From Stillwater-Ponca City (OK) Ostomy Outlook April 1997:

Urine Salt Crystal Deposits

Urine salt crystal buildup around urinary stomas is one of the most difficult skin care problems I find with urostomates. Urine secretes a certain amount of salt, but whether the urine is acid or alkaline determines the amount secreted. An alkaline-based urine secretes 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 is 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, and with most patients I have seen with this problem, two factors are usually dominant. The stoma opening in the appliance in all cases has been too large, and these patients were wearing a rubber-type appliance. These two aspects may not always stand true, but in those cases I have seen, these two factors were present. Another aspect is that some of these patients did not use a night drainage system, thus allowing urine to remain in the appliance while they slept, continually bathing the stoma with urine; also, personal hygiene, not only of the skin area around the stoma, but the cleaning and proper care of the appliance was poorly done.

Our next question must be what to do in case you have a urine crystal buildup problem. I will list these solutions in steps:

• Determine the circumference of the stoma and purchase a new faceplate or appliance (preferably semi-disposable). The appliance should be changed every two or three days.

• Every time the appliance is changed, a vinegar and water solution should be used to bathe the stoma. Use one part vinegar to three parts water. Bathe for several minutes with a cloth. This solution may be used between changes by inserting some in the bottom of the appliance (a syringe may be used for this) and lying down for about 20 minutes to let the solution bathe the stoma.

• To keep control of the situation, change the alkaline urine to an acid urine. The easiest and most successful way is by taking ascorbic acid (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 medication.

• If you can follow these procedures, you should have no further problem with urine crystal buildup. However, if you do begin to see them again, take action immediately before trouble starts.