Ostomy types and care – colostomy, ileostomy, urostomy

Ostomy types and care – colostomy, ileostomy, urostomy

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, bowel obstruction, inflammatory bowel disease (such as Crohn’s disease), and other issues.

If you are a caregiver taking care of someone with an ostomy, these are some of the issues and concerns that you may encounter.

If you are a caregiver caring for a person with an ostomy, changing the ostomy bag can be a little daunting at first, until you learn what works well (and not so well) for that person.

Types of stoma and associated surgical procedures

As a caregiver, it’s helpful to know  the different types of ostomy procedures so 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 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 & pouch

Changing the flange and pouch is a necessary part of after-care to manage the output and help keep the skin and stoma healthy.

Hollister, a developer and manufacturer of healthcare products like ostomy equipment, has Ostomy Care Resources available on their website to help you manage your stoma, including how to change various styles of flange and pouch, and how to measure your stoma. You may have been taught to change the flange in a different way for a special reason, therefore you should continue 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 those types of foods, for example nuts, sweetcorn and fibrous foods (see the above nutrition guide for more information).

How do I know if there is an ileostomy blockage?

Symptoms of an ileostomy blockage: If a blockage occurs you may notice a foul odor, clear liquids, and abdominal and stoma swelling, plus the person in your care may show signs of 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 you are caring for 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 them, but if the problem persists, you should arrange for an Enterostomal Therapy Nurse (ET) to make an assessment.

  • If you have nurses, or a personal support worker visiting, tell them the ostomy problems that you are experiencing so that they can arrange an assessment.
  • If you do not currently have additional help at home, the Canadian Association of Enterostomal Therapy has a service called ‘Find an ET’ so that you can easily locate an ET nurse near you. Our highly-skilled Elizz nurses are also available to help you manage this procedure. Call us at 1-855-Ask-Eliz to order home services for the person you’re taking care of or visit our Home Care Services.  

Stoma leakage issues:

  • how to measure ostomyMeasure 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 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 can cause leakage from beneath the flange. Sometimes adding a little paste in the crease or fold can help, and if not, an ET nurse can help you find a solution.

Skin is becoming red, sore and/or broken:

  • Check for leaks or change to size of stoma.
  • Always remove flanges gently, pressing skin away with one hand while slowly removing with the other.
  • Redness on the skin in the exact same shape as the flange may mean 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 and the excess dusted away, then sealed with a spray of no-sting barrier. These types of supplies are available from your local home health care store.

See also, our Elizz caregiving article on Good Skin Care.

Resources

These company websites have some great information including booklets that talk more about each stoma type and how to care for them. Websites include:

 

 

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