Ostomy
Types of Ostomies
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Colostomy
Ascending Colostomy
Location: Ascending portion of the colon. Right lower quadrant of the abdomen.
Output: Liquid initially - then may become pastelike.
Appliance Recommendations: 1 or 2 piece drainable appliance with skin barrier.Transverse Colostomy
This ostomy is located in the mid-abdomen or on the upper right side of the abdomen. The discharge is usually liquid or paste-like and usually remains that way. It is frequently a temporary ostomy. Skin protection is very important.
Location: Transverse portion of the large intestine. Middle of the abdomen - many times near the umbilicus.
Output: Liquid initially - semiformed to paste like in 4 to 6 weeks.
Appliance Recommendations: 1 to 2 piece drainable appliance with skin barrier.Descending/Sigmoid Colostomy
This type of stoma is usually located on the lower left side of the abdomen. Initially the stool will be liquid or semi formed but after 4-6 weeks the bowels will be more solid. Management of the colostomy can be either with an open or closed end pouch and is available in one or two piece styles. Liquid deodorants or carbon filters are available to handle any odor problems. Occasionally people elect to do a procedure called irrigation to regulate the bowel movements. Discuss this with your physician or ostomy nurse after three months.
Location: Descending portion of the large intestine. Lower left quadrant.
Output: Initially soft or liquid - formed stool usually after six weeks.
Appliance Recommendations: 1 or 2 piece drainable pouch or 1or 2 piece closed pouch. Stoma cap if you irrigate.
Location: Sigmoid portion of the large intestine. Lower left quadrant of the abdomen.
Output: Fully formed stool after 4 to 6 weeks.
Appliance Recommendations: 1 or 2 piece drainable or closed. Stoma caps if control is achieved through irrigation. -
Ileostomy
The ileostomy stoma is located on the lower right side of the abdomen. The output is usually paste-like and contains digestive enzymes so skin protection is very important. Dietary and fluid considerations are necessary to prevent blockage. Pouch systems for the ileostomy can be one or two piece and should be drainable. A skin barrier should come built into the pouch. The output is very caustic to the skin and occasionally extra skin barrier products may be necessary. Special dietary considerations are to chew your food well. Avoid nuts, corn chips, popcorn and Chinese vegetables. Such foods are hard to digest and can cause blockage. Signs of blockage are abdominal pain and cramping, swelling of the stoma, profuse watery discharge followed by no output. If you experience blockage it is important to call your surgeon for treatment. Do not attempt to instill anything into the stoma.
Location: The terminal portion of the small intestine, usually located in the right lower quadrant of the abdomen.
Output: Liquid to paste like consistency.
Appliance Recommendation: 1 or 2 piece drainable pouch with a skin barrier. -
Urinary Diversion
An ileal conduit can also be referred to as a Urostomy. The stoma looks much the same as all ostomies. It is red, moist and lies on the abdomen. The output is a continuous flow of urine which should be clear. Occasionally there will be shreds of mucus in the urine and this is normal. The stoma is usually located on the right side of the body, below the belt line. Pouching options are either a one or two piece urostomy system with a built in skin barrier and drain tube for easy emptying. Usually people will attach a night drainage bag to allow them to sleep through the night without having to get up to empty the pouch.
Urinary Diversion - Ileal Conduit
Output: Urine with mucus shreds.
Appliance: 1 or 2 piece with urostomy valve and skin barrier. -
Peristomal Skin Care
Peristomal Skin Care
A correctly fitting pouch is necessary to protect the stoma and the peristomal skin. It is important to remember that stoma size and shape may change so measure your stoma with each pouch change for 4-6 weeks to insure a properly fitted pouch. Caring for the skin around the stoma is the single most important thing you can do. Healthy skin is vital for good stoma management. Prevention of irritation is far easier than having to treat the irritated skin.
Routine Skin Care
Careful pouch removal to prevent ripping your skin.
Wash around the stoma carefully-it may bleed and this is normal.Peristomal Skin Problems
Itching or burning is the first sign of leakage. It is important to change the pouch at once. Common skin problems include rash or breakdown of skin around the stoma as a result of leakage or mechanical irritation. The most common irritations are excoriation, which is caused from pouch leakage, allergy or radiation. Folliculitis is an inflammation of the hair follicles. Shaving the peristomal skin should not be done with each pouch change as severe irritations can result. Itching and redness around the stoma can be a yeast rash. If you notice any problems with the skin around the stoma or under the tape, call and see your ostomy nurse as soon as possible. Many times another pouching system will be better for you. Another alternative is the use of others tapes or skin barriers. It's important not to try and self treat. Many times home remedies will make the situation worse and the pouch will not hold.
Ostomy
An ostomy is a surgically created opening to discharge waste from the digestive or urinary tract. Thousands of people have ostomy surgery every year. For many, ostomy surgery is a lifesaving procedure. Whatever the indication for ostomy surgery is, once you are confronted with this option questions and concerns are paramount.
All types of ostomies are named for the portion of the intestine where they are located. Depending upon location, the consistency of the fecal matter changes. Ostomies do not have sphincter muscles to control the discharge so people with ostomies generally wear an odorfree pouch to collect the waste material. To make an ostomy, the surgeon brings part of the intestine through the abdominal wall. This opening is then referred to as a stoma. The stoma should always be red and moist. It should feel much like the interior of your mouth. The stoma is not painful, as there are no nerve endings present. The stoma bleeds easily as it has an excellent blood supply and this is referred to as pinpoint bleeding. If the stoma bleeds and does not stop you should see your physician or your ostomy nurse. If there is blood in your stool or urine you should see your doctor.
Concerns
Odor: Perhaps one of the biggest concerns to the new ostomate is odor. This is a very common concern, however with a proper fitting and applied pouching system; odor should not be a problem. The current pouches available today are odor proof. If you do notice an odor check the seal of your pouch to make sure a leakage has not occurred. In addition pouch deodorants are available. These specialized products do not mask the odor but are biological odor eliminators. Also some ostomates find oral deodorizers very effective.
Gas
Initially after abdominal surgery gas is problematic. This is true for almost all abdominal surgical procedures. What makes it more uncomfortable for the new ostomate is the inability to control the noisy flatus. Initially for the first six weeks after surgery this is embarrassing. However, it does subside after 4-6 weeks, unless you were extremely gassy prior to surgery. Some of the things that aggravate gas production are smoking, chewing gum, mouth breathing, and chewing with your mouth open. Certain foods such as beans, beer, broccoli, brussel sprouts, cabbage and carbonated beverages have a tendency to cause increased amounts of gas.
Diet
There is no such thing as a special diet for ostomies. Many times if you have another condition such as diabetes your doctor will have you on a special diet for that but generally not for an ostomy. People with an ileostomy should avoid foods with seeds, nuts and those difficult to digest such as corn chips, and Chinese foods. The cardinal rules for diet with an ostomy are:
- Eat a balanced diet
- Chew your food well and eat slowly
- Add foods to your diet gradually to see how they affect your system
- Drink plenty of water - 6 to 8 glasses per day
Bathing and Skin Care
With an ostomy you can bathe or shower as you did before surgery. You may elect to wear the pouch or remove it. This is a personnel choice. On days you will change the entire system, it is probably better to shower with the appliance off. Always check the skin around the stoma for any rashes, open areas, or irritations. Notify the doctor or ostomy nurses if this does occur.
Clothing
No special clothing is required. Even clothes that are tight fitting will not harm the stoma. None need to be aware of your wearing a pouch unless you tell them. Women can wear panty hose or even lightweight girdles for support. These things will not keep the stoma from functioning.
Travel
Keep your pouches with you. They will melt in extreme heat if stored in luggage compartments or the trunk of a car. Air pressure from airplanes will not affect your pouch system. It is always good when you travel to take enough supplies with you.
Exercise and Sports
Ostomy surgery should not keep you from being active. The only restriction on activity is heavy lifting. People with ostomies swim, fish, hike, ride horses, golf, tennis, volleyball, sail, and jog. You are the only one to limit yourself after fully recovering from surgery.
Sex and Personal Relationships
Ostomy surgery initially plays havoc with our body image. Do not despair - as soon as you are adept at caring for yourself and recovered from surgery you will find your are ready to resume intimate relationships. Honest - open communication between partners is essential. There are pouch covers and opaque pouches available. If you have questions about sex after surgery, discuss this with your doctor or ET nurse.
Emptying and Changing Pouch
How to empty your pouch:
Sit on the toilet with the pouch directly between your legs. Place some tissue in the toilet to prevent splashing. Hold the end of the pouch upward so the waste will flow away from clamp. Carefully remove clamp. Grasp the end of the pouch with tissue. Dry it well. Reapply the clamp. Don't hold pouch so high that water contacts the stoma. You may break the seal. Always empty the pouch when 1/3 full.
One Piece Pouch Change:
Change the pouch every 4-6 days or if leakage occurs. Gently remove the old pouch. Wash the skin well with warm water. Pat dry. Measure the stoma. Cut the pouch to size. Peel off the backing. Apply barrier paste around the opening you just cut. Apply prepared pouch over the stoma. Allow a small amount of air to remain in the pouch. Clip the bottom of bag securely.
Two Piece Pouch Change:
Change the pouch once per week or if leakage occurs. Gently remove the old pouch and wafer. Wash the skin well with warm water. Pat dry. Measure the stoma. Cut the wafer to size. Peel off the backing. Apply barrier paste around the opening you just cut. Apply prepared wafer over the stoma. Snap on the pouch. Clip the bottom of bag securely.
Supplies
Supplies that might be needed are wafers, pouches, paste and deodorant. There are additional accessories available if necessary.