Definition Treatment for bowel disease sometimes requires the removal of part or all of the intestines. A new way for stool to leave the body must be created. A surgeon may create a connection between the bowel and the outside of the body. This is called a colostomy. The opening from the abdomen to the outside of the body is called a stoma. A colostomy may be temporary or permanent. When a person has a colostomy, education and initial care will be provided by a team of health professionals. These may include a doctor, nurse, social worker, and dietician. An enterostomal therapist might also help with care. This person is usually a registered nurse with specialised training and certification. People with colostomies are given information and training specific to their needs. Ongoing care may often extend well beyond the initial hospital stay.
Who is a candidate for the procedure? A person may need a colostomy if he or she has had an infection, inflammation, or blockage in the bowel. The colostomy may also be part of treatment for bowel cancer. Bowel defects or injuries might also result in a colostomy. The underlying condition that leads to a colostomy will affect a person's emotional, psychological, and physical recovery from surgery.
How is the procedure performed? Colostomy education begins before surgery. Diagrams, photographs, and examples of equipment are used to help to explain what the person might expect after surgery. Concerns about upcoming changes in body image, lifestyle and sexuality are also addressed.
The colostomy will begin to function 3 to 6 days after surgery. At first, a nurse or enterostomal therapist will take care of the colostomy. This person will also teach the person how to care for the colostomy on his or her own. Gradually, the individual will be able take over the care of the stoma and the skin around the stoma.
The stoma is red and shaped in an oval. It resembles the skin on the inside of the lower lip. A drainage bag or pouch is attached to the skin around the stoma. The stool will drain into this pouch. The size of the stoma will vary at first due to swelling and weight fluctuation. The stoma size in turn determines the size of the pouch. The stoma is often checked 3 weeks after surgery, when swelling has subsided. The final size and type of pouch used will be set about 3 months after the colostomy. This is when a person's weight and size are likely to have stabilised.
There are many types of pouches available. Most pouches are odour-resistant and disposable. The nurse or enterostomal therapist will help the person choose a properly fitting appliance. Good skin care around the stoma is critical. Before applying a fresh pouch, the skin around the stoma is washed gently with a mild soap. A gauze dressing may be used to cover the stoma while the skin is cleaned. The skin is patted completely dry with a gauze pad. Rubbing should be avoided. A doctor may suggest using nystatin powder on the skin around the stoma to combat irritation or yeast growth. A skin barrier, which may be a wafer or paste, is then applied to protect the skin from bowel contents draining through the stoma. The backing of the adhesive surface of the pouch is removed. The bag is then pressed down around the stoma for 30 seconds. The pouch is removed and drained when it is one-third to one-fourth full. If the pouch becomes too full, the weight could cause the bag to come off and spill.
Colostomy irrigation, a procedure where fluid is inserted into the bowel through the stoma, might be used to regulate the passage of stool. This helps avoid constipation. The doctor will advise when and how to perform irrigation.
A dietician can help a person with a colostomy choose a balanced diet. It may be desirable to eliminate some foods. For example, foods that cause excessive gas and odour are often avoided. These foods include:
members of the cabbage family
beans
eggs
fish
nuts
Foods or fluids such as fruits, soda, coffee, carbonated beverages, or high-fibre items may cause diarrhoea. Foods with hard-to-digest kernels, such as popcorn, may need to be avoided, as well. Non-irritating foods can be substituted for those that must be restricted.
What happens right after the procedure? The person should be encouraged to talk about how they feel about having a colostomy. Questions about sexuality and body image are common. These can be addressed by the healthcare team. The pouch presents no physical reason to limit sexual activity. Some persons wear pouch covers, or smaller pouches, during sex. Concerns about lifestyle changes can be discussed with a doctor.
What happens later at home? Visits from homecare nurses or enterostomal therapists can help with the adjustment to day-to-day living. Some people may find it helpful to join support organisations such as the Stomatherapy Association.
What are the potential complications after the procedure? Specific instructions will be given about when to call the doctor. Skin irritation and infection can result from stool that does not drain properly. Diarrhoea, or the passage of frequent watery stool, may occur. Stool can accumulate in the bowel, and require treatment for removal. Sometimes a stoma may prolapse, often this is associated with a hernia.
Author: Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
