It's In The Bag!

This is a bit out of sequence but I think it's time I explained how one manages without a bladder. Two tubes normally connect your kidneys to your bladder, one on each side. When the bladder is removed these ureters connect to a urinary diversion instead which is made from a short section cut out of your bowel and pushed out through your abdomen to emerge a few inches to the right of your navel.

There is no storage device in this arrangement to replace the storage capacity of the bladder so the steady dribble of urine from the kidneys is collected in a urostomy/stoma bag attached to your skin over the "stoma" which looks a bit like a small raspberry. This bag fits neatly over the stoma and has quite a large surround of adhesive material to hold it in place. This bag can be emptied through a drain in the bottom plugged either by a bung or a tap according to the patient's choice.

This bag holds about 300ml which isn't much more than half a pint so needs emptying quite frequently but there is a way of increasing storage capacity by use of a "leg bag". Leg bags come in a few variations but the ones I use fit to the inside of my calf and are attached by two strips of velcro which hold it firmly against my leg. A tube connects to the drain on the stoma bag. The two bags together give me about 1 litre or about 1.75 pints of storage capacity which is quite useful if you are going to be away from a bathroom for several hours.

There is a third type of bag called a "night bag". This one sits on a stand beside your bed and is again connected by a pipe to the drain of the stoma bag. I forget exactly how much this one holds but it is pretty large and I reckon would probably handle a night in the pub quite well.

The hard thing to understand is that you never feel the need to go to the bathroom so you have to get in the habit of checking that your bag or bags are not too full fairly frequently. The large night bag is important as otherwise it's quite likely you would sleep past the time when the stoma bag filled up and you finished up lying in a pool of urine - an uncomfortable and embarrassing experience.

The leg and night bags can be used for a week before disposing of them but the stoma bag is best changed every two days. The rule here is that you will not be discharged from hospital until the "stoma nurse" is satisfied that you can change your bag.

The first step is to remove the old bag which is stuck to your skin quite firmly and removing it can be somewhat uncomfortable though I am told that after a time the skin toughens up and you hardly feel it. Next you use a wipe to wash the skin so as to remove all the remnants of the adhesive from the old bag and then dry the skin well with another wipe and finally a tissue. Remember that while you are doing this the stoma can discharge some urine so speed is quite important as is having something to clear up any escaping drops of urine.

Next you peel the backing off the new bag and place the hole that has been cut in it over the stoma then press down the adhesive so it sticks to your skin. The trick is to start pushing it down near the stoma itself so as to prevent any uring getting under the adhesive and then press down the outer edges. It appears that a better job is done if you then keep rubbing and pressing the bag with your warm hand to get some heat into the adhesive so it holds more firmly. I reckon that the change takes me about ten minutes though no doubt I will get faster with practice.

I have to admit to a few disasters some of which were not entirely my fault. The first accident was in hospital when the nurses were fitting my bags for me and emptying them, too. A physiotherapist had turned up to take me for a short walk and neither he nor I thought to check how full my leg bag was. So we set off along the corridor, off the ward and up a flight of stairs. He was pleased with my progress and as we set off back downstairs the full bag was putting me off balance and felt very awkward. We had just got back on the level again when the damned bag came off my leg and somehow I was trailing a stream of urine behind me as we headed back to my room. I was thoroughly disgusted and that was the first pair of pyjamas ruined that day. The lesson is always to empty your bag before going for a walk.

At home I disconnect my leg bag at night and connect a night bag directly to my stoma bag so gravity does its job without any fuss and all the urine drains smootly into the night bag. In hospital they were worried about a leg bag not being connected overnight and insisted on my using all three bags with the night bag connected to my leg bag. This just did not work for me for one reason or another and twice during the night I found myself lying in a pool of urine. In that one 24-hour period I got through 4 pairs of pyjamas.

After that I did not go to bed at night but just sat in my chair. This was not ideal but I simply could not get comfortable norcould I relax in that bed with the only plumbing arrangement they would allow. Since I came home I have not had one overnight mishap though I have had a couple during the day. Thank heavens for modern automatic washer-dryers!

I had changed my bag on the Monday just before leaving hospital and that one should have lasted until Wednesday however at about 11pm on Tuesday I became aware that I was leaking and that I would have to change bags. This was to be my first bag change at home and unsupervised and I was tired and had drunk a couple of stiff whiskies so the timing was not ideal. However I did the change and got into my pyjamas but decided not to go to bed for about an hour just to make sure that everything was secure. It wasn't as half an hour later I had wet pyjamas and had to do yet another bag change. This one did last me until Thursday morning when I had a visit from a stoma nurse who gave me some very useful hints on how to maximise the adhesive qualities of the bag. Sadly that bag too lasted only some 36 hours before leaking and I had begun to wonder if, in my case, I would need to change my bag every day. In fact since then I have obviously improved my technique and have had no leaks and the last two bags have easily lasted two days.

I think I can do this!