Welcome to my 7th episode of the #UnderstandingUrostomies series all about urostomy and using a Night drainage system.
I have noticed that not everybody with a urostomy will use a night drainage system at night. In this post, I will explain a bit more about the different types of night drainage systems available and cover some hints and tips.
So...why use a night drainage system?
With a urostomy there is an option at night, lying flat for long periods of time or wheelchair users in the daytime, to increase the capacity by adding a night drainage system. This helps avoid getting up to empty the pouch and allows uninterrupted sleep.
Gravity drains the urine to a bedside container. This keeps your pouch from getting so full and heavy that it pulls away from your body. It also protects your stoma and skin against the build-up of strong urine. Do not be alarmed if you see threads of mucous in the night bag, If you have an ileal conduit this will be due to the mucous secreted as lubrication by the bit of bowel used as the conduit.
How does the night drainage system work?
At night the bottom of the pouch can be connected via the tap to a night drainage system which carries urine away from the stoma while you sleep. A non-return valve prevents the reflux of urine. This lets you sleep undisturbed due to gravity draining the urine to a bedside container or bag. It also helps protect your stoma and skin against the build-up of strong urine and mucus.
Different types of Night Drainage Systems
There are several types of night drainage systems. Whatever type you choose, you need to set up the system before attaching to your urostomy pouch. These are:
- NIGHT BAGS - Usually hold a 2-litre capacity. However, I have found that it can never fill up this much due to an air bubble. Therefore I make sure that it does not fill more than 1500ml. Night bags can come as a single use or re-usable. They are usually held in a position away from the body on either a floor stand or a hanger which hooks onto the bed or left loose in a basin or small waste bin. Flatpack night drainage stand is ideal for travelling.
- NIGHT CONTAINERS or BOTTLES - Again they hold a 2-litre capacity. They are usually made of translucent plastic.
- U-DRAIN is a fairly new concept and replaces the need to use night drainage bags and bottles. U-drain is permanently fitted into the bedroom and consists of an internal wall socket next to the bed which is connected to the house drainage system. The urostomy is connected to the wall socket by a tube and the urine flows into this. Once disconnected in the morning it is flushed with water and disinfectant by a syringe. The connection tube needs to be changed at regular intervals to keep bacteria at a minimum. The system incorporates a one-way valve to eliminate odours and stop back-flow. In a few weeks, I will write a blog post interviewing the founder of u-drain and why he set up this system.
Night bags are probably the most common to be used. In most cases, a connector is attached to the night bag tubing which allows different manufacturers of pouches and night bags to fit together. I know that Respond does a Urostomy pouch and a night bag that attaches perfectly without a connector but generally in most cases it is advisable to use one that comes with your pouches if you use different night bag products. Quite a lot of urostomates prefer different manufacturers for the different items so the connectors are brilliant for this.
So, what do I use?
In my case, I use a E4 Careline Night bag which I attach to a nightstand. When I am in the hospital which is frequent for me I usually have it on a hook.
For my urostomy pouch, I use the SenSura Mio 1 piece urostomy convex pouch. The connector comes with the pouches and fits perfect to my ConvaTec careline E4 bag. The cap goes over the connector with no problems when it is not in use.
I try to make sure my bag is halfway down the bed on the floor. I have had a Supra-pubic Catheter for 7 years so I am used to being restricted in bed.
How often should the night bag be changed?
After extensive research recommendations by the Medicines and Healthcare Products Regulatory Agency (MHPRA) are for manufacturers to state that the use of drainable night bags should be changed 5 days to 7 days being regarded as maximum. The question is not whether a bag looks fine and continues to function but the likelihood of the bag being colonised by bacteria including E-coli which will not be removed after rinsing even with household disinfectants. If the container and tubing start to look cloudy or changes colour then you should change the bag sooner.
Should I clean the night bag?
It is advised that the night bag should be cleaned daily if it is not 'single' use only. This can be with a solution of 1 part vinegar to 3 parts water flushed through the tube into the night bag. You can open the tap and release the contents straight away but generally letting it sit for an hour is better practice. Then hang up the drainage tubing so it can air dry. A cap should then be put over the tubing or connector but If this doesn't fit I actually put a disposable latex glove over it instead.
As stated above that using just water itself is also ok because household disinfectants will not remove the E-coli.
Hints and tips
I think that over time it is about learning what works for you and what is most comfortable. I have learnt through observing on the Urostomy Awareness Facebook Group that it is very much your own preference. Here are a few tips that I have learnt or heard along the way using my night bag:
- Sometimes urine may not drain due to an airlock. To avoid this when you connect your urostomy pouch to the night bag leave about a third of urine still in the pouch. When you connect up do squeeze the pouch to establish the urine to flow into the night bag and help to prevent airlock and vacuums.
- It is advised to keep the tubing and night drainage below the level of the pouch when sleeping. Personally, I tend to connect up when I am in bed. I also make sure that my night bag is positioned on the stand half-way down the bed. The tube MUST NOT go 'uphill' because gravity is needed for the urine to flow.
- Some two-piece pouches will allow you to turn the pouch 90 degrees to the body. This eliminates any possibility of the tube getting tangled with the legs as the tube remains far away at mid-body level.
- If you have trouble with the wrong connectors then you can put the tube in hot water before to make it soft and add the connector to it.
- To avoid twisting at night whilst sleeping some urostomates wear an anti-twist strap that fastens the tube of the bag to the leg. Also, some manufacturers have extended tubing to enable more movement and anti-kink tubing.I believe that Coloplast you can connect 2 tubes together so the reach is longer.
- If the urine fails to drain and the bag shrivels up causing a vacuum I disconnect, straighten the tube then reconnect back up and that usually works. Picture below of what I mean
- I do however have the occasional accidents and find mattress protectors are a godsend and I actually have a set of 3.
- A night bag in the car for emergencies can save all sorts of embarrassment if stuck in traffic jams.
- When travelling long distances a leg bag can be attached to the pouch to add capacity and security
- When you get admitted to hospital remember to bring the connectors with you. THIS IS REALLY IMPORTANT It is very hard to find your specific connector when in the hospital and the lack of awareness from the nursing staff can add to this.
Can I sleep without the night bag?
Although not advisable it is possible but the pouch will need to be emptied at least twice during the night. Some people do prefer to do this instead of being tied to the side of the bed and restricted. However, you may have to wake up at night but that depends on how much you drink and your output. Personally, I have a huge amount of output and prefer the safety of the night bag. I also have to get up a few times at night to empty my ileostomy but I find connecting up puts my mind at rest.
As you can see it boils down to your personal preference and whether you put having an undisturbed sleep over having freedom when sleeping. However, I feel I need to mention that the only medical reason I can think of to use a night drainage system is backflow to the conduit and kidneys which can be uncomfortable and painful but more importantly over time could cause kidney damage. I guess it is about finding what works for you and getting used to a change in sleeping habit. My next post will talk about sleeping positions and how we had to adapt after surgery!
Thank you for reading this post I hope you find it helpful. I would love to hear from you :)