After surgery to remove your bladder you normally pass urine in a different way. How you do this depends on the surgery you have had.
After a urostomy
After having a urostomy, you pass urine through an opening (stoma) in your tummy (abdomen).
The stoma looks like a small spout sticking out of your abdomen. It is red like the inside of your mouth. It does not hurt because it has no nerve supply. So you must be careful not to injure it.
The stoma is swollen just after your operation. It gets smaller as it heals. It produces a thick white mucus, which collects in your bag along with the urine. The amount of mucus gradually lessens over time, but it will always produce some mucus. This is normal.
At first, your nurse will change your urostomy bags until you learn to care and change your urostomy yourself.
There are many different types of urostomy bags. The nurse helps you find out which is best for you. You can't smell anything from the bag. The bags are very flat and do not rustle as you move around. Under ordinary clothes, no one can tell you are wearing one.
The bag can stay in place for a few days at a time. It has a tap or bung at the bottom of the bag so you can empty it into the toilet.
Your stoma nurse gives you some urostomy bags to take home when you first leave hospital. They also usually help you fill out the medical exemption certificate form to qualify for free prescriptions. If not you can get this form from the GP.
Your nurse might set up an ordering system for you to get the bags from your local pharmacy prescription and delivery service.
Or they might give you a prescription card with details of all the equipment you need. You then you take the card to your GP to get more bags.
When you collect this from your pharmacy you will then need to show your medical exemption card so you don't have to pay for your stoma equipment.
Living with a stoma
Your stoma nurse might visit you when you go home, to make sure you are coping. Or a district nurse might visit you instead. Do ask for their help if you have any questions or difficulties. You’ll be given contact numbers if you have any questions when you go home.
You could also join the Urostomy Association. Members can visit you before and after your operation to support you and give advice on how to cope. You can also meet other people with urostomies and keep up to date with new ideas.
After a continent urinary diversion
After having a continent urinary diversion, you pass urine through an opening (stoma) in your abdomen. Your stoma eventually becomes less obvious than if you’d had a urostomy. At first it is swollen and red. But it shrinks as it heals and becomes far less noticeable.
Your stoma is delicate and has no nerve supply. So you need to treat it gently.
At first, you have a tube (catheter) into the stoma that is connected to a drainage bag.
The catheter stays in for 2 to 3 weeks while your internal urine pouch heals. It's important that the pouch does not become stretched by collecting urine at first. But soon you only need to put a tube in when you want to empty the pouch. This is called self catheterisation.
Living with an internal urine pouch
You have to empty your pouch frequently in the first 2 to 3 months. You usually set an alarm for night times, but your nurse and surgeon will go through this with you. Then after you get used to your pouch and how it feels. You'll generally need to empty it at least every 4 hours or when you feel it's full.
You also need to wash out your pouch from time to time. This is called irrigation. This is because the part of bowel that is used to make the pouch carries on making mucus. The mucus has to be flushed out or it could block the stoma.
After bladder reconstruction
When you wake up after bladder reconstruction, you have a tube to drain urine (catheter) going into your urethra. Your nurse measures how much urine you are producing.
The catheter stays in for up to 3 weeks while your new bladder heals. Your nurse shows you how to keep a record of how much urine you pass. The nurse can put the catheter back in for a short time if you are not passing enough urine, or have difficulty passing any at all.
After the nurse takes out the catheter, you begin to learn how to empty the new bladder. You do this by increasing the pressure in your tummy (abdomen).
Life after bladder reconstruction
You have to empty your pouch frequently in the first 2 to 3 months. Then you need to empty it every four hours. Most people soon feel comfortable with doing this. You also have to wake up once or twice at night to pass urine.
After recto sigmoid pouch surgery
When you wake up after recto sigmoid pouch surgery, you have a tube to drain urine (catheter) going into your urethra. Your nurse measures how much urine you are producing.
Your catheter stays in for up to 3 weeks while your new bladder heals to make sure there are no leaks at the joins.
After this, the nurse takes out the catheter. You then learn how to empty the new bladder by increasing the pressure in your abdomen.
Living with a recto sigmoid pouch
With a recto sigmoid pouch, you pass urine and stools through your back passage (rectum). You have to do this frequently in the first 2 to 3 months. Then you need to empty it every 2 to 3 hours. You also have wake up once or twice at night to pass urine.
You are more likely to get kidney infections after this operation, because bacteria can travel up the ureters to the kidney from the bowel. So you need to drink plenty of liquids to try to prevent infection.
There is also a long term increase in the risk of developing bowel cancer in the future.