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Patient advice following the Formation of a Colostomy

The following guidelines will make caring for your Colostomy easier. Keep this information close at hand for quick reference.

A Colostomy is formed surgically when part of the colon (large bowel) is brought through an opening in the abdominal wall. The part of the colon that is brought onto the surface of the skin is called a stoma. Body waste can then exit the body through the stoma and be collected externally using a colostomy appliance. In the majority of cases the stoma is placed on the left hand side of your abdomen, midway between your hip and umbilicus. However the siting of the stoma is discussed along with the Stoma Care Nurse in order to determine the best position for the individual patient.

There are many reasons why you might require a stoma, but it is usually performed in order to improve your current condition. The reasons will have been discussed with you by your consultant and Stoma Care Nurse. A colostomy can be permanent or temporary depending on the surgical procedure you have had done.

It is important to remember that because a stoma is without sphincter muscles, there is no control over when bodily waste leaves the body. That is why a stoma appliance (pouch) is required to collect this waste.

The Stoma should be red and moist in appearance and similar to the texture of the inside of your mouth. A colostomy tends to be quite flush to the skin. There is little if no sensation to the stoma, however because it is a vascular area then it not unusual for the stoma to bleed slightly when cleaning it. Initially following surgery the stoma will appear quite swollen and it usually takes around 4-6 weeks to shrink to its expected size.

The output from the stoma immediately after surgery can be very loose; however it depends on how much of the colon (large bowel) has been resected. Once your body settles down and you begin to manage to return to a normal diet the stool should become more formed. Certain foods and drinks can influence the output, which will be mentioned later in this information sheet.

There is the option of trying to regulate your bowel movements by emptying the colon at a scheduled time through Colostomy irrigation. This is a personal decision and isn’t always appropriate however this will be discussed with you along with your Consultant and Stoma care Nurse. This option allows the individual to gain some control over their stoma and can avoid them needing to wear a colostomy bag; using a small stoma cap instead.

Stoma Care - Helpful Hints

  • Eat a well balanced diet including vegetables and fresh fruits. Eat on a regular basis. Drink at least 6 to 8 glasses of fluids per day.
  • Eat slowly and chew your food thoroughly. Avoid chewing gum, smoking and drinking through a straw, as this may help to reduce gas.
  • Eating yoghurt or peppermint preparations may help to reduce gas.
  • To help control gas at night, try not to eat after 8pm. This will allow your bowel time to settle down prior to you going to bed.
  • There are certain foods that can cause more odour than others. Foods such as asparagus, baked beans, broccoli, cabbage, cauliflower, eggs, fish, onions, garlic can cause strong odours for some people. Although your pouch is odour proof, if you eat these types of food you may notice a stronger smell when changing your pouch. If this causes any concern, you may wish to limit these foods in your diet.

Applying the pouch system.

Equipment Required

Tissues/Wipes
New Appliance
Bowl of warm water
Scissors
Disposal bag
Any accessories required, e.g. adhesive remover, protective wipe/spray etc Measuring device/template

Ensure you have all your equipment close at hand when preparing to change your appliance.

  1. Wash your hands prior to starting the procedure
  2. Stand or sit in a position which is more comfortable for you. You can use a mirror if this is easier for you. Remember that you must try and keep the skin around the stoma wrinkle free to help form a good seal.
  3. If you are still using a drainable system, empty the contents into the toilet first.
  4. Have the disposal bag close to hand or place the bottom of the appliance into the disposal bag.
  5. Remove the appliance. Peel the adhesive off the skin with one hand while exerting gentle pressure on skin with the other. Adhesive remover sprays can also be used. It is important to remember that if you get hairs growing close to your stoma, you may trim off them off with safety razor or scissors. This can help in the removal process.
  6. Wash the stoma itself and the skin around the stoma with warm water or cleansing lotions provided by the stoma companies that are un-perfumed and mild. Your stoma may bleed a little when being washed; this is normal. Rinse and dry well. It is essential to ensure the area is prepared well prior to a new appliance being applied.
  7. Ensure you check your stoma for any changes, e.g. size. If the stoma has shrunk ensure the flange is cut to the appropriate size. The appliance should be cut very slightly larger than the stoma in order that effluent cannot cause skin damage.
  8. A protective barrier wipe can be applied to skin around the stoma at this point and allowed to dry.
  9. If using a 1 piece system fold the flange/appliance slightly over in half. Removal backing from the flange. Place the bottom half of the folded flange up towards the base of the stoma. Once you have placed the appliance in the correct position unfold the other half of the flange over the stoma. Ensure you use your finger tips to secure the base around the stoma, as this will be the area where any effluent will hit first therefore it is essential that this is secured first. You can then move out to secure the rest of the base.
  10. Place your hand over the stoma and the pouch for a minute or so. The heat from your hand can help the appliance stick to your skin.
  11. If you are using a drainable system, we would advise you to change your appliance alternate days or if any leak is detected. If you have moved to a closed system (1 piece) then it is normal to change your appliance 1-2 times a day. If you have a 2 piece system, the base plate should be changed on alternate days and detachable bag will need to be changed 1-2 times a day.
  12. Ensure you dispose of all used items in a plastic disposable bag which is tied and then placed in the domestic waste bin.

Dietary Advice

After formation of your Colostomy you will continue to digest and absorb all nutrients normally in your small bowel. The length of the large bowel, resected during surgery (if any) will affect the amount of water and salts that are absorbed in your colon. The more large bowel you have had removed, the looser the colostomy output will be.
The long term dietary expectation for a person who has a Colostomy is generally a healthy one. Most people with a Colostomy can have, within reason, any food or drink. Constipation can be an issue; however this can be prevented or resolved with dietary measures and laxatives (if required). It is important to remember that everyone is different and reacts differently to particular foods so the following information is only a guide. It would be advisable to keep a food diary and make a note of any foods that cause you any problems. It doesn't mean that you have to rule all the foods out that but it will allow you to manage your Colostomy better.

Diet initially following surgery

Immediately after surgery the bowel can behave very differently to usual and this may last for several weeks. It is important that you recommence food and drinks slowly. You may experience episodes of nausea until the gut settles. Introduce a light diet initially and once this has been tolerated all foods can be tried. However remember this process can take several weeks following surgery depending on the individual.

After surgery protein and carbohydrates are essential in order to help with wound healing and to give energy.

Meal pattern

Developing a pattern in your eating regime can be beneficial in managing your stoma more effectively.

  • Take your time eating your meals and chew your food properly
  • Avoid heavy meals and snacks prior to bedtime
  • Avoid alcohol and caffeine drinks prior to bed time
  • Initially following surgery you will find that smaller meals will be tolerated easier. But ensure you eat regular smaller meals in order that you gain adequate intake

As with any operation, but in particular with bowel surgery, you may find it takes longer for your appetite to return to normal. It is a good idea to reintroduce food gradually, starting with a nutritious diet that is easy to digest.

Table 1. Dietary concerns for a patient with a Colostomy and possible causes

Foods that can cause loose stools

Foods high in fibre. i.e. green vegetables, baked beans, chocolate, spicy foods, hot drinks, alcohol, dried fruit.

Can help to thicken stools

Banana, peanut butter, rice/rice pudding, applesauce, white bread, gelatine products i.e. jelly babies, marshmallows

Foods that can cause excessive wind

Asparagus, brocolli, brussel sprouts, cabbage, cauliflower, cucumber, onions, mushrooms, nuts, milk, fish, beer.

Foods that can cause odour

Alcohol, cauliflower, asparagus, fish, brussel sprouts, cheese (certain types), cabbage, eggs, onions, garlic, baked beans, certain medications,vitamins.

Bathing/Showering

  • You may shower or bathe with your pouch on or off. Remember that your stoma may function during this time.
  • Although you don't necessarily have to change the appliance once you have got it wet it is advisable to ensure that you dry it off (using a hair dryer or towel).

Sexual Relationships

It is important that you give yourself time to recover following surgery and adjust to the changes that you are undergoing personally. Sexual activity is one of our normal functions and having a stoma should not prevent this activity. It is understandable that you may have concerns but talking through them with your partner can help improve communication and understanding. For men it is possible that they can experience some difficulty with erection and ejaculation, as the nerves and blood supply involved with sexual function lie close together and may be bruised during any pelvic surgery. If this remains a problem please discuss with your consultant or stoma care nurse.

  • Change/empty appliance prior to commencing sexual activity.
  • Secure the bottom of the bag upwards with tape or wear a Stoma cap
  • Remember sexual activity will not harm the stoma
  • Any position that is comfortable for you both is suitable for sexual activity.

Going away from home

  • Ensure you take a small bag containing a supply of wipes, new system x2, small spray bottle of water and a disposable bag. If travelling abroad ensure you keep these in your hand luggage.
  • If travelling on a airplane, book an aisle seat to help to allow you the ease of going to the bathroom.
  • Obtain an Ostomy Travel Certificate from your Stoma Nurse or local stoma association. This will assist you when travelling through customs/airport security, if there is any reason to explain your stoma products.

Exercise following surgery

Having a stoma should not prevent you from exercising or from being as physically active as you were before. It is important that you allow some time for recovery and build up gradually. Contact sports could potentially have some implications however this should be discussed with your specialist or stoma nurse and they will advise as to whether these are possible.

Phantom Rectum

It is not uncommon to experience the sensation of wanting to open your bowels in the normal way even though the passage of stool has been re directed via the stoma. This is a normal sensation often relieved by just sitting on the toilet. It is not unusual for you to pass some mucus from the back passage as the bowel remaining will continue to produce mucus. If this does continue to be a problem contact your specialist or stoma nurse who will advise on possible options to relieve this sensation.

Colostomy Irrigation

Colostomy irrigation is a method of mechanically cleaning the colon of faeces by instilling water through the stoma. As the water flows against the wall of the bowel it stimulates peristalsis and aids evacuation. The aim of the irrigation is to gain control over the stoma output so that the faeces are evacuated at this period of time. This enables the patient to avoid wearing an Colostomy bag but using a cap instead, which is more discreet. This method requires education by the Stoma Care nurse once recovery from the surgery has taken place and the stoma has begun to function properly. This method is optional and depends on personal preference. For further information regarding this please contact your Stoma nurse/ colorectal nurse.

Arranging your supplies.

Your Stoma nurse will arrange your supplies prior to your discharge through Fittleworth Healthcare. You will be given enough supplies to see you through until your own supplies arrive. The prescription will be arranged through your GP and the company. This is usually within 24-48 hrs. Your supplies will include wipes, disposal bags and your actual stoma appliance. You can order additional accessories if required such as adhesive spray remover, barrier wipes, barrier rings, deodorant sprays etc.

Useful Addresses

Colostomy Association
PO Box 8017
Reading, Berkshire
RG6 9DF

Tel: 01189867597
Helpline: 08005876744
www.colostomyassociation.org.uk

Debbie Johnson, Stoma Care Nurse
Tel: 07732769093

Email: debrajohnsonwhittton@msn.com