What to expect after surgery: the early days
Preparing for urostomy surgery can feel daunting and it’s only natural to have lots of questions, including about what to expect when you first wake up with your stoma. Check out this FAQ guide to help you prepare for the early days after your operation.
After your surgery, you will wake up in the recovery room, where a nurse will look after you until you’re ready to go back to the ward.
Everyone is different and you may wake up in the intensive care (ICU) or high dependency unit (HDU) after your operation. This is so your doctors can keep a closer eye on you. This may happen if:
* your operation took longer than planned
* your operation was more complicated than expected
* you have other health conditions
You usually move back to the ward within a day or so.
When you wake from surgery, you will have various tubes attached to your body; this is quite normal.
As well as cannulas for a drip and wound drain, you will have ureteric ‘stents’. These are thin tubes that drain the urine from your ureters into your urostomy bag. The purpose of the stents is to protect the newly formed join where the ureters meet the piece of small bowel your stoma is made from. Once the initial post-operative swelling has started to reduce, the stents may fall out by themselves, or your stoma care nurse will gently remove them.
Looking after your urostomy can be a bit fiddly until this time. Things should get easier once the stents have been removed.
Your urostomy will work as soon as it is formed, and you will notice that you have no control over – or sensation – when you pass urine into your urostomy bag.
Initially, your wee may have a red colour to it. Don’t be alarmed by this – it will quickly return to its normal appearance. You may also notice some mucus in your urine or around your stoma, which is also normal.
Most people who have urostomy surgery stay in hospital for 10 to 14 days. If you have minimally invasive (robotic) surgery, you may need to spend less time in hospital.
After your operation, you will need medicines to manage any pain for a few days.
To begin with, you may be given painkillers into a vein using an electronic pump. You will have a hand control to press when you need more of the painkiller.
Some people are given painkillers into their back (an epidural). The drugs numb the nerves in the area where you had the operation to control your pain. You usually have them through a drip attached to an electronic pump.
Sometimes during the operation, the surgeon puts small tubes into the area around the wound. Your doctor or nurse uses these tubes to give you painkillers. This helps to numb the nerves in the same way as an epidural.
If you are in pain, tell your nurse or doctor straight away.
You will be given painkillers to take home with you.
After waking from your operation, your nurse will offer you sips of water. You can gradually drink more and then try eating a light diet.
Most new urostomates find that they can get back to normal eating and drinking within a few days.
The nurses will encourage you to start moving about as soon as possible after your operation. This helps to prevent problems such as chest infections or blood clots. They will encourage you to do regular leg movements and deep breathing exercises. A physiotherapist or nurse can explain these to you.
You will have dressings over your wounds. After a couple of days, your nurse will change them and clean your wounds.
Your wounds will have stitches or clips. The stitches are usually dissolvable so won’t need removing. The clips are not dissolvable and stay in for 10 days. A nurse will take them out for you at home or you might need to go back to hospital to have this done.
Your nurse will give you information about how to care for your wounds at home.
Wound infections can be a complication of the surgery. Signs of infection include:
* heat
* redness
* swelling
* fluid or pus coming from the wound
* feeling unwell
* a fever or high temperature.
Tell your nurse or doctor if you have any of these symptoms, even after you go home. If you are unable to talk to your hospital team, contact your GP.
Your urostomy should stand out slightly, like a small spout. However, it can be flat to your abdomen. It will be soft to touch, pink-red in colour and moist, rather like the inside of your mouth. There is no nerve supply to your stoma, so it will not feel painful.
At first, your urostomy is likely to be swollen, but over the following weeks it will gradually reduce in size.
Since you will no longer have a bladder, your wee will drain continuously into a waterproof urostomy bag you stick over your stoma. Your stoma nurse will show you or your carer how to empty and change it so that you feel confident doing this before you go home.
Changes in your poo – You may experience a temporary change in your bowel movements following surgery. This is completely normal as part of your small bowel has been used to create your urostomy. Also, you are likely to have changed your usual pattern of eating and drinking around the time of your operation.
As your bowels start to settle, you may experience diarrhoea or constipation for a while, but this will pass and gradually things return to normal. Tell your doctor or specialist nurse if it continues, as there are medications which can sometimes help to settle things down.
Urinary tract infections (UTIs) – As a urostomate, you will be at higher risk of having recurrent urinary tract infections (UTIs). It is important that you are aware of the signs and symptoms, so do read our managing and preventing UTIs information page and see the recording of our webinar on the topic.
Parastomal hernias – Urostomates can be prone to developing parastomal hernias, where a lump or swelling develops under or around the stoma. Our Help for hernias blog contains advice on how to avoid parastomal hernias and what to do if you develop one. You can also see a recording of our webinar on the topic.
Whilst in hospital and for a while when you are home, when you cough or sneeze, hold a pillow or folded towel firmly on your abdomen over your stoma to minimise the strain placed on this area. Your nurse should show you how to do this.
It is normal to feel very tired in the weeks following surgery and that everyday activities such as showering sap your energy. Be gentle on yourself and remember that, because you have undergone major surgery, your body will take time to heal and adjust. Minimise lifting anything over a couple of kilograms for at least six weeks and gradually increase your threshold over the following weeks.
Recovery time can vary from person to person and depends on several factors, including your overall health, the reason for your urostomy, the type of operation (open or robotic), and any complications that may arise. The good news is that most people find they can resume many normal activities within a few months after their operation, but it can take much longer than this for your body to fully heal.
Showering – The nursing staff can help guide you with showering and washing, and will be there to assist if need be. Take a shower every day, if you can, to clean your wound. If you have staples or stitches, it’s okay to get them wet.
The nursing staff will advise you on care of the wound and whether the type of dressing/bandage can get wet during showering. Do not take a bath for the first four weeks after your surgery.
Eating and drinking – You can eat all the foods you did before your surgery, unless your doctor or nurse gives you other instructions.
It’s very important to stay well hydrated by drinking plenty of water. You should drink enough so that your wee is very light yellow or clear. If it becomes dark yellow, you need to drink more.
Your surgeon and your stoma nurse will tell you how soon you can get back to doing things such as work, driving, shopping, gardening or playing sport. This will depend on the type of surgery you had and how your recovery is going. It is important not to drive earlier than you are advised as this can invalidate your insurance, or you may injure yourself or someone else.
Before you leave hospital, you will be given an outpatient appointment for a follow-up visit a few weeks after your surgery. It is a good time to discuss any concerns you may have after your operation. Your doctor will tell you if you need any further treatment.
Your consultant, GP and stoma care nurse can provide guidance to help you recover from surgery and keep well.
Please remember that the Urostomy Association is here for you, your family and your carers, too. Our trained one-to-one support volunteers all live with a urinary diversion so understand from their own experience what you might be going through. They provide support over the telephone, or in person where possible. If you would like us to link you up with a volunteer in your local area, please get in touch.
Continue to explore our website and you’ll find advice covering all aspects of living with a urostomy, from managing night drainage to travelling with confidence, plus inspirational real-life stories.
You can also join our private Facebook group where members find it helpful to post queries. Usually there is someone who has experienced the question asked and can offer informal suggestions.
If you have any questions, then do not hesitate to get in touch via our helpline on 01223 910854 or via our contact us facility.