Medical Oncologist
CION Cancer Clinics
Urine infections after urinary diversion | CION Cancer Clinics
After a urinary diversion, bacteria in the urine are normal and are not an infection on their own. An infection is bacteria plus symptoms: fever, pain in the side, feeling unwell or urine that has suddenly changed. Repeated infections usually have a cause that can be found and fixed. This page explains why they happen, which signs cannot wait, what the clinic does, and what lowers the chance of the next one. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- Why do I keep getting urine infections after my diversion?
- What is usually behind repeated infections?
- What happens when I come in with a suspected infection?
- Four things families tell us about urine infections
- What lowers the chance of the next infection?
- Common questions about infections after urinary diversion
The short answer
Why do I keep getting urine infections after my diversion?
Because urine now passes through a piece of bowel, and bowel always carries bacteria. After a urinary diversion, bacteria in the urine are normal and are not, on their own, an infection. An infection is bacteria plus symptoms: fever, pain in the side, feeling unwell, or urine that has suddenly changed.
Why the diversion makes infection more likely
The bladder used to sit between the outside world and the kidneys, and it emptied fully every few hours. A conduit, a neobladder or a pouch is made from bowel, it never empties completely, and it makes mucus that bacteria grow in. Urine that sits still, or flows back up towards the kidney, gives bacteria the time they need. That is the whole story behind most repeated infections.
Colonised is not the same as infected
Your report may say "bacteria seen" or name an organism even when you feel perfectly well. Doctors call this colonisation. It is expected after this operation, and treating it with antibiotics does not help. It breeds bacteria that antibiotics no longer work on, which is a far bigger problem later. Your team treats you, not the urine test.
When repeated infections need a cause found
Several infections in a year, or one that reached the kidney, means something is letting urine sit still or flow backwards, and that something is usually fixable.
This page is about the ileal conduit, neobladder and continent pouch. If you still have your bladder, the advice is different.
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One thing that cannot wait
Fever with shivering, pain in your side or lower back, vomiting, or confusion after a urinary diversion means the infection may have reached the kidney or the blood. There is no bladder to hold it back now. Go to the nearest emergency department the same day, say you have had a cystectomy with a urinary diversion, and take your discharge summary. Do not wait for a urine culture result, and do not start leftover antibiotics at home first.
Not sure whether this applies to you?
Ask an oncologistFinding the cause
What is usually behind repeated infections?
Each of these can be looked for with a scan, a blood test and sometimes a camera check. Each has a fix.
A stone
Stones form more easily after a diversion because of mucus, still urine and changes in the body's acid balance. A stone in the kidney, the conduit or a pouch is a shelter for bacteria. An ultrasound or CT finds it.
A narrowing at the join
Where the ureters, the tubes from the kidneys, are stitched to the bowel, scar tissue can slowly narrow the opening. Urine backs up, the kidney swells, and infections follow. A scan shows a swollen kidney before you feel anything.
Words on the report
- Stricture: the narrowing itself
- Hydronephrosis: the kidney swollen with held-up urine
A pouch or neobladder not emptying fully
Urine left behind after every emptying is urine that sits still. People with a neobladder who strain less, or empty less often, see more infections. Timed emptying and, for some, a catheter to empty fully, settle it.
Back flow up to the kidney
In some diversions urine can travel back up the ureter when the pouch or conduit is full. Emptying before the bag or pouch gets full, and a night drainage bag for conduits, keeps the pressure low.
Too little fluid makes every one of these worse.At the clinic
What happens when I come in with a suspected infection?
A proper urine sample
Not from the bag. Urine in the bag has been sitting with bacteria for hours and will always grow something. The nurse takes a fresh sample from the stoma with a clean small catheter, or a mid-stream sample from a neobladder.
Blood tests
A blood count and kidney function, to see whether the infection is affecting the whole body and whether the kidneys are under strain.
A scan if it is not the first time
An ultrasound is quick and shows a swollen kidney or a stone. A CT is used if the ultrasound is unclear or the team suspects a narrowing at the join.
Treatment that fits the result
Antibiotics chosen to match what the culture grows, by tablet if you are well and by drip if you are not. Your team sets the drug and how long you take it. Finish what is prescribed.
Fixing what caused it
If a stone or a narrowing is found, that is dealt with separately, usually once the infection has settled. Without that step the infections come back.
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Commonly believed
Four things families tell us about urine infections
"The report shows bacteria, so he needs antibiotics."
Not if he feels well. Bacteria in the urine are expected after a diversion. Antibiotics given for a test result rather than for symptoms do not prevent the next infection, and they make the bacteria harder to treat when a real infection comes.
"We tested the urine from the bag and it grew germs."
Urine from the bag will always grow germs, because it has been sitting with them for hours. Only a fresh sample taken from the stoma with a clean catheter, or a mid-stream sample from a neobladder, tells the team anything useful.
"Cranberry juice will stop the infections."
The evidence for cranberry after a diversion is thin. It does no harm in normal amounts, but it is not a treatment and it does not replace drinking enough plain water, emptying on time and finding the cause of repeated infections.
"An antibiotic course every month will keep him safe."
A long-term low-dose antibiotic is sometimes used, for a small group of people, after the cause has been looked for. It is a decision your team makes, not a habit to start with leftover tablets. Repeated courses without a plan breed resistant bacteria.
Day to day
What lowers the chance of the next infection?
Water, flow and clean equipment. Together they do more than any tablet.
Drink through the day
Enough plain water that the urine stays pale. Spread it across the day rather than drinking a lot at once. In a Telangana summer, and on days you are outdoors, that means noticeably more than in winter. Ask your team how much is right for you if you also have a heart or kidney condition.
Keep urine moving
Empty the bag when it is a third full. Use a night drainage bag so urine drains all night instead of pooling. With a neobladder or a pouch, empty by the clock, not by feeling, because the new bladder cannot tell you it is full.
Clean the night bag properly
Rinse it every morning with water, let it dry hanging, and replace it as often as the stoma nurse advises. A night bag that is reused for weeks without cleaning is a common source of repeated infection.
What this page cannot tell you
It cannot tell you whether your symptoms are an infection, or which antibiotic you need. That needs a proper sample and a culture. It also cannot tell you why your infections keep returning. That needs a scan, and it is worth asking for one rather than accepting another course of tablets.
Bring every culture report to your follow-up. The pattern across several reports tells the team more than any one result.Questions we are asked
Common questions about infections after urinary diversion
How do I know it is an infection and not just cloudy urine?
Cloudy urine with mucus is normal after a diversion and means nothing on its own. An infection brings a change: fever, feeling unwell, pain in the side or back, urine that suddenly smells foul or turns dark, or less urine than usual. Symptoms decide, not the look of the bag.
Will there be burning when I pass urine, like before?
Usually not with a conduit, because urine no longer passes through the urethra. That is why people miss the early signs. With a neobladder there may be burning or urgency. For everyone, fever and pain in the side are the signs to act on.
Can I take the antibiotic I had last time?
No. Starting leftover antibiotics hides the bacteria from the culture, so the team cannot see what is growing or what will work. Give a proper sample first, then take what is prescribed for it. If you are very unwell, go to the emergency department rather than treating at home.
Does an infection damage the kidneys?
A single treated infection rarely does. Repeated kidney infections, or an untreated one with a blocked ureter, can leave scarring and slowly reduce kidney function. That is why the cause of repeated infections is looked for, and why kidney function is checked at every follow-up.
Is the stoma itself infected if it looks red?
A healthy stoma is red and moist, like the inside of the cheek, and that is normal. Red, sore skin around the stoma is usually urine on the skin, a fit problem, not an infection. A stoma that turns dark, pale or grey, or bleeds heavily, needs to be seen the same day.
Why does the team want a scan when it is only an infection?
Because the second or third infection is usually a sign, not a coincidence. A scan looks for a stone, a swollen kidney or a narrowing where the ureters join the bowel. Finding one of those and fixing it stops the cycle. Another antibiotic course alone does not.
Can I catch the infection from a dirty bag or night bag?
Bacteria from a poorly cleaned night bag or connector can track back towards the stoma. Rinse the night bag each morning, dry it hanging, keep the connector clean, and replace it as the stoma nurse advises. Day bags are single use and should not be washed and reused.
Is this covered by Aarogyasri or my insurance?
Treatment of an infection after cancer surgery, and the scans to find its cause, are usually part of ongoing cancer care. Aarogyasri, CGHS, ECHS and EHS are accepted and most cashless insurers are empanelled. Call the helpline with your card details and we will check before you travel.
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Sources
- NHS — Urostomy
- NHS — Urinary tract infections (UTIs)
- American Cancer Society — Urostomy guide
- National Cancer Institute — Bladder Cancer Treatment (PDQ) - Patient Version
- Macmillan Cancer Support — Bladder cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Kidney Function After Urinary DiversionWhat repeated infections can do to the kidneysMetabolic Problems After Bowel-Based DiversionWhy stones form more easily after this operationSmell, Leakage and Confidence With a UrostomyWhich smells are normal and which are notFollow-Up After Radical CystectomyThe checks that catch a problem earlyComplications and Red FlagsThe signs after any cancer surgery that cannot wait
Talk to us
Infections keep coming back?
Tell us what has happened so far and we will help you reach a surgical oncologist who deals with urinary diversion every week. One helpline serves every CION centre.