Colostomies are performed for various reasons, including trauma, blockages, and infections. The procedure requires postcolostomy care by the patient, nursing staff and physicians. Patients should monitor their stoma appearance, intake and output, and report any changes to their surgeon. Patients can choose between single-use or reusable and one-piece or two-piece bag systems. Colostomy patients should inform their doctors of any abdominal pain, fever, or skin irritation.
Colostomies are performed for various reasons, including trauma, blockages, and infections. The procedure is quite intense and requires a commitment to postcolostomy care by the patient, nursing staff and physicians. Caring for a colostomy patient requires knowledge and compassion.
Conditions such as diverticulitis, inflammatory bowel disease, cancer, or trauma sometimes require a colostomy. In general, the surgery takes two to four hours. The most common type of colostomy procedure is the Hartmann colostomy, a procedure in which the colon is cut in half. The end of the colon leading to the stomach is fed through the abdominal wall and attached to the skin. This area is the stoma.
After surgery, the end of the colon near the rectum becomes dormant. Most colostomies performed can be reversed after the affected colon tissues have healed. In the days following surgery, you should check the appearance of your stoma to make sure it stays red and moist.
If you experience a color change, especially a darkening to a purple or black tone, you should share this information with your surgeon right away. Check the abdomen for distention or bleeding near the incision site. Intake and output should be monitored to reduce the patient’s risk of dehydration or electrolyte imbalance.
Within six to eight weeks, the swelling will subside and the stoma will shrink to its normal size. The stoma and surrounding skin should be routinely evaluated. Note the color and height of the stoma, and look for skin damage such as blisters, ulcers, or rashes.
Patients with certain types of colostomy — descending or sigmoid — might choose not to wear a pouch and opt for irrigation instead. To prepare for flushing, the colostomy patient should sit on the toilet. Insert a flexible, water-soluble gelatin-coated catheter no more than 3 cm (7.6 inches) into the stoma. Stop at the first sign of resistance. If necessary, use a gloved, lubricated finger to dilate the stoma.
After the catheter is in place, 16.9 to 33.8 cc of warm fluid fills the colon. If the colostomy patient experiences cramps, the fluid flow should be stopped until the cramps subside and then continued slowly. The liquid stays in the colon for a few minutes before being flushed down the toilet.
Sometimes the side-to-side or back-and-forth motion will encourage the return velocity of the fluid to increase if slowed. The colostomy patient should note the amount and type of fluid returned after irrigation. Any obstruction or ostomy prolapse should be reported immediately.
Patients who must use a bag system can choose between single-use or reusable and one-piece or two-piece. In the one-piece system, the wafer and pouch are connected and attach to the stoma site. The wafer and pouch are separated in the two-piece system. The wafer sticks to the skin and the pouch to the wafer. The colostomy patient must evaluate the advantages and disadvantages of each system.
To replace the colostomy bag, carefully remove the attached system. Be gentle with wafer removal. The adhesive remover can be used to prevent skin breakdown. The area around the stoma should be cleaned and dried. Note any skin damage and seek appropriate treatment for the patient in the event of a rash, blister, or fungal infection.
Apply the sealant to the skin surrounding the stoma and apply the new wafer. To keep the abdomen flat, the colostomy patient may find that standing works best. Place the wafer against the skin. The stoma should pass through the hole with a ring of space between the stoma and the wafer.
Use your finger to apply pressure to the wafer and ensure proper adhesion to the skin. Connect the bag to the wafer. You will hear a click as the plastic circles seal. Place the tail closure over the open end of the pouch.
Colostomy patients should inform their doctors of any abdominal pain, fever, or skin irritation. A change in bowel habits or a hernia — which often appears as a bulge around the stoma — requires further medical attention. Problems with stoma site leaks or a desire for a different pouch system can easily be resolved by a visit to a doctor.
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