Colostomy Care

This is the specialized care required for a colostomy. For some medicalproblems involving the large intestine, also known as the colon, a new passagemust be created to allow stool to leave the body. An opening in the abdominalwall is created by a surgeon. The surgeon connects the colon to the outsideabdominal wall of the body. This is called a colostomy.The opening in the abdomen on the outside of the body is called a stoma.

Who is a candidate for the procedure?

A person may need a colostomy if he or she has had aninfection, inflammation, or blockage in the bowel. The colostomy mayalso be part of treatment for colon cancer.Bowel defects or injuries might also result in a colostomy. The underlyingcondition that leads to a colostomy will affect a person’s emotional,psychological, and physical recovery from surgery. A colostomy may betemporary or permanent.

How is the procedure performed?

Colostomy education begins before surgery. Diagrams,photographs, and examples of equipment are used to help to explainwhat the person might expect after surgery. Concerns about upcomingchanges in body image, lifestyle, and sexuality are also addressed.

When a person has a colostomy, a team of healthcareprofessionals provides education and initial care. These may include a doctor,nurse, social worker, and dietitian. An enterostomal therapist, known as an ET,might also help with care. ETs are usually registered nurses who have hadspecialized training and certification in the care of ostomies and wounds.People with colostomies are given information and training specific to their needs.Ongoing care may often extend well beyond the initial hospital stay.

The colostomy will begin to function 3 to 6 days after surgery.At first, a nurse or ET will take care of the colostomy.This person will also teach the person how to care for the colostomy onhis or her own. Gradually, the individual will be able to take over the careof the stoma and the skin around the stoma.

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The stoma is red and shaped in an oval. It resembles the skinon the inside of the lower lip. A drainage bag or pouch is attached to theskin around the stoma. The stool drains into this pouch. The stoma sizedetermines the size of the pouch. The size of the stoma may vary at firstdue to swelling and weight fluctuation. The stoma is often checked 3 weeksafter surgery, when swelling has subsided. The final size and type of pouchused will be set about 3 months after the colostomy. This is when a person’sweight and size are likely to be stable again.

There are many types of pouches available. Most pouches areodor-resistant and disposable. The nurse or ET can helpthe person choose an appliance that fits well. Good skin care around thestoma is critical. Before applying a fresh pouch, the skin around the stomais washed gently with a mild soap. A gauze dressing may be used to coverthe stoma while the skin is cleaned. The skin is patted completely dry witha gauze pad. Rubbing should be avoided. A healthcare provider may suggestusing nystatin powder on the skin around the stoma to combat irritation oryeast growth. A skin barrier, which may be a wafer or paste, is then appliedto protect the skin from bowel contents draining through the stoma. Thebacking of the adhesive surface of the pouch is removed. The bag is thenpressed down around the stoma for 30 seconds. The pouch should be removedand drained when it is one-third to one-fourth full. If the pouch becomestoo full, the weight could cause the bag to come off and spill.

Colostomy irrigation, a procedure in which fluid is inserted intothe bowel through the stoma, might be used to regulate the passage of stool.This helps avoid constipation.The healthcare provider will advise when and how to perform irrigation.

A dietitian can help a person with a colostomy choose a balanceddiet. It may be helpful to avoid some foods, such as those that cause gas andodor. These foods include:

beans

eggs

fish

members of the cabbage family

nuts

Foods or fluids such as fruits, coffee, carbonatedbeverages, or high-fiber items may cause diarrhea. Foods with hard-to-digestkernels, such as popcorn, may need to be avoided as well. Nonirritating foodscan be substituted for those that must be restricted.

What happens right after the procedure?

The person should be encouraged to talk about how he or shefeels about having a colostomy. Questions about sexuality and body imageare common. These can be addressed by the healthcare team. The pouchpresents no physical reason to limit sexual activity. Some persons wearpouch covers, or smaller pouches, during sex. Concerns about lifestylechanges can be discussed with a healthcare provider.

What happens later at home?

Visits from homecare nurses or ETs canhelp the person adjust to day-to-day living. Some people may find ithelpful to join support organizations such as the United Ostomy Association.

What are the potential complications after the procedure?

Specific instructions will be given about when to call thehealthcare provider. Skin irritation and infection can result from stool thatdoes not drain properly. Diarrhea, which is the passage of frequent watery stool,may occur. Stool may also get backed up in the bowel and require manual removal.