Caring For Your Stoma

A stoma is an artificial opening that allows faeces or urine either from the intestine or from the urinary tract to pass. It is the result of an operation to remove disease such as cancer, Crohn's disease, Diverticulitis, or a Bowel Obstruction to the digestive or urinary system.

Three main types of Stoma

1. 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.
2. 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 defecation, will need to be collected in a pouch.
3. 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 ileal conduit or a Bricker bladder. 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.

What does a stoma look and feel like?

• After surgery, your stoma may be quite swollen
• Your stoma will be moist and pinkish red in colour
• It will reduce in size after 6-8 weeks of recovery
• There is no sensation in the stoma - so it is not at all painful to touch
• The stoma can bleed a little when being cleaned, especially in the beginning
• Some people can have more than one stoma depending on their condition

Why do I need to wear an ostomy pouch?

• An ostomy pouch is necessary to collect the output securely and conveniently from your stoma.
• The design of your ostomy pouch will depend on whether you have a colostomy, ileostomy or urostomy.
• Nobody will know you’re wearing one unless you decide to tell them.

Changing your pouch:

1. Colostomy: The pouch needs to be changed between one and three times a day, depending on the amount of output.
2. Ileostomy: The pouch needs to be drained several times a day.
3. 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.

Taking care of your stoma:

It is important to keep the skin around your stoma healthy. Contact between stoma output and skin causes skin irritation that affects how well the adhesive on the appliance sticks to your body.

Six steps to keep your skin healthy:

• Make sure your skin is clean and completely dry before applying the adhesive
• Adjust the hole in the adhesive so that it exactly fits around your stoma
• Make sure that there is full contact between the adhesive and your skin – use a bit of light pressure with your hand
• Change your appliance as soon as you feel any discomfort or itching
• Check the size of the stoma regularly, especially if you have a hernia
• Make sure to use the stoma appliance and accessories most appropriate for your body profile

Overcoming Issues faced with a Stoma

1. 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, ballooning can occur. 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.
2. Skin Irritation: Skin irritation around your stoma is usually caused by leakage from your ostomy pouch and the output from your stoma getting underneath the adhesive and onto your skin. It is uncomfortable and can stop your pouch from working well. Try more frequent changes or consider an erosion-resistant adhesive if you’re not already using one. If the pouch may not be the best fit for your stoma. Assess the diameter and shape of your stoma to see if your template has the right size and shape. Use the release liner from the pouch as a guide and if needed, adjust the hole in the adhesive so that it exactly fits the diameter and shape.
3. Pancaking: This happens when there is a vacuum in the stoma bag and the bag sticks together. This stops the output from dropping to the bottom of the bag and can block the filter. There is then a risk that the pouch will be pushed off the abdomen. Blowing air into the pouch before putting it on will help stop a vacuum from occurring. In addition, a drop of oil or lubricant in the pouch will help the output to get to the bottom of the bag.

References
Coloplast Ireland