Stoma or Ostomy care

Stoma or ostomy care is a specialized service at Columbia Asia Hospitals. Trained stoma care nurses provide stoma and wound care and train the care providers or patient’s themselves on stoma care at home.   Stomas are usually created by colorectal surgeons, gastrointestinal surgeons, general surgeons, urologists and pediatric surgeons. Caring for the stomas is a very important aspect for the patient to lead a normal life after the procedure. Columbia Asia provides the highest level of medical services for problematic, hard-to-heal wounds as well as ostomy care including colostomy, ileostomy, urostomy, fistulas and leaking tube/drain sites.

Before discharge, a new ostomy patient and caregiver are taught how to empty the pouch, establish a schedule for pouch changes, how to ensure protection from effluent, and use accessory supplies appropriately

What is an ostomy or stoma? 

An ostomy is a procedure performed to redirect body’s waste products due to disease, trauma or defects in the colon, bowel and bladder. An opening is created in the abdomen for stool or urine to leave the body. The exact location on the abdomen will depend on the procedure for which a stoma is created. The wastes are collected in a pouch and cleared periodically. The most important aspect of stoma care is the skin barrier, which protects the wound from the wastes and helps the pouch stay attached to the skin. This is also called a barrier, wafer or face plate. Applying the skin barrier is a skill which will be taught to the care giver. Stomas may be temporary or permanent. The bags can be emptied into the water closet but the bags should be disposed of with infectious wastes. 

Types of ostomy/ stoma

  • Colostomy: is a stoma in the large intestine 
  • Ileostomy is a stoma in the small intestine
  • Urostomy is a stoma for urine to leave the body

What is a healthy stoma?

  • Stoma should be above skin level
  • Red and moist stoma (pallor suggests anemia, dark hue may be due to reduced blood supply to the area)
  • No gap between the skin and the edge of the stoma
  • No redness, rash, ulceration or inflammation in the surrounding skin

Concerns in stoma care

  • Selection of a proper site for the stoma to prevent risk of skin infection etc
  • Placement of bag should be so that there is no restriction by clothes or waist line
  • Caring for the ostomy wound
  • Cleanliness of the area around the stoma is the most important aspect of stoma care, as infection, fungal issues and irritation are some common concerns
  • Odor from pouch

Problems associated with stomas

  • Many patients develop anxiety and depression. Adequate counselling is important. 
  • In the first few weeks patient may experience a sudden urge to defecate. This is known as phantom rectum and will pass with time. 
  • There may be changes with amount and consistency of stools. 
  • Excessive wind and malodorous stools can be managed with dietary changes. 
  • Skin around the stoma can develop an allergic reaction to materials used for stoma
  • Ileostomies have a very high output and carry a risk of dehydration. 
  • Bleeding during bag changes may occur. 
  • Prolapse, narrowing or blockage of stoma can occur. Stenosis with ribbon like stools and excessive high pitched wind will require surgical correction
  • Stomas can cause excessive wind during air travel, due to changes in cabin pressure
  • Weight loss or gain, can affect the functioning of an ostomy.

Life with stomas

A person with a stoma can continue to lead a normal life. Bathing, showering or swimming is possible as the adhesive is water proof.

Despite having a colostomy, one can lead a normal life and enjoy physical and social activities as before getting the stoma. Minor changes in adapting to a stoma and keeping a positive outlook is very important. 

Your colorectal surgeon and your stoma care nurse will provide you with practical tips so you can maintain a healthy and happy life, albeit with a little care

Will my sexual intimacy be limited?

Sexual life can be resumed once the doctor clears you. Both partners need to know that with a little understanding one can have the intimacy of a healthy sexual life. 

An opaque pouch or a pouch cover is available to shield the stoma. Using different sexual positions is also another option.

Some persons may need professional help for depression or managing emotional concerns. Managing a pregnancy with a stoma also needs special care and can be provided by your doctor or stoma care nurse. 

Dietary advice

Most patients will be advised a normal diet. Depending on the type of your ostomy, some may be advised modifications in eating habits to control the frequency and consistency of bowel movements.  The average daily output of an ileostomy is about 500 ml per day but may be up to 1,000-1,500 ml in a day.  The average daily output of a colostomy is about 500 ml per day, with a range of about 200-700ml.

Learning to monitor the amount and consistency of your bowel movements

A Large output from the stoma or ostomy can result in dehydration, while sudden reduction of output can indicate impending constipation.  You will be advised to chew your food well and drink plenty of fluids.  The dietician will tailor make your diet chart to suit your stool consistency, to avoid potential blockages.  An ostomy will not lead to malnutrition unless a part of the intestine has been removed during surgery. Most patients introduce different types of food slowly and learn to monitor the effect of each food on the ostomy function.

Steps to apply the pouch 

  • Place all the equipment needed close at hand before removing your pouch.
  • Wash your hands with soap and water
  • Stand or sit in front of a mirror. ...
  • Gently remove the used pouch 
  • Wash the stoma and the skin around the stoma and pat dry with tissues
  • Hold the pouch with the sticky side close to the body
  • Apply the skin barrier paste and paste the barrier
  • Place the hand over the barrier as the heat from the skin will help the barrier stick

Emptying the pouch

The patient or the caregiver is taught to empty the pouch when it is one-third to half full. Not emptying the pouch at this stage will lead to too much weight, which can pull the pouch off the skin, allowing leakage. Also, emptying is easier if the pouch isn’t full. The patient or the caregiver is made to practice emptying the pouch before discharge. Pouches are odor-proof, so rinsing is not necessary. If the patient insists on rinsing, advise him to instill water into the lower portion of the pouch, avoiding the barrier. Getting water on the barrier and stoma will break down the barrier and may cause a fungal rash on the peristomal skin. However, it is preferable to avoid rinsing

Establishing a schedule for pouch changes

Routinely, drainable pouches and urostomy appliances are changed every 3 to 5 days, but depending on the patient’s output, abdominal contours, and ability to change the pouch, changes may take place as often as daily or as infrequently as weekly. 

If the patient experiences itching or burning under the barrier or notices or suspects leakage, he should change the pouch immediately. One should not to tape the edge of a barrier to stop a leak because the effluent will quickly cause skin breakdown. Instead, the patient should remove the entire pouching system and assess for leakage.

Teach the patient to determine a barrier’s wear time by examining the back of it. If the barrier has broken down, he’ll see a color change. If leakage resulted from a break down on the barrier’s edge, the patient should decrease the interval between pouch changes. If there’s no color change, the barrier can be kept for more time

Measuring the stoma

In the first 6 weeks after surgery, the patient must measure the stoma weekly because bowel swelling decreases during this time. After 6 weeks, the patient can measure the stoma monthly, unless body weight fluctuates or an inflammation causes stoma swelling.

To keep the peristomal skin protected from effluent, the patient should learn how to use a stoma measuring guide. 

Using accessory supplies

Routine use of adhesive remover, skin prep, or skin sealant may decrease the ability of the pouch to adhere. If peristomal skin is intact, the patient shouldn’t use ostomy powder. Use it sparingly on weepy, denuded skin to help dry and prepare the area for the barrier application. After dusting the reddened area, the patient must brush off the excess powder to make sure the barrier will stick. The patient is taught how to use ostomy paste sparingly, to fill in and level out uneven peristomal skin (dips, scars, skin folds) and prevent leakage. 

When to call the doctor

Call the doctor if you have any of the following symptoms:

  • If the stoma is purple, black or white
  • Severe cramps lasting over 6 hours
  • Severe watery discharge from stoma                            
  • No output from stoma for 3 days
  • Excessive bleeding from stoma
  • Stoma pulled inward below skin level
  • Severe irritation of skin 

Why Columbia Asia

  • Care provided with concern, compassion and empathy
  • Skill and expertise in managing stoma care
  • Physicians and nurses specially trained in ostomy care. 
  • Latest techniques and equipment in stoma care
  • Care plan developed in conjunction with patient, your primary care physician, nurses, dieticians and care provider at home
  • Treatment coordinated with Home Healthcare Services

“Be Strong because things will get better. It may be stormy now, but it never rains forever”

 

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