As I mentioned in Part 1 of this series, I have an ileostomy. So this article, like the colostomy piece, comes from research rather than personal experience. Urostomies are genuinely underrepresented, even within the ostomy community. I've come across people with urostomies on Instagram, and I suspect many of them face the same challenge of not finding others who truly understand what they're dealing with. Writing this one has also been teaching me. If you have a urostomy, I hope it helps you feel a little less invisible here.
What is a Urostomy?
A urostomy is a surgical opening that diverts urine away from a damaged or removed bladder. Unlike an ileostomy or colostomy, it has nothing to do with stool. The bladder is bypassed entirely, and urine exits the body through a stoma on the abdomen into a pouch worn on the outside.
The most common reasons someone gets a urostomy are bladder cancer, bladder dysfunction, birth defects affecting the urinary tract, trauma, radiation damage, and certain neurological conditions. Most urostomies are permanent, because they're typically done when the bladder can no longer function or has been removed.
The Ileal Conduit: How It Actually Works
The most common type of urostomy is called an ileal conduit. The name sounds complicated, but the idea is fairly straightforward. A short segment of the small intestine is disconnected from digestion entirely and repurposed as a tube (the "conduit"). The two ureters, which normally carry urine from the kidneys to the bladder, are connected to one end of this segment. The other end is brought through the abdomen to create the stoma.
The bowel segment isn't doing any digesting anymore. It's purely acting as a passage for urine to travel from the kidneys to the outside. Because it's still a piece of bowel tissue, it continues to produce small amounts of mucus. This can be alarming when you first notice it in the pouch, but it's completely normal and just means the conduit is working as it should.
Mucus in a urostomy pouch is expected and normal. It comes from the bowel tissue used to create the conduit, and it is not a sign of infection.
Output Is Continuous
This is where a urostomy is fundamentally different from a bowel ostomy. Your kidneys produce urine continuously, so the output never stops. There's no voluntary control and no timing output around meals or activity the way some people with bowel ostomies learn to do. The pouch needs to be emptied regularly throughout the day, usually every two to four hours.
Urostomy pouches are designed specifically for this. They have a drain valve at the bottom that opens to empty, which is different from drainable stool pouches that open at the top. There's also an anti-reflux valve built into the bag that prevents urine from flowing back toward the stoma when you move around.
Overnight is where things get practical. Most people connect their urostomy pouch to a larger drainage bag via a tube before bed so they don't have to wake up to empty during the night. It becomes part of the routine, and most people set it up without thinking much about it after a while.
Skin Care: A Different Challenge
With an ileostomy, the main skin challenge comes from digestive enzymes in the output. With a urostomy, it's a different problem. Urine is alkaline, and over time, alkaline urine can cause crystals to form around the stoma and degrade the adhesive seal on the pouching system. You might notice a white, gritty buildup around the stoma if this is happening.
Keeping urine more acidic helps prevent this. Vitamin C supplementation and cranberry products are commonly used for this reason. Staying well hydrated also matters, since diluted urine is less likely to cause crystal buildup and irritation around the stoma.
Monitoring your urine is something urostomates learn to do. Cloudiness, a stronger smell than usual, or an unexpected change in colour can be signs of a urinary tract infection. (Foods like beets and asparagus do change urine colour and smell, but that's completely harmless.) UTI risk is elevated with a urostomy because the bladder's natural defence mechanisms are no longer in place, so knowing what your normal looks like makes it easier to catch changes early.
Knowing your own normal is one of the most useful things you can do. Urine colour, clarity, and smell are your early warning system.
Diet and Daily Life
One thing that's genuinely different compared to bowel ostomies is that diet doesn't have a major impact on urostomy output. You don't need to manage blockage risk or think about how specific foods affect output consistency the way ileostomy or colostomy users do. The main dietary focus is staying hydrated, which helps dilute urine and reduces the risk of crystal buildup and infection.
People with urostomies swim, travel, stay active, and get on with their lives, with some adjustments. Waterproof pouching systems exist. Swimwear options work the same way they do for other ostomy types. Travel requires planning for bag changes and figuring out the nighttime drainage setup in a new environment, and those things become routine over time.
If you have a urostomy, you're part of a community that is smaller and harder to find than the ileostomy or colostomy communities, but it exists. Young people with urostomies are out there. I hope this becomes one of the places you find them.
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