May 2009
Page 5
Urine Salt Crystal Deposits
By Linda Saunders, CWOCN
Urine salt crystal buildup around urinary stomas is one of the most difficult skin care problems I find with
people who have urostomies. Urine secretes a certain amount of salt, but whether the urine is acid or alkaline determines the amount secreted. An alkaline-based urine secrets more salt than an acid-based urine; thus, we have more salt-crystal-buildup when we have an alkaline urine.
How can you tell if you have urine crystals? First, they can be seen as a growth, white or light brown in color, around the base of the stoma. The stoma and the area, which the growth involves, are very likely to be tender and sore. Sometimes the stoma will be completely covered by the crystals and can no longer be seen.
What are some of the underlying factors, which cause urine crystals, other than alkaline urine? In my opinion - with most patients I have seen with this problem - two factors are usually dominant. The stoma opening in the skin barrier in all cases was too large, and these patients were wearing a pouching system designed primarily for a fecal ostomy. These two aspects may not always stand true, but in those cases I have seen, these two factors were present. Other aspects include those patients who do not use a night drainage system, thus allowing urine to remain in the pouch while they slept. This practice continually baths the stoma with urine at night.
Moreover, personal hygiene - not only on the skin area around the stoma but the cleaning and proper care of the pouching system - was performed poorly. Our next question must be what to do in case one has a urine-crystal-buildup problem. I will list these
solutions in steps:
- Determine the circumference of your stoma and cut your skin barrier to the correct size; i.e. not so big as to allow your peristomal skin to show, and not so small as to more than just "brush" the stoma.
- Change your pouching system twice a week at least. It is surprising how many people only change their skin barrier when it starts to leak. The goal is to change it before it leaks.
- Every time you change your skin barrier, bath your stoma with a vinegar and water solution. Use one-part vinegar to three parts water. Bathe the stoma for several minutes with a cloth. This solutions may be used between changes by inserting some of this vinegar solution in the bottom of your pouch - a syringe may be used for this - and then lying down for about 20 minutes to let the solution bathe the stoma.
- To keep control of the situation, change the alkaline urine to acid urine. The easiest and most successful way is by taking Vitamin C orally. The dosage will depend on your age, but the normal adult dosage is 250 mg four times daily. Be sure to consult your physician before taking oral medications.
If you follow these procedures, you should have no further concerns regarding a urine-crystal-buildup. However, if you do begin to see them again,
take action immediately before trouble starts.
SOURCE: The New Outlook on-line, UOA Chicago, April 2008, via Inside Out On-line May/09.
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