Frequently Asked Questions On Ostomy
An
ostomy is a surgically-created intestinal or urinary tract diversion that modifies the normal pathway for waste elimination. This opening is called a "
stoma". It is made by creating a space in the abdominal wall. Unlike in the original passage, there is no sphincter muscle on the stoma. Therefore, there is no control over the elimination of waste and the patient will need to wear a
Ostomy bag to collect the waste that flows from the stoma.
An ostomy is an surgically made opening in the body, specifically in the abdomen, created surgically for the discharge of bodily waste matter.
An ostomy bag, also referred to as an ostomy pouch, is designed to collect feces or urine discharged from the stoma. It is usually made from plastic and available in varying styles and sizes.
Timing varies for each individual. No matter which type of an ostomy a person has, the stoma bag typically has to be emptied about 4 to 8 times daily.
Manufacturer recommends using an ostomy bag for a maximum of seven days. After this, the product might break down or no longer offer the protection for which it has been designed.
An
ostomy belt supports your colostomy, urostomy or ileostomy bag and conceals your ostomy appliance. It holds the weight of your ostomy bag as it fills and reduces the burden of gravity or stress on your flange/wafer thus increasing the wear time of your device. It also keeps your ostomy appliance discreet under your clothing.
An ostomy or skin barrier, also known as a wafer or flange, is an ostomy device that is made to fit around the stoma. It fixes to the peristomal skin creating a seal around the stoma to prevent leakage and maintains a secure connection between the pouch and the stoma.
You can do either. Soap and water from the shower will not harm the stoma. If showering with it off, it is best to choose a time the stoma is least active, such as in the morning before eating or drinking anything. Water will not compromise the pouching system, however, if you have a pouch with a filter, you will need to place the sticker provided in the box over the filter. Once the filter gets wet, it does not work properly. Some will cover the pouch with plastic and
medical tape to keep it dry.
Stoma nurses have differing opinions on this. I am proactive in keeping the peristomal skin healthy and recommend using it. It sets up the skin to accept the adhesive. Choose one without alcohol. If the skin becomes red or breaks down, it won’t burn.
It is normal to pass mucous and/or stool from the rectum when you have an ostomy. One of the functions of the colon is to secrete mucous to keep things lubricated. This is still occurring even though you are diverted. If your surgery was emergent and you did not do a bowel prep to clean the colon prior to surgery, you will eventually pass what was remaining in the colon. If you have a loop colostomy or a loop ileostomy rather than an end ostomy, stool can travel down the part of the stoma that is still connected to the lower end. This allows the waste to travel the normal route.
If you have a colostomy, wear time of the pouch can be up to 7 days. Again, I am proactive in keeping the peristomal skin healthy and recommend the pouch be changed every 5 days. If you have an ileostomy, wear time is 3-4 days. The output is more acidic from digestive enzymes and can breakdown the material of the barrier more quickly. Don’t wait for the system to leak before changing. You can be in control.
Stomas placed in the lower right or left abdomen will usually be below the waist and sit underneath pants. This makes them less noticeable. For stomas placed in the upper abdomen can be a little more challenging. Wearing loose-fitting shirts is helpful. Consider a pouch cover. For women, wearing a longer top will conceal the bottom of the pouch. For men, also wearing long shirts and avoiding tucking into the pants are a good idea. You may want to consider looking into a Wrap. This is an undergarment that men or women can wear around the portion of the abdomen where the stoma is. It minimizes the bulk of the pouch and has a pocket to support the pouch as it fills. Check out
Ostomy support garments on the HPFY website.
There are three common types of ostomies:
- Colostomy
- Ileostomy
- Urostomy
There are many reasons why you would need a stoma. Bladder cancer, Bowel cancer, inflammatory bowel disease, diverticulitis, or a bladder or bowel obstruction are all common causes. Depending on the cause, a stoma may be temporary or permanent.
Managing peristomal skin is one of the most important things. Although, some people feel one does not need to use a
skin barrier film for protection, one should be “pro-active” in keeping the skin in good shape. It is recommended to use one. It is also recommended to clean the peristomal skin with water. Soap can leave a residue and most soaps have
moisturizers in them. Adding moisture to the skin can hinder the adhesive of your next pouching system. Avoid using “baby wipes” or flushable wipes as many of these have moisture additives as well. If you develop skin redness or a rash, consider discussing with an ostomy nurse or your surgeon.
An ileostomy bag needs to be emptied multiple times day since the output is loose. A closed ended pouch is not appropriate. Insurance will cover 2 pouches per day. If you choose to go this route, it will be costly as you would need to pay out of pocket. If you have a colostomy and have 1-2 BMs per day, the closed end ostomy pouch is economical and a good choice. Flushable liners are available and can be used for either ileostomies or colostomies but you will need to use a 2-piece system.
Hollister, Coloplast, ConvaTec,Nu-Hope, Micro-Skin all offer 1- and 2-piece pouching systems, flat or convex. Each manufacturer offers different options. As an example, some of the Coloplast lines are firmer than others. These feel more secure to some. While others like the flexibility of Micro-Skin. Velcro closures are different on each of these manufacturers' products. Some may have a skin sensitivity to one brand but not to others. Nu-Hope makes special molds for special needs. Coloplast offers deep convexity for those stomas that retract deeply when sitting. They also offer a “convex flip” for parastomal hernias. Once you are comfortable with managing your ostomy, it is recommended to request samples of others to see what features you may like better.
First, check the fit of your barrier. The size and shape of your stoma can change with weight gain or loss, or the development of a parastomal hernia (a bulging around the stoma). If the skin is red but not moist, consider stoma powder and use a barrier film spray over the powder so your pouch will adhere well. If you develop a rash that is itchy, it most likely is a fungal rash from moisture (this occurs most often in warmer weather). Using an antifungal powder with each pouching change will help. Use a barrier film spray over the powder so your pouch will adhere well. Stop using it once the rash has resolved. If the skin is raw and moist, consider
Marathon skin protectant (made by Medline). Once applied to the weepy skin, Marathon leaves a dry coating over the skin, allowing your pouching system to stick. Be sure to change the system in about 3 days to reassess the skin (you want to be sure it is healing).
- With an ileostomy, the small intestine is brought up through the skin to create the stoma. The output is expected to be loose since the function of the colon is bypassed.
- With a colostomy, the colon is used to create the stoma. The output is based on where in the colon the stoma is created. A stoma closest to the rectum can have formed stool whereas the closer to the right side or small intestine, the stool becomes looser.
- A urostomy is made out of the small intestine. The ureters from both kidneys are connected to allow urine to drain from the body. This type of ostomy is placed when the urinary bladder needs to be removed.
The best time to change is the time when the ostomy is least active. For ileostomies, this is usually the first thing in the morning before eating or drinking anything. Of course, if the pouch is leaking, it should be changed immediately. The same is true for colostomies. Urostomies are usually active most of the time.
It is recommended to empty the pouch when it is half full. The fuller the pouch, the heavier it becomes. The weight may cause separation of the barrier from the skin, causing leakage.
Traveling with an ostomy is not difficult but requires some planning. Obtaining a TSA card from the
United Ostomy Association is a good idea if you are flying. Carry supplies onboard in a carry-on bag in case your luggage is lost. Use disposable products when possible. Pack extra supplies, this way you can worry less about running out.
There is no sphincter muscle to stop the flow of stool from any ostomy. Ileostomies drain stool often. Urostomies drain urine often. Those with colostomies do not have control over stool output. However, if the stoma is in the sigmoid or descending colon and there is a stool which has formed, irrigation is an option for controlling stool output.
Absolutely! While pouching systems can get wet, there are many products available for “waterproofing” your system. Try barrier strips or occlusive/ transparent dressings placed around the edges. Try the Ostomy Secrets website for swimwear (for both men and women). It is recommended to keep an extra pouching system at hand just in case. Also, empty your pouch before jumping in.
Yes, the stoma has many blood capillaries at the surface. They rupture easily when cleaning or touching the stoma. This should stop rather quickly. If the opening is too small and rubbing on the edge of the stoma, you may note more bleeding. If your pouch is filling with blood, contact your surgeon immediately.
No. The stoma has no nerve endings and no feeling when touched or when it is draining air or stool. You should be cautious when wearing a seat belt or participating in contact sports.
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