About the author
My name is Michaela Parker. I’ve been a stoma care nurse for around 20 years, including with the Nottingham Appliance Management Service (NAMS). I have lots of experience of urology and colorectal nursing, supporting people in both hospital and community settings.
Managing night drainage: your questions answered
Getting a good night’s sleep is so important, but for people living with a urostomy this is not always straightforward due to issues around obtaining smooth drainage. There’s also the worry of potential leaks at night.
Drawing on my professional experience, and with input from my colleagues, this article addresses urostomates’ most frequently asked questions, based on latest guidelines.
What is a night drainage system?
For most people with a urostomy, relying on just their bag to collect urine throughout the night is not enough. Using a larger system to collect drainage is also encouraged to prevent urine collecting in the bag. This also prevents urine building up as you sleep and causing pressure that can result in a leak. It’s also good practice to allow free drainage of urine to prevent any build-up close to your urostomy, reducing risk of infection.
Night drainage systems are an integral part of your stoma supplies and can be obtained in the same way. When you’re ready for discharge from hospital, your nurse specialist will usually recommend the right system for you. But as time progresses you may become aware of alternatives you’d like to try, such as those you’ve seen at product open days or on social media. In this case, you should talk to your stoma care nurse as there may be product compatibility issues that need to be discussed.
How do I set up the system?
Setting up and using a night bag system is relatively straightforward. Each night, at the time that suits you, push or clip the drainage tube into place. Each morning, or whenever is convenient, disconnect the tube, empty it into the toilet and rinse it through with hot water.
Drain any water over a sink or bath and then dry all connections. Cover the connection end with a protective cap (there’s usually one on all new night drainage systems – so save it), or clean it with piece of tissue or gauze. Store in a clean place, on the stand, until you need it again.
Night drainage systems have a connector at the end for attaching to your urostomy bag. Some have what is called a ‘universal connector’ that is cone shaped for pushing into your pouch if it has a bung or soft outlet. The connector may have little ridges along it to encourage a stronger connection with the tube and bag.
Some night drainage systems have a connector with a clip mechanism, usually specifically designed by each manufacturer, to be used with a pouch that has a hard tap. As a result, this clip mechanism can only be used with certain pouches.
How often should I change my system?
My colleagues and I see such variance in how often people change their system – from every night, to once every two weeks, right through to being led by the odour from the tubing and pouch.
In our professional opinion, you should change your night drainage system twice a week. However, everyone’s clinical circ*mstances are different. So, if you’re unsure, do seek advice from your stoma care nurse.
The tube feels too short – what can I do?
People with a urostomy often say that wearing a night drainage system can feel strange at first. Most either get used to it in time or simply choose not to use one, getting up in the night to empty their bag instead.
Most night drainage systems have tubing that measures approximately 100-120cms. Factors such as the height and shape of your bed will influence how much tubing is free for comfort and movement.
Nightstands are available – free of charge – from delivery companies, or you can buy yours online. They are a good piece of kit to assist with supporting the tube and the bag as it fills. Having the stand closer to you can prevent your tube feeling restricted. Using a nightstand that attaches to the side of your bed, or that’s supported by the weight of your mattress, may allow for a little more tube length. Talk to your stoma nurse or delivery company about the various options available.
How can I get comfortable enough to sleep?
It’s common for people to feel caught up in the tubing as they move around in their sleep. We’ve already looked at the placement of the bag, but it’s also important to consider placement of the tubing. Trying to ensure a free-flowing, kink-free tube can be a challenge in itself!
Tubing that lies in between your legs and feeds behind often allows for a better flow. The urostomy bag tends to lay in a more natural position and, tethered by your knees closing together, the tubing is less likely to kink. If the feeling of the tubing against your leg is uncomfortable, try wrapping it in soft or quilted fabric to help reduce this.
You may also like to use a leg strap, or leg sleeve. Leg straps wrap around your leg and secure with a Velcro-type material. The device then allows for the night drainage tubing to be secured to the strap, keeping it straight and closer to your body.
A leg sleeve is a short piece of elasticated, circular material that you pull onto your leg and wear at the point where the tubing is to be secured. Most people wear it on their thigh. The night drainage tubing is then fed down behind the material and kept in place next to your leg.
These straps and sleeves can be obtained as part of your prescription or bought from medical suppliers.
What can I do to avoid night-time leakage?
Night leakage can happen for a number of reasons. Check that the connections on your night drainage system are secure. Systems with a specific connector usually ‘click’ into place. Universal connectors should be pushed securely into place so they don’t fall away easily – some force should be required to connect and disconnect them.
Leakage can also occur if your flow of urine is blocked and so ‘back flows’ into the bag, causing pressure and forcing the bag to leak. To prevent your bag from bending and the night tubing from kinking, refer to the tips suggested above.
Some urostomates report that they forget to close the outlet at the bottom of the night drainage system before resting for the night, or ‘catch’ the outlet (perhaps in the middle of the night without the light on), causing it to open. Of course, this can result in many hours’ leakage onto carpet or furniture. Get into the habit of checking connections before settling down for the night. And it’s a good idea to place the stand in a plastic tray, bin or box – in the event of leakage, all is then contained!
I get ‘vacuuming’ with my bag – what can I do to stop this?
The most effective way to prevent this is to connect to night drainage when there is still some urine in your urostomy bag, so don’t drain it all out. Urine will drain into the night bag and remove any vacuum.
Another tip is to keep the whole system flowing downwards once it’s all connected, and wherever possible, lower than your urostomy bag.
What’s the best way to clean my night bag?
There are no hard and fast rules on this, so it’s best to speak to your stoma specialist. However, as a minimum, hot tap water is good enough for rinsing through the system, to help flush any residue. Some people use a little liquid soap or even go as far as using a small amount of disinfecting solution, but this isn’t essential.
Be sure to drain away cleaning fluid rather than leaving your bag to soak. A warm, moist environment is an ideal place for bugs to develop! Wipe dry any exposed areas, such as outlets, and cover with clean gauze or tissue.
How can I avoid bacteria passing from my night bag to my urostomy bag?
Night drainage systems usually have a barely visible one-way valve system within the bag, which helps prevent backflow of urine. However, it’s important to be aware bacteria may be present and colonising along any part of the urinary pathway. This could occur from the night drainage system right up to the kidney, so good hygiene during every aspect of urostomy care is vital.
- Change your pouch regularly to help reduce mucous build-up near your urostomy, or within the tubing or drainage system.
- Wash your hands thoroughly before and after emptying, or changing, your bag or night drainage system.
- Change your bag and drainage system regularly, in accordance with advice from your stoma nurse. Doing this, rather than waiting until you notice odour from your urine or drainage system, is really important in preventing infection.
Following the advice here should help you stay healthy and feel as comfortable as possible at night, but always speak to your stoma care professional if you have any concerns.
