Tag Archives: colostomy

The Basics of an Ostomy

A lot of people have confused about different types of ostomies and aftercare. This article is written to help them understand ostomy in the best possible way.

Different terms are associated with the Ostomy such as stoma, colostomy, urostomy, ileal conduit, and ileostomy. So mean of you don’t know the difference between these terms and you want to know what happens if you undergo this condition.  Here are some examples with a complete explanation of all these processes.

How to take care of a colostomy patient?

Ms. Lora is a 69-year-old woman. She is a black –American and a retired educational officer. Her family members i.e. father and elder brother died because of breast and bowel cancer. All of them used to eat pork and foods high in fats. They also used to smoke a lot.

Even though Ms. Lora never had any difficulty or discomfort in her bowel movements, but she noticed less stool output with constipation and diarrhea for the last seven months.

The diseases that can reason for colostomy are:

  • Crohn’s disease
  • Constipation
  • Fistula in between rectum and vagina
  • Hirschprung disease
  • Birth defects
  • Imperforate anus
  • Perofrated diverticula
  • Rectal injury
  • Necrotizing enterocolitis

Ms. Lora needs to undergo a colostomy. A piece of the colon will be used to make a stoma and divert the passage of the bowel contents toward it.

She had a sigmoid colostomy that’s why it is made on the left side of the abdomen.

On the 3rd to 5th day, gas functioning will start.  At the start, the feces will be dark red or brown along with the mucus. Gradually it will come to normal color and consistency.

Ms. Lora’s healthcare expert may recommend she adapt an irrigation method that will help her regulating her smooth bowel and movements. It also helps in predicting bowel movements. So a patient does not need to wear a pouching system.

It is introduced in the body through a colostomy irrigation kit.

Ms. Lora’s nurse helped her to choose the best pouching system for her. Also, she helped her to learn about how to take care of her stoma. She can use these appliances or accessories for the first few weeks or days after the surgery. A skin barrier or wafer might be needed.

Her nurse will also educate her about how to clean the stoma and change the pouch. Simple water is the best of cleaning the stoma. Avoid any kind of soap or oil. Dry the skin completely and then attach the new pouching system.

Ms. Lora’s nurse will encourage her to look at her stoma. She needs to know the difference between a diseased or healthy stoma. The stoma should look as red as her mouth’s tissues. There is no nerve ending present in the stoma, it must be always wet or soggy. There can be stomal bleeding sometimes; there is nothing to be worried about. It can be risky if the bleeding does not stop for hours.

Ms. Lora wants to know how to empty the pouch. The nurse informs her that she needs to empty her pouch once it is one-third filled. She can use a tail closure and directly empty it into the toilet.

In case of some complications such as intestinal blockage, rectal injury, or parastomal hernias a second surgery is needed.

How to take care of an ileostomy?

Mr. Ben is a 29 years old white-American with a background of ulcerative colitis when he was eighteen years old. Her two sisters died because of toxic megacolon at twenty-five. When he was 7 years old his father died of gastrointestinal hemorrhage and his mother died two years after due to diabetes. He has many friends who can take care of him. He has been admitted for surgery for the restorative proctectomy also referred to as, ileal pouch-anal anastomosis.

Before her surgery and while he was admitted, the nurse inquired about the early bowel prep and antibiotic uptake. Mr. Ben tells him that he drank polyethylene glycol to cleanse his bowel completely. And he also consumed antibiotics.

Then his surgeon told him that his colon and rectum needed to be removed while his anus and sphincter will remain intact. The surgeon told him that he will use a part of his ileum to make a reservoir (internal). This will be a temporary ileostomy till the pouch heals completely. This ileostomy is required for almost eight to twelve weeks.

Mr. Ben has discovered different types of pouching systems on the internet. His nurse introduced him to a two-piece pouching system.  The pouching system should be sterile until it Is opened.

After the stoma surgery, he was under observation in the ICU for forty-eight hours. The nurse checked his abdomen if it was soft or tender. This ileostomy was made on the lower right side.

Mr. Ben used a nasogastric tube and a urine bag. He had a little pain compared with the pain at the time of ulcerative colitis.

The day when his bowel movements can be heard, the nasogastric tube and catheter were removed. His recovery was on the way and he started to empty the Ostomy pouch with the help of a nurse on his side. The nurse told him to prevent leakage and change his pouch after every four to six hours.

His doctor asked him to drink plenty of water and drinks to prevent dehydration.  And chew his food properly. He should take foods that can thicken his stool.

On the 8th day following the surgery, he will be discharged from the hospital with an Ostomy nurse.

How to take care of a patient with a urostomy?

Mr. J is a fifty-six years old Hispanic lady. He has three adults.  Four years ago he undergo an ileal conduit for the treatment of bladder cancer. It is the most used procedure for patients with invasive bladder cancer.

During the first few days, the nurse noticed yellowish urine with mucus m in the urostomy pouch, placed at the right side of the umbilicus. She also ensures the presence of the stents near the stoma.

Mr. S abdomen is soft and he has active bowel movements. His nurse told him how to change or drain the pouch. He used a stoma cap for preventing leakage. He sits on the toilet seat and drains the pouch between his legs into the seat.

His doctor told him that he must drink 8 Oz water daily. He should avoid garlic, asparagus, and onion because it may lead to an offensive odor in his pouch.

He knew the limitations of his physical activities. He can participate in sports but should avoid games that require a lot of pressure on the abdomen.

What is the role of a nurse?

All the test and procedure before Ostomy makes a patient very nervous. He is already worried about his Ostomy and is almost blank that how he or she would handle this situation. An Ostomy nurse helps the patient to learn their basic care routine. He or she encourages them towards improvement. If you get an expert and kind Ostomy nurse you can recover in time.

Guide for an Ostomy Nurse

Many nurses are not sure about how to take care of an Ostomy patient. This article will help you to get answers to all your questions.

In the USA almost 100,000 individuals undergo Ostomy surgery every year. Fecal or urinary diversion surgeries are performed which allows the body to pass out urine and feces. Ostomies can be permanent or temporary. It can be continent or incontinent. In case of incontinent surgeries, you need to keep an external pouching system with you. In this article, we will mainly discuss incontinence and types of pouching systems.

During this procedure, a hole is created in the abdomen and a small or large intestine is pulled up to the abdominal wall and sewed there, resulting in a stoma. A stoma is an opening that allows the feces and urine to leave the body. The surgeon decides which portion of the intestine will be involved in the surgery depending upon the condition of the patient.

Some situations which demand Ostomy are:

  • Colon cancer or rectal cancer
  • Any trauma or injury in the bowel or rectum such as a bullet shot.
  • Leakage in the bowel
  • Cancer in the bladder

The most basic and common types of Ostomy are:

  • Ileostomy
  • Colostomy
  • Urostomy

In the case of Ostomy, a patient can’t control urination or fecal discharge because there is no sensation or nerves around the stoma. Also, there is no sphincter present. This is the reason a patient can’t control the flow of the gas, urine, or feces out of the body.

Ileostomy

This type of Ostomy ileum also called the small intestine is involved in the formation of the stoma. It allows the feces to leave the body. Ileostomy patients always require a pouching system to collect the feces, very acidic. If these feces come in contact with the stoma it may destroy stromal tissues.

Colostomy

Different parts of a colon are used for the creation of a stoma. Colostomy patients can use the irrigation method. It helps them to predict their next bowel movement and they can live without wearing a pouch. They usually use a cap or a stopper over the stoma instead of the pouching system. This cap can be helpful to absorb any possible mucus and protects stoma, and your clothes.

Urostomy

A urostomy is also known as the ileal conduit. During this surgery, the surgeon attaches the ureters with the one end of the ileum and brings the second end to the abdominal surface to form an opening, stoma. A conduit is formed through the section of the ileum, that’s why a pouching system is a required must.

Stoma

A normal and healthy stoma appears dark pink and red. It looks damp, bright, and non-ulcerated. You feel no pain over the stoma. With time, it shrinks in size. Mostly, it takes six weeks for a stoma to heal. If you notice something extraordinary you must consult it with a doctor.

Typically, a stoma is submerged indicating that it comes a little out of the skin. This helps in attaching the pouching system. In the case of ileostomy and urostomy stoma maybe two centimeters over the skin while one centimeter in case of colostomy. The height may differ depending on the obesity, shortening of intestines, and tumors.

Stomas that are flat with the skin or more embedded give hard time to the patients for attaching pouching system. In this type of stoma, there are chances of more leakage of feces and urine below or beneath the pouch. If a patient with budded stoma notices any retraction he or she should contact the doctor.

Sometimes a stoma gets prolapsed and a part of the intestine can protrude out. It is an alarming situation. There can be many reasons for a prolapsed stoma, such as:

  • Pregnancy
  • Strained abdominal muscles
  • Obesity
  • Increased pressure between the abdomen
  • Parastomal hernia ( a serious condition)
  • Surgical errors

The prolapsed stoma can be treated with sugar or a cold compress. Both of the methods lessen the swelling.

Site for the stoma

The stoma can be created in any portion of the abdomen ( all four quadrants). It depends on the type of Ostomy. The location of a stoma is very important as it can prevent many complications and stool output also depends on the location of the stoma.

Different outputs

During the first few days after the surgery, a patient is not allowed to take anything by mouth (N.PO). There is very low stool output and it is very dark hot red. Gradually food and liquids are allowed and the output starts to change. It becomes dark green and then becomes brown and there is also an increase in the output.

As soon as a person starts to eat through the mouth there can be an odor in the stool. It can make you awkward in public places. For this issue, a filter or deodorant is placed inside the pouch.

The output depends on the type of Ostomy and part of the intestine that is involved. For example, Ileostomies outputs are liquid, semisolid feces are formed as a result of ascending or transverse colostomy. And output results of descending and sigmoid colostomy are completely formed solid.

The output of the urostomy differs from other ostomies that produce feces. Urine production should start instantly. There might be blood in the urine for some time after the urostomy. The patient may also notice mucus, it is normal and it will decrease after some time of the surgery.

To prevent the blocking of the ureters stents are placed and brought outside the stoma. These are very flexible, lenient. After some days of the surgery, they are removed by the doctor. Sometimes you may notice urine dripping out of these stents. In this condition, advice from a healthcare provider is needed.

Stoma skin problems

ICD or irritant contact dermatitis is the most common skin issue following the Ostomy. It takes place due to the interaction of bowel contents with the skin. It might be due to pouch leakage or sealing issues.

It almost affects 55% of the patients after the Ostomy. The symptoms of ICD are:

  • Loss of epidermal tissues
  • Cramps
  • Damp area

If it is left untreated it can cause more soreness or discomfort. The skin around the stoma should look normal just like the other skin on the abdomen.

Mucocutaneous separation is another complication. It occurs if the clamps or sutures that hold the stoma to the abdomen get too rigid and if the blood supply to the stoma is disturbed due to any reason. In this condition, the clamps are lost and there is a hollow by the side of the stoma. This space or pocket is filled with alginate and is bandage by using hydrocolloid, then the pouching system is placed.

Some other skin issues are:

  • Contraction of the stomal opening is called stoma stenosis
  • Stoma becomes very dark or black called stoma necrosis
  • Redness and moist skin around the stoma called allergic contact dermatitis
  • Enlargement of blood vessels known as peristomal varices
  • Inflated hair follicles called folliculitis
  • Ulcers nearby the stoma, ulcerative colitis, Crohn’s disease, and arthritis

Things you must know about the pouching system

Ostomy pouching systems are used for the collection of urine or stool. They differ in size and structure. There are some noticeable differences.

Types of the Pouching system

The pouching system used for colostomy or ileostomy can have an open or closed-end. A patient who uses an open-end pouch can drain or empty the pouch without removal of the pouch. And it can be closed after emptying it. While a pouch with closed ends needs to be removed each time you want to empty it. These pouches are odor-resistant. If there is no leakage or there are no fees attached outside the pouch, the odor must not be there.

The main difference between the urostomy pouches is that it has a spout at the end of the pouch. This end is used for draining the urine out. You must keep the spout in the open position when you want to drain the pouch. There is also an antireflux baffle that prevents the backflow of the pouch. You can use a connector along with a spout to increase the storage capacity of the pouch during the night. It will help you to have proper sleep without any disturbance.

Pouching systems are classified as a one-piece barrier or two-piece barrier. The only difference between a one-piece pouching system and a two-piece pouching system is that there is no separation between the skin barrier and the pouch in the case of a one-piece pouching system.

How to empty and change the pouch?

The pouch should be emptied when it is almost one-third filled. If the pouch gets heavy it pulls the pouch downward and there might be a leakage of the bowel contents.

If you notice any leakage you must change your pouch immediately. Otherwise, it can cause peristomal skin issues.

You can wear a pouching system for two to three days if there is no leakage. Don’t confuse yourself between changing the pouch and emptying the pouch.

How to prevent popping of the pouch

Sometimes there may be  a lot of gas in the pouch. If the gas is not ventilated at a time the pouch becomes like a balloon. The patient can use a filter within the pouch which helps in preventing gas accumulation and is odor resistant.

Must know

Before leaving a hospital a patient must know how to change or empty the pouch, how to observe the stoma, and cut the skin barrier according to the size of their stoma. You should encourage your patients to look at their stoma. You must help them to believe that there is nothing shameful or embarrassing about it.