it is pre lubricated)
- look at your stoma to check it is clear of any mucus
- use a tissue with warm water to wipe away any mucus
- make sure one end of the catheter is in the container or toilet ready to collect urine
- gently feed the catheter into your stoma
- keep feeding the catheter in until urine starts to come out, then insert it a further 4 to 6 cm
- drain the urine into the container or toilet
- when no more urine comes out insert the catheter in a little more to make sure no more urine is left inside
- gently remove the catheter out of your stoma
- throw the catheter away
- wash your hands
Sometimes you may have trouble getting the catheter in. If this happens, try pulling it back a bit and gently pushing it in again. It can help to roll the catheter between your fingers as you put it in.
Washing out your urine pouch
Washing out your pouch is also called irrigating the pouch. Mucus can build up inside the pouch. So you might need to wash this out regularly. If mucus builds up in the pouch, the stoma can stop draining properly. You can develop bladder stones or problems with infection.
How often do I wash out my urine pouch?
Your specialist nurse tells you how often you need to do this. It varies, and the advice is different for each person.
What you need
To wash out your pouch you need:
- a disposable catheter
- lubricating gel
- cooled boiled water for irrigating
- 50ml catheter syringe
- container for your the waste, or access to a toilet
Washing out the pouch
Start by emptying the urine out of your pouch with the catheter. But leave the catheter in after the urine has all drained out. Then:
- pull up the irrigating solution into the syringe
- fit the syringe onto the end of the catheter
- gently push the end of the syringe in so that the water is pushed into your pouch
- disconnect the catheter and empty the contents into the toilet or gently withdraw the contents (follow the advice given to you by your stoma nurse)
- fill the syringe again and repeat
- keep irrigating and emptying the syringe until there is no more mucus and the fluid that comes out is clear
- gently pull out the catheter and throw it away
Your doctor or stoma nurse might prefer you to use sterile salt water solution (saline) or bottled water. Different people prefer one solution to another, but they are all fine to use. You can use bottled water to wash out the pouch if you’re away from home.
The amount of mucus your pouch produces might decrease with time. So you may be able to irrigate less often. Eating certain foods will also cause more mucus to develop. You can eat less of these foods to reduce the amount of mucus you produce.
Stoma appliances
Stoma appliances are products such as urostomy bags and catheters to help you care for your stoma.
Get support
Some organisations can give you advice and support. They might be able to arrange for you to meet other people with an internal urine pouch.
Meeting someone who has been through a similar experience might help you to cope. They know what is important to tell you. And they can answer your questions from first hand experience.
