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Looking after your internal urine pouch

You might have an internal pouch to hold urine after you’ve surgery to remove your bladder (cystectomy).

On your tummy (abdomen) you have a small hole called a stoma. The stoma acts like a valve to stop the urine coming out. This is called a continent urinary diversion.

At the hospital

While your body heals you’ll have a thin tube (catheter) in a new opening on your tummy (stoma). The catheter is in place for about 6 weeks after your operation to allow your urine to drain.

After this time you’ll come back into hospital and learn how to empty your pouch and wash it out. Your stoma nurse shows you how to do this. 

Emptying the 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. 

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.

To empty your pouch you need:

  • a disposable catheter
  • some lubricating gel
  • a container to drain urine into
  • gauze / tissues

You may also want a mirror to begin with to be able to guide the catheter into your stoma.

Diagram showing self catheterisation of a urinary diversion

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.

You don't have to worry about keeping anything 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
  • 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 the pouch

Mucus can build up inside the pouch. So you need to wash this out regularly. If mucus builds up in the pouch, the stoma can stop draining properly and you can develop bladder stones. 

Washing out the pouch is also called irrigating the pouch. Your stoma nurse tells you how often you need to do this (it can vary).

To wash out your pouch you need:

  • a disposable catheter
  • some lubricating gel
  • cool boiled water for irrigating
  • 50ml catheter syringe
  • container for your water

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.

Stoma appliances

Stoma appliances are products such as urostomy bags, irrigation systems, and catheters to help you care for your stoma. 

Get support

Some organisations can give you advice and support. They can arrange for you to meet other people with an internal urine pouch and keep up to date with new ideas. Meeting someone who has been through what you are experiencing might help you to cope. They know what is important to tell and can answer your questions from first hand experience.

For support and information, you can call the Cancer Research UK information nurses on freephone 0808 800 4040, from 9am to 5pm, Monday to Friday. They can give advice about who can help you and what kind of support is available.
Last reviewed: 
01 Jul 2019
  • The Royal Marsden Manual of Clinical Nursing Procedures (9th edition)
    L. Dougherty and S. Lister. Wiley Blackwell, 2015

  • Good Practice in Health Care. Continent Urinary Diversion
    European Association of Urology Nurses, 2010

  • Managing the aftercare of patients with a Mitrofanoff pouch
    R Leaver
    Journal of Community Nursing, 2016. Volume 30Issue 1, Pages 40 - 46

  • The Essentials of Pouch Care Nursing
    J Williams
    Whurr Publishers Ltd, 2002

  • The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. If you need additional references for this information please contact patientinformation@cancer.org.uk with details of the particular risk or cause you are interested in. 

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