My Bladder Cancer Fight

I will try and not be as windy today.

The rest period is over for your stoma and the skin under the pouch.

NOTE: I forgot to mention in post 2a.
If you need to attend to the skin under the pouch, the rest period is the time to apply whatever material is needed. If there is any evidence of broken skin, a rash apply some triple antibiotic. If the skin has been itchy apply some Monistat 7 . You get the idea. This is the time to treat the skin that needs to be attended to. If you apply a substance that is a cream, you will not need to apply the Diaper Rash Ointment. Most of these ointments are moist enough that they will protect the stoma and the skin from rubbing on the diaper.

I would not recommend that you apply Diaper Rash Ointment over any other ointment, for ex. Triple antibiotic. I do not know about any reaction that might take place but why take the chance. After your 3rd or 4th baby diaper change, you can apply some Diaper Rash Ointment as the previous ointment will have been absorbed into the skin.

The main thing to remember, prior to putting on the diaper, is that you want the area to be moist so that there is no chaffing of the skin to further complicate things.

Things you need to do before you take your final shower and put on a new pouch. I am ONLY going to talk about the one piece pouch here. I cannot use a 2 piece pouch as my parastomal hernia causes pressure sores with the 2 piece. More on 2 piece later.

• 1. Gather everything together that you will require.

• 2. If you use the ‘cut to size’ Urostomy pouch’ you need to cut it now according to the size of your stoma. You can purchase pre-cut pouches but I do not recommend them for new Urostomites. In every box of Urostomy pouches sold there will be a ‘stoma guide’ in the box. This is just a piece of cardboard with different size holes cut in it. Hold it against the stoma to determine what size you need. For the first six months to a year, the stoma will vary in size slightly. This is why you should measure each time you make a pouch change. Later you will probably only need to measure one a week. Do follow the manufacturers recommendations.

• 3. You will notice on the back side of the pouch that lays against you skin there is a very thin layered of cloth- like material glued to the back. This is to prevent the plastic pouch from sticking to you thigh. The groin is normally a hot area and with the urine being expelled is at body temperature, things can get hot down there. Some manufacturers just ruff up the backside of the pouch to help prevent sticking. I do not like these. So let me tell you about my little trick.

Ladies require, when the monthly visitor begins to arrive, a panty shield. This is a very thin absorbent pad that has sticky tape on one side to adhere it to the crotch of their panties. Take one of these, cut it to the right length, peal off the tape cover and apply it to the back of your Urostomy pouch. No more pouch sticking to your thigh in hot weather. Guaranteed. I use Carefree body Shape Thins. There is more than one way to skin a cat.

• 4. Your Urostomy Nurse will help you determine what is necessary for you to use to give you the best possible leak free time during the three days that you will be wearing this pouch. Use the knowledge of this person, they are worth their weight in gold. She can determine if you require anything additional such as a barrier ring between your skin and the glue of the pouch.

• 5. If you have skin folds or any type of indentations on the skin where the pouch is going to be applied, you must fill in these holes. Here is what I am talking about. You are going to repaint the living room. When you get everything ready, you find that there are a couple of cracks and a few nail holes that need to be repaired. You get out the poly fill and go to work. This is the same thing. You fill in the holes and cracks with a stoma paste not poly fill. Every manufacturer has there own brand. Just follow their instructions carefully.

• 6. You will need a mirror about one foot square. Find a drawer in the bathroom that you can pull out, place the mirror on the lip of the drawer so you can pull out or shove in the drawer to adjust the mirror to the right angle for seeing the stoma area clearly. If you do not have a drawer, improvise something that is adjustable for the mirror to get the best angle. In motels, I have used the phone book and the bible to prop up the mirror to the right angle. I don’t think the Lord would mind me using the bible this way.

• 7. At least 3-4 wash clothes.

• 8. A hair drier with a low setting.

• 9. You need the best possible lighting. I use two florescent work lamps that I found at Canadian Tire. They have a hook on the top so that I can hang a light on each side of the mirror at the top. Wal-Mart sells them. For me, these give excellent light.

Ok, everything is ready. Take it all into the bathroom and place it in a handy spot near your mirror.

Take your shower, If you use a wash cloth while showering use a clean one to do the stoma area. Your stoma will not appreciate being washed with the same cloth that you used on your feet.

You will have realized that during the operation, the Surgeon had shaved the area of your abdomen where the pouch is located. If it is necessary shave the area. This is not going to be very pleasent to remove later, if the glue from the pouch is tangled in pubic hair. Keep this area free from hair.

When you come to the stoma and the surrounding skin use plenty of soap (no perfume, no lotion) and give the area a good but gentle wash. Do not scrub. I rinse out the wash cloth and wipe gently over the area again. Then allow the shower to spray water over the area for about a minute. Do not spray directly on the area but aim the spray just above and let it trickle down over the stoma and the surrounding skin. Since you had washed everything else and the stoma area was the last thing you washed, you are finished.

Get out of the shower and dry off. Dry everything but around the stoma area. When you are finished drying the rest of your body take a new dry face cloth, you may need a couple, and very gently dry the area. Do more patting dry than rubbing.

Finished

Now apply the new pouch.

• 1. Take a new clean wash cloth and pat around the stoma area. Since you have set up your mirror and lights before getting in the shower you are ready to go.

• 2. Now is the time to fill in all the cracks and crevasses with stoma paste. Follow the manufactures instructions. This material will harden when exposed to air so you must work at a good speed.

• 3. Take the pouch and remove the protective cover over the flange that will be applied to you abdomen. Using the hair dryer on low gently warm the material under this protective cover. Set it back down on the counter sticky side up.

• 4. Use the hair dryer on low and dry the skin around the stoma. Use common sense here as you do not want to burn your skin or the stoma. The stoma has no nerve endings so it cannot tell you if it is getting to hot and burning.

• 5. You are ready to apply the pouch. No doubt the stoma has been dripping urine while you have been doing the above. Take another wash cloth and gentle pat thinks dry.

• 6. Just before you apply the pouch do one final pat with the wash cloth. Moving quickly hold the pouch over your stoma so that the stoma is centered in the opening. Make sure that the drainage plug is pointing DOWN and gently press the pouch to your abdomen. You have to move quickly here because you want to get the pouch glued to the abdomen before the stoma shoots out another drop or two of urine. Urine and the glue on the back of these pouches do not mix well together. If even a couple of drops of urine get trapped behind the glue, your pouch will leak before too long.

• 7. I take the hair dryer, on low, and gently apply some heat over the pouch where it is glued to the abdomen. The particular material that is used to adhere these pouches to your abdomen work better and stick better when they have warmed up to body temperature. If you want to, you can stand there for three or four minutes with your and over the pouch to warm it up.

You are finished. My God, did you remember to close the drain plug? I have done this a few times. I have even tried to apply the pouch to my abdomen without taking off the protective cover that protects the glue. I could not figure out for a moment why the damn thing was not sticking to my abdomen.

Come on, the odd time, even after years of changing the pouch, you will suddenly do the most stupid thing. Just part of life and being an Urostomite.

I get dressed but do not sit down for at least fifteen minutes. My family and friends are familiar with me walking around the house holding my groin with one hand during this time. No big deal, just applying a little extra heat for the glue.

Well that is my routine. You will develop a routine that you are comfortable with.

Again just a reminder that you must, at all costs, keep the stoma and the skin under the pouch glue as clean as you possibly can. This will greatly reduce your chances of infections.

The above is my normal routine. If for some reason that I cannot avoid and I need to change my pouch NOW, I just take a shower and apply the new pouch right away. I certainly do not make this a habit. I believe that the skin needs a resting period but once in a while slapping on a new pouch immediately is not going to do any harm. At the next change, just rest it longer. Once a month, I remove the pouch about 7 AM and rest everything until around 10 PM. But still do what the hell I want to do.

Next post will be part 3
Sorry, I still have too much gas.

Posted on April 16th, 2008 by Neil
Filed under: Bladder Cancer - Background, My Cancer, Urostomy Pouches