Colostomy
Colostomy
The gastrointestinal tract is a long connection that extends from the mouth to the anus. Food travels from the mouth, to the esophagus, to the stomach, to the small intestine, to the large intestine, and finally out through the anus. The colon is broken down into the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum. The colon is responsible for removing water, nutrients, and electrolytes from partially digested food. The remaining material leaves the body through the anus.
A colostomy is a surgery in which a part of the colon is brought out through a created opening in the abdominal wall skin surface. This created opening is called the stoma. A colostomy bag is attached to the stoma to drain the waste. Colostomies can be permanent or temporary depending on the technique used. Colostomies are named for the part of the colon that is connected to the outside of your body.
Physicians perform colostomies through either laparoscopic surgery or open surgery. There are multiple methods of colostomies as described below.
Colostomy Methods
Single barrel (end) colostomy -
The colon, rectum, and anus distal to the colostomy is surgically. This is permanent.
Loop colostomy -
There is one stoma that contains two openings. One opening is the active portion of the colon and puts out stool. The other opening puts out mucus and is connected to the rectum and anus. Mucus is secreted by the colon to protect itself and is usually passed with normal bowel movements. Mucus will pass through both the stoma and the anus.
Double barrel colostomy -
The colon is divided into two ends that have their own separate stomas. Similar to the loop colostomy, one active end puts out stool and the other inactive end puts out mucus. Sometimes the proximal end of the inactive part is sewn closed and left inside the abdomen while the active end has its own stoma (figure 5). In this situation, mucus only passes through the anus.
Types of colostomies
Double barrel colostomy -
The colon is divided into two ends that have their own separate stomas. Similar to the loop colostomy, one active end puts out stool and the other inactive end puts out mucus. Sometimes the proximal end of the inactive part is sewn closed and left inside the abdomen while the active end has its own stoma (figure 5). In this situation, mucus only passes through the anus.
Transverse colostomy -
This is done where the colon goes across the upper abdomen. Stool from this type of colostomy is usually soft because it has not gone through much of the colon.
Ascending colostomy -
his is done near the beginning of the colon on the right side of the abdomen. The stool is usually liquid in this colostomy. This is a rare type of colostomy.
*All of the aforementioned techniques can be used at any part of the colon.
Types of colostomy pouches/bags
One piece system -
This consists of a skin barrier and a pouch joined together as a single unit. This fits around your stoma and is attached with an adhesive. When you need a fresh bag, the whole unit is removed and replaced with a new one.
Two piece system -
A base plate fits tightly around your stoma and a pouch is attached to it. The pouch is changed as needed. The base plate is changed every 2-3 days.
Closed pouch -
These are discarded after one use.
Open ended pouch -
These are drainable pouches and are left attached to the body while emptying.
More detailed parts of the ostomy bags as below:
How to clean my stoma site?
Only use warm water and soft paper towels to clean around the stoma site. Do not use anything else around the stoma site unless specifically instructed to do so. You can shave around the stoma site to help the stoma pouch adhesives.
What should my stoma site look like?
- The opening should be red and moist.
- The site may bleed easily especially if accidentally hit. Bleeding should be little.
- The stoma should stick out above the skin.
- The stoma will be swollen after surgery. It may take 6 weeks for it to shrink to its permanent size.
- The skin surrounding the stoma should be clean and well maintained.
- The stoma should not be painful since there are no nerve endings in the stoma.
Colostomy irrigation (for descending and sigmoid colostomies only)
- Your colostomy should be irrigated once a day or every other day to allow more increased control over your bowel movements.
- Gather your supplies: Irrigation kit which includes an irrigation bag, tubing catheter, irrigation cone, and a plastic sleeve; a hook to attach the irrigation bag; and water soluble lubricant.
- Sit next to a toilet.
- Close the clamp on the tubing catheter attached to the irrigation bag.
- Fill the irrigation bag with approximately 4 cups of warm water. Water that is too cold may cause cramping.
- Hang the bag on a hook above the toilet. The bottom of the bag should be near the level of your shoulders.
- Hold the tubing over the toilet and open the clamp to release air from the tubing. Once water starts to flow out of the tubing, close the tubing.
- Remove the cap or pouch from your stoma and clean the skin around the stoma.
- Place the round opening on the sleeve around your stoma and stick it to your skin if it has an adhesive.
- Place the open end of the sleeve over the toilet.
- Attach the cone to the tubing on the bag. Then add a small amount of lubricant to the cone.
- Slip your hand through the opening at the top of the sleeve and insert the cone into the stoma.
- Hold the cone in place and slowly open the clamp on the catheter tubing to allow all of the water to flow into the stoma. When the water is done, close the clamp on the tubing.
- Wait about 1 minute and then remove the cone and seal the top of the sleeve.
- Allow the excreted contents to flow through the sleeve and into the toilet for 15 minutes. If you want, you can clamp the bottom of the sleeve to move around and empty it into the toilet after 15 minutes.
- Clean the skin around the stoma and cover the stoma with a cap or pouch.
- Rinse the cone and sleeve with water. Hang the sleeve to dry.
Stoma Pouch Care Instructions
How to prepare and attach a one piece stoma pouch
https://www.youtube.com/embed/VET_5HqSXMc
https://www.youtube.com/embed/WoiNCmCK4uo- Gather your supplies: pen, scissors, disposable one piece stoma pouch, cleaning cloths, bowl of warm water, and a stoma measuring guide.
- Use your measuring guide to measure your stoma. This should be a snug fit.
- Next use that same measurement on the center of the flange and draw a circle around the outline.
- Cut starting from the center around the flange using scissors.
- Once the flange is cut to the correct size you are now ready to apply the stoma pouch.
- Remove the clear plastic material from the back of the pouch to expose the sticky side.
- Place the pouch over the stoma and press firmly over the pouch to ensure it is stuck securely to your skin.
How to prepare a two piece stoma pouch
https://www.youtube.com/embed/IakmnQKE75c
https://www.youtube.com/embed/21v_YbzDiJ8- Gather your supplies: pen, scissors, disposable two stoma pouch, the adhesive/flange, cleaning cloths, bowl of warm water, and a stoma measuring guide.
- Use your measuring guide to measure your stoma. This should be a snug fit.
- Next use that same measurement on the center of the flange and draw a circle around the outline.
- Cut starting from the center around the flange using scissors.
- Remove the clear plastic material from the back of the pouch to expose the sticky side.
- Place the flange over the stoma and press firmly around it to ensure it sticks on the skin.
- Next attach the pouch to the flange making sure it clicks to ensure it is in place.
How to empty a drainable stoma pouch
https://www.youtube.com/embed/UOrt34dn1Kk- Sit or stand near the toilet.
- Put toilet paper in the toilet to minimize splashing.
- Lift the drainable stoma pouch and open the velcro fastening.
- Gently lower the end of the bag into the toilet and let the contents drain out.
- Clean the end of the pouch with a wipe. Then fasten the velcro to close the bag.
- Do not let the bag become too full because it will make it more difficult to empty.
How to remove your stoma bag
https://www.youtube.com/embed/BJ9rRbBIkeY- Place one hand on your skin above your pouch.
- Use your other hand to grip the top of the bag/flange and pull downwards and away from your body to remove the bag.
- Clean the surrounding skin with warm water if you plan on placing another bag.
How to dispose your stoma pouch
https://www.youtube.com/embed/sEvRGZt52BU- Remove your stoma bag as described in the How to remove your stoma bag section.
- When using a closed bag, you can cut the bottom of the bag and empty the contents into the toilet. Alternatively, you can close the velcro at the top of the bag. After either method, put this used stoma pouch into a disposable bag and throw it away with the rest of your garbage.
- If you are using a drainable pouch, empty it then put it into a disposable bag and throw it away with the rest of your garbage.
- Never flush your stoma pouch in the toilet as this can cause clogging.
Activity
- Bathing - You can take a shower with a pouch on or off. Only use water to clean around the stoma. Water usually does not go into the stoma and if it does, it will not harm it. It is normal for the stoma to produce a little output while bathing.
- Swimming - If a pouch is on, then swimming is okay. We recommend using an ostomy belt or waterproof tape around the edge of the skin barrier.
- Sleeping - Children and adults can sleep on the abdomen if desired. Infants should sleep on their backs for added safety.
Leakage
Make sure you are checking the size of your stoma regularly to ensure a snug fit with the pouch. An increase in output from the stoma can also cause leakage issues. If the increased output doesn’t resolve after a few days, you may need to call your provider.
Ballooning
This is when your stoma pouch fills with gas and causes it to be displaced away from your body. Push the top of the bag into your abdomen which will cause some of the air to go back into the stoma. You can do this as many times as necessary. Consider eating smaller and more frequent meals throughout the day.
Pancaking
This is when the internal layers of the stoma bag stick together and create a vacuum which prevents contents from dropping to the bottom of the bag. You can try blowing air into a pouch prior to application. Sometimes a small drop of oil placed into the hole of the adhesive can help the contents slide to the bottom.
Sore Skin
After surgery, your abdomen can change shapes and sizes. It is important to check your template size to ensure a correct fitting stoma pouch. Consider removing the adhesive around the stoma bag and see if there is any trapped feces that may be causing irritation.
Bleeding
A small amount of bleeding after wiping the stoma is normal. However, if there is a copious amount of blood in the stoma pouch, you should call your provider.
Hernia
You can have herniation of bowel loops and intra-abdominal fat through the stoma which is called a parastomal hernia. Usually these don’t cause significant symptoms. You can try using abdominal support garments. It is possible to have these repaired depending on the severity of your symptoms.
Prolapse
THis is when the bowel extends in length outside of your abdomen. You can cut your template size 5mm larger to prevent the bowel from rubbing against the pouch if you have a stoma prolapse.
- Signs of infection including fever, chills, or foul odor lasting more than a week.
- No ostomy output for 4-6 hours with cramping and nausea.
- Severe watery discharge lasting more than 5 or 6 hours.
- A lot of blood in your stoma pouch.
- Unusual change in your stoma size or color.
Sources :
- https://www.cancer.net/navigating-cancer-care/how-cancer-treated/surgery/types-ostomy/colostomy
- https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/surgery/ostomies/colostomy/types-of-colostomies.html
- https://www.behance.net/gallery/22214915/Cameo-Ostomy-Bag-Design
- https://www.salts.co.uk/en-gb/your-stoma/after-your-surgery/changing-your-stoma-bag
- https://www.salts.co.uk/en-gb/your-stoma/living-with-a-stoma/problems-you-may-experience