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Colostomy Care

 

Your Bowel & How it Works

The main function of the digestive system is to prepare and process food to be absorbed and used by the body. The mouth provides a mechanical breakdown of foods eaten. From here, the food passes through the esophagus into the stomach.

 

The food is stored in the stomach for a short while and eventually enters the bowel, also called the intestine or gut. The bowel or intestine is a tube-like structure that is divided into two major parts. The parts are called the small bowel and the large bowel. The small bowel starts below the stomach. This part is called the duodenum. The bowel continues on, loosely coiled in your abdomen. This section of the small bowel is called the jejunum. The last part of the small bowel, just before it becomes the large bowel is called the ileum. The entire small bowel is approximately 20 feet long. The small bowel does all the work to digest and absorb the food you have eaten.

 

The next part of the bowel is the large bowel or colon. This part is about 6 feet long and it frames the small bowel. It is divided into 6 sections: cecum, ascending, transverse descending, sigmoid, and rectum. The large bowel's function is to remove the water from your waste products (stool) and to store these products until you are ready to eliminate them.

 

Knowing Your Colostomy

The aim of this site is to help you to become more familiar with your Colostomy. Your bowel disease has resulted in the need for your waste products to be rerouted through a surgically created opening in the abdomen called a Stoma (the Greek word for mouth).

 

No doubt you are experiencing a variety of feelings regarding your colostomy. A sense of loss of self-esteem or control over your own body is not unusual. You may even feel that those whom you love will no longer love you in return. You are not alone in your reaction. More than one million North Americans live with ostomies and one hundred thousand undergo this type of surgery every year. There will be many people upon whom you will be able to call for help and these will be discussed further on.

The food that you eat eventually arrives in the bowel (or intestine). This organ is a tube like structure that is divided into 2 sections the small and the large bowel. The small bowel does all the work to digest the food which you have eaten while the large bowel functions to remove water from your waste products or stool and to store these products until you are ready to eliminate. Even after the removal or bypassing of part of your large intestine, you will still have all of your small bowel to digest your food and a part of your large bowel to absorb water and store waste.

 

Colostomies & Stomas

A colostomy is a surgically created opening in the colon (or large bowel) to permit elimination of body wastes. The consistency and frequency of discharge from the colostomy will vary depending upon its location in the colon. The end of the large bowel has been brought out through a surgically created opening to form a stoma. Stomas are wet, shiny and their surface is red in colour (similar to the tissue that lines your mouth). They have no nerve endings and therefore are not sensitive to touch or pain. They are, however, very rich in blood vessels and may bleed slightly when rubbed. This is normal and should not be cause for alarm. Stomas may shrink a little in size during the first few months following surgery and therefore should be measured periodically in order to ensure and accurately fitting appliance.

 

Body waste (stool) will now be passed from the stoma into a collection device or pouch, which is secured on your abdomen. There will no longer be any urge to pass stool, nor will there be control as you had previously. For the first while the stool will be more liquid but gradually will thicken up and return to a more normal consistency.

 

Loop colostomies are slightly different. If yours is a loop colostomy it probably has been done only as a temporary measure. A loop of bowel has been brought through a small opening on your abdomen and supported by a glass rod or plastic bridge. The rod or bridge is removed 7-10 days after surgery. A small incision has been made in the loop of bowel to permit the passage of stool. The loop looks like one large stoma but actually has 2 separate openings. Usually the right opening passes stool and the left one only mucous.

 

Caring for your Colostomy

Caring for your colostomy will soon become part of your daily routine requiring very little of your time if it is looked after properly. The frequency with which you change your appliance will depend upon the type of colostomy you have and its location as well as the type of appliance your Enterostomal Therapist fits you for.

 

Regardless of the differences between colostomies, certain principles shall remain the same:

 

1. Always use a skin barrier of some sort. Your skin can easily be damaged by stool that is allowed to rest on the skin.

2. Most appliances are designed to stay on 3-5 days but the appliance must be changed as soon as you feel any itching or burning beneath your skin barrier. Similarly, redness or skin breakdown around your stoma is an indication for action.

 a) Recheck the size of the stoma and adjust the opening in the skin barrier accordingly. There should be only  1/16 th to 1/8 th of an inch of skin showing around the stomal base. A rule of thumb is to cut  the barrier as close to the stoma as possible without touching it.

b)Avoid use of any soap containing a skin cream base.

c) Use of a Canada Care skin barrier paste is beneficial.

d) Call your enterostomal therapist if problems persist.

 

3. Your colostomy will develop its own pattern of elimination and you will learn when the quiet times are and use them to your advantage for colostomy care.

4. You may bathe or shower with your appliance on or off. When changing your appliance, wash the skin around it with mild soap and water. Rinse with Canada Care Skin Antiseptic and dry well. You may choose to shave the skin at this time as well.

5. Depending upon the type and location of your colostomy, you may or may not be able to irrigate and therefore control the functioning of your colostomy. If you are a candidate for irrigation this will be discussed with you at some point during your hospitalization.

 

Dietary Considerations

1. No special diet is necessary, however, foods that caused difficulties prior to surgery will no doubt continue to be bothersome. Following surgery, foods should be introduced gradually until a normal diet is achieved. New foods should be introduced one at a time. If not tolerated the first time, they should be tried again later. Try smaller portions at the beginning and gradually increase the quantity.

 

2. Chew your food well, in a relaxed atmosphere.

3. It is recommended that 6-8 glasses of fluid are to be consumed daily.

4. Three regular meals per day are important to establish good bowel habits and ensure proper nutrition. Skipping meals increases gas production.

 5. Medications for diarrhea and constipation should not be taken without direction from your physician.

 6. In the presence of diarrhea, there will be an increased need for potassium. Good sources include: meat, fish, poultry, dried fruit, bananas, oranges, tomatoes, and their juices, sweet potatoes, potatoes, dried legumes and whole grain cereals. If diarrhea persists, consult your physician.

 To relieve diarrhea:

Avoid naturally laxative foods such as prunes, figs, flax and licorice. Restrict fiber in diet and emphasize foods like peanut butter, cheese, applesauce, rice, bananas, tapioca and boiled milk.

 

7. To relieve constipation:

Increase your fiber intake to include whole grain cereals, bran, fresh fruits, raw vegetables and fluids (including prune juice or lemon juice / warm water).

 

8. To control gas:

Flatus (or gas), is often caused by swallowing air. Carbonated beverages, beer and chewing gum may also contribute to the problem. Sleeping on your back also causes gas after abdominal surgery you will spend upwards of 18 hours a day on your back so you will experience more gas in the post-operative recovery period. When you are back to the regular 24-hour routine, the gas will diminish. The following gas-producing foods may not be tolerated:

 

Beans-dried (navy, lima, and kidney), broccoli, cabbage, cantaloupe, cauliflower, chives, corn, cucumber, leeks, onions (bulb and green), peas (dried), radishes, peppers (red and green), sauerkraut, and/or turnips (yellow and white).

 

It is important to remember to eat slowly and to chew your food thoroughly. It is not necessary to avoid gas-producing foods completely. Rather, try them in small amounts to see which, if any, cause problems.

 

9. To control odour:

The following foods may cause odour: asparagus, beer, cabbage family, cheese, eggs, fish, legumes, and onions.

 

Certain drugs and vitamin preparations may also cause odour. Parsley, yogurt and buttermilk may help to control odour.

 

10. If you are concerned with odour there are a number of prepartions available that control and eliminate odour. Consult the Ostomy Care Centre at (613) 234-1222 for more information.

11. Bowel upsets can be caused by conditions not related to your diet such as emotional pressure and the effects of travel. Foods that cause problems should be re-introduced after a period of time.

12. It is important to achieve and maintain your ideal body weight.

 Suggested Meal Pattern

 

Breakfast      Fruit or juice

                       Whole grain cereal and/or bread

                       Egg, cheese, meat or meat alternative

                       Milk

                       Beverage

 

Lunch             Egg, cheese*, meat or meat alternative

                       Whole grain bread and/or potato

                       Fruit and/or vegetable

                       Milk

                       Beverage

 

Dinner           Egg, cheese*, meat or meat alternative

                       Whole grain bread and/or potato

                       Fruit and/or vegetable

                       Dessert

                       Milk

                       Beverage

 

Between meal nourishments may be taken as directed. *An additional iron source must be chosen when cheese is substituted for egg, meat or meat alternative.

 

Relationships

Your own attitude toward your ostomy will be the most important one. If you have a healthy attitude, others will adopt it.

 

Very few people will be aware of your ostomy and it is up to you, and you alone, to decide who you want to tell and when.

 

Resumption of sexual relations often takes time. Much pressure regarding returning to previous sexual activity level is self-imposed and should be disregarded. Give yourself time to recover fully from your surgery and even then keep in mind that there may be physical factors, which may delay resumption.

 

In certain instances, particularly in men who undergo extensive surgery, it may be difficult or impossible to achieve and / or sustain an erection. Problems such as these are not common but they are possible. If there is a problem with the sexual response cycle your Enterostomal Therapist or physician will be able to discuss various alternatives with you.

 

Sexual concerns are very common between partners, whether ostomy surgery is involved or not and the most important factor in finding or returning to a satisfying sexual relationship is honest and open communication. If time is taken and feelings are discussed openly, you'll be surprised at how quickly a return to physical intimacy is established.

 

Activities

A colostomy is in no way a restriction on your previous lifestyle. Rough contact sports (without special stomal protection) might result in stomal injury and perhaps should be avoided. Otherwise, you are free to enjoy all the activities that you enjoyed before.

 

Electrolytes

Because your colon has been removed, and the purpose of the colon is to absorb the fluids from the digested food you will have to be aware of fluid loss. Fluids such as sodium, potassium, magnesium, etc. are lost through everyday living, more so during strenuous exercise and perspiration. I find good sources of these electrolytes are found in tomato juice, bananas, coke, beer, apple juice and Gatorade.

 

Travel

Traveling to certain countries may dictate caution when drinking their local water. Your safest bet in countries where the water is questionable is to buy bottled water. Similarly, colostomates who irrigate must be careful. If the water is unsafe for drinking, you may have to boil the water, cool it to room temperature and then use if for irrigation.

 

Remember to always bring along adequate supplies with you when you are traveling abroad. When traveling by air it is important to keep them with you in your hand luggage in order to avoid the risk of losing them should your checked baggage be sent elsewhere.

 

Financial Resources

Some financial assistance may be available from the following:

 

  1. Extended health care plans.
  2. Provincial medical plans.
  3. Disability pension recipients
  4. Veterans (DVA)
  5. Canadian Cancer Society may offer financial assistance if the ostomy is a result of cancer.
  6. Some local United Ostomy Association Chapters
  7. Other local community associations.