ILeal Conduit - Basic Care:

An ileal conduit, or ileal loop as it is sometimes called, is a way of diverting
urine outside of the body when the urinary bladder has been removed. A
piece of small intestine is used to form a conduit. A short section of the
small intestine is separated and the intestine is sewn back together with no
change in bowel movements. One end of the separated section is closed
and the ureters, which normally carry urine from the kidneys to the bladder
are sewn into the piece of small intestine. The open end of the intestine
section is brought out to the right side of the abdomen where it opens to
the outside as a stoma. Urine will now pass through this conduit and out
the opening in the abdomen.

The conduit cannot store urine the way the bladder did. Therefore, urine
will be flowing continuously and an appliance (pouch) must be worn as a
collecting device.

Stoma

Stoma is the name given the opening made in the abdomen. It is similar to
the tissue on the inside of your cheek and a slightly reddish color is
normal. The stoma is not painful or sensitive to touch. It can be washed
gently with mild soap and water, just like your skin. Water will not hurt it or
run into it, so you may shower or bathe with your appliance off. The stoma
has a good blood supply and may bleed slightly when you are washing it.
Do not be concerned as long as there is only a small amount of bleeding
that stops in a short time.

After surgery there will be a small amount of swelling of the stoma. With
time the stoma will get smaller, usually reaching its "normal" size within
three to six months after surgery .

Immediately after surgery there usually will be two very small tubes (called
stents) in the stoma. They serve as supports while the sutures inside are
healing. The stents are temporary and will not come out before you go
home. They will fall out on their own or your physician will remove them.
Either way there is no pain or cause for concern.


Skin Care

The skin around your stoma needs special attention since it will have an
adhesive of some kind over it continuously. Remove your appliance gently
using warm water. Do not pull or tear the faceplate off! You will injure your
skin.

Wash the skin gently with mild soap (regular bath soap) and warm
water. Rinse the soap off well or it will irritate the skin and interfere with the
adhesion of the appliance.

Dry the skin thoroughly. This is very important because damp skin can
prevent your appliance from sticking. A small hair dryer on a "cool" setting
is very useful. Remember, urine flows continuously from the stoma. When
drying the skin use a gauze roll or a piece of clean cloth to absorb the
urine and keep the skin dry.

The best time to change your appliance is in the morning before you have
had anything to drink. Urine output will be less then, so you can dry your
skin with less effort.

Appliances

There are several types of urinary appliances. Immediately after surgery,
while you are in the postoperative care unit, you will be fitted with a urinary
appliance to collect your urine and keep you dry.  For the first few days
after surgery you will have a temporary appliance with a "skin barrier" to
protect your skin. The appliance will be connected to a continuous
drainage bag that will be emptied periodically by the nurses or nurses'
aides. The appliance will be changed when necessary by the nurses
and/or enterostomal therapists.

While you are in the postoperative care unit your enterostomal therapist
will be planning for the permanent appliance you will wear when you go
home. By "permanent" we mean that these appliances are worn five to
seven days, removed, cleaned and reused rather than discarded. There
are both one-piece and two-piece appliances. These are specially
designed bags which adhere to the skin with either cement or
double-faced adhesive discs. Different types are best for different
individuals. The examples
shown are three types of appliances. Numerous brands are available. Your
enterostomal therapist will help you decide which appliance is best for you.

As you gain strength and begin to feel better, you will be taught how to
care for your stoma, skin and appliance. Proper care will be demonstrated
several times and then you will be asked to do it yourself with supervision.
Do not feel that you have to learn everything the first time. It is important
for you to be able to care for yourself and have confidence in your ability.

Your enterostomal therapist will instruct you in the use and care of the
appliance and will inform you where to obtain needed supplies. When you
go home you will have with you written instructions about the care of your
skin and appliance, addresses of sources for supplies and the telephone
number of St. Joseph Hospital's enterostomal therapist office.

Both the appliance and adhesives are made of hypoallergenic materials
and allergy is not a common problem. However, if you are allergic to one
product, your enterostomal therapist can suggest an alternative.

Some people wear cloth pouch covers over their appliance. These can be
made of an attractive, soft material that keeps the vinyl or rubber appliance
away from the skin. Many men who do heavy outdoor work find that these
cloth covers keep the appliance from "sweating" against their skin. Old
t-shirts provide a source of soft, easily laundered material for men. Women
often make very attractive, feminine pouch covers for their appliances.

Because the characteristics of your stoma and abdomen change, as they
might in the case of a weight gain, your equipment will be measured
frequently to make certain it still fits you properly. Any time you return to
the doctor's office, please remember to bring your equipment, as well as
any needed supplies, since similar supplies may not be stocked.  This is
especially true if you go to your local hospital, which may not have the
supplies necessary for your appliance. The habit of self-reliance should be
learned early.

Cleanliness is a must!   If your appliance is clean and you are drinking
adequate amounts of fluids, there should be little or no odor. Various foods
and drugs (such as antibiotics) may give an odor to your urine. A
strong odor or sudden change in your urine, with the urine looking cloudy
and "strong", may be a symptom of infection. Bacteria cause a strong odor.
You should let your physician know, especially if you have a fever and do
not feel well.

Because you have had surgery on your urinary tract, you need to drink
(at least!) between two and three quarts of fluids daily to keep your system
flushed. Your doctor may prescribe ascorbic acid (Vitamin C) tablets, which
help keep your urine acidic. This reduces the possibility of infection and
keeps down the odor of the urine.

Your appliance will need to be emptied frequently, as the weight of
the urine in the bag will pull on the faceplate and might break the seal.
Usually emptying the bag every two or three hours is sufficient. Soon,
however, you will be able to tell by the feel of your appliance when it needs
emptying. It may need emptying more often after a meal or when you have
just had something to drink.

When you go to bed you will need to connect your appliance to straight
drainage to keep from having to get up during the night to empty the bag.
Besides, urine sitting in the pouch overnight is a good growing medium for
bacteria and infection.

You may want to have the drainage tubing run off the bed to your side.
Or you may want to run the tubing down your pajama pant leg and over the
foot of the bed.   

We suggest that you place the end of the tubing in a disposable jug (such
as a bleach bottle or plastic milk jug) that can be cleaned easily and
thrown away periodically.

You can clean the tubing and the container with vinegar or bleach. Be sure
you anchor the tubing to the mouth of the container so that the tubing does
not pullout and drain onto the floor. Do not let the tubing go down into the
container below the level of the drain. Room for air exchange is needed to
promote drainage. Some people place their container in a small trash can
and make "skirts" for the unit so that it is inconspicuous and attractive.

Everyday Living  

There is no need to alter your everyday living pattern because of your
ileal conduit.

Clothes

The style of clothing you wear does not need to change. Your
appliance will not be conspicuous through your clothing. Women can
continue to wear a light girdle and it will not interfere with the flow of urine.
A belt lying over the faceplate should be checked to see if it is rubbing the
stoma or putting pressure on the faceplate. Otherwise, it is okay.  Many
young people have ileal conduits and continue to wear tight jeans and
hiphugger pants just as they did before surgery .

Foods

You can eat any foods you enjoyed before your operation.   

Baths

You can bathe or shower with your appliance on or off. On the day you
plan to change your appliance, bathe or shower with your appliance off.
Other days, bathe or shower with it on. As long as you have a good seal,
you should have no problem.

Work  

As soon as you recover from your surgery and have approval from your
physician, you can return to your previous activities. Many of our patients
with ileal conduits have jobs that are quite physical.

Play

Almost any activity other than contact sports, such as football or
soccer, is fine. We suggest you avoid contact sports because a blow to
your
abdomen or to the faceplate of your appliance could injure your stoma or
conduit. Golf, tennis, bowling and similar activities are certainly acceptable.
Even go swimming if your like. Of course, for good hygiene, you should do
so only with your appliance on. There are several kinds of waterproof tape
that can be used as a "picture frame" around the faceplate to give you a
better seal.

Travel

If travel is a part of your job or pleasure, carry on.  Do not stay
home because of your ileal conduit. Keep a clean appliance on hand for a
quick change if it is needed. Sometimes all that is needed is an adhesive
disc in your pocket or purse--you can reuse the appliance you have on.
When planning a trip, take along necessary supplies or find out where
they can be obtained along the way. However, it is probably safer to take
along what you need. Again, self-reliance is the best solution.


Many men place their supplies in a small shaving bag.  Women often find
an attractive cosmetic bag convenient.

Sexual Activity

In the past, probably the most neglected part of rehabilitation was
sexual adjustment. Due to the nature of your surgery, there will be physical
alterations to your sexual ability, the added presence of a urinary
appliance on your side, and an understandably disconnecting change in
your own body image. This is a very individual and personal matter
concerning you and your spouse. The medical and nursing staff are
sincerely interested in your complete rehabilitation and will discuss this
subject with you or answer any questions you might have.

APPLIANCE AND SKIN CARE CHECKLIST  

1. Change your urinary appliance every 5 to 7 days. If pain or itching
occurs
around the stoma, change it more often.

2. Remove pouch daily if yours is a two-piece appliance. Rinse out bag
and check to see that faceplate is centered over stoma.

3. Plan to change your appliance early in the morning, before breakfast.
You
will have less urine flow at this time of day.

4. On change days, take a tub bath or shower with your appliance off.
Wash the stoma gently with warm water and soap. Other days, bathe or
shower with your appliance on.

5. If your skin becomes red and sore:

a. Wash area with warm water and soap, rinse well and dry thoroughly. A
hair dryer on a "cool" setting is helpful.

b. To heal irritated skin, sprinkle Karaya Powder on reddened area, brush
off extra powder and spray with skin prep.

6. Empty urine from bag frequently. The weight of accumulated urine will
pull the appliance off.

7. You must drink 2 to 3 quarts of liquids every day.

8. Connect appliance to drainage when sleeping.

9. If your urine has a strong odor:

a. Be sure your bag is clean! Soak the bag in vinegar solution (one part
vinegar to two parts water) to remove odor.

b. Drink cranberry juice or take Vitamin C tablets.

10. With your doctor's permission, resume any activity you participated in
before your operation. If you have persistent skin problems or problems
with
your appliance, call or write your enterostomal therapist at St. Joseph
Hospital.


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