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What's the best way of telling someone you have an ostomy?

Hi there, I need some advice please...I've been going to my local nightclub for 5 years, I guy who's also gone there all that time (and longer apparently) is suddenly showing an interest in me. He's very shy, quiet and hardly talks to anyone but his close mate, they're both bachelors, it was my new 'hairdo' (my wig since hair loss due to low dose chemo for my crohn's) that did it, they were lightheartedly arguing whether it was me or not! I started chatting to the quiet guy, I've only ever said ...


Views: 1129 Replies: 12

Ostomy diet

Is there such a thing as an ostomy diet? I am barely getting any output from my colostomy in at least a month, and I have absolutely no appetite. Last year I was in hospital with what they thought was a partial small bowel obstruction. My "diet" has been small amount of baby oatmeal and some coffee at breakfast: maybe cup of soup for lunch. Small amount of yogurt, jars of baby fruit. I tried to eat small amounts of well-cooked green beans with the carrots today. I've tried to dri...


Views: 512 Replies: 10

Is it possible to be regular with an ostomy?

Hello Everyone! Is it possible to become regular with an ostomy? My dr told me to drink Citrucel everynight to become regular. I find its all day long, Is it possible to train your colon?


Views: 727 Replies: 11

Recycling ostomy bags???

Has anyone ever heard of cleaning ostomy bags after use? I am all for recycling, but I am also concerned about the health risks.


Views: 904 Replies: 15

Disposing of an ostomy bag at a friend's house

I have an ileostomy and i like to use closed end pouches and change them twice a day. I can carry an Ostaway Bag (black, thick, zip-lock) with me and keep a fresh closed end ostomy bag with me in my pocket. Often when I am at someone's house i need to dispose of one bag and put on a fresh one. I really prefer using the closed-ended pouches and i know there isn't any smell if they are put inside the black, thick, Ostaway Zip-Lock Bag. My question is; do you think it is o.k. to throw this in s...


Views: 1273 Replies: 9

Naming my ostomy

I never thought of naming my stoma. I guess by now I would have to call it "old timer" as I have had it for 40 years now.....


Views: 575 Replies: 6

Collection of tips from people with an Ostomy >>


Colostomy Guide

Introduction

For the thousands of people who have serious digestive diseases, colostomy can be the beginning of a new and healthier life. If you have had a chronic (long-term) or even life-threatening disease, after you recover from this surgery, you can look forward to feeling much better. You can also look forward to returning to all the activities you enjoyed in the past.

This guide will help you better understand colostomy--what it is, why it's needed, how it affects the normal digestive system, and what changes it can bring to a person's life. Some of the terms you will hear from your health care team are used here. You will find a list of words ( a glossary) in the back to help you with the medical terms. Words on the list will appear in italics when they are first mentioned in this guide.

What is a colostomy?

A colostomy is an opening in the abdominal wall that is made during surgery. The end of the colon is brought through this opening to form a stoma. Where on the abdomen the colostomy will be located depends on which part of the colon is used to make it. The enterostomal therapy nurse (ET nurse) or the surgeon will choose the correct location for your stoma.

Colostomy surgery is done for many different diseases and conditions. Some colostomies are done because of malignancy (cancer), others are not. In children, they may be created because of birth defects. Sometimes a colostomy is short-term, sometimes it is life-long. Some colostomies are large, some small; some are on the left side of the abdomen, some are on the right side, others may be in the middle.

When you look at a stoma, you are actually looking at the lining (the mucosa) of the intestine, which looks a lot like the lining of your cheek. The stoma will look pink to red. It is warm and moist and secretes small amounts of mucus. Unlike the anus, the stoma has no valve or shut-off muscle. For this reason, you cannot control of the passage of stool from the stoma, although bowel movements can sometimes be managed in other ways.

The way the stoma looks depends on the type of colostomy the surgeon makes and on individual body differences. Although it may look quite large at first, it will shrink to its final size about 6 to 8 weeks after surgery. The shape will be round to oval. Some stomas may stick out a little, while others are flush with the skin.

A colostomy is not a disease, but a change in anatomy. It surgically changes normal body function to allow stool to pass after a disease or injury. Although a colostomy makes an important change for the patient, the operation itself is rather simple. The body's chemistry and digestive function are not changed by having a colostomy.

What does a colostomy do?

After a colostomy has been created, the intestines will work just like they did before except:

• The colon beyond the colostomy (and/or the rectum) is disconnected or removed.

• The anus no longer serves as the exit for stool.

Since nutrients are absorbed in the small intestine, a colostomy does not affect the body's ability to be nourished. The main functions of the colon are to absorb water, to move the stool toward the anus, and to store it in the rectum until evacuation becomes necessary. When a colostomy interrupts the passage of stool, the storage area is no longer available.

The higher up in the colon the colostomy is made, the shorter the bowel is. The less time the bowel has to absorb water, the more liquid (or soft) the stool is likely to be. A colostomy further down in the colon, near the rectum, will discharge stool that has been in the intestine a longer time. Depending on the effects of illness, medicines, or other forms of treatment, the longer bowel can produce a more solid or formed stool. Some people with colostomies find that they are able to pass this stool at certain times of the day with or without the help of irrigation.

After the operation, some people still may feel urges and even have some discharge from the anal area. This discharge is mucus, blood, and at times stool, left from the operation. If the rectum is intact, it will continue to put out mucus that can be harmlessly passed whenever you have the urge.

Why have a colostomy?

A colostomy lets people enjoy a full range of activities such as traveling, sports, family life and work, even though they have a stoma and a pouch system. People who have colostomies may continue to enjoy a normal life span.

Some diseases of the colon are treated by creating an exit for stool or feces before it reaches the rectum. A colostomy is such a procedure. (The word colostomy comes from the words colon and stoma, stoma meaning mouth or opening).

When certain conditions are present in the lower bowel, it may be necessary to give part of the bowel a rest. It is kept empty by keeping stool from getting to that part of the bowel. To do this, a short-term (temporary) colostomy is created so that healing may take place. Depending on the healing process, this may take a few weeks, months, or even years. In time, the colostomy is reversed (removed) and the bowel works as it did before.

When part of the colon or the rectum becomes diseased, a permanent colostomy must be made. The diseased part of the bowel must be totally removed or permanently rested. In this case, the colostomy provides an exit for stool that will not be closed at any time in the future.

The normal digestive system

After food is chewed and swallowed, it passes through the esophagus into the stomach. From there it goes into the small intestine. Hours can go by before it moves into the large intestine (colon). After hours or even days, it leaves the body by way of the anus. For most of its passage, the food is liquid and loose. Water is absorbed in the colon, causing the stool to become a firm mass as it nears the rectum.

The small intestine

The small intestine is the longest section of the digestive tract. Food nutrients are digested and absorbed here as food is moved through by peristalsis. (Peristalsis is the wave-like movement of intestine muscles that moves food along the digestive tract.)

The small intestine is about 20 feet long. It is made up of 3 sections:

• duodenum (first part), which is 10 to 12 inches long and begins at the outlet (bottom part)of the stomach

• jejunum (second part), which is about 8 to 9 feet long

• ileum (third part), which is about 12 feet long; it connects to the large intestine at the cecum

The small intestine lies loosely curled in the abdominal cavity.

The large intestine

The large intestine (also called the colon or large bowel) joins the small intestine where the ileum and cecum meet on the body's right side. It is about 5 to 6 feet long, and is made up of several sections:

• cecum – the entry point for food that has been through the small intestine, now a highly acidic liquid. It contains the ileocecal valve which keeps food from backing up into the ileum.

• ascending colon – the contents are acidic liquid. This section goes up the right side of the body.

• transverse colon – the contents are less acidic liquid. This section goes across the abdomen.

• descending/sigmoid colon – the contents become more formed. This section does down to the rectum starting from the left side of the body.

The main jobs of the large intestine are absorbing water and electrolytes (minerals the body needs, like calcium and potassium), moving stool, and storing digestive waste until it is passed out of the body.

There are 2 major types of activities in the colon, peristalsis and mass reflex. During peristalsis, the muscles of the colon are constantly contracting and relaxing. These movements happen in all the different parts of the colon, but are not noticed. The purpose of peristalsis is to mix and knead the food and to extract water, which makes the end product, formed stool. When stool collects in a part of the colon, muscles in that part relax and stretch to hold it. Pressure builds as the stretch limit is reached. At this point, a mass reflex, stronger than peristalsis, pushes the stool into the next part of the colon. From there, it moves into the rectum. This happens automatically, several times a day, usually following a meal or a drink.

The rectum and anus

The 2 end portions of the digestive tract are the rectum and anus. Special nerve pathways to the brain make us aware when the stool reaches this section. Only at this point do we have any control over part of the digestive process. As the stool enters the rectum, we feel the need to have a bowel movement. The anal sphincter allows us to control this. Unlike the rest of the digestive tract, it contracts or relaxes at our will. Contraction will stop a bowel movement while relaxation will permit it to continue.

Types of colostomies

A colostomy can be short-term (temporary) or life-long (permanent) and can be made in any portion of the colon.

Transverse colostomies

The transverse colostomy is in the upper abdomen, either in the middle or toward the right side of the body. Some conditions of the colon such as those caused by diverticulitis, inflammatory bowel disease, cancer, obstruction, injury, or birth defects can lead to a transverse colostomy. This type of colostomy allows the stool to exit from the colon before it reaches the descending colon.

When conditions such as those listed above cause problems in the lower bowel, the affected part of the bowel might need time to rest and heal. A transverse colostomy may be created to keep stool out of the area of the colon that is inflamed, infected, diseased, or newly operated on, thus allowing healing to take place. Such a colostomy is usually temporary. Depending on the healing process, the colostomy may be needed for a few weeks, months, or even years. Over time, given your good health, the colostomy is likely to be reversed (closed) and you will go back to normal bowel function.

A permanent transverse colostomy is made when the lower portion of the colon must be removed or permanently rested. This type may also be needed if other health problems make it unwise for the patient to have further surgery. Such a colostomy provides a permanent exit for stool and it will not be closed at any time in the future.

Types of transverse colostomies

There are 2 types of transverse colostomies: loop transverse colostomy and double-barrel transverse colostomy.

Loop transverse colostomy: The loop colostomy may look like one very large stoma, but it in fact has 2 openings. One opening expels stool, the other only puts out mucus. A colon normally makes small amounts of mucus to protect itself from the bowel contents. The mucus passes with the bowel movements and is usually not noticed. Despite the colostomy, the resting part of the colon continues to make mucus that will come out either through the stoma or through the rectum and anus; this is normal and expected.

Double-barrel transverse colostomy: When creating a double-barrel colostomy, the surgeon divides the bowel completely. Each opening is brought to the surface as a separate stoma. The 2 stomas may or may not be separated by skin. Here, too, 1 opening expels stool and the other puts out only mucus (this stoma is called a mucus fistula). Sometimes the mucus fistula is sewn closed at the time of surgery and left inside the abdomen. In such a case, only 1 stoma would be seen on the abdomen (single-barrel colostomy) and mucus from the resting portion of the bowel would pass out through the rectum.

The newly formed transverse colostomy

Right after surgery, your colostomy may be covered with bandages or it may have a clear pouch over it. The type of pouch used right after surgery is usually different from those you will use at home. Before you look at your colostomy for the first time, keep in mind that it may be quite swollen after surgery; it also may have bruises and stitches. While a stoma normally is moist and pink or red in color, it may have a deeper color at first. Your stoma will change a lot as it heals. It will get smaller and any discoloration will go away, leaving a moist red or pink stoma. This process may take several weeks.

You will soon notice that, although you can usually tell when your colostomy is going to pass stool or gas, you cannot control the movement. Your colostomy does not have a sphincter muscle or control mechanism like your anus does. For this reason, you will need to wear a pouch over your colostomy to collect the output. Your ET nurse or doctor will help you select a pouching system that is right for you. This is also discussed in more detail in the section "Choosing a pouching system."

Characteristics of a transverse colostomy

When a colostomy is made in the right half of the colon, only the short portion of colon leading to it is active. The consistency of the discharge from a transverse colostomy varies from time to time and from person to person. A few transverse colostomies discharge firm stool at infrequent intervals, but most of them move fairly often with a soft or loose stool. It is important to know that the stool contains some digestive enzymes that are very irritating to the skin, so this skin must be protected.

Attempts to control a transverse colostomy with special restrictive diets, medicines, enemas, or irrigations usually do not work and are not often recommended. Most commonly, an appliance or pouching system is worn over a transverse colostomy at all times. A lightweight, drainable appliance holds the colostomy output and protects the skin from contact with the stool. This appliance bag does not usually bulge, so it's not easy to see under your clothes.

Closure of the transverse colostomy

When the colostomy is made, there may or may not be a plan to close it again. Not all transverse colostomies can or should be closed.

If you are to have your colostomy closed the surgeon may say that he or she plans to "take it down" in a few weeks or months; then, again, sometimes no plans are mentioned. There are many things that must be taken into account when thinking about closing a colostomy, such as:

* the original reason for the colostomy
* whether your body can take more surgery
* your health since the operation
* other problems that may have happened during or after surgery

It is wise to discuss these things with your surgeon before you leave the hospital so that you know what the plans are and when he or she wants to see you again. If you are home now and did not get instructions, call the doctor's office or clinic and find out what the doctor wants you to do. It is your job to stay in touch with the doctor.

Ascending colostomy

The ascending colostomy is placed on the right side of the abdomen. When a colostomy is located in the right half of the colon, only a short portion of colon remains. This means that the output is very liquid. A drainable pouch is worn for colostomies like this. This type of stoma is rarely used since an ileostomy is a better stoma when the discharge is liquid.

Stool in the right half of the colon is liquid and contains many digestive enzymes. The discharge from an ascending colostomy will usually be loose or semi-solid. It can also irritate the skin due to the action of the enzymes in it. This type of colostomy puts out drainage all of the time and cannot be controlled. The colostomy must be covered with a lightweight, drainable pouch. This will protect the skin from contact with the stool. Caring for an ascending colostomy is much like caring for a transverse colostomy (discussed above).

Descending and sigmoid colostomies

Located at the end of the descending colon, the descending colostomy is placed on the lower left side of the abdomen. Most often, the output is firm and can be controlled.

A sigmoid colostomy, which is different from a descending colostomy, comes from the sigmoid colon, just a few inches lower in the digestive tract. Because of this, it may produce more solid and more regular stool. The sigmoid colostomy is probably the most common type of colostomy.

Both the descending and the sigmoid colostomies can have a double-barrel or single-barrel opening. The single-barrel, or end colostomy, is the more common type. The stoma of the end colostomy is either sewn flush with the skin or it is turned back on itself (like the turned-down top of a sock).

The stool of a descending or sigmoid colostomy is firmer than that of the transverse colostomy and does not have as much of the irritating enzymes in it. Output from these types of colostomy may happen on a reflex basis at regular, expected times. The bowel movement will take place after a certain amount of stool has collected in the bowel above the colostomy. Two or 3 days may go between movements. Spilling may happen between movements because there is no anus to hold the stool back. Many people use a lightweight, disposable pouch to prevent accidents. A reflex will set up quite naturally in some people. Others may need mild stimulation, such as juice, coffee, a meal, a mild laxative, or irrigation.

While many descending and sigmoid colostomies can be trained to move regularly, some cannot. Training, with or without stimulation, is likely to happen only in those people who had regular bowel movements before they became ill. If bowel movements were irregular in earlier years, it may be quite difficult, or impossible, to have regular, predictable colostomy function. Spastic colon, irritable bowel, and some types of indigestion are some conditions that cause people with colostomies to continue to have bouts of constipation or loose stool.

It is often said a person must have a bowel movement every day. In truth, this varies from person to person. Some people have 2 or 3 movements a day, while others have a bowel movement every 2 or 3 days or even less often. Figure out what is usual for you, not what is usual for others.

Colostomy management

Think of your colostomy's function as you did your natural bowel movements. You still have the same bowel, just a little less of it. The real change is having the stool come out of an opening made in the abdomen. Learning how to care for your colostomy will help you adjust.

There is no one way to take care of a colostomy. As colostomies differ, so does taking care of them. This guide offers you suggestions and ideas for managing your colostomy. Discuss the ideas with your doctor or ET nurse and adapt them to your situation. Give new things a fair trial but do not continue them if they do not make you more comfortable. What is good for someone else may not be good for you. Use the weeks of recovery for learning and trying different things.

In our society, bathroom needs are kept private. This is the same for a person with a colostomy. While you learn the new procedures, you may need help. But before long you will again be in control. A good sense of humor and common sense are key when changes in body function take place. Be confident. You can learn the new system.

In the beginning, it will be hard to tell what your stools will be like or when they will come out. The doctor and ET nurse will work with you to find the best way to contain the stool so you will not be surprised or embarrassed. There are many ways that this can be done. The choice depends on your type of colostomy, your usual bowel function, and your personal preference.

Caring for a transverse colostomy

Care of any colostomy is really not very hard to do, but getting to the point where you feel comfortable takes a lot of learning, a lot of practice, the right supplies, and a positive attitude. Keep in mind the following points:

• An appliance that will keep you from soiling your clothing is the right one for you.

• The colostomy will put out stool no matter what you do, but the form of stool is affected to some extent by what you eat and drink.

• Gas and odor are part of the digestive process and cannot be prevented. Still, they can be controlled so that you will not be embarrassed.

• Emptying the appliance often during the day helps keep it from leaking and bulging underneath your clothing.

• Changing the appliance (putting on a fresh one) should be done before there is a leak. It is best to not change it more than once a day and not less than once every 3 or 4 days.

• Having an ostomy should not irritate your skin. This can be prevented by having a correctly fitted appliance and by using special materials for ostomy care.

Bowel movements with a descending or sigmoid colostomy

You can treat the bowel movement through a colostomy like a normal movement through the anus, just let it happen naturally. But, unlike the anal opening, the colostomy does not have a sphincter muscle that can stop the passage of stool. Because of this, a pouch must be worn to collect anything that might come through, whether it is expected or not. There are many lightweight pouches available that are hard to see under clothing. They stick to the abdomen around the colostomy and may be worn at all times, or worn only as needed.

Some people with a descending or sigmoid colostomy find that by eating certain foods at certain times, they can make the bowel move at a time that works best for them. With time and practice, they may feel so certain of this schedule, they will wear a pouch only when a movement is expected. Some people use only this method to keep bowel movements on a regular schedule, while other use it along with irrigation.

Choosing a pouching system

Deciding what pouching system or appliance is best for you is a very personal matter. When selecting your appliance, it is best to consult someone who knows how to fit ostomates. ET nurses are very good at this. Many doctors and nurses have experience in this area too. There should be someone in the hospital who is experienced and will get you started with equipment and instructions. As you are getting ready to leave the hospital, be sure you are referred to an ET nurse, a clinic, or a chapter of the United Ostomy Association of America. Even if you must go out of town to get such help, it is worthwhile, as you want to get a proper start and avoid making mistakes.

Over the years, colostomy pouching systems have gotten a lot better. Those available years ago were bulky and often smelled bad. Today, there is a wide selection of pouches that do not even show under clothing. Since they are made of disposable materials, they are worn once, or just a few times, and then discarded. This helps to control the smell.

You may not need to wear a pouch but many colostomates do. For example, those who have a transverse colostomy, those who do not wish to irrigate, and those who have some return between irrigations. (More information on irrigation is coming up.)

A good pouching system should:

• be secure, with a good leak proof seal that lasts for up to 3 days

• have an odor-resistant pouch

• offer skin protection

• be nearly invisible when covered with clothing

• be easy to apply and to remove

Choosing the best pouching system is a very personal matter. It is important for you to be well-fitted. When you are trying out your first pouching system, it is best to talk with an ostomy nurse or someone who has experience.

Disposable stoma pouches

Pouches come in many styles and sizes, but they all do the same job--they collect stool drainage that comes through the stoma. Some can be opened at the bottom for easy emptying. Others are closed and are removed when filled. Still others allow the adhesive skin barrier, also called the face plate or flange, to stay on the body while the pouch may be taken off, washed out, and reused. Everyone needs to have some type of stoma pouch on hand, if only for emergency purposes.

Along with the different kinds of pouches, other supplies such as flanges, clips, and belts are shown. Some types of pouching systems need these supplies. Pouches are made from odor-resistant materials and vary in cost. Pouches are either clear or opaque and come in different lengths. There are 2 main types of systems available:

* one-piece pouches with an attached skin barrier
* two-piece systems made up of a skin barrier and pouch that can be removed from the barrier

The face plate or flange of the pouch may need a hole cut out for the stoma, or it may be sized and pre-cut.

Stoma covers

A gauze or tissue can be folded neatly, touched with a small amount of water-soluble lubricant, placed over the stoma, and covered with a piece of plastic wrap. Such a dressing may be held on with medical tape, underclothing, or an elastic garment. Plastic, ready-made stoma caps are also available. Stoma covers may be used for colostomies that put out stool at regular, expected times.

Ordering supplies

It is a good idea to reorder supplies a few weeks before you expect them to run out to allow enough time for delivery. Don't stockpile supplies because they may be ruined by moisture and changes in temperature. Keep all your supplies together on a shelf, in a drawer, or in a box in a dry area away from hot or cold temperatures.

To order more pouches, skin barriers, and other ostomy products, you will need the manufacturer's name and product numbers. Supplies may be ordered from a mail order company, from a medical supply store, or from a local pharmacy. For information and help in ordering, you may contact a local ET nurse, the product manufacturer, telephone directory business pages, or the Internet (try the search words ostomy supplies).

Sterility

You don't have to use sterile supplies. For instance, facial tissue or cotton balls can be used in place of gauze pads. The stoma and surrounding skin are not sterile, but clean.

Appliance seal

The length of time a pouch will stay sealed to the skin depends on many things, such as the weather, skin condition, scars, weight changes, diet, activity, body shape near the stoma, and the nature of the colostomy output.

• Sweating during the summer months in warm humid climates will shorten the number of days you can wear the pouching system. Body heat, added to outside temperature, will cause skin barriers to loosen more quickly than usual.

• Moist, oily skin may shorten the length of time you can wear it.

• Weight changes will also affect how long you can wear a pouch. Weight gained or lost after colostomy surgery can change the shape of your abdomen. You may need an entirely different system.

• Diet may affect your seal. Foods that cause a watery output or liquid stool is more likely to break a seal than a thicker discharge.

• Physical activities may affect wearing time. Swimming, very strenuous sports, or anything that makes you sweat may shorten wearing time.

Irrigation (for descending and sigmoid colostomies only)

Irrigating to have regular, controlled bowel movements is up to each person, but it should be fully discussed with your doctor or ET nurse before a decision is made. The irrigation procedure is taught and done slightly differently , depending on the experience of the doctor and the ET nurse teaching you.

Modern equipment includes a plastic irrigating container with a long tube and a cone or tip to put water into the colostomy. An irrigation sleeve is worn to carry the irrigation output into the toilet. You can use a tail closure or clip and a belt for extra irrigation sleeve support, too.

Basic irrigation tips

• Choose a time in the day when you know you will have the bathroom to yourself.

• Irrigations may work better if they are done after a meal or a hot or warm drink. Also, consider irrigating at about the same time of day you usually moved your bowels before you had the colostomy.

• Put 1000 cc (1 quart) of lukewarm (not hot) water in your irrigating container. You may need a little less. NEVER connect the tube directly to the faucet.

• Hang the container at a height that makes the bottom of it level with your shoulder when you are seated.

• Sit yourself on the toilet or on a chair next to it. Sit up straight.

• Put on the plastic irrigation sleeve and place the bottom end in the toilet bowl.

• Wet or lubricate the end of the cone with water-soluble lubricant.

• To remove air bubbles from the tubing, open the clamp on the tubing and let a small amount of water run into the sleeve. Re-clamp the tubing and put the cone into the stoma as far as it will go, but not beyond its widest point. Again, slowly open the clamp on the tubing and allow the water to flow in.

• The water must go in slowly. You may shut the clamp or squeeze the tube to slow or stop the water flow. It takes about 3 to 5 minutes to drip in 1000 cc of water. Hold the cone in place for 10 more seconds.

• The amount of water you need depends on your own body. Do not use more than 1000 cc and you may need less. The purpose of irrigating is to remove stool, not to be strict about the amount of water used.

• You should not have cramps or nausea while the water flows in. These are signs that the water is running in too fast, you are using too much water, or the water is too cold. After the water has been put in, a bowel movement-type cramp may happen as the stool comes out.

• After the water has run in, remove the cone. Output or "returns" will come in spurts over a period of about 45 minutes. As soon as the major portion has come, you may clip the bottom of the irrigating sleeve to the top with a clasp. This allows you to move around, bathe, or do anything you wish to pass the time.

• In time you will know when all the water and stool have all come out. A squirt of gas may be a sign that the process is done, or the stoma may look quiet or inactive.

• If the complete irrigation process always takes much more than an hour, talk to your doctor or ET nurse.

• Which one, or which combination of the above methods you use depends on many factors, such as:

• The amount of intestine there is before the colostomy.

• Your lifelong bowel habits.

• Your skill with these techniques.

• Your personal feelings about the colostomy.

• Your talks with your doctor or your ET nurse.

Select a method, or a combination of methods, that will almost match your body's normal bowel habit or pattern. In the beginning, you may need to try different things under a doctor or ET nurse's guidance. Just remember, it will take time to establish a new system. Having regular daily habits will help. If you find certain foods or irrigation procedures let you regulate your bowel movements, continue to do what you have done at the same time every day. Regular habits will promote regular bowel functions. On the other hand, it is never wise to be a slave to habits. Occasional changes in routine will not harm you.

Helpful hints

As you learn more, you may have questions. There is no one right answer, only suggestions and ideas for you to try. This section has many suggestions that come from the experiences of other patients. But remember, no 2 people are alike.

Protecting the skin around the stoma

A colostomy that puts out firm stool usually causes few, if any skin problems. If the stool is loose, as is often the case with transverse colostomies, it can irritate the skin. As you get stronger and get better at handling your equipment, skin irritations will become less of a problem. Here are some ways to prevent skin problems:

• Use the right size pouch and skin barrier opening. An opening that is too small can cut or injure the stoma and may cause it to swell. If the opening is too large, it could possibly irritate the skin. In both cases, change the pouch or skin barrier and replace it with one that fits well.

• Change the pouching system regularly to avoid leakage and skin irritation. Leaks can cause itching and burning if the pouching system is not changed quickly, and the skin can become irritated.

• Do not rip the pouching system away from the abdomen or remove it more than once a day unless there is a problem. Remove the face plate gently by pushing your skin from the pouch rather than pulling the pouch from the skin. Water will often help.

• Keep the skin clean with water. If needed, you can use a mild soap and rinse very well. Pat dry before putting on the gauze or pouch. This can be done in the shower or tub.

• Watch for sensitivities and allergies to adhesive, skin barrier, paste, tape, or pouch material. They can develop after weeks, months, or even years of using a product since you can become sensitized over time. If your skin is irritated only where the plastic pouch lays against you, you might try a pouch cover. These are available from several manufacturers, or you can make your own. You may have to test different products to see how your skin will react to them. If you feel comfortable testing yourself, follow the recommendations under "Patch Testing" that follow. If you are not comfortable doing this on your own, and the problem continues, talk to your doctor or ET nurse.

Patch testing

Place a small piece of material to be tested on the skin of your abdomen, far away from the colostomy. If the material is not self-sticking attach it with an adhesive tape that you know you are not allergic to. Leave it on for 48 hours.

Gently remove the patch at the end of 48 hours and look for redness or spots under the patch area. If there is no redness after 48 hours, it is generally safe to use the product. But, in a few cases, reactions that took longer than 48 hours to show up have been reported.

Itching or burning before 48 hours pass is a sign of sensitivity. Remove the material right away and wash skin well with soap and water.

A reaction to the tape is also possible. If this is the case, the redness or other irritation will only be in the area outlined by the tape.

If you seem to be allergic to a certain product, try one made by another company and patch test it, too. You will probably find one that works for you. Allergies are not as common as is irritation caused by the faulty use of a product. For this reason, always read the directions that come with a product. When in doubt, check with your ET nurse or doctor.

Spots of blood on the stoma

Spots of blood are no cause for alarm. Cleaning around the stoma as you change the pouch or skin barrier may cause slight bleeding. The blood vessels in the tissues of the stoma are very delicate at the surface and are easily disturbed. The bleeding will usually stop as easily as it started.

Shaving hair under the pouch

Having a lot of hair around the stoma area can make it hard to get the skin barrier to stick well and may cause pain when removing it. Shaving with a razor or trimming hair with scissors is helpful. Always use a straight edge or razor carefully. A mild soap or shaving cream may be used. Rinse well.

Flatulence (gas)

Right after surgery it may seem that you have a lot of gas almost all the time. Most abdominal surgery is followed by this uncomfortable, embarrassing, yet harmless symptom. As the tissue swelling goes down, you will have less gas. But certain foods, such as eggs, cabbage, onions, fish, beans, milk, cheese, and alcohol may cause gas.

Eating regularly will help prevent gas. Skipping meals to avoid gas or output is not smart. Some people find it best to eat a smaller amount of food 4 to 5 times a day.

You may be worried about the response others may have to gassy noises. You will find that these noises sound louder to you than to others and may only sound like stomach rumbling to them. If you are embarrassed by these rumblings when others are nearby you can say, “Excuse me, my stomach’s growling.” If you feel as though you are about to release gas when you are with people, casually fold your arms across your abdomen so that your forearm rests over your stoma. This will muffle most sounds. Check with your ostomy nurse about products you can take to help lessen gas, such as Beano®.

Odor

Odors are usually linked to gas, loose stools, or diarrhea. Some foods can produce odor: eggs, cabbage, cheese, cucumber, onion, garlic, fish, dairy foods, and coffee are among them. If you find that certain foods bother you, avoid them. Some medicines, for example, vitamins and antibiotics, cause stools to have an odor. Discuss this problem with your doctor. He or she may be able to prescribe another type of medicine.

Odors may be worse with transverse colostomies. This problem may be dealt with by placing deodorants in the pouch and by changing pouches often. It is best to use odor-proof pouches that can be thrown away after a single use.

If the colon is emptied well, odors are less likely. Irrigations may be helpful. It may be necessary to use a deodorant you take by mouth; there are several on the market. Discuss these problems with your ET nurse or doctor.

Care of the posterior wound

In some patients the rectum and anus are removed. This will leave a surgical wound in that area called a posterior wound. Care of the posterior wound is based on simple hygiene and the use of dressings or pads to collect and contain any drainage. Infections or drainage that lasts may be treated by antibiotics, irrigations, or sitz baths. Your doctor should outline the treatment for you to follow.

Constipation, loose stools, and diarrhea

In a normal state of health, the form of stool that the bowel puts out is related to what is put in. Timing and frequency of meals, emotional experiences, medicines, and sickness also play a role. This is true whether or not one has a colostomy.

Constipation is often the result of an unbalanced diet, or not eating or drinking enough liquids. A medicine may also be the cause. Fear may be at the root of it, or problems with the irrigation process. These are matters to talk over with your ET nurse or doctor. If you have had constipation problems in the past, before surgery, remember how you solved them and try the same things now. But DO NOT use laxatives without asking your doctor first.

Diarrhea is usually a warning that something is not right. Diarrhea is defined as frequent, loose, or watery bowel movements in greater amounts than usual, whether one has a colostomy or not. Diarrhea is different from loose bowel movements. Loose stools are common in transverse and ascending colostomies. This is due to the shortened length of the colon and is not a sign of sickness or disease. Certain foods or drinks may cause diarrhea. If this happens, and you should try to find out what they are and avoid them.

You should talk with your doctor or ET nurse if you have ongoing diarrhea or constipation,. Discuss the foods and liquids you take in, your eating schedule, how much you usually eat, and any medicines you might be taking. Something may be prescribed for you to help slow things down or to stimulate the bowel. Remember, no matter what, you need a well-balanced diet and good fluid intake to have a good output.

Phantom rectum

Phantom rectum is much like the phantom limb of amputees who feel as if their removed limb is still there. It is normal for you to feel as if you have to move your bowels the way you did before surgery. This can happen for years after surgery. If the rectum has not been removed, you may also have this feeling and may pass mucus when sitting on the toilet. Some who have had their rectum removed say that the feeling is helped by sitting on the toilet and acting as if a bowel movement is taking place.

Colostomy complications

The most common problem after colostomy surgery (other than skin irritation) is herniation around the colostomy. Signs of a hernia may be a bulge in the skin around the stoma, problems irrigating, partial obstruction (blockage), and sometimes prolapse of the colon (the bowel pushes itself through the stoma).

Many of these problems can be avoided if the stoma site is marked before surgery at a place that lies within the rectus abdominus muscle (the "6-pack muscle") near the middle of the abdomen. The ET nurse can be of great help in this. The ET nurse is also helpful in managing any problems you might have.

When you should call the doctor

You should call the doctor if you have:

• cramps lasting more than 2 or 3 hours

• severe unusual odor lasting more than a week (this may be a sign of infection.)

• unusual change in your stoma size or how it looks

• blockage at the stoma (obstruction) and/or the inner part of the stoma coming out (prolapse)

• a lot of bleeding from the stoma opening (or a moderate amount in the pouch that you notice several times when emptying it) (NOTE: Eating beets will lead to some red discoloration.)

• injury to the stoma

• a cut in the stoma

• continuous bleeding where the stoma meets the skin

• severe watery output lasting more than 5 or 6 hours

• anything unusual going on with your ostomy

A stoma can become narrowed (stenotic) with time, usually over many years. This may also be caused by injury from irrigation or a short-term poor blood supply right after surgery. Stenosis can usually be corrected with a minor operation if it becomes a problem.

Now that we use irrigation cones, rupture or perforation of the colon is rarely seen. They can still happen, though, if care is not used when putting the irrigation cone into the stoma.

Hospitalization

Take your ostomy supplies with you if you have to be in the hospital. The hospital may not have the same type you use. Prepare yourself to do some explaining and teaching, especially if you go to a hospital where colostomy patients are not seen too often, or if you go for a condition not related to your ostomy.

Do not assume that all hospital staff know a lot about colostomies. Do not let the hospital staff do any procedures you think may be harmful, such as laxatives, giving an enema through the stoma or rectum, or using a rectal thermometer. If you are in doubt about any procedure, refuse to have it done and ask to talk to your doctor.

Also ask to have the following information listed on your chart:

* type of ostomy or continent diversion you have
* whether your rectum has been removed or is intact
* details of your management routine and products used
* procedures to be avoided (see above)

Living with a colostomy

Learning to live with a colostomy may seem like a big project. It is much like any other major change in your life. Beginning a new job, moving to another city, marriage, and having children are all examples that require adapting to a new way of life. At first, you have to get used to the new aspects of these experiences, which may take some time. Having a positive outlook on life, patience, and a sense of humor are keys to adjusting to any new situation.

There are times after surgery when you may feel discouraged. You may feel alone and isolated. Because the whole experience is so new to you, you may feel awkward, frustrated, and uncertain. Feeling discouraged is real and normal. You might cry, be angry, and respond in ways that are unusual for you. Talking to a trusted friend, nurse, clergy, and certainly another person with an ostomy may help you work through those feelings.

Your social life can be as active as it was before surgery. You can enjoy all the things you did before, such as travel, sporting events, and eating at restaurants. The first time you go out of the house after surgery, you may feel as if everyone is staring at your pouch even though it cannot be seen under your clothing. Remember, you may feel your pouch on your body, but no one can see it.

You may also worry about your pouch filling with gas and bulging under your clothing. A quick trip to the rest room can take care of this problem. If you are worried about your pouch filling up right after eating at a social event, remember that people without colostomies often need to go to the rest room after eating. Nobody will think it unusual if you do the same. You will probably find that you need to empty your pouch less often than you need to urinate.

Telling others

You might be worried about how others will accept you and how your social role may be changed. It is natural to wonder how you will explain your surgery. Your friends and relatives may ask questions about your operation. Tell them only as much as you want them to know. Do not feel as if you have to explain your surgery to everyone who asks. A brief answer would be that you had abdominal surgery, or that you had part or all of your colon removed.

If you have children, answer their questions simply and truthfully. A simple explanation will be enough for them. Once you have explained what a colostomy is they may ask questions about it and want to see your stoma or the pouch. Talking about your surgery in a natural way will help get rid of any wrong ideas that they may have. They will accept your colostomy much the same way you do.

If you are considering marriage, talking with your future spouse about life with a colostomy and its affect on sex, children, and family acceptance will help to correct many of your partner's wrong ideas. Going to an ostomy support group meeting together may also be helpful. Talking to other couples, in which one partner has a colostomy, will give you both an experienced point of view.

Clothing and appearance

You do not need special clothing because colostomy pouches are fairly flat and hard to see under most clothing. The pressure of undergarments with elastic will not harm the stoma or prevent bowel function.

If you were sick before surgery, you may find you can now begin to eat normally for the first time in years. As your appetite returns, you may gain weight. This can affect the clothes you choose more than the pouching system itself.

Cotton knit or stretch underpants may give you extra support and security. Panty hose are also comfortable for some. A simple pouch cover adds comfort by absorbing body sweat and also keeps the plastic pouch from resting against the skin. Men can wear either boxer or jockey-type shorts.

Eating

Everything we eat and drink serves as building blocks for the body. To stay in good health, the body needs carbohydrates, proteins, fats, minerals, and vitamins. Water is also a key part of good health. At least 8 to 10 eight-ounce glasses of water per day is recommended. Having a balanced diet helps maintain good nutrition and keep the bowel's activity normal.

We have a clear understanding of what the body needs for good health. Most people have heard of the "food pyramid," which shows how many servings of various types of food are needed for good health. Within the pyramid's six food groups (grains, fruits, vegetables, dairy, animal protein, and minimal amounts of fats and sweets) are foods that provide all the needed nutrients. Choose most of the foods you eat from plant sources.

• Eat 5 or more servings of a variety of fruits and vegetables each day.

• Choose foods and drinks in amounts that help you keep a healthy weight

• Choose whole grains instead of processed or refined grains

• Limit your intake of processed and red meats.

There is no such thing as a colostomy diet. After healing is complete and the ostomy is working normally, most people with colostomies can return to foods they normally eat. If you have a special diet because of heart disease, diabetes, or other health problems, you should ask your doctor about a diet that will work for you.

Foods can be acidic or alkaline, bland or spicy, laxative-like or constipating. Foods act differently on different people. It is good to try to return to your former normal diet. Chew well and see the effect of each food on your colostomy. Those foods that have disagreed with you most of your life may still do so.

If you wear an appliance all the time, you will suffer no embarrassment if something you have eaten produces an unexpected discharge. You will soon learn which foods produce gas or odor, which cause diarrhea, and which lead to constipation. As you learn these things you can regulate the bowel's behavior to a large extent.

Note: You cannot prevent the intestine from moving by not eating. An empty intestine produces gas. No matter what your plans for the day might be, eat regularly, several times a day, and perhaps a small meal before retiring. Your colostomy will function better for it.

Daily life

Once you have recovered from surgery, you may continue a normal day's routine, just as you did before the operation. A colostomy will not keep you from most physical activities. Once you have learned to care for your colostomy, it will not interfere in your day's schedule.

Returning to work

As your strength returns, you can go back to your regular activities. If you go back to work, you may want to tell your employer or a good friend about your colostomy. Being open about it will help educate others. Keeping it a complete secret may cause practical problems.

Colostomates can do most jobs. But heavy lifting may cause a stoma to herniate (bulge outward around the stoma) or prolapse (in inner part of the stoma can fall outward). A sudden blow in the pouch area could cause the face plate to shift and cut the stoma. Still, there are colostomates who do heavy lifting, such as fire fighters, mechanics, and truck drivers. There are athletes who have stomas, too. Check with your doctor about your type of work. As with all major surgery, it will take time for you to regain strength after your operation. A letter from your doctor to your employer may be helpful should your employer have doubts about what you will be able to do.

Sometimes people with a colostomy find that their employer thinks the colostomy will keep them from doing their job. This also happens to some colostomates who are applying for a new job. You should know that your right to work is protected by parts of the US Rehabilitation Act of 1973, and the Americans with Disabilities Act of 1992, as well as by sections of your state and local laws. If you feel you are being treated unfairly because of your colostomy, check with the United Ostomy Association of America or with a local legal resource about protecting your rights.

Intimacy and sexuality

Sexual relationships and intimacy are important and fulfilling aspects of your life that should continue after ostomy surgery. But there is a period of adjustment after surgery. Your attitude is a key factor in re-establishing sexual expression and intimacy. Sexual function in women is usually not changed, although sexual potency of men may sometimes be affected (but usually only for a short time). Talk to your doctor and/or ostomy nurse about any problems or concerns you or your partner might have.

Any sexuality concerns you have are best discussed openly between you and your partner. It is likely that your partner will have anxieties about sexual activities due to lack of information. An intimate relationship is one in which it matters how well 2 people can communicate.

The first time you become intimate after surgery things may not go perfectly. Men may have trouble getting and keeping an erection and women sometimes have pain during intercourse. These conditions will usually improve with time. Your interest in sex will probably return over time as your strength returns and you get better at managing your pouch system. Body contact during sexual activities will usually not harm the stoma or loosen the pouch from the abdomen.

Women may consider wearing crotchless panties, "teddies," or a short slip or nightie. Men may consider wearing a cummerbund around the midsection to secure the pouch. There are several types of pouch covers that can be purchased or you can make your own.

Ostomy surgery may present more concerns for single people. When to tell that "someone special" depends on the relationship. Brief casual dates may not need to know. If the relationship grows and leads to intimacy, your partner needs to be told about the ostomy before a sexual experience. For more information, see the American Cancer Society document Sexuality for the Man with Cancer and his Partner, or Sexuality for the Woman with Cancer and her Partner.

Exercise, play, and sports

Everyone needs daily exercise to keep good health and body function. Again, a colostomy presents no barrier to all types of exercise and sports. There are a few safety measures you should think about. Many doctors do not recommend contact sports because of possible injury to the stoma from a severe blow, or because the pouching system may slip. But, special protection can prevent these problems. Weight lifting could cause a hernia at the stoma. Check with your doctor about such sports. Indeed, people with colostomies are distance runners, weight lifters, skiers, swimmers, and take part in most other types of athletics.

Bathing and swimming

Water will not harm the colostomy. You can bathe or shower with or without a pouching system in place. Soap will not irritate it and water will not flow in.

You can swim with your pouching system in place. For sanitary reasons, you should use a stick-on pouch when you go swimming in fresh water or in the ocean. Remember these points:

• If you use a support belt, you can leave it on if you want to.

• You may want to protect the barrier by taping the edges with waterproof tape.

• You may want to choose a swimsuit with a lining for a smoother profile. Dark colors or busy patterns can also help hide the pouching system. Women may want to choose a suit with a well-placed skirt or ruffle. Men may want to try a suit with a higher waist band or longer leg.

• Women may wear stretch panties made especially for swim suits.

• Men may want to wear bike shorts or a support garment sold in men's underwear departments or athletic wear departments under their bathing suits.

• Men may prefer to wear a tank top and trunks, if the stoma is above the belt line.

• Before swimming, empty your pouch and remember to eat lightly.

Travel

All methods of travel are open to you. Many people with colostomies travel just like everyone else, this includes camping trips, cruises, and air travel. Here are some travel suggestions:

• Take along enough supplies to last the entire trip plus some extras. They may not be easy to get where you are going. Even if you don't expect to change your pouch, take along everything you need to do so. Leave home fully prepared. Find out if and where supplies are available before a long trip. A local UOAA chapter may be helpful.

• Take along a recent issue of the Ostomy Quarterly. It contains a list of suppliers. For a complete listing of UOAA chapters, a copy of the Chapter Directory can be requested from the UOAA office. You can get information on ostomy suppliers from UOAA chapters, ET nurses, surgical supply firms, medical centers, and perhaps hospitals. The local phone book is a good place to look; colostomy supplies and ostomy may be cross-referenced in the index; also check under Ostomy Association and American Cancer Society. You may be able to telephone or fax your own supply source and have supplies sent to you. In some cases, delivery can be made in 24 hours.

• You can work out a way to change your appliance anywhere you travel, even in the woods or on a plane. If your appliance is reusable, you can soak it in your favorite solution by putting both in a plastic container with a tight-fitting lid, or in a plastic bag that zips closed.

• Seat belts will not harm the stoma when adjusted comfortably.

• When traveling by car, keep your supplies in the coolest part of the car. Avoid the trunk or back window ledge.

Traveling by plane

• When traveling by plane, remember that checked luggage sometimes gets lost. Carry an extra pouching system and other supplies on the plane with you. Be sure your adhesive remover is non-flammable. Small cosmetic bags with plastic linings or shaving kits work well. These should be kept in your carry-on luggage.

• To avoid problems with luggage inspection, have a note from your doctor stating that you need to carry ostomy supplies and medicine by hand.

Traveling abroad

• Before traveling abroad, get a current list of English-speaking doctors in the areas you will be visiting. The International Association for Medical Assistance to Travelers (IAMAT) at 716-754-4883 publishes lists of English speaking doctors in over 2,500 cities around the world.

• To avoid problems when going through customs or luggage inspection, have a note from your doctor stating that you need to carry ostomy supplies and medicines by hand (something like "MEDICALLY NECESSARY-OSTOMY SUPPLIES"). Further problems might be avoided by having this information translated into the language or languages of the country(s) you are visiting. The note could be written in several languages, on one piece of paper, and carried with your passport.

• Traveler's diarrhea is a common problem for tourists in foreign countries, whether you have an ostomy or not. The most common cause of diarrhea is impure water and/or food. It may also be caused by changes in water, food, or climate. Don't eat unpeeled fruits and raw vegetables. Be sure drinking water is safe. If the water is not safe, do not use the ice either. Bottled water or boiled water is recommended. Your doctor can give you a prescription for medicine to control diarrhea. Get it filled in your home state before you leave so that you can take the medicine with you just in case you need it.

Glossary

Adhesive: substance used to attach an ostomy pouch system to the body

Adhesive Remover: liquid or wipe used to dissolve adhesive so pouches can be removed from the body

Appliance: collecting device for waste eliminated from your colostomy. Also called a pouching system. Consists of an adhesive face plate and a pouch.

Colon: part of the intestine that stores digestive material and absorbs water and minerals. Also referred to as the large intestine or the large bowel.

Colostomy: a surgical opening of the colon (large intestine) brought to the surface of the abdomen

Cone: part of the irrigation set for sigmoid colostomy. It is the plastic cone-shaped piece at end of tubing which fits snugly against stoma to keep solution in the colostomy.

Diverticulitis: inflammation of the diverticula (little sacs on the colon); can cause abscesses, scarring with stricture, or perforation of the colon with peritonitis in severe cases. Some cases are difficult to tell from colon cancer on x-rays.

Diverticulosis: presence of diverticula (little sacs on the colon); very common; diverticula are found in more than half of the people over 50.

Enzymes: substance formed in animal and plant cells that starts or speeds up specific chemical reactions.

ET nurse or Enterostomal Therapy Nurse: a specially trained nurse who takes care of and teaches ostomy patients, teaches nursing personnel in hospitals and clinics, and work closely with the nursing and medical professions to improve the quality of ostomy rehabilitation programs

Face plate: molded rubber or plastic part of a two-piece reusable pouch system. The face plate fits around the stoma next to the skin and connects to the ostomy pouch. Also called a flange or adhesive skin barrier

Feces: excrement, stool, bowel movement

Fistula: an abnormal passage between two internal organs or from an internal organ to the surface of the body

Hernia (abdominal): the bulging of an internal organ through the abdominal muscles; can happen around stomas

Irrigation: an enema given through the stoma; this done by some colostomates at regular intervals to regulate passage of stool.

Malignancy: the condition of being cancerous; very dangerous or harmful

Mucus: fluid secreted from glands or cells. It lubricates membranes, including digestive tract

Obstruction: any blockage in the digestive tract. Symptoms include no ostomy output over several hours or spurts of watery stool, often along with abdominal cramping and nausea.

Ostomate: a person who has a colostomy, ileostomy, or urostomy

Ostomy: also called a stoma. A surgically created opening in the abdominal wall through which the body gets rid of waste. Refers to ileostomies, colostomies, and urostomies

Ostomy visitor: person with an ostomy who has special training to visit people before or shortly after ostomy surgery. The visitor offers support and educational advice rather than medical information.

Peristalsis: progressive waves of motion that occur without voluntary control to push waste material through the intestine

Prolapse: a "falling out" or protrusion in which the stoma becomes longer. Compare to retraction

Retraction: the act of drawing back. In reference to ostomy, the stoma draws back into the body. Compare to prolapse

Skin barrier: any one of many substances used to cover skin around the ostomy to protect it from stool

Stenosis: narrowing or tightness of the stoma that may cause obstruction (blockage)

Stoma (opening): the end of the ureter, ileum, or colon that may be seen coming through the skin. It often protrudes like a nipple and is 3/4" to 1 and 3/4" in diameter. It is usually bright red to pink in color. There are no nerve endings in the stoma, so it is not a source of pain or discomfort.

Stricture: an abnormal narrowing of a body passage.

     

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