Colostomy Care

What is a colostomy?
A colostomy is an opening that is made in the colon with surgery. After the opening is made, the colon is brought to the surface of the abdomen to allow stools to leave your body. The opening at the surface of the abdomen is called a stoma. The stool leaves the colon through the stoma and drains into a flat, changeable, watertight bag or pouch. The pouch is attached to the skin with an adhesive (substance that seals the pouch to the skin).

A colostomy is sometimes needed for certain health conditions or diseases. Some of these include cancer, diverticular disease, Crohn's disease and trauma or injury. A temporary colostomy may be needed to allow the colon to rest and heal for a period of time. A temporary colostomy may be in place for weeks, months, or years. The temporary colostomy will eventually be closed and bowel movements will return to normal. A permanent colostomy is usually needed when a part of the colon must be removed or cannot be used again.

Where is the colon located? The colon is part of the digestive system. The digestive system consists of the parts of the body that are involved in the digestion (breakdown) of food. Food moves from your stomach to the small intestine where food is digested and nutrients are absorbed. The food then goes to the colon (part of the large intestine). The colon absorbs water from digested food and turns the digested food into stool.

What are the different types of colostomies? Colostomy types are related to the place on the colon where the surgery is done. The location of the surgery depends on your health condition and the reason you need to have a colostomy.
Ascending colostomy: This colostomy has a stoma (opening) that is located on the right side of the abdomen. The output (stool) that drains from this stoma is in liquid form.

Transverse colostomy: This colostomy has a stoma that is located in the upper abdomen towards the middle or right side. The output that drains from this stoma may be loose or soft.

Descending or sigmoid colostomy: This colostomy has a stoma that is located on the lower left side of the abdomen. The output that drains from this stoma is firm.

What types of products are used for colostomies?
Pouch: There are a variety of sizes and styles of colostomy pouches. Pouches are lightweight and odor-proof. Pouches have a special covering that prevents the pouch from sticking to the body. Some pouches also have charcoal filters which release gas slowly and help to decrease gas odor. The following is general information about types of colostomy pouches:

Open-ended pouch: This type of pouch allows you to open the bottom of the pouch to drain the output. The open end is usually closed with a clamp. The open-ended pouch is usually used by people with ascending or transverse colostomies. The output from these colostomies is looser and is unpredictable (does not drain at regular times).

Close-ended pouch: This type of pouch is removed and thrown away when the pouch is filled. Close-ended pouches are usually used by people with a descending or sigmoid colostomy. The output from these types of colostomies is firm and does not need to be drained .

One-piece: A one-piece pouch contains the pouch and adhesive skin barrier together as one unit. The adhesive skin barrier is the part of the pouch system that is placed around the stoma and attached to skin. When the pouch is removed and replaced with a new one, the new pouch must be reattached to the skin.

Two-piece: The two-piece pouch has two parts: an adhesive flange and pouch. The adhesive flange stays in place while the pouch is removed and new pouch is attached to the flange. The pouch does not need to be reattached to the skin each time. The two-piece system can be helpful for patients with sensitive skin.

Pre-cut or cut-to-fit pouches: Some pouches have pre-cut holes so you do not have to cut the opening yourself. Other pouches can be cut to fit the size and shape of your stoma. Cut-to-fit pouches are especially useful right after your surgery because your stoma decreases in size for about eight weeks.

Stoma covers and caps: Stoma caps or covers can be placed on the stoma when the stoma is not active (draining). People with descending or sigmoid colostomies who irrigate may use stoma covers or caps. The cover or cap is attached to the skin in the same way as a pouch.

Skin protection:

Film: A film can be placed on the skin to protect against damage from the adhesive material. Films are helpful for people with sensitive, dry, or oily skin.

Pectin-based paste or paste strips/rings: These products are helpful for protecting skin against output that contains digestive enzymes (proteins that break down foods). Ascending or transverse colostomies can produce output that contains digestive enzymes, which can irritate or damage the skin. The paste is also used to create a flat pouch surface by filling in small skin creases.

How do I change my pouch? The way in which you should change your colostomy pouch depends on the type of pouch you use. Your caregiver will give you specific instructions on how to change your colostomy pouch. The following is general information about how to change your pouch:
Ask your caregiver about how often to change your colostomy pouch. The amount of time that you should leave your pouch on your abdomen depends on many things. The type of pouch you wear affects the amount of time you can wear a pouch. The kind and amount of stool you have also affects how long the pouch stays on.

If you are wearing an open-ended pouch, empty the contents from pouch into the toilet. 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.

Clean the skin around the stoma with warm water. You may also use soap but do not use soaps that have oil or perfumes. Pat your skin dry.

Use a pouch that has an opening that is one-eighth of an inch larger than the stoma.

Use skin protection products if you have irritated skin around the stoma. The skin can be treated with these products to protect your skin and create a dry surface.

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 newly applied pouch for 30 seconds. The warmth of your hand can help to mold the adhesive skin barrier into place.

Place the old pouch in another plastic bag to be thrown away if the pouch is disposable. If you use a reusable pouch, talk to your caregiver about how to clean the reusable pouch.

How do I empty my pouch?
Empty the pouch when it is one-third to one-half full. Do not wait until the pouch is completely full because this could put pressure on the seal, causing a leak. The pouch may also detach, causing all of the pouch contents to spill.

Place toilet paper into the toilet to reduce splash back and noise.

Take the end of the pouch and hold it up. Remove the clamp (if the pouch has a clamp system).

You may need to make a cuff at the end of the pouch to keep it from getting soiled.

Drain the pouch by squeezing the pouch contents into the toilet.

Clean the cuffed end of the pouch with toilet paper or a moist paper towel. You may also rinse the pouch but it is not necessary. Make sure and keep the end of the pouch clean.

Undo the cuff at the end of the pouch. Replace the clamp or close the end of the pouch according to your caregiver's instructions.

What is irrigation? People with descending or sigmoid colostomies may be able to irrigate their colostomies on a regular basis. Irrigating the stoma means putting a fluid into the stoma to empty the bowel. This may also be called an enema. Irrigation allows a person to have timed bowel movements. Irrigation can allow a person to be free from stool output for about 24 to 48 hours. Once stool output is regular, a stoma cap can be used between irrigations instead of using a drainable pouch. The stoma cap will absorb mucus and deodorize and vent gas.
Talk to your caregiver about whether irrigation is right for you. Irrigation may be right for you if you had regular bowel movements before the colostomy. You should also be physically able to perform the irrigation procedure. It is also important to have a lifestyle that will allow regular irrigation. For example, you should have a daily schedule in which you can schedule enough time to regularly irrigate. You should also be free from certain colostomy problems. People with problems such as a prolapse or a hernia should not irrigate. Irrigation could make a prolapse worse or create a hole in the bowel. Irrigation could also cause leakage of stools between irrigations or make it hard to control bowel movements.

How do I irrigate my colostomy? Ask a specially trained caregiver such as an ostomy nurse how to properly irrigate your colostomy. Below are some general steps for irrigation:
You will need a plastic irrigating container with a long tube and a cone to introduce water into the 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.

Choose the same time each day when you will not be interrupted to irrigate your colostomy.

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. The amount of water each person needs to put in the irrigating container varies. Ask your caregiver how much water you will need to irrigate. Hang the irrigation container at a height in which the bottom of the container is level with your shoulder. Sit up straight on the toilet or on a chair next to the toilet.

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 bowel.

Release air bubbles from the tubing on the plastic irrigating container by releasing the clamp. Allow a small amount of water to be released into the sleeve. Clamp the tubing again.

Moisten the end of the cone with water or lubricate it with water-soluble lubricant.

Place the tip of the cone about three inches deep into the stoma. Make sure there is a snug fit but do not place the cone too deeply or forcefully into the stoma. Release the clamp on the tubing again and allow the water to flow into the stoma. The water must go in slowly and takes about five to ten minutes. Keep the cone in place for another 10 seconds.

Remove the cone from the stoma. 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. You may move around for about 30 to 45 minutes until all the water and stool has drained. Drain the output from the sleeve into the toilet. Clean the area around the stoma with mild soap and water and pat dry.

What are some problems that can happen with a stoma? Most stoma problems happen during the first year after surgery.
Stoma retraction: Retraction happens when the height of the stoma goes down to the skin level or below the skin level. Retraction may happen soon after surgery because the colon does not become active soon enough. Retraction may also happen because of weight gain. The pouching system must be changed to match the change in stoma shape.

Peristomal hernia: Peristomal hernias occur when part of the bowel (colon) bulges into the area around the stoma. Hernias are most obvious during times when there is pressure on the abdomen. For example, the hernia may be more obvious when sitting, coughing, or straining. Hernias may make it difficult to create a proper pouch seal or to irrigate. The hernia may be managed with a hernia belt. Changes may also need to be made to the pouching system to create a proper seal. Surgery may also be done in some people.

Prolapse: A prolapse means the bowel becomes longer and protrudes out of the stoma and above the abdomen surface. The stomal prolapse may be caused by increased abdominal pressure. Surgery may be done to fix the prolapse in some people.

Stenosis: A stenosis is a narrowing or tightening of the stoma at or below the skin level. The stenosis may be mild or severe. A mild stenosis can cause noise as stool and gas is passed. Severe stenosis can cause obstruction (blockage) of stool. If the stoma is mild, a caregiver may enlarge it by stretching it with his finger. If the stenosis is severe, surgery is usually needed.

What types of foods can I eat after a colostomy?
People with colostomies can eat a regular diet. Choose healthy foods from all the food groups. To avoid constipation, eat foods such as oatmeal, whole-grain breads and cereals, fruits and vegetables. There may be some foods that you cannot tolerate very well. If a food gives you cramps or diarrhea, do not include that food in your diet. Try the food again in a few weeks. Eat small portions first and then gradually increase your portion sizes.

You may want to avoid foods that cause gas and odor. Some foods that may cause gas and odor are vegetables such as broccoli, cabbage, and cauliflower. Other foods include beans, eggs, and fish. You can also reduce gas by eating slowly and not using straws to drink liquids. Foods that may help to control odor and gas in some people are fresh parsley, yogurt and buttermilk.

Drink at least 8 to 10 (eight ounce) cups of water each day. Follow your caregiver's advice if you must limit the amount of liquids you drink. Healthy liquids for most people to drink are water, juices, and milk. Limit the amount of caffeine you drink, such as coffee, tea, and soda.

How can a colostomy fit into my lifestyle?
Work: You can go back to work when your caregiver says it is OK. You may need special support to prevent a hernia if you work is heavy labor, such as lifting or digging. You may need an ostomy belt over the pouch to keep it in place if you move a lot at your job.

Exercise: Exercise is very important. Talk to your caregiver about an exercise program once you feel stronger. Together you can plan a program that works for you. It is best to start slowly and do more as you get stronger. Exercising makes the heart stronger, lowers blood pressure, and helps keep you healthy. Your body and mind should feel better after exercising. Walking, jogging, bicycling, and swimming are good exercises. Talk with your caregiver before playing contact sports. You may need to wear a special support or a colostomy cover to protect your stoma. Empty your pouch before playing sports.

Bathing or swimming: You may take a bath with or without your pouch. You can take a shower or bath with your pouch off. Water will not go into the stoma during a shower or bath. For swimming, you should always wear your pouch. Empty your pouch before getting into the water if you swim. You may want to put waterproof tape strips over the edges of your skin barrier.

Relationships:

You may feel anxious, nervous, or scared when you first start to care for your colostomy. You may not like the way your body looks. You may feel like you are no longer in control of your body. These are normal feelings. Talk to someone close to you or to your caregiver about these feelings.

Learning to live with a colostomy may be difficult for both you and your spouse. Together you can find ways to live with this change in your life. It will take time for you to feel better after surgery. If you had an active sex life before colostomy surgery, it can be the same after surgery. You cannot hurt your stoma by having close body contact. Be sure to empty the pouch before having sex.

Traveling: Always carry extra colostomy supplies and pouches with you when traveling. Take enough supplies for your trip. You may not be able to find what you need while traveling. Contact your local ostomy group or ostomy nurse for help. They may be able to give you a list of ostomy caregivers in the area you are visiting.

If you fly, pack your supplies in your carry-on luggage not your checked suitcase because luggage is sometimes lost or delayed.

If you drive, do not put your supplies in the trunk or glove compartment. This can cause your supplies to get hot, melt and not stick well. Keep your ostomy supplies in the coolest place in the car.