Colostomy
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COLOSTOMY What is a colostomy? The colon, rectum and anus are the last sections of the body’s digestive system. Although they are an important part of the system, they have little to do with digesting food or absorbing nutrients. In fact, the large intestine can be thought of as the body’s trash compactor. As "leftover" liquid flows through the colon, it becomes solid waste (feces). The waste material is passed through the various sections of the colon, and then moves onward to the rectum. From there, it is eliminated from the body through the anus. When the colon, rectum or anus is unable to function normally because of disease or injury, or needs to rest from normal function, the body must have another way to eliminate the waste. A colostomy is an opening in the large intestine that is brought out onto the surface of the abdomen. This provides a new path for waste material and gas to leave the body. The colostomy opening is also called a stoma. It can be permanent or temporary. Why is a colostomy performed? There are many reasons why a colostomy becomes necessary. Some of the conditions that may require a colostomy include: Colorectal cancer Traumatic injury Intestinal obstruction Diverticulitis (an inflammation or infection of small sacs or outpouchings, called diverticula, of the inner lining of the intestine) Crohn's disease (a chronic inflammatory disease that involves all layers of the intestinal wall and can disrupt normal bowel function) Incontinence or constipation How is a colostomy performed? A colostomy results from a surgical procedure performed under general anesthesia. During the surgery, healthy colon is brought through an opening in the abdominal wall and stitched to your skin. Unlike the anus, the opening (stoma) has no sphincter muscle, so you cannot control the exit of waste. You will need to wear a pouch (called an ostomy collecting device) to collect the waste flow. What are the complications of a colostomy? In some cases, skin irritation can result from stool that leaks under the pouch. A hernia can develop around a colostomy. The bowel may become narrow or it may prolapse, which means it gets longer. Proper fitting of an ostomy pouch can help prevent skin irritation. The wound, ostomy, continence nurse, also called an enterostomal therapy nurse, can help choose an appropriate pouch and suggest ways to care for your skin.
Colostomy Care How to change pouch? The following is general information about how to change your pouch: 1. Ask how often to change your colostomy pouch: The type of pouch you wear affects the amount of time it can be worn. The kind and amount of bowel movement you have also affects how long the pouch stays on. 2. Remove the pouch: Gently remove the pouch by pushing the skin down and away from the adhesive skin barrier with one hand. With the other hand, pull the pouch up and away from the stoma. 3. Gently clean the skin around your stoma: Use mild soap and water. Do not use soaps that have oil or perfumes. Pat your skin dry. 4. Use a pouch with the right size opening: Use a pouch that has an opening that is ⅛ of an inch larger than your stoma. 5. Use skin products to help reduce irritation: These products can help protect your skin and keep it dry. 6. Use slight pressure to place your pouch: Center the pouch over the stoma and press it firmly into place on clean, dry skin. It may be helpful to hold your hand over the new pouch for 30 seconds. The warmth of your hand can help stick the adhesive skin barrier into place. 7. Dispose of the used pouch correctly: If the pouch is disposable, place the old pouch in another plastic bag and throw it in the trash. If you use a reusable pouch, talk to your caregiver about how to clean it. How to empty the pouch? 1. Empty the pouch when it is ⅓ to ½ full: Do not wait until the pouch is completely full. This could put pressure on the seal and cause it to leak or spill. 2. Hold the pouch up by the bottom end: If the pouch has a clamp system, remove the clamp. You may need to roll the end back to keep it from getting soiled. 3. Drain the pouch: Place toilet paper into the toilet before you empty the pouch to reduce splash back. Drain the pouch by squeezing the contents into the toilet. 4. Clean the end of the pouch: Use toilet paper or a moist paper towel. You may also rinse the pouch but it is not necessary. Keep the end of the pouch clean. 5. Close the end of the pouch: Unroll the end of the pouch. Replace the clamp or close the end of the pouch according to your caregiver's instructions.
What is irrigation? Irrigation is when you put fluid into your stoma to empty your bowel. Your caregiver will tell you if you can irrigate your colostomy. Irrigation allows you to time your bowel movements. Your bowel movements need to be regular and free of problems before you can use a stoma cap and irrigation. Schedule regular times to irrigate your colostomy. How to irrigate the colostomy?
1. Ask an ostomy nurse or someone specially trained in ostomy care how to properly irrigate your colostomy. Below are some general steps for irrigation: 2. Gather your supplies: You will need a plastic irrigating container with a long tube and a cone to put water into your colostomy. You will also need an irrigation sleeve that will direct the output into the toilet. You will need an adjustable belt to attach the irrigation sleeve and a tail closure for the end of the sleeve. 3. Choose the same time every day to irrigate: This will help decrease problems with your colostomy. 4. Know how much liquid to use: Fill the irrigating container with about 16 to 50 ounces (500 to 1500 mL) of lukewarm water. The water should not be cold or hot. Ask your caregiver how much water you will need to irrigate. Hang the irrigation container so that it is level with your shoulder. Sit up straight on the toilet or on a chair next to the toilet. 5. Attach the irrigation sleeve to your stoma: Take the adjustable belt and attach it to the irrigation sleeve. Place the belt around your waist and place the sleeve over your stoma. Place the end of the irrigation sleeve into the toilet bowl. 6. Release air bubbles from the tubing: Release the clamp and allow a small amount of water to flow into the sleeve. Clamp the tubing again. 7. Moisten the end of the cone: Use water or a water-soluble lubricant. 8. Place the tip of the cone 3 inches into your stoma: Make sure the fit is snug, and do not force the cone. Release the clamp on the tubing again and slowly allow the water to flow into the stoma This should take about 5 to 10 minutes. Keep the cone in place for another 10 seconds. 9. Remove the cone: Allow the output to drain into the irrigation sleeve for about 10 to 15 minutes. Dry the end of the irrigation sleeve. Clip the bottom of the sleeve to the top with a clasp or close the end of the sleeve with the tail closure. It may take 30 to 45 minutes to drain. You may move around during this time. Empty the output from the sleeve into the toilet. Clean the area around the stoma with mild soap and water and pat dry. How to care for your skin? 1. Look at the skin around your stoma each time you change your pouch. Your stoma should be pink or red and moist. You may have a small amount of bleeding when you clean your stoma. This is normal. Your stoma will get smaller and become its normal size in about 8 weeks. 2. Make sure the skin barrier opening fits well: The skin barrier is the part of the pouch that sticks to the skin of your abdomen. It should be no more than ⅛ of an inch larger than your stoma. If the opening is too large, bowel movement can leak onto your skin and cause irritation. Measure the size of your stoma with the guide that comes with your colostomy supplies. Make sure you cut the skin barrier smaller as your stoma gets smaller. 3. Soothe irritated skin: If your skin is red, it may mean that the skin barrier was on too long. It is important to find the cause of your skin irritation. Ask your caregiver if you need help finding the cause of your skin irritation.
What types of foods can I eat after a colostomy? 1. Eat a variety of healthy foods: Healthy foods include fruits, vegetables, whole-grain breads, low-fat dairy products, and lean meats. Do not eat foods that give you cramps or diarrhea. 2. Limit foods that may cause gas and odor: These include vegetables such as broccoli, cabbage, and cauliflower. Beans, eggs, and fish may also cause gas and odor. Eat slowly and do not use a straw to drink liquids. Yogurt, buttermilk, and fresh parsley may help control odor and gas. 3. Drink liquids as directed: Ask your caregiver how much liquid to drink each day and which liquids are best for you. This may help reduce constipation. What are some problems that can happen with a stoma? Most stoma problems happen during the first year after your surgery. 1. Stoma retraction: This is when the height of the stoma goes down to or below the skin level. Retraction may happen soon after surgery if the colon does not become active soon enough. Retraction may also happen if you gain weight. The type of pouch you use may need to be changed to fit the stoma shape. 2. Peristomal hernia: This is when a part of your large intestine bulges into the area around the stoma. A hernia may be more obvious when you sit, cough, or strain. Hernias may make it difficult to create a proper pouch seal or irrigate. You may need to change the type of pouch you use or wear a hernia belt. You may need surgery to repair the hernia. 3. Prolapsed: This is when a part of your bowel pushes out of your stoma. The stoma prolapsed may be caused by increased abdominal pressure. Surgery may be done to fix the prolapsed. 4. Stenosis: Your stoma may become narrower. Your caregiver may be able to stretch your stoma if it has mild stenosis. Severe stenosis can cause blockage and surgery is usually needed.you may notice a stronger odor when emptying your pouch. If this is a concern, you may want to limit these foods in your diet.
Colostomy Care How to change pouch? The following is general information about how to change your pouch: 1. Ask how often to change your colostomy pouch: The type of pouch you wear affects the amount of time it can be worn. The kind and amount of bowel movement you have also affects how long the pouch stays on. 2. Remove the pouch: Gently remove the pouch by pushing the skin down and away from the adhesive skin barrier with one hand. With the other hand, pull the pouch up and away from the stoma. 3. Gently clean the skin around your stoma: Use mild soap and water. Do not use soaps that have oil or perfumes. Pat your skin dry. 4. Use a pouch with the right size opening: Use a pouch that has an opening that is ⅛ of an inch larger than your stoma. 5. Use skin products to help reduce irritation: These products can help protect your skin and keep it dry. 6. Use slight pressure to place your pouch: Center the pouch over the stoma and press it firmly into place on clean, dry skin. It may be helpful to hold your hand over the new pouch for 30 seconds. The warmth of your hand can help stick the adhesive skin barrier into place. 7. Dispose of the used pouch correctly: If the pouch is disposable, place the old pouch in another plastic bag and throw it in the trash. If you use a reusable pouch, talk to your caregiver about how to clean it. How to empty the pouch? 1. Empty the pouch when it is ⅓ to ½ full: Do not wait until the pouch is completely full. This could put pressure on the seal and cause it to leak or spill. 2. Hold the pouch up by the bottom end: If the pouch has a clamp system, remove the clamp. You may need to roll the end back to keep it from getting soiled. 3. Drain the pouch: Place toilet paper into the toilet before you empty the pouch to reduce splash back. Drain the pouch by squeezing the contents into the toilet. 4. Clean the end of the pouch: Use toilet paper or a moist paper towel. You may also rinse the pouch but it is not necessary. Keep the end of the pouch clean. 5. Close the end of the pouch: Unroll the end of the pouch. Replace the clamp or close the end of the pouch according to your caregiver's instructions.
What is irrigation? Irrigation is when you put fluid into your stoma to empty your bowel. Your caregiver will tell you if you can irrigate your colostomy. Irrigation allows you to time your bowel movements. Your bowel movements need to be regular and free of problems before you can use a stoma cap and irrigation. Schedule regular times to irrigate your colostomy. How to irrigate the colostomy?
1. Ask an ostomy nurse or someone specially trained in ostomy care how to properly irrigate your colostomy. Below are some general steps for irrigation: 2. Gather your supplies: You will need a plastic irrigating container with a long tube and a cone to put water into your colostomy. You will also need an irrigation sleeve that will direct the output into the toilet. You will need an adjustable belt to attach the irrigation sleeve and a tail closure for the end of the sleeve. 3. Choose the same time every day to irrigate: This will help decrease problems with your colostomy. 4. Know how much liquid to use: Fill the irrigating container with about 16 to 50 ounces (500 to 1500 mL) of lukewarm water. The water should not be cold or hot. Ask your caregiver how much water you will need to irrigate. Hang the irrigation container so that it is level with your shoulder. Sit up straight on the toilet or on a chair next to the toilet. 5. Attach the irrigation sleeve to your stoma: Take the adjustable belt and attach it to the irrigation sleeve. Place the belt around your waist and place the sleeve over your stoma. Place the end of the irrigation sleeve into the toilet bowl. 6. Release air bubbles from the tubing: Release the clamp and allow a small amount of water to flow into the sleeve. Clamp the tubing again. 7. Moisten the end of the cone: Use water or a water-soluble lubricant. 8. Place the tip of the cone 3 inches into your stoma: Make sure the fit is snug, and do not force the cone. Release the clamp on the tubing again and slowly allow the water to flow into the stoma This should take about 5 to 10 minutes. Keep the cone in place for another 10 seconds. 9. Remove the cone: Allow the output to drain into the irrigation sleeve for about 10 to 15 minutes. Dry the end of the irrigation sleeve. Clip the bottom of the sleeve to the top with a clasp or close the end of the sleeve with the tail closure. It may take 30 to 45 minutes to drain. You may move around during this time. Empty the output from the sleeve into the toilet. Clean the area around the stoma with mild soap and water and pat dry. How to care for your skin? 1. Look at the skin around your stoma each time you change your pouch. Your stoma should be pink or red and moist. You may have a small amount of bleeding when you clean your stoma. This is normal. Your stoma will get smaller and become its normal size in about 8 weeks. 2. Make sure the skin barrier opening fits well: The skin barrier is the part of the pouch that sticks to the skin of your abdomen. It should be no more than ⅛ of an inch larger than your stoma. If the opening is too large, bowel movement can leak onto your skin and cause irritation. Measure the size of your stoma with the guide that comes with your colostomy supplies. Make sure you cut the skin barrier smaller as your stoma gets smaller. 3. Soothe irritated skin: If your skin is red, it may mean that the skin barrier was on too long. It is important to find the cause of your skin irritation. Ask your caregiver if you need help finding the cause of your skin irritation.
What types of foods can I eat after a colostomy? 1. Eat a variety of healthy foods: Healthy foods include fruits, vegetables, whole-grain breads, low-fat dairy products, and lean meats. Do not eat foods that give you cramps or diarrhea. 2. Limit foods that may cause gas and odor: These include vegetables such as broccoli, cabbage, and cauliflower. Beans, eggs, and fish may also cause gas and odor. Eat slowly and do not use a straw to drink liquids. Yogurt, buttermilk, and fresh parsley may help control odor and gas. 3. Drink liquids as directed: Ask your caregiver how much liquid to drink each day and which liquids are best for you. This may help reduce constipation. What are some problems that can happen with a stoma? Most stoma problems happen during the first year after your surgery. 1. Stoma retraction: This is when the height of the stoma goes down to or below the skin level. Retraction may happen soon after surgery if the colon does not become active soon enough. Retraction may also happen if you gain weight. The type of pouch you use may need to be changed to fit the stoma shape. 2. Peristomal hernia: This is when a part of your large intestine bulges into the area around the stoma. A hernia may be more obvious when you sit, cough, or strain. Hernias may make it difficult to create a proper pouch seal or irrigate. You may need to change the type of pouch you use or wear a hernia belt. You may need surgery to repair the hernia. 3. Prolapsed: This is when a part of your bowel pushes out of your stoma. The stoma prolapsed may be caused by increased abdominal pressure. Surgery may be done to fix the prolapsed. 4. Stenosis: Your stoma may become narrower. Your caregiver may be able to stretch your stoma if it has mild stenosis. Severe stenosis can cause blockage and surgery is usually needed.you may notice a stronger odor when emptying your pouch. If this is a concern, you may want to limit these foods in your diet.
