A stoma or ostomy is an opening that has been surgically created to allow stool or urine to be diverted to a bag worn on the lower abdomen. An ostomy procedure may be needed if a person has colon or rectal cancer, a bowel obstruction, inflammatory bowel disease (such as Crohn’s disease), etc.
If you are caring for a person with an ostomy, changing the ostomy bag can be a little daunting until you learn what works well (and not so well) for that person.
Ostomy Types and Associated Surgical Procedures
As a caregiver, it’s helpful to know the different types of ostomy procedures so that you can provide the best after-care possible for the person you’re taking care of.
Colostomy – This is when a piece of the colon (large bowel) is brought through an opening in the abdominal wall. A colostomy procedure may be performed for many types of diseases or conditions such as malignancy (cancer), diverticulitis, obstruction, or fecal incontinence (the accidental loss of stool).
Ileostomy – This procedure is performed when a piece of the ileum (small bowel) is brought through an opening in the abdominal wall. Some of the reasons for needing an ileostomy include ulcerative colitis, Crohn’s disease, familial Polyposis, complications of cancer, or to allow a damaged/inflamed colon to heal after an injury or surgery.
Urostomy (or ileal-conduit) – Urostomy surgery is performed when the urinary bladder needs to be removed. The tubes that usually connect the kidneys to the bladder (ureters) are now connected to a piece of the ileum that has been detached from the rest of the bowel and brought through an opening in the abdominal wall.
If you are a caregiver taking care of someone with an ostomy, these are some of the issues and concerns that you may encounter.
Changing the Ostomy Flange and Pouch
Changing the flange and pouch is a necessary part of the after-care to manage the output and help keep the skin and stoma healthy.
Hollister, one of the makers of ostomy equipment, has great step-by-step instructions on their website to guide you through a basic appliance change. You may have been taught to change the flange in a different way for a special reason. You should continue changing the flange in that way unless you start to have problems with leakage.
Ostomies and Nutrition
Usually, a well balanced diet is recommended to avoid constipation and dehydration. Unless the doctor has suggested otherwise, try to include fibre and at least six to eight glasses of fluid per day.
The Diet and Nutrition Guide from United Ostomy Associations of America, Inc. has an excellent resource related to ostomies and nutrition.
For people with an ileostomy, it is extremely important that the food is chewed well as some foods that don’t digest easily can get caught in the stoma and cause a blockage. If the person you are caring for has difficulty chewing food well, it may be best to avoid foods such as nuts, sweetcorn, and fibrous foods - see the above nutrition guide for more information.
How do I know if there is an ileostomy blockage?
If a blockage occurs you may notice a foul odor, clear liquid, leaking from the stoma, as well as abdominal and stoma swelling. The person may also have abdominal cramping and darker urine or less urine. The United Ostomy Association of America, Inc. (UOAA) created a ‘blockage card’ which explains what you should do and also what to expect if you need to arrange for the person to visit the emergency room.
Common Problems to Look For
Sometimes leakage from beneath the flange or skin problems can occur that require attention. There may be things that you can do to help solve this but if the problem persists, you should arrange for an Enterostomal Therapy (ET) Nurse to do an assessment.
- If you have nurses or a personal support worker visiting, inform them of the ostomy problems that you are experiencing so that they can arrange for an assessment.
- If you do not currently have additional help at home, Nurses Specializing in Wound, Ostomy and Continence Canada has webpage that allows you to easily locate an ET Nurse near you. Our highly-skilled Elizz nurses are also available to help you. Call us at 1-855-Ask-Eliz to order home services for the person you’re caring for or visit our Services page.
Stoma Leakage Issues
- Measure the stoma using the measuring guide that comes in the ostomy supply box. The opening in the flange should be a couple of millimetres larger than the size of the stoma. Sometimes when a person loses or gains weight, the stoma will also change in size.
- Ensure that the skin is completely dry before putting on the new flange.
- Warming the new flange under your arm or with a hair dryer will help it to stick to the skin better.
- New creases or folds in the skin can cause leakage from beneath the flange. Sometimes adding a little paste in the crease or fold may help but an ET Nurse can help you find a solution.
Skin is becoming red, sore, and/or broken:
- Check for leaks or adjust the flange to the size of the stoma.
- Always remove the flange gently by pressing the skin away with one hand while slowly removing the flange with the other.
- Redness on the skin in the exact same shape as the flange may mean that the person is having a negative reaction to it. An ET Nurse can help you find a solution.
- For slight redness and irritation, Stomahesive® powder can be sprinkled on lightly (dust the excess away) and then sealed with a spray of no-sting barrier. These types of supplies are available from your local home health care store.
If the stoma appears purple, blue, or grey/black in colour, the person should report to the nearest emergency room immediately.
You may find the following caregiving websites helpful. They have information about each ostomy type and how to care for them.