Controlling Alkaline Urine
Issue One


"It only takes 20 to 30 minutes for the bacteria to double its count in the pouch!"


"6.5 pH alkaline level is above normal"

"This alkaline condition may indicate a urinary infection"

Odorous urine is usually caused by a high alkaline condition, which is frequently associated with bacteria in the urine. Irrigation of the pouch with a solution of vinegar and water will help, but will not correct the alkaline urine coming from the stoma. The higher the alkaline condition of the urine, the more likely the urine will have a strong odor and that bacteria will be present. Incidentally, it only takes 20 to 30 minutes for bacteria present to double it’s count in the pouch.

Indicators of alkaline urine

Usually the urine has a darker yellow color. Sometimes calcium deposits can be seen on the appliance, stoma or the peristomal skin.

Additional problems:

  1. Irritated skin pebbled with what appears to be tiny warts (pseudoverrucous hyperplasia lesions)
  2. Closing (stenosis or stricture)of the stoma opening
  3. Tendency of the stoma to bleed easily
  4. Calcium deposits that collect inside the appliance opposite the opening (these deposits can scratch and cause the stoma to bleed)

How to test urine for alkaline level

One of the easiest ways to do this is with Nitrazine paper.  If you do not already have a Nitrazine Test Packet, you can obtain this item from your medical supply pharmacy.  One packet will last for about 2 years.  The paper is best stored in a dry place, (not in the bathroom or where there may be high humidity).

Step One

Take a fresh sample of the urine

The best way is to do this is when you change your pouch and the pouch is off. Lean over and let a drop of urine drip onto a small strip (1 ½"- 2") of nitrazine paper. Do not let the nitrazine paper touch the stoma and do not use urine that has been in the pouch, as they will give false readings. An alternate method is to let a little urine drip into a clean dry container and dip the end of the paper into the urine. Shake off any excess urine and immediately compare the paper to the color chart on the packet.

Step Two

Compare this color immediately against the Color Scale on the Paper Dispenser. Avoid color comparison in fluorescent light. Use daylight or incandescent light.

When the color of your urine test sample corresponds to the purple-blue end of the color scale (above 6.5pH), the alkaline level is above normal. This alkaline condition may indicate a urinary infection. It is important to check with your doctor. It may very often be only a simple matter of body chemistry that is easily corrected by a change in diet or an antibiotic prescribed by your doctor

Tips for good body chemistry

If the urine test shows too much alkaline or too much acid, the first step to usually correct the problem is to increase your water intake. If you are not on fluid restrictions by your physician, you should drink six-to-eight, 8 oz glasses of water daily. A good practice is to drink one glass over the period of one hour, and continue until you feel hydrated (no dry lips or eyes) Then, continue to drink one glass over the period of two to three hours, depending on how hydrated you feel. Another good way to tell if you need more water is when you have dark-colored urine. On the other hand, very light colored or colorless urine may mean that you are over-hydrating by drinking too much water. In addition, introducing some cranberry, plum or prune juices to your diet (10 ounces daily) may help to decrease high alkaline urine readings. Most other fluids and juices cause an alkaline urine response.

Note: Check the juice labels. Frequently the contents do not contain what the front labels state and have more juice or sweeteners than the declared values. Fruit juice can be high in calories/carbohydrates and can contribute to weight gain. They can be diluted to one part juice and one part water. Also, too much prune juice has a laxative effect.

Taking Vitamin C (ascorbic acid), may help decrease the alkalinity of the urine. The dose should be based on your pH level. Try to keep the reading on the nitrazine paper close to the ideal 6.0, (between 5.5 and 6.5). Below 5.5 means too much acid. This means you are taking too much Vitamin C. Above 6.5 means too much alkaline, and you may need more Vitamin C in your diet. Try doses of 250 mg. of Vitamin C. three times a day (morning, mid-day and evening) or 500mg twice a day, (a.m. & p.m.). Time release, one a day doses, are not so good, as the body eliminates Vitamin C in 6-8 hours (even the timed released). High doses do not assure better absorption and could cause gastric/intestinal irritation. Vitamin C should not be taken if you are taking sulfa drugs (Bactrim), as taken together can cause kidney damage. An alternative and/or in addition to the Vitamin C, are cranberry tablets,(usual dose 400mg. twice a day). Before taking any of these drugs consult with your physician.

Sufficient water intake is most important (in hard water regions, distilled drinking water may be recommended as distilled water contains no minerals or additives - just the distilled vapor from boiling water at the distillery).

Treatment for skin irritation

Use soft cloths soaked in a 50/50 solution of warm water and distilled white vinegar. Apply gently to affected area for 10 to 15 minutes. This will remove calcium deposits and help neutralize any pH imbalance where urine has contact with the skin. Allow to air dry. Consult your local E.T. nurse for any further treatment.

Check for leakage around the base of your appliance. Make sure the appliance opening closely matches the stoma size. If not, remeasure this opening to minimize skin exposure to effluent.

If skin irritation continues, consult your enterostomal therapist. He or she can suggest additional treatment to meet your individual needs.

Maintain proper appliance hygiene

It is good hygiene to irrigate the pouch daily with a 50/50 solution of warm water and distilled white vinegar. A deodorant may then be used in the pouch. However, keep in mind the use of a deodorant - while providing a pleasant scent - should not be misconstrued as a solution to a persistent urine odor. When the infection or body chemistry condition is corrected, a few drops of deodorant can be added to the pouch daily after irrigation.

There are a number of excellent deodorants formulated especially for ostomy use. You can select the one you find most effective and pleasing to you.

If you have any questions concerning this subject please call Nu-Hope Laboratories toll-free 1-800-899-5017 (or by toll, 1-818-899-7711) and ask to talk with Mickey Galindo, Nu-Hope Laboratories' WOC/ET Nurse on staff.