Night Drainage Systems For Use with a Urostomy
By Terry GallagherOne advantage of having a urostomy is that by using a suitable night drainage system, there is no need to get up in the middle of the night to visit the bathroom as the drainage system takes care of that! There are many systems and pitfalls to be avoided and I would like to share with you some of the hints and tips which I have picked up over the years during which I had a catheter and now I have a urostomy.
(Urostomate and Ileostomate)
Let’s start by looking at what is needed. The night drainage bag is a two litre capacity catheter drainage bag made by several firms. These include Convatec Bard, Coloplast and many others. The bags are of two main types: reusable and disposable. Because the urostomy pouch isn’t sterile, there is no need to use sterile night drainage bags, although, because they are mainly designed for catheter users, the majority of the reusable bags will be sterile when they are first opened. The reusable type have a tap in the bottom and are emptied into the toilet every morning. It is helpful to have a funnel which can be attached to the nozzle end of the tubing connected to the bag. Water should be washed through the bag and tubing after it has been emptied in the morning. When there is about half a litre of water in the bag, vigorous shaking (with the tap close, of course!) will help to wash the bag thoroughly.
Next, empty it into the toilet and repeat two or three times, followed finally by a mild disinfectant solution which prevents bacteria build up in the bag during the day. This can be made up in a plastic jug and poured in. I used a disinfectant called Savlon which is based on cetrimonium bromide and chlorhexidiene. Once this has drained out, the bag can be left until the night time. The reusable bags should be used for a maximum of five to seven days before it should be disposed of. In the UK we have a medical waste collection service, it is important to follow local procedures for dealing with medical waste. At the very least, the bag should be flushed out as for a normal day before disposal. I prefer to use the disposable bags. These are single use without tap and the cost in the UK is comparable to the more expensive bags with a tap over a period of, say, a month. The single use bags have a tear section in the top for emptying into the toilet and are then put with my other medical waste in a special bin in my bathroom. Both types have non-return valves (although it is possible to get the single use ones without these, they are to be avoided at all costs!) to prevent urine passing back up the tube.
However life is never simple and the manufacturers of stoma products seem to go out of their way at times to make life more complicated than necessary. Standard catheter drainage night bags have a universal cone shaped connector, often ridged to make a more secure connection, which fits any catheter or leg bag. However stoma manufacturers have their own patented design of taps which may, or more probably not, connect to a standard 2 litre catheter night bag. I use Dansac products and Dansac make a reusable night bag which connects without adapter to their own urostomy pouches. Unfortunately the standard connector won’t fit, but Dansac do supply an adapter (fortunately) which does enable the connection of a standard catheter connector. In the morning, I remove this connector, wash it under hot running water, then drop it in a Tupperware tub filled with Savlon disinfectant. In the evening, I remove it from the tub, wash it again under hot running water and dry it on kitchen paper inside the tubing where the catheter connection fits - this ensures that the connector doesn’t slide out again because it hasn’t gripped on the wet tubing. The Coloplast urostomy pouches do accept a normal catheter connection straight into the pouch’s tap, but I find the pouches drop off! Each to their own. However, when choosing a bag, the longer the tubing, the better, particularly if you roll about a lot in bed as the longer tube gives more room for movement. The new Coloplast tubing is four foot long which is great, but it is ridged and uncomfortable to lie on - swings and roundabouts again.
With regard to tubing, my disposable bags have a narrow bore tubing to connect between me and the night bag whereas many of the reusable bags have tubing which wouldn’t disgrace a garden hose. Narrow tubing is more comfortable, if there is a choice, and drains just as well.
Having chosen a bag (either the one supplied by your pouch company or a bag with a standard catheter connector and adapter if necessary) the bag needs support. There are a range of stands available. The most common is the white wire stand used by hospitals and is my preference. I can pick it up by the handle and walk with it to the bathroom in the middle of the night to empty my ileostomy pouch, or in the morning to dispose of it before I shower. The second type is the flat pack plastic one. I also have one of these which I take away on holiday with me. The disadvantage of this type of bag support is that it stands a little way from the bed because of the angled legs and so reduces the amount of tuning available. A third type slides under the mattress and hangs down at the side of the bed. These have advantages especially with divan beds where the washing up bowl (see below) cannot be pushed under the bed, but make it more awkward if, like me, you have to get up in the night to use the toilet. Whatever you decide upon, buy a cheap rectangular plastic washing up bowl to put the stand in, or hang the bag over for the under mattress type, ‘just in case’.
In case of what? do I hear you ask? The two eventualities which may occur are a leaking tap or a defective bag which splits as it fills. I’ve had the first and fortunately, so far, never the second, but the bowl catches any leakage or bursts and protects the bedroom carpet. Piece of mind comes cheap at the price of the washing up bowl. A square one holds the stand better and, if you have a metal framed bed like me, can be pushed under the bed so that the catheter bag is flush against the mattress.
One important point, however, is that the night drainage bag must be lower than the top of the mattress. If this is not the case, then the bed will need raising on blocks, or longer legs fitted if a divan bed, to raise the bed to a better height. If using a camp bed, the drainage bag can lie in the washing up bowl, or, if actually camping out of doors, the bag can lie on a plastic bag or sheet. It isn’t advisable in a normal bed to put the bag straight into the bowl as this reduces the length of tubing available.
If you are having problems with the length of tubing on the bag, then it is possible to buy extension tubing. This too will need washing out each morning and, again, should only be used for up to seven days before replacement.
So it’s time for bed. Probably you’ve been to the bathroom to empty your pouch before connecting it to your night bag? Bad move! It is much better to have at least 100 ml of urine in your pouch before connecting to the night drainage bag. This means that the urine flows down the tubing into the bag, flushing the air in the tubing into the bag. This stops airlocks and is an absolute ‘must’ to avoid drainage problems at night. You have probably been told to drink plenty to avoid kidney stones and infection? I was told by a nurse on a urology ward that the best bladder washout is to drink plenty. The same applies for a urostomy and I have never forgotten those wise words from that nurse. However, a visit to the bathroom is still indicated. It is very important to wash hands before connecting up the night bag and to wash them again in the morning before disconnecting to try to keep the risk of infection as low as possible.
You’re going to be hooked up to a 2 litre drainage bag overnight so you don’t have to worry about your pouch filling. Drink about a litre of water before going to bed. That’s right, I did say one litre. This will flush through your kidneys and your ileal conduit or urostomy overnight, keeping your urine dilute and flushing any ‘bugs’ through your pouch and away from your stoma. Remember that your urostomy pouch which you put on was clinically clean, not sterile, so bacteria will start growing in that pouch as soon as urine starts to fill it. This is why I’ve been recommended to change my urostomy wafer every three days and my pouch every 36 hours to avoid the risk of infection. By drinking plenty last thing at night, you’ll help to keep free from urinary tract infections which can be extremely painful as they affect the kidneys. In the morning, that one litre of fluid will be in the bag and you’ll have avoided producing concentrated urine overnight which can encourage stone formation. You’ve probably heard the ‘cranberry juice’ message as it helps to prevent e coli, a bacterium which lives in our intestines and is a common cause of urinary tract infections, adhering to the inside of the urostomy should the bugs accidentally get there. I know this is about night drainage systems, but, on the subject of infections, did you know that a very common infecting organism for urostomies is proteus mirabilis? If we urostomists do get an infection, ‘blind’ therapy should probably be ciprofloxacin, a good broad spectrum antibiotic, and metronidiazole which is active against proteus mirabilis, so the problem is treated quickly no matter what the cause.
Now it’s time for bed. Your urostomy is probably on your right hand side, so you’ll have put your washing up bowl, catheter bag stand and night drainage bag on the right of your bed. There’s about 100 ml. of urine in the night bag where you drained your pouch to avoid airlocks, and you’ve drunk your water. Now here comes the next pitfall. Imagine you’re lying on your back in bed with the drainage bag on your right. Your pouch is connected, firmly because you checked, to the tubing which is running over the top of your leg to the bag. This is a recipe for twisted bags and leaks. The solution (and trust me, it works!) Is to have the tubing running down between your legs and under your right thigh. When you roll onto your left side, the tubing is lower than your stoma, so continues to drain. When you roll on your right side, the tubing is only slightly uphill and the vacuum caused by the urine in the tubing will help to pull the urine through (the one way valve in the drainage bag helps to maintain that vacuum and help drainage.) If you have the tubing running over the top of your leg, when you roll on your left side, the tubing has to pass over the top of your thigh and doesn’t drain. My way prevents the tubing and pouch from twisting. It does mean that you are lying on the tubing, but this won’t block it and the knowledge that drainage will continue without problems all night is reassuring.
I prefer a two piece urostomy system as I can wear a belt with it to help to keep the pouch in place and support its weight. The other reason is that, in the morning after disconnecting the night bag, the vacuum created will have sucked all the air out our the pouch and the stoma will be looking a little flattened. ‘Popping’ the top of the flange a little and letting some air in by pulling on the front of the plastic film allows the stoma to return to normal.
I must now touch on a difficult subject. These days I use products which I am both confident with and in using. I haven’t had a wet bed since I was asked to be on the Convatec trial for the Esteem urostomy pouch and the wretched things came off because they had urine soluble adhesive on the wafer (grrrr!). However, this must always be considered a possibility, so mattress protection is, in my view, essential. In the UK, there are machine washable terry towelling mattress covers with a PVC backing and elasticated sides to fit the mattress. These aren’t too bad to sleep on. The ordinary PVC covers do tend to be noisy, hot and uncomfortable as they promote sweating. The waterproofed nylon covers are, from my own experience, next to useless unless they have a complete surface coating which then makes them as bad to sleep on as PVC. They soon cease to be waterproof unless they have the surface coating. My preference is for a hospital style cover. In fact, I have a pressure relieving mattress on my bed which doesn’t squash my stomas if I roll onto my front. The cover is knitted polyester which stretches and has a breathable polyurethane coating. This is really comfortable to sleep on and I would recommend a similar cover for bed protection.
When I go to a hotel, I ring up and explain my medical needs. I have found hotels to be very happy to make up the bed with a waterproof sheet ‘just in case’ and also to supply an extension cable if needed to plug in my CPAP - but that’s another matter. I also take disposable absorbent bed pads as well. By this means I have never had an accident in a hotel bed!. The bed pads I use are made by Pampers and are called ‘Bed Mats’ in the UK. They’re sold to put on children’s beds and are reasonably comfortable to sleep on for a few nights and easier than having to ask for the bed to be changed in the middle of the night should the worst happen.
I cannot leave this subject without mentioning leg bags. People with catheters use a leg bag for urine storage as opposed to our pouches. We can use a leg bag as well for car journeys when rest rooms are further apart than the capacity of our pouches, or for attending that concert or play when we don’t want to have to get up in the middle because we really shouldn’t have had that extra cup of coffee! I sue the Manfred Sauer BendiBag which hold 1.3 litres, have very discrete tubing (Bard, there is no need for the hose pipe you use on your bags!) And I like the slide tap option with the 20 cm tube. This gives me enough additional capacity for long car journeys and, because the bag attaches above the knee, it doesn’t slide down as it fills. Connecting the leg bag is just like connecting a night bag. In England there is the M25 around London - a motorway where traffic is often at a standstill. There are no service areas on the M25, so when I visit my mother-in-law in Sussex which is 100 miles from the last service station, I have enough capacity to ensure that I can get there, traffic jams included. Some people connect a night bag to their pouch when on a long journey. This probably works better for ladies with a skirt than for men with trousers as I find it impossible to connect and disconnect discretely in the car.
Over the years, I have experimented and found what works for me. I hope that you may find some useful information in the above.
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