A urostomy is a surgery that creates a new path for urine to leave your body through an opening in your abdomen, bypassing the bladder entirely. It’s most commonly performed when the bladder needs to be removed due to cancer, though other conditions can require it too. The opening on your skin is called a stoma, and urine drains through it into a small pouch you wear on the outside of your body.
How a Urostomy Works
During the most common type of urostomy, called an ileal conduit, a surgeon removes a short segment of your small intestine (about 15 cm from the lower end, called the ileum) and fashions it into a tube. The remaining intestine is reconnected so your digestive system continues working normally. Your ureters, the tubes that carry urine from your kidneys to your bladder, are detached from the bladder and connected to this new intestinal tube instead.
The far end of that tube is brought through your abdominal wall to create the stoma. Urine flows continuously from your kidneys, through your ureters, into the intestinal tube, and out through the stoma into a collection pouch. You don’t control when urine comes out. There’s no sensation or muscle to hold it back, so the pouch collects it around the clock.
Why People Need a Urostomy
Bladder cancer is the most common reason. When the cancer requires removal of the entire bladder, the urine still needs somewhere to go. During that same surgery, other nearby structures may also be removed, including lymph nodes, the appendix, and in some cases reproductive organs like the prostate or uterus.
Other reasons include severe bladder damage from radiation therapy, chronic inflammatory conditions affecting the bladder, birth defects in the urinary system, and neurological conditions that leave the bladder unable to function.
Other Types of Urinary Diversion
The ileal conduit is the most common approach, but it isn’t the only one. Two alternatives avoid the need for an external pouch.
- Indiana pouch: A surgeon creates an internal reservoir from portions of your intestine and connects it to a small stoma, often at the belly button. A surgically created valve keeps urine inside the pouch. You drain it yourself by inserting a thin catheter into the stoma every four hours or so. No external bag is needed.
- Neobladder: A new bladder is constructed from a section of small intestine and connected to your urethra, the natural exit point. You urinate by tightening your abdominal muscles. Some people find they can’t fully empty the neobladder this way and need to use a catheter several times a day.
Not everyone is a candidate for these alternatives. Your surgeon will recommend the best option based on the reason for surgery, your anatomy, and your overall health.
What a Healthy Stoma Looks Like
A healthy stoma is pinkish-red and moist, similar to the inside of your cheek. It sticks out slightly from the skin surface. This raised shape is intentional: it helps urine drain cleanly into the pouch and protects the surrounding skin from constant contact with urine, which can cause irritation over time.
The stoma has no nerve endings, so touching it doesn’t hurt. It may bleed slightly when cleaned, which is normal. What you’re watching for are color changes (a stoma turning dark or pale can signal a problem) and changes in size or shape, which are common in the first weeks after surgery as swelling goes down.
Pouching Systems and Daily Management
A urostomy pouching system has two main parts: a wafer (also called a baseplate or skin barrier) that sticks to your skin around the stoma, and a pouch that collects the urine. You can choose between a one-piece system where the wafer and pouch are permanently attached, or a two-piece system where they snap apart so you can replace the pouch without removing the wafer from your skin.
Most pouches have a drain valve at the bottom that you open to empty urine into the toilet. You’ll empty the pouch several times a day. At night, you can connect a larger drainage bag to the bottom of the pouch using an adaptor, so you don’t need to wake up to empty it. If the tubing tends to come loose while you sleep, taping the connections or using a leg stabilizer helps keep everything secure.
Several accessories can make the system more comfortable and reliable. A barrier ring or protective seal fits around the base of the stoma to improve the wafer’s fit and prevent leaks. Elastic barrier strips hold the wafer in place and add waterproofing. An ostomy belt wraps around your waist for extra security. Many people also keep a small emergency kit with a pre-cut wafer, a spare pouch, and gauze pads in their bag or car.
Skin Care Around the Stoma
Skin irritation around the stoma is one of the most common challenges. Across all types of stomas, peristomal skin complications have been reported in up to 43% of patients. Urine is particularly irritating to skin, which is why the stoma is designed to protrude slightly, directing flow into the pouch rather than letting it pool against your abdomen.
Keeping the skin clean and dry when you change the wafer is key. If the wafer opening is too large, exposed skin will come into contact with urine. If it’s too small, it can put pressure on the stoma. Getting the right fit takes some practice in the early weeks, and a stoma care nurse can help you find the right size as your stoma settles into its permanent shape.
Long-Term Health Monitoring
Living with an ileal conduit is safe and manageable, but it does require ongoing medical follow-up, particularly for kidney health. A long-term study tracking patients over a median of about eight years found that 66% experienced at least one conduit-related complication over time. The most frequent issues involved changes in kidney function (27% of patients), stoma-related problems (24%), bowel issues (24%), and urinary tract infections including kidney infections (23%).
These complications tend to accumulate with time. Within the first five years, about 45% of patients experienced a complication. Among those who lived 15 years or longer with their conduit, that number rose to 94%, with half showing upper urinary tract changes and 38% developing urinary stones. This doesn’t mean the surgery fails. It means that regular monitoring of your kidneys through imaging and blood work remains important for as long as you have the conduit.
Diet and Hydration
You should aim for at least 8 cups (64 ounces or 2 liters) of fluid daily, and more if your output is high, if you’re exercising, or in hot weather. Staying well-hydrated keeps urine dilute, which reduces odor and lowers the risk of urinary stones.
Eating smaller, more frequent meals (four to six per day) on a regular schedule helps your body absorb nutrients well and reduces gas. Chew food thoroughly, as poorly chewed food can occasionally cause issues at the stoma site. When trying new foods, introduce them one at a time so you can identify anything that causes unwanted effects like excess gas or strong odor. If a food seems problematic, skip it for a couple of weeks and then try again.
Certain foods can help manage urine odor naturally. Cranberry juice, buttermilk, yogurt with active cultures, kefir, and parsley are all worth incorporating into your regular diet. Taking only sips of fluid while eating and then waiting 30 minutes after the meal before drinking more freely can also help with digestion.
Exercise, Swimming, and Staying Active
Most people can return to their usual physical activities after recovery. Swimming is entirely possible with a urostomy. You’ll typically be advised to wait about six weeks after surgery and to make sure any wounds are fully healed and dry before getting in the water.
Before swimming, empty your pouch completely so it lies flat and is less noticeable under a swimsuit. The seal on a modern pouching system holds up well in water. If you’re nervous, test it first by lying in a full bathtub to confirm the seal stays snug. After swimming, towel-dry the pouch or change it if you prefer.
For discretion, women often find that patterned swimsuits or high-waisted styles help conceal the pouch outline. Some wear a sarong or beach wrap for extra coverage. Men can wear Lycra cycling shorts under swim trunks, which sit a bit higher on the waist and hold the pouch securely in place. A stoma guard, which fits over the pouch and stoma, can provide extra protection during contact sports or more vigorous exercise.