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ILEAL CONDUIT - BASIC CARE An ileal conduit, or ileal loop as it is sometimes called, is a way of diverting urine outside of the body when the urinary bladder has been removed. A piece of small intestine is used to form a conduit. A short section of the small intestine is separated and the intestine is sewn back together with no change in bowel movements. One end of the separated section is closed and the ureters, which normally carry urine from the kidneys to the bladder are sewn into the piece of small intestine. The open end of the intestine section is brought out to the right side of the abdomen where it opens to the outside as a stoma. Urine will now pass through this conduit and out the opening in the abdomen. The conduit cannot store urine the way the bladder did. Therefore, urine will be flowing continuously and an appliance (pouch) must be worn as a collecting device. Stoma Stoma is the name given the opening made in the abdomen. It is similar to the tissue on the inside of your cheek and a slightly reddish color is normal. The stoma is not painful or sensitive to touch. It can be washed gently with mild soap and water, just like your skin. Water will not hurt it or run into it, so you may shower or bathe with your appliance off. The stoma has a good blood supply and may bleed slightly when you are washing it. Do not be concerned as long as there is only a small amount of bleeding that stops in a short time. After surgery there will be a small amount of swelling of the stoma. With time the stoma will get smaller, usually reaching its "normal" size within three to six months after surgery . Immediately after surgery there usually will be two very small tubes (called stents) in the stoma. They serve as supports while the sutures inside are healing. The stents are temporary and will not come out before you go home. They will fall out on their own or your physician will remove them. Either way there is no pain or cause for concern.
The skin around your stoma needs special attention since it will have an adhesive of some kind over it continuously. Remove your appliance gently using warm water. Do not pull or tear the faceplate off! You will injure your skin. Wash the skin gently with mild soap (regular bath soap) and warm Dry the skin thoroughly. This is very important because damp skin can prevent your appliance from sticking. A small hair dryer on a "cool" setting is very useful. Remember, urine flows continuously from the stoma. When drying the skin use a gauze roll or a piece of clean cloth to absorb the urine and keep the skin dry. The best time to change your appliance is in the morning before you have had anything to drink. Urine output will be less then, so you can dry your skin with less effort. Appliances There are several types of urinary appliances. Immediately after surgery, while you are in the postoperative care unit, you will be fitted with a urinary appliance to collect your urine and keep you dry. For the first few days after surgery you will have a temporary appliance with a "skin barrier" to protect your skin. The appliance will be connected to a continuous drainage bag that will be emptied periodically by the nurses or nurses' aides. The appliance will be changed when necessary by the nurses and/or enterostomal therapists. While you are in the postoperative care unit your enterostomal therapist will be
planning for the permanent appliance you will wear when you go home. By "permanent"
we mean that these appliances are worn five to seven days, removed, cleaned and reused rather than discarded. There are both one-piece and two-piece appliances.
These are specially designed bags which adhere to the skin with either cement or double-faced adhesive discs.
Different types are best for different individuals. The examples As you gain strength and begin to feel better, you will be taught how to care for your stoma, skin and appliance. Proper care will be demonstrated several times and then you will be asked to do it yourself with supervision. Do not feel that you have to learn everything the first time. It is important for you to be able to care for yourself and have confidence in your ability. Your enterostomal therapist will instruct you in the use and care of the appliance and will inform you where to obtain needed supplies. When you go home you will have with you written instructions about the care of your skin and appliance, addresses of sources for supplies and the telephone number of St. Joseph Hospital's enterostomal therapist office. Both the appliance and adhesives are made of hypoallergenic materials and allergy is not a common problem. However, if you are allergic to one product, your enterostomal therapist can suggest an alternative. Some people wear cloth pouch covers over their appliance. These can be made of an attractive, soft material that keeps the vinyl or rubber appliance away from the skin. Many men who do heavy outdoor work find that these cloth covers keep the appliance from "sweating" against their skin. Old t-shirts provide a source of soft, easily laundered material for men. Women often make very attractive, feminine pouch covers for their appliances. Because the characteristics of your stoma and abdomen change, as they might in the case of a weight gain, your equipment will be measured frequently to make certain it still fits you properly. Any time you return to the doctor's office, please remember to bring your equipment, as well as any needed supplies, since similar supplies may not be stocked. This is especially true if you go to your local hospital, which may not have the supplies necessary for your appliance. The habit of self-reliance should be learned early. Cleanliness is a must!
If your appliance is clean and you are drinking adequate amounts of fluids, there should be little or no odor.
Various foods and drugs (such as antibiotics) may give an odor to your urine. A Because you have had surgery on your urinary
tract, you need to drink Your appliance will need to be emptied
frequently, as the weight of When you go to bed you will need to connect your appliance to straight You may want to have the drainage tubing run off the bed to your side. We suggest that you place the end of the tubing in a disposable jug
(such as a bleach bottle or plastic milk jug) that can be cleaned easily and thrown away
periodically. Everyday Living There is no need to alter your everyday living pattern because of your Clothes The style of clothing you wear does not need to change.
Your Foods You can eat any foods you enjoyed before your operation. Baths You can bathe or
shower with your appliance on or off. On the day you plan to change your appliance, bathe or shower with your appliance off.
Other days, bathe or shower with it on. As long as you have a good seal, you As soon as you recover from your surgery and have approval from your Play Almost any activity other than contact sports, such as football or Travel If travel is a part of your job or pleasure, carry
on. Do not stay Many men place their supplies in a small shaving bag. Women often find an attractive cosmetic bag convenient. Sexual Activity In the past, probably the most neglected part of rehabilitation was 1. Change your urinary appliance every 5 to 7 days. If pain or itching occurs 2. Remove pouch daily if yours is a two-piece appliance. Rinse out bag and check to see that faceplate is centered over stoma. 3. Plan to change your appliance early in the morning, before breakfast. You 4. On change days, take a tub bath or shower with your appliance off. Wash the stoma gently with warm water and soap. Other days, bathe or shower with your appliance on. 5. If your skin becomes red and sore:
6. Empty urine from bag frequently. The weight of accumulated urine will pull the appliance off. 7. You must drink 2 to 3 quarts of liquids every day. 8. Connect appliance to drainage when sleeping. 9. If your urine has a strong odor:
10. With your doctor's permission, resume any activity you participated in °Copyright 2006 BHUROLOGY.com |
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