Friday, December 5, 2008

COLOSTOMY CARE

WHAT YOU SHOULD KNOW
A typical ostomy is an opening through the skin of the abdomen into the intestine (bowel), where stool is formed. The opening may tap into the ileum (an ileostomy) or the colon (a colostomy). The ileum is located at the end of the small intestine; the colon is the last part of the large intestine. In either area, the opening is called a stoma. While you have an ostomy, bowel movements will drain through the stoma and into a pouch on your abdomen. Ostomies can be temporary or permanent, depending on the type of disorder involved.
Care
There are many kinds of pouches for use with an ostomy. With time, you can decide what type works best for you. You will need to empty the pouch 4 to 6 times a day if you have an ileostomy, and 1 or more times a day if you have a colostomy. For both types, you'll need to change the pouch every 4 to 6 days, and clean it if you reuse it. You'll also have to care for the stoma and the skin around it. An Enterostomal (EN-ter-OH-sto-mull) Therapy Nurse (ETN) or your doctor will show you what to do. You may want to join a group that can offer you and your family support and give you information about ostomies. Ask your ETN for the name of a support group in your area or call the United Ostomy Association at 1-800-826-0826.

WHAT YOU SHOULD DO

Living With an Ostomy
 People feel anxious, nervous, or scared when they first begin dealing with an ostomy. They find it unpleasant and sometimes feel they've lost control of their body. Such feelings do improve with time. Talking about them with your doctor, or someone close to you, will help you get past them.
 Learning to live with an ostomy may be difficult for both you and your spouse. Don't try to ignore the problem. Be frank with each other, and try to share your feelings. Together you can find ways to cope with this change in your life.
 If you had a happy sex life before ostomy surgery, it can be the same afterward. Close body contact can't hurt your stoma; but do be sure to empty the pouch before having sex. You may also want to wear a pouch cover.
 After an ileostomy, the intestine has difficulty digesting high fiber foods such as corn, celery, apples, nuts, popcorn, or grapes. Do not eat large amounts of these foods for several weeks after surgery. Ask your doctor to tell you when you can begin eating foods with hulls, peels, or seeds. Eat small amounts at first to see how your intestine digests the fiber.
 Because bowel movements leave the body sooner through an ileostomy, your intestine will not have a chance to absorb certain "long acting" or "sustained release" medications or drugs in hard-capsule form. Tell your doctor and your pharmacist that you have an ileostomy. They can order the kind of medicine that your intestine will handle best.
 You should not use laxatives while you have an ileostomy because your bowel movements will already be soft and semi-liquid. Tell your doctors that you have an ileostomy so that they won't give you laxatives before a test or surgery.
 It is important to drink enough to replace the liquid lost in your bowel movements. Drink 6 to 8 large glasses of water, juices, or other liquids each day. Or, if you are on a fluid limit, follow your doctor's advice.
 Constipation can be a problem if you have a colostomy. Drinking plenty of liquid will help. Also try to include a lot of high-fiber foods in your diet, including cereals, beans, vegetables, and whole-grain breads.
 Try to maintain a healthy diet that includes all five food groups: fruits, vegetables, breads, dairy products, and meat and fish. Remember, however, that if you eat certain foods, such as eggs, cabbage, onions, beer, and some cheeses, you may have unpleasant gas. Do not eat too much or eat too fast. Chew your food very well.
 A woman with an ostomy can have a baby; but be sure to talk to your doctor before you get pregnant. It may be advisable to wait a year or so after surgery so your body has a chance to heal and return to normal.
 Talk to your doctor about an exercise program once you feel better. Exercise makes the heart stronger, lowers blood pressure, improves your mood, and helps keep you healthy. Among the best activities are walking, jogging, bicycling, and swimming. Start slowly and do more as you get stronger. Don't play contact sports unless your doctor says it's OK. If you swim, empty your pouch before getting into the water. You may want to put waterproof tape over the edges of the device that secures the pouch.
 Always carry extra ostomy supplies and pouches with you when traveling. Luggage is sometimes lost, so keep some of your supplies in a carry-on bag. Take enough for the entire trip. You may not be able to find what you need while traveling. Your local ostomy group may be able to give you a list of ostomy doctors in the area you're visiting.
Emptying the Pouch
 Empty the pouch when it is a third to half full. You will probably need to empty the pouch 4 to 6 times a day.
 Sit on the toilet with the pouch hanging between your legs. Or sit on a chair next to the toilet with the pouch opening aimed into the toilet.
 Point the opening of the pouch into the toilet and remove the clamp that keeps the pouch closed. Slide your fingers down the outside of the pouch to squeeze the contents out of the pouch. Clean the inside of the pouch opening with a piece of rolled-up toilet paper.
 After emptying your pouch, you may rinse it out with room-temperature water. To do this, use a rubber ear syringe to squirt water inside the pouch. Tip the pouch to get the water up into the top. Empty it and rinse again, if you like. You may want to rinse the pouch many times to clean it, but you do not need to rinse it each time you empty it.
 If you use a pouch deodorant, put some into the pouch after you've finished rinsing it.
 Put the clamp back onto the pouch to close it. Wash your hands with soap and water.
Skin and Pouch Care
 Ostomy pouches come in many styles: one-piece, two-piece, disposable, reusable, cut-to-fit, and pre-cut, for example. Some people prefer an opaque white or beige pouch to a clear one. Your ETN or doctor can help you decide which type is best for you.
 When you change your pouch, check the stoma and the skin around it. The surface of the stoma is mucous membrane---pink or red and moist-looking. Because it has many small blood vessels, it may bleed when you clean and wipe it. Do not worry about the bleeding unless it fails to stop. The stoma may get smaller during the first weeks after surgery.
 The part of the pouch that sticks to your abdomen is called a skin barrier wafer. The wafer opening for the stoma must fit snugly around it. Use the measuring guide that comes with your ileostomy supplies to check the size of the stoma. As it gets smaller, you will need to reduce the size of the opening you cut in the skin barrier wafer. If the opening is too large, intestinal contents will leak and irritate your skin.
 Irritated skin may also mean that you've left the wafer on too long. If the stoma becomes red or irritated, let your doctor know. It's always important to find out why.
 Cleaning and changing your pouch regularly will prevent unpleasant odors. You may also want to try different pouch deodorants. Change the pouch in the morning, before you've had anything to eat or drink, or at another time of day when the stoma is unlikely to be active. After a while, you'll probably get to know when to expect a bowel movement. If one isn't on the way, you can take off the pouch and bathe or shower before putting on a clean replacement.
 The length of time that the pouch stays tightly secured to your abdomen depends on many things, such as the size and shape of your stoma and the shape of your belly. Large amounts of watery bowel movement will shorten the wearing time. If the pouch stays on for only 1 or 2 days, let your ETN or doctor know.

Changing a One-Piece Disposable Pouch
Keep the following within easy reach:
1. Stoma measuring guide or pattern.
2. Scissors.
3. New pouch.
4. Soft wash cloth.
5. Soap and water.
6. Razor for shaving hair on abdomen.
7. Pouch deodorant (if desired).
8. Plastic bag for your used pouch.
Wash your hands with soap and water. Using the measuring guide or pattern, trace the correct opening onto the skin barrier of the new pouch, then cut out the opening you traced. Take off the paper backing that covers the adhesive on the skin barrier of the new pouch. Lay the pouch near you with the adhesive side up.
Empty the pouch you've been wearing into the toilet. Remove the pouch by pushing down on your abdomen with the fingers of one hand and peeling off the pouch with your other hand. Remove the clamp from the old pouch and save it for use with the new pouch. Put the used pouch into the plastic bag and throw away.
Wash thoroughly around your stoma with mild soap and warm water. Do not use soaps that contain baby oil, cold cream, or perfumes. Rinse and dry your skin with a dry soft cloth. You should not leave any stool or wafer residue on your skin. You may want to shave or clip hairs around your stoma.
Center the pouch opening over your stoma. Press the skin barrier wafer onto your abdomen. Make sure there are no creases or wrinkles in the wafer. Squirt some pouch deodorant into the bottom pouch opening. Move the deodorant around the inside of the pouch with your fingertips. Use a piece of toilet paper to wipe deodorant off the opening. Put on the clamp that you removed from your old pouch.
Changing a Two-Piece Snap-On Disposable Pouch
Keep the following within easy reach:
1. Stoma measuring guide or pattern.
2. Scissors.
3. New pouch.
4. New skin barrier wafer.
5. Soft wash cloth.
6. Soap and water.
7. Razor for shaving hair on abdomen.
8. Pouch deodorant (if desired).
9. Plastic bag for your used pouch.
Wash your hands with soap and water. Using the measuring guide or pattern, trace the correct opening onto the skin barrier wafer, then cut out the opening you traced. Remove the paper backing that covers the wafer's adhesive. Lay the wafer near you with the adhesive side up.
Empty the pouch you've been wearing into the toilet. Remove the pouch and skin barrier wafer from your abdomen. (It's easier to leave the wafer and pouch together and remove both at the same time.) While pushing down on your abdomen with the fingers of one hand, peel off the old wafer and pouch with the other hand. Remove the clamp from the old pouch and save it for use with the new pouch. Put the used pouch into the plastic bag and throw away.
Wash thoroughly around your stoma with mild soap and water. Do not use soaps that contain baby oil, cold cream, or perfumes. Rinse and dry your skin with a dry soft cloth. You should not leave any stool or wafer residue on your skin. You may want to shave or clip hairs around your stoma.
Center the opening of the new skin barrier wafer over your stoma, then press the wafer onto your abdomen. Make sure there are no creases or wrinkles in the wafer. Snap the new pouch onto the wafer. Squirt some pouch deodorant into the opening at the bottom of the pouch. Use your fingertips to move the deodorant around the inside of the pouch. Wipe deodorant off the opening with a piece of toilet paper. Put on the clamp that you removed from your old pouch.


Changing a One-Piece Reusable Pouch
Keep the following within easy reach:
1. New double-faced adhesive disk or appliance cement.
2. Clean reusable pouch.
3. Skin barrier ring or paste.
4. Soft wash cloth.
5. Soap and water.
6. Razor for shaving hair on abdomen.
7. Pouch deodorant if desired.
 Wash your hands with soap and water. Remove the paper backing from one side of the adhesive disk. Center the sticky side of the adhesive disk over the face-plate opening of the new pouch. Press the adhesive disk onto the face plate, making sure there are no wrinkles in the disk. Alternatively, you can put a thin layer of cement on the face plate of the pouch. You can then lay the pouch nearby with the sticky cement or disk side up.
 Remove the clamp from the pouch you've been wearing and save it for use with the next pouch. Empty the pouch you have on into the toilet. Remove the pouch from your abdomen by pushing down on your abdomen with the fingers of one hand while peeling off the used pouch with your other hand. A soft, soapy wash cloth or an adhesive-remover wipe may make it easier to remove the pouch. Put the used pouch aside to be cleaned later.
 Wash thoroughly around your stoma with mild soap and warm water. Do not use soaps that contain baby oil, cold cream, or perfumes. Rinse and dry your skin with a dry soft cloth. You should not leave any stool or adhesive residue on your skin. You may want to shave or clip hairs around your stoma.
 You may want to put a skin barrier ring or barrier paste on the skin around your stoma. If you use paste, put a thin layer on the skin around your stoma and let it dry.
 Center the pouch opening over the stoma and press it firmly into place. Squirt some pouch deodorant into the bottom pouch opening. Move the deodorant around the inside of the pouch with your fingertips. Use a piece of toilet paper to wipe away deodorant from the pouch opening. Put the clamp on the bottom of the pouch.
Cleaning a Reusable Pouch
Clean your pouch well every time you change it. This will reduce odor and extend the life of the pouch.
Remove the old double-faced adhesive or cement from the face plate of the pouch. Roll it off with your fingertips or use an adhesive remover solution.
Rinse the used pouch with warm water. Using a long-handled brush, scrub the inside of the pouch with liquid soap and warm water. Rinse the pouch with warm water. Hang the pouch over a towel rack or hook to dry. Keep the pouch away from sunlight or heat, which can harm it.
Wash your hands with soap and water. Store the pouch in a cool, dry place after the inside has dried.
Call Your Doctor If...
You have an ileostomy and you are vomiting or have diarrhea. People who have an ileostomy can quickly get dehydrated. Signs of dehydration include dry mouth or tongue, a dry stoma, failure to urinate as much as normal, and dizziness on standing up.

Seek Care Immediately If...
You have severe abdominal pain.
You vomit more than 3 times in 1 hour.
You are too weak to stand up.
You feel as though you are going to pass out.
You cannot stop your stoma from bleeding.
You have an ileostomy and nothing has come out for several hours. This may mean that your intestine is blocked.

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