COLOSTOMY

Colostomy
is a surgical procedure that brings the end of the large intestine through the abdominal wall. Stools moving through the intestine drain into a bag attached to the abdomen. The procedure is usually done after Bowel resections or injuries and it may be temporary or permanent.

Types
The type of colostomy varies with the portion of the colon brought to the skin's surface. The types are termed: ascending, transverse, descending, or sigmoid colostomy. When the ascending part of your colon is brought to the skins surface your colostomy will be on the right side of your abdomen anywhere from the appendix to just under your right rib. Your stool will be thick liquid. When a transverse colostomy is used, your stool will be either liquid or paste-like. Depending on which section of your colon is brought out, you may have either a descending or sigmoid colostomy. Because most of your colon is still intact and functioning, your stool will be formed.

 Loop transverse colostomy: The loop colostomy may look like one very large stoma, but it in fact has 2 openings. One opening expels stool, the other only puts out mucus. A colon normally makes small amounts of mucus to protect itself from the bowel contents. The mucus passes with the bowel movements and is usually not noticed. Despite the colostomy, the resting part of the colon continues to make mucus that will come out either through the stoma or through the rectum and anus; this is normal and expected.

Double-barrel transverse colostomy:

When creating a double-barrel colostomy, the surgeon divides the bowel completely. Each opening is brought to the surface as a separate stoma. The 2 stomas may or may not be separated by skin. Here, too, 1 opening expels stool and the other puts out only mucus (this stoma is called a mucus fistula). Sometimes the mucus fistula is sewn closed at the time of surgery and left inside the abdomen. In such a case, only 1 stoma would be seen on the abdomen (single-barrel colostomy) and mucus from the resting portion of the bowel would pass out through the rectum.

There are a number of reasons to perform a colostomy: Intra-abdominal infection, such as perforated diverticulitis Injury to the colon or rectum (for example, a gunshot wound) Rectal cancer Perineal wounds or fistulas

Risks
Reactions to medications Problems breathing Bleeding Infection Narrowing or obstruction of the colostomy opening (stoma) Skin irritation

 Whether a colostomy is temporary or permanent depends on the specific disease or injury. In most instances, colostomies can be reversed.

Prognosis
The colostomy functions to drain stool (feces) from the colon into the colostomy bag. Most colostomy stool is softer and more liquid than stool that is passed normally. The degree of liquidity of the stool depends on the location of the intestinal segment used to form the colostomy.

STOMA
Stomas come in all shapes and sizes. Some are round and others are oval. It may stick out (a budded stoma) or be flat (a flush stoma). The color should be a deep red or pink color. The stoma is warm and moist, like the inside of your cheek. The stoma can be an end (the end of the colon is brought out to the skin level) or a loop stoma (a loop of colon is brought out). When you clean your stoma, you may see a drop of blood as you wash it. This is normal. The stoma has many small blood vessels just like the inside of your mouth. (You may have noticed that your gums sometimes bleed slightly when you brush your teeth. That is also normal.) Do not be afraid to wash your stoma.

 Your stoma will change in size throughout your life with weight gains or losses. A change will be most noticeable in the first 6-8 weeks after surgery. Surgery causes swelling. As the swelling decreases, your stoma size will become smaller. Once a week, it is important for you to measure your stoma and fit the pouch opening according to size. Your stoma has no nerve endings, so it is not painful when touched. You do not have to be afraid to touch it. However, you should protect it from sharp objects, which could cut into the stoma, such as seat belts and large belt buckles.

COLOSTOMY CARE
It is best to empty your pouch when it is 1/3 - 1/2 full of either air or stool. This will prevent the pouch from getting too full and pulling off. When you empty your pouch, place toilet paper in the toilet to prevent splashing. Then, sit down and empty pouch between your legs. You may also stand facing the toilet to empty the pouch. Clean the end of the pouch with toilet paper and replace the clip on the pouch. Your pouch will need to be changed routinely every 4-7 days and when any of the following occurs: leakage itching under the pouch burning under the pouch Your pouch system prevents stool from getting on your skin. Stool is irritating to your skin; therefore, if any of the above conditions occur, remove pouch and check your skin.

Remove old pouch Remove pouch gently by lifting up on tape while pressing underneath on skin. Do not rip or tear pouch off as this can irritate the skin. If pouch is adhering too well, a wet wash cloth may be used to press on the skin behind the barrier. Clean the skin Cleanse skin and stoma with a wet wash cloth or wipe. Soap may be used but must be rinsed well. Allow skin to dry. Check for any skin changes. Refer to skin irritation section if changes are seen. Measure the stoma Before applying pouch, re-measure stoma with the guide. Make a note of the new size opening. If stoma is larger take the prepared pouch and re-cut it. If smaller, apply pouch and at the next pouch change adjust the size. For the first 2 months after surgery, measure the stoma whenever you change your pouch. Adjust the size as needed. Apply pouch Center opening in wafer around the stoma and apply sticky side to skin. Press down to assure all edges are sealed. Attach clip to the bottom of the pouch.

How to Treat Irritated Skin

Remove pouch gently. Cleanse with a wet washcloth. Gently dry surrounding skin. Sprinkle ostomy protective powder on reddened skin. Dust off or blot with a wash cloth. It will look like most of the powder has been removed. The powder will seal in to allow the irritation to heal. It will also provide a dry surface for the pouch to seal on the skin. Recheck the size of the stoma opening used.

Danger Signs
Stoma changes color from pink-red to purple-black. Excessive bleeding from stoma opening. Continuous bleeding between stoma and skin. Unusual bulging around your stoma. Any unusual problems with abdominal pain or continuous nausea and vomiting.

IRRIGATION
Colostomy irrigation is a way to regulate bowel movements by emptying the colon at a scheduled time. The process involves infusing water into the colon through the stoma, which stimulates the colon to empty. By repeating this process regularly once a day or once every second day the colon can be trained to empty with minimal to no spillage of waste in between irrigations. Colostomy irrigation also can help the patient avoid constipation.

 Colostomy irrigation may be done once a day or once every other day depending on your preference and ability to regulate your bowel movements. It generally takes about six to eight weeks for the bowel to become regulated with irrigation. It is important to establish a routine and irrigate at the same time each day.

Tips
Choose a time in the day when you know you will have the bathroom to yourself. Irrigations may work better if they are done after a meal or a hot or warm drink. Also, consider irrigating at about the same time of day you usually moved your bowels before you had the colostomy. Put 1000 cc (1 quart) of lukewarm (not hot) water in your irrigating container. You may need a little less. NEVER connect the tube directly to the faucet. Hang the container at a height that makes the bottom of it level with your shoulder when you are seated. Sit yourself on the toilet or on a chair next to it. Sit up straight. Put on the plastic irrigation sleeve and place the bottom end in the toilet bowl. Wet or lubricate the end of the cone with water-soluble lubricant

 To remove air bubbles from the tubing, open the clamp on the tubing and let a small amount of water run into the sleeve. Re-clamp the tubing and put the cone into the stoma as far as it will go, but not beyond its widest point. Again, slowly open the clamp on the tubing and allow the water to flow in. The water must go in slowly. You may shut the clamp or squeeze the tube to slow or stop the water flow. It takes about 3 to 5 minutes to drip in 1000 cc of water. Hold the cone in place for 10 more seconds. The amount of water you need depends on your own body. Do not use more than 1000 cc and you may need less. The purpose of irrigating is to remove stool, not to be strict about the amount of water used.

 You should not have cramps or nausea while the water flows in. These are signs that the water is running in too fast, you are using too much water, or the water is too cold. After the water has been put in, a bowel movement-type cramp may happen as the stool comes out. After the water has run in, remove the cone. Output or "returns" will come in spurts over a period of about 45 minutes. As soon as the major portion has come, you may clip the bottom of the irrigating sleeve to the top with a clasp. This allows you to move around, bathe, or do anything you wish to pass the time. In time you will know when all the water and stool have all come out. A squirt of gas may be a sign that the process is done, or the stoma may look quiet or inactive.

POUCHING
Pouches come in many styles and sizes, but they all do the same job--they collect stool drainage that comes through the stoma. Some can be opened at the bottom for easy emptying. Others are closed and are removed when filled. Still others allow the adhesive skin barrier, also called the face plate or flange, to stay on the body while the pouch may be taken off, washed out, and reused. Everyone needs to have some type of stoma pouch on hand, if only for emergency purposes. Along with the different kinds of pouches, other supplies such as flanges, clips, and belts are shown. Some types of pouching systems need these supplies. Pouches are made from odor-resistant materials and vary in cost. Pouches are either clear or opaque and come in different lengths. There are 2 main types of systems available: one-piece pouches with an attached skin barrier two-piece systems made up of a skin barrier and pouch that can be removed from the barrier The face plate or flange of the pouch may need a hole cut out for the stoma, or it may be sized and pre-cut.

Protecting the skin around the stoma

Use the right size pouch and skin barrier opening. An opening that is too small can cut or injure the stoma and may cause it to swell. If the opening is too large, it could possibly irritate the skin. In both cases, change the pouch or skin barrier and replace it with one that fits well. Change the pouching system regularly to avoid leakage and skin irritation. Leaks can cause itching and burning if the pouching system is not changed quickly, and the skin can become irritated. Do not rip the pouching system away from the abdomen or remove it more than once a day unless there is a problem. Remove the face plate gently by pushing your skin from the pouch rather than pulling the pouch from the skin. Water will often help.

 Keep the skin clean with water. If needed, you can use a mild soap and rinse very well. Pat dry before putting on the gauze or pouch. This can be done in the shower or tub. Watch for sensitivities and allergies to adhesive, skin barrier, paste, tape, or pouch material. They can develop after weeks, months, or even years of using a product since you can become sensitized over time. If your skin is irritated only where the plastic pouch lays against you, you might try a pouch cover. These are available from several manufacturers, or you can make your own. You may have to test different products to see how your skin will react to them.

Blood in the stoma

Spots of blood are no cause for alarm. Cleaning around the stoma as you change the pouch or skin barrier may cause slight bleeding. The blood vessels in the tissues of the stoma are very delicate at the surface and are easily disturbed. The bleeding will usually stop as easily as it started.

Shaving hair under pouch

Having a lot of hair around the stoma area can make it hard to get the skin barrier to stick well and may cause pain when removing it. Shaving with a razor or trimming hair with scissors is helpful. Always use a straight edge or razor carefully. A mild soap or shaving cream may be used. Rinse well.

Flatulence (Gas)
Right after surgery it may seem that you have a lot of gas almost all the time. Most abdominal surgery is followed by this uncomfortable, embarrassing, yet harmless symptom. As the tissue swelling goes down, you will have less gas. But certain foods, such as eggs, cabbage, onions, fish, beans, milk, cheese, and alcohol may cause gas. Eating regularly will help prevent gas. Skipping meals to avoid gas or output is not smart. Some people find it best to eat a smaller amount of food 4 to 5 times a day.

Odor
Odors are usually linked to gas, loose stools, or diarrhea. Some foods can produce odor: eggs, cabbage, cheese, cucumber, onion, garlic, fish, dairy foods, and coffee are among them. If you find that certain foods bother you, avoid them. Some medicines, for example, vitamins and antibiotics, cause stools to have an odor. Discuss this problem with your doctor. He or she may be able to prescribe another type of medicine. Odors may be worse with transverse colostomies. This problem may be dealt with by placing deodorants in the pouch and by changing pouches often. It is best to use odor-proof pouches that can be thrown away after a single use. If the colon is emptied well, odors are less likely. Irrigations may be helpful.

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