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In advance of our Stoma Care Clinic this Thursday, here is Eamonn's comprehensive piece on Stoma (types, management, issues, care)...

Posted by Eamonn Brady on

Stoma care

A stoma is the result of an operation to remove disease such as cancer, Crohn's disease or diverticulitis or from a bowel obstruction or injury to the digestive or urinary system. It is an artificial opening that allows faeces or urine either from the intestine or from the urinary tract to pass. There are three main types of stoma related to the digestive and urinary system - these are: colostomy, ileostomy and urostomy.

Colostomy

In a colostomy operation, part of your colon is brought to the surface of your abdomen to form the stoma. A colostomy is usually created on the left-hand side of your abdomen. Stools in this part of the intestine are solid and, because a stoma has no muscle to control defecation, will need to be collected using a stoma pouch.

Ileostomy

In an ileostomy operation, a part of your small bowel called the ileum is brought to the surface of your abdomen to form the stoma. An ileostomy is typically made in cases where the end part of the small bowel is diseased, and is usually made on the right-hand side of your abdomen. Stools in this part of the intestine are generally fluid and, because a stoma has no muscle to control defaecation, will need to be collected in a pouch.

Urostomy

If your bladder or urinary system is damaged or diseased and you are unable to pass urine normally, you will need a urinary diversion. This is called a urostomy. An isolated part of the intestine is brought onto the surface of the right-hand side of your abdomen and the other end is sewn up. The ureters are detached from the bladder and reattached to the isolated section of the intestine. Because this section of the intestine is too small to function as a reservoir, and there is no muscle or valve to control urination, you will need a urostomy pouch to collect the urine.

 

Surgery

 

The days after stoma surgery can be challenging. You have a pouch attached to your abdomen and lots of new things to learn. It's important to remember that it takes time to adjust, but it will get easier. With support from your stoma care nurse and practical guidance on how to change your ostomy pouch and care for your skin, you should soon be able to do the things you’ve always done.

 

Ostomy Pouch

 

An ostomy pouch is necessary to securely and conveniently collect the output from your stoma. No matter what type of ostomy you have, all the output from the stoma must be collected in a secure and convenient way. Ostomy pouches are designed to adhere to the skin on your abdomen around your stoma and collect the output.

The design of your ostomy pouch will depend on whether you have a colostomy, ileostomy or urostomy. Your stoma care nurse will show you which one is right for you. Pouches are secure and discreet. Nobody will know you’re wearing one unless you decide to tell them. It can be difficult at first to accept the fact that you will have to wear an ostomy pouch on your stomach, you should soon start to realise that it’s possible to live much as you did before.

Changing your pouch

How often you change or empty your pouch depends on the type of stoma you have:

  • Colostomy: The pouch needs to be changed between one and three times a day, depending on the amount of output.
  • Ileostomy: The pouch needs to be drained several times a day.
  • Urostomy: The pouch needs to be drained several times a day. During the night, a urostomy bag or a small urostomy appliance can be attached to a night bag so you don’t need to get up to drain your bag.

The Stoma

 

What does the stoma look and feel like

After surgery, your stoma may be quite swollen to begin with, but will reduce in size over time – usually after six to eight weeks.

No sensation, no pain

A stoma is red in colour. This is because it is a mucous membrane, just like the mucous membrane inside your mouth. There is no sensation in the stoma, so it is not painful to touch. The stoma can bleed a little when being cleaned, especially in the beginning, but this is quite normal, and should stop shortly afterwards.

Stomas come in all different shapes and sizes - some are quite short and sit flat against the belly, while some protrude a little. Some people will have more than one stoma, depending on their condition. 

How a stoma affects daily life

It will take time to adjust to life with a stoma. But there’s no reason why it should stop you doing the things you already do, from sports to socialising. After your stoma operation you will need some time to recover. The time needed will vary from person to person. Your stoma will change in the first weeks following surgery, in terms of both size and output. Also, you might lose or gain weight in these weeks.

Getting started with a pouch
Having a stoma means you have no control over when you defecate or, in the case of a urostomy, when you urinate. This means that you always need to wear a pouch to collect your output.

Healthy skin
In order for your pouch to adhere properly, it is very important to keep the skin around your stoma healthy. When the pouch is attached correctly, there is no risk of smell from your stoma and less risk of skin irritation. Before you leave hospital, you will be trained in how to choose and manage your stoma pouch and how to take care of your skin.

Food and drink
In general you can eat and drink as normal. Try to see how your stoma reacts to different foods. Your stoma care nurse or surgeon will advise if you need to take special precautions. In general, your stoma is no hindrance to working, socialising, playing sports, travelling or other hobbies. Your stoma will change in the first weeks following surgery, in terms of both size and output. Also, you might lose or gain weight in these weeks.

Possible pouch problems

 

Ostomy leakage

How to spot leakage and how it is different from mechanical irritation and other complications.

If you experience skin problems or complications, you should always consult your stoma care nurse straight away. However, spotting evidence of leakage early can help you catch a potential skin problem even before it develops.

Start by looking for any stoma output, either on your skin or on the back of the adhesive plate. Even if there is no direct visual sign of leakage, be aware of anything unusual, such as if the adhesive plate looks 'melted' (because the adhesive has reacted with the output).

Signs of mechanical irritation

If your skin is red, sore and moist, maybe even bleeding a little, but you have not had any leakage, the issue could be 'mechanical'. That means your skin is simply being irritated from removing the pouch too often, too vigorously, or from cleaning or scrubbing the skin to roughly.

To avoid mechanical irritation, try to be as gentle as possible, both when removing your adhesive baseplate and when cleaning the skin. Try to peel the plate off slowly, rather than ripping or tearing off. Using the other hand to hold the skin tight can help reduce stress on the skin. Adhesive removers may also help when removing the appliance.

Ballooning

What is ballooning?

When you swallow food or water, you also swallow a certain amount of air. Most stoma pouches have charcoal filters built into the bag. These allow the wind to be released. However, if the filter capacity cannot handle the amount of wind produced, or if the filter has become wet or blocked by the stoma output, the pouch can expand out due to being filled with air/ gas which is called ballooning.

 

What can you do to reduce ballooning?

One of the main ways to reduce ballooning is to reduce the amount of air entering your digestive system produces. All people are different and some foods that increase wind for one person does not do the the same for another.

 

Reducing ballooning

  • Eat regular meals throughout the day
  • Sip drinks and try not to rush your meals
  • Chew food thoroughly.
  • Eating live yoghurt or taking pro-biotics daily can help to balance the bacteria in your digestive system, which in turn can reduce wind.

Causes of ballooning

  • Certain food types such as spicy or high fibre foods and some vegetables (e.g. onions, cabbage, beans) can increase the amount of wind produced.
  • Fizzy (carbonated) drinks lead to an increased amount of air entering the intestine.
  • Other activities such as drinking through straws, drinking from a bottle with a sports cap, chewing gum, smoking, shortness of breath and even snoring can increase the amount of air swallowed.

What to do when you experience ballooning

If ballooning does occur, you can release the gas from the pouch in the privacy of a toilet, if you use an open bag or use a two-piece system. Changing the pouch if the filter blocks can also help prevent ballooning. Finally, it may be worth trying another type of stoma pouch and filter type. Your stoma nurse will advise you.

Free Stoma Clinic on Thursday June 13th

Whelehans Pharmacy are hosting a Stoma Care Clinic at our private consultation room at Whelehans Pharmacy Pearse St Mullingar on Thursday June 13th. This clinic is free of charge to everyone. The clinic will be run by Lucy Fitzgerald, Clinical Nurse Specialist who has years of experience caring for people who have had stoma surgery. Book your free place by calling Whelehans at 04493 34591 or email health@whelehans.ie. So, if you are experiencing any issues with managing your Ileostomy, Colostomy or Urostomy, book your free 45-minute private consultation now.


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