Bowel disease: Caring for your ostomy

An ostomy is a surgical procedure. When a part of the digestive system is diseased or damaged and not able to work normally, a hole is made in the abdomen and a portion of the small or large intestine is brought to the surface of the skin. This opening is known as the ostomy, and the end of the exposed intestine is known as the stoma. A colostomy and an ileostomy are cared for in a similar manner with similar products.

See a picture of the large intestine .

See a picture of the small intestine .

See a picture of a colostomy stoma .

When you have a colostomy or ileostomy, waste leaves the body through the stoma, the end of the intestine that is attached to the abdominal wall, instead of the anus. Since there is no muscle around the stoma, you are not able to control when waste or gas passes out of the body. An odor-proof plastic pouch (an ostomy pouch) surrounds the stoma to collect the waste. It is held to your skin with an adhesive. Pouching systems may be one-piece or two-piece.

• In a two-piece system, the pouch and barrier (sometimes called a flange or wafer) are separate. The pouch contains a closing ring that attaches it to the barrier. This is generally a snap ring, similar to those found on food-storage containers. The barrier fits around the stoma and sticks to your skin.
• In a one-piece system, the pouch and barrier are a single unit.

See a picture of a colostomy pouch .

Other accessories may include:

• Curved (convex) barriers, which conform better to some abdomens.
• Ostomy belts, which help support the pouch.
• Pouch covers, which conceal the pouch.
• Skin barrier paste, which fills in folds or skin irregularities of the abdomen to form a better seal.
• Skin wipes or powders, which protect the skin under the barrier and around the stoma.
• Tape, which supports the barrier and is used for waterproofing.
• Tape remover, which makes removing the pouch easier.

Test Your Knowledge

Test your knowledge about what an ostomy is.

1. When you have had an ostomy, you are not able to control waste leaving your body.

   1. True

      This answer is correct.

      When you have had an ostomy, you are not able to control waste leaving your body. An ostomy pouch collects the waste as it leaves your body. One exception is a continent ileostomy, in which a pouch and a valve are made in the lower end of the small intestine (the ileum). The surgeon then connects the valve to an opening (stoma) in the skin of the lower abdomen. After this surgery, you can insert a tube into the valve to release stool from the intestines.

   2. False

      This answer is incorrect.

      When you have had an ostomy, you are not able to control waste leaving your body. An ostomy pouch collects the waste as it leaves your body. One exception is a continent ileostomy, in which a pouch and a valve are made in the lower end of the small intestine (the ileum). The surgeon then connects the valve to an opening (stoma) in the skin of the lower abdomen. After this surgery, you can insert a tube into the valve to release stool from the intestines.

You need to care for your ostomy because:

• You eliminate body waste through the end of the exposed intestine (stoma). Elimination of body waste must be done to ensure health.
• Without proper care, skin irritation is possible, making it difficult to maintain a good seal between the skin and the barrier.
• You want to continue to live a full life. Understanding how to care for your ostomy will help you live comfortably with it. See living with an ostomy.

Test Your Knowledge

Test your knowledge about why you need to care for an ostomy.

1. One reason you need to care for an ostomy is to prevent skin irritation.

   1. True

      This answer is correct.

      Proper care helps prevent skin irritation.

   2. False

      This answer is incorrect.

      Without proper care, skin irritation can develop, making it difficult to maintain a good seal between the skin and the barrier.

Proper care for your ostomy includes learning how to empty and replace the pouch and watching for skin irritation.

If you have abdominal cramping or little or no waste output into your pouch, call your doctor.

Some people choose to irrigate a colostomy. Irrigation is a procedure in which you stimulate and flush the intestines at a regular time to control when you eliminate solid wastes.

Note: If caring for an infant or child with an ostomy, the same information and procedures generally apply. But the ostomy pouch will be smaller and will need to be replaced every 2 to 3 days. Different adhesives may be used to attach the pouch because a child's skin is more sensitive than an adult's skin. Your wound, ostomy, and continence nurse (WOCN) will help you learn how to care for your child with an ostomy. Irrigation is not appropriate for children.

Emptying your ostomy pouch

Ostomy pouches can be drainable or closed. A drainable pouch opens at one end to allow you to empty it. A closed pouch is disposed of and replaced with a new one as needed.

The pouch fills with waste and gas. It is best to empty the pouch when it is one-third to one-half full. This prevents the pouch from getting too full and heavy and pulling off. Many people routinely empty the pouch each time they urinate.

• Drainable pouch. Place some toilet paper in the bowl to prevent splashing. Sit down on the toilet with the pouch between your legs. The pouch is usually held shut with a clip system. Simply unclip it and allow its contents to fall into the toilet. Clean the end of the pouch with toilet paper and reclip it.
• Closed pouch. Unsnap the pouch from the barrier and dispose of it. Do not flush it down the toilet. Putting the pouch in a ziplock bag reduces odor. You then need to attach a new pouch.

Replacing your ostomy pouch

The pouching system is usually replaced every 4 to 7 days or whenever there is a leak in the pouch or itching or burning under the barrier. The pouch itself is usually replaced after each bowel movement. An infant's or child's pouching system is generally replaced every 2 to 3 days.

• Prepare the new pouch and barrier. Cut an opening in the new barrier slightly larger than the stoma. You may also have a precut barrier. If you have a two-piece system, snap the pouch to the barrier. Remove the paper backing from the barrier so that the adhesive is exposed. You may need to use some skin barrier paste to obtain a better skin seal.
• Remove the old pouch and barrier. Remove your old pouch by peeling away the barrier and gently lifting the pouch while pressing down on the skin below the pouch. Be sure not to irritate the skin as you remove the barrier and pouch. If the pouch is sticking and is difficult to remove, use an adhesive remover underneath the barrier. Dispose of the old pouch and barrier.
• Clean your skin. Clean your skin and stoma with a wet washcloth or wipe. You may shower to clean the stoma. You may use soap, but if you do, rinse well. Allow your skin to dry and check your skin and stoma for signs of irritation. See Treating skin irritation below.
• Measure your stoma, if necessary. After your surgery, the size of your stoma may change. Your doctor may want you to measure it and will provide a measurement guide to help you do this.
• Put the new pouch on. Position the opening in the barrier around the stoma and apply the sticky side to the skin. Press down until all edges are sealed. If your pouch is open-ended, attach the clip.

Treating skin irritation

The stoma is normally pink to red. Call your doctor if your stoma:

• Develops a pale color.
• Becomes dusky or blue.
• Swells.
• Bleeds.

If the skin under your pouch is red, irritated, or itchy, you need to treat your skin. Follow these steps:

1. Gently remove the pouch.
2. Clean the skin under the pouch with water.
3. Dry the skin.
4. Sprinkle ostomy protective powder on the skin and then blot it off.
5. Reattach or replace the pouching system.

If you continue to have skin irritation, consult your wound, ostomy, and continence nurse or another nurse or a doctor.

Irrigating a colostomy

Irrigating a colostomy allows more control over the elimination of waste because it stimulates the intestine to function at a regular time. It is generally done at the same time every day or every other day. If you irrigate, you may need only a cover or pad over your stoma and may not need an ostomy pouch.

Children do not use irrigation.

Only a colostomy can be irrigated. You cannot irrigate an ileostomy.

To irrigate a colostomy, you need to have all of the following equipment and supplies ready, including:

• Lubricant.
• An irrigation set, which includes a container for water, tubing with a cone end (one end of the tubing attaches to the container and the cone end is inserted into the stoma), and a clamp.
• An irrigating sleeve and belt. (The sleeve is a long, clear plastic bag, open at the top and bottom. It snaps onto the barrier.)
• Toilet tissue.
• A toilet to dispose of waste.

See a picture of colostomy irrigation .

A two-piece pouch system is usually used for irrigation. A nurse or doctor will show you how to irrigate your colostomy. The basic procedure is as follows.

Getting ready

1. Place 16 fl oz (473 mL) to 32 fl oz (946 mL) of lukewarm water (cold water can cause cramping) in the container to use as irrigation solution. The exact amount depends on the person. Your nurse or doctor will help you determine the amount you need.
2. Hang the container at about shoulder height-18 in. (46 cm) to 24 in. (61 cm) above your stoma. You will need a hook or other device to do this.
3. Find a comfortable position, such as in a chair in front of the toilet or on the toilet.

Preparing the equipment

1. Remove your colostomy pouch from the barrier and snap the irrigation sleeve to the barrier. Attach the sleeve belt for security, and place the end of the sleeve in the toilet, bedpan, or other disposal unit.
2. Unclamp the tubing to let some of the irrigation solution flow through the tubing and out the cone. This removes air from the tubing.
3. Reclamp the tube.
4. Lubricate the irrigating cone and gently insert the cone into the stoma through the upper opening in the sleeve. Press the cone firmly but gently. Do not force the cone into the stoma or insert it more than 3 in. (7.6 cm) into the stoma.

Irrigating

1. Unclamp the tube and allow the irrigation solution to flow into the stoma slowly for 5 to 10 minutes. If cramping occurs, stop the flow for a few seconds but leave the cone in place.
2. When the desired amount of solution flows in, or when you feel full, clamp the tubing and remove the irrigation cone from your stoma. Waste will come out of the stoma and empty through the sleeve into the toilet or other disposal unit.
3. It takes 30 to 45 minutes for all the waste to empty. But after the initial flow of waste slows down (10 to 15 minutes), you may clamp the sleeve shut at the bottom and move around. Many people use this time for shaving and other grooming.
4. When the waste return is completed, unsnap the sleeve and put on your usual pouch or covering.
5. Clean all supplies and store for reuse.

Test Your Knowledge

Test your knowledge about how to care for your ostomy.

1. An adult should change the pouching system:

   1. Every day.

      This answer is incorrect.

      An adult should change the pouching system every 4 to 7 days or whenever there is a leak in the system or itching or burning under the barrier. The correct answers are b and c.

   2. Every 4 to 7 days.

      This answer is correct.

      An adult should change the drainable pouching system every 4 to 7 days or whenever there is a leak in the system or itching or burning under the barrier. The correct answers are b and c.

   3. If there is a leak in the system, itching under the barrier, or burning under the barrier.

      This answer is correct.

      An adult should change the drainable pouching system every 4 to 7 days or whenever there is a leak in the system or itching or burning under the barrier. The correct answers are b and c.

2. You should empty your pouch when:

   1. It is one-third to one-half full.

      This answer is correct.

      Emptying the pouch when it is one-third to one-half full prevents the pouch from getting too full and heavy and pulling off.

   2. It is full.

      This answer is incorrect.

      Empty the pouch when it is one-third to one-half full. Doing so prevents the pouch from getting too full and heavy and pulling off. The correct answer is a.

Now that you have read this information, you are ready to care for your ostomy. If you have any questions about caring for your ostomy, contact your doctor or a wound, ostomy, and continence nurse (WOCN).