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Colostomy / Ileostomy /Pouch Procedures What is an Ostomy? The word "ostomy" is derived from Greek and means a surgically created opening connecting an internal organ to the surface of the body. Different kinds of ostomies are named for the organ involved. The most common types of ostomies in intestinal surgery are an "ileostomy" (connecting the small intestine to the skin) and a "colostomy" (connecting the large intestine to the skin). An ostomy may be temporary or permanent. A temporary ostomy may be required if the intestinal tract can't be properly prepared for surgery because of blockage by disease or scar tissue. A temporary ostomy may also be created to allow a disease process or operative site to heal without irritation by the passage of stool. Temporary ostomies can usually be reversed with minimal or no loss of intestinal function. A permanent ostomy may be required when disease, or its treatment, impairs normal intestinal function, or when the muscles that control the rectum do not work properly or require removal. The most common causes of these conditions are low rectal cancer and inflammatory bowel disease. How Will I Control My Movements? Once your ostomy has been created, your surgeon or an Enterostomal Therapist or "ET nurse" (a nurse who specializes in ostomy care) will teach you to apply and wear a pouch called an ostomy appliance (bag). The pouch is made of a special form of plastic which is held to the body with an adhesive skin barrier. Many sizes and styles of ostomy pouches are available. The pouch is disposable and is emptied or changed as needed. The system is quite secure; "accidents" are not common, and the pouches are odor-free. The frequency of your bowel movements will vary, depending on the type of ostomy you have, your diet, and your bowel habits prior to surgery. For permanent colostomies, irrigation will be taught. Daily irrigation can train the colostomy to the extent that an appliance or bag may not be necessary or only a smaller bag may be enough. We encourage all of our permanent colostomy patients to irrigate. An Ostomy is for Living An ostomy is for living...possibly better living than you've had for a while. The surgery that altered a bodily function also freed you from the troubles of disease. Now you're ready to start moving toward a full and normal life again...with lots of questions to be answered. Some of the answers to questions that almost every person with a new ostomy has are listed here. But you will have many other very personal questions. After all, it's your body and your special way of life. There are many people who can help you with these -- the doctor, the nurse, the ET nurse, and perhaps another person who is living with an ostomy. Do I Leave My Pouch On or Take It Off when I Bathe or Shower? This is pretty much a matter of preference when you have an ileostomy, transverse colostomy, or urostomy (a general word used to describe any type of urinary diversion). With a sigmoid colostomy – because there are periods of inactivity – it may be easier to bathe or shower without a pouch. Soap and water will neither hurt the stoma nor flow into the opening. Adjust the showerhead so that the full force of the water does not hit the stoma. If you wear your pouch in the shower or tub, you may want to put extra tape around the edge of the skin barrier. Can I Wear the Clothes I Have Now? Unless you're looking for a good excuse to buy a whole new wardrobe...yes. The important thing is to be comfortable, look good, and feel good. Don't worry about the pouch showing. Modern pouching systems are designed to lie flat against the body with no telltale bulge, particularly if the pouch is emptied at regular intervals. This is much easier if you irrigate your colostomy daily. Can I Wear a Girdle or Athletic Supporter? Ladies first. Pantyhose, if you are used to wearing them, are fine to help keep the pouch in place. If you prefer a girdle or panty girdle, choose a soft, stretchy one without stays or a front panel. It will do everything at once – hold up your stockings, give you a neat look, and help keep the pouch in place. Now for the gentlemen. As for athletic supporters, wear one that is one size larger than usual until you get used to the pouch. Just be sure your doctor approves of your wearing a supporter. When Can I Eat the Things I Like? You have just had abdominal surgery, and it will take a little time for your bodily functions to return to normal. Until then you will be eating food that is nourishing and easily digested. Later the doctor will give you the go-ahead to return to a normal diet. You may want to add one new food at a time. But, in general, any food that has agreed with you in the past should continue to agree with you. Is There Anything I Should Not Eat? If you are already on a special diet (like that for diabetes or high blood pressure), stay with it. To maintain good health, eat a balanced diet...that is, one that supplies the amounts of carbohydrates, protein, fat, minerals, and vitamins your body needs. Even if you no longer have a colon, the small intestine will efficiently extract the nutrients you need if you provide it with the proper food. Chewing your food well, eating regularly, and drinking plenty of water are a few other common sense rules to follow. You will want to avoid things like corn, popcorn, etc. Other than that, eat what is comfortable for you and what satisfies you. Can I Swim? Of course...if you know how to swim. You may also water-ski, skydive, and surf – many people with ostomies do. Just make sure the pouching system is secure. Bathing suits made of textured or dark-colored materials will better hide the outlines of the pouch. Some women prefer bathing suits with skirts and some men boxer-style trunks, but snug-fitting suits can be worn. What About Other Sports? There are those who ride horseback, climb mountains, bowl, and play tennis and golf. Keep fit at whatever sports you enjoy. However, you should avoid heavy lifting, which may cause herniation around the stoma. Also, you shouldn't engage in rough contact sports such as boxing, wrestling, or football without special protection for your stoma and your doctor's permission. What Can I Do About Odor? The modern odor proof pouches, if kept clean and changed regularly, should free you from this worry. However, your own body chemistry and certain foods can affect stool odor. Some of the foods you might want to try out, and then avoid if the results are unpleasant, are those in the onion and cabbage families, eggs, cheeses, and beer. Asparagus will cause urine odor. If you have a urostomy, consult your doctor if your urine smells especially foul – a urinary tract infection may be present. Putting an Aspirin tablet inside the pouch will also help to decrease odor. Can I Travel? Of course. Globe-trotters have come up with some tips that will make traveling pleasant and worry-free. Always carry your ostomy supplies in hand luggage that you can keep with you, just in case your other luggage goes to Omaha when you go to Atlanta. Fasten a seat belt below or well above your stoma. In a car, seat belts plus shoulder straps are better. You may want to try a few short weekend trips before taking off on a longer vacation. It may be a good idea to take twice as many supplies as you usually need in case of an emergency. Also, locate an ostomy supply dealer in the area you are visiting. How Do I Manage When I'm Away from Home? Once your convalescence is over, you are going to feel like going out for an evening or for a day's shopping expedition. Go and have fun. Using public restroom facilities presents no more problems now than it did before. If there is no door to the cubicle, stand with your back to the restroom door while you empty the pouch. To cover any splashing sound, flush the toilet and empty the pouch at the same time. Floating toilet paper will also help reduce splashing. Carry a small package of tissues or wipes. They come in handy, especially when the toilet paper dispenser is empty. What Do I Tell My Friends and Relatives about My Surgery? Only what you want to tell them. If you prefer, only your immediate family need know. However, you may also want to tell people with whom you have a close personal relationship – those whom you visit and who visit you frequently. Will My Physical Activities Be Limited? The answer to this question is usually an emphatic NO! You may have friends or acquaintances who have an ostomy of which you are unaware. Public figures, prominent entertainers, and even professional athletes have ostomies that do not significantly limit their activities. All your usual activities, including active sports, may be resumed once healing from surgery is complete. Will an Ostomy Affect My Sex Life? Most patients with ostomies resume their usual sexual activity. In men, removal of the lower rectum for cancer may result in sexual dysfunction due to injury to nerves that pass close to the rectum. This is unrelated to the ostomy. Many people with ostomies worry about how their sexual partner will think of them because of their appliance. This perceived change in one's body image can be overcome by a strong relationship, time, and patience. Support groups are also available in many cities. If the surgical procedure will require removal of the rectum, you may wish to discuss sexual function with your colon and rectal surgeon or an ET nurse prior to surgery. It is often comforting and reassuring for a patient who is facing a permanent ostomy to visit with another person who has already been through the surgery and adjusted to his or her ostomy. Such visits can often be coordinated by your surgeon or ET nurse. If circumstances dictate the need for an ostomy, it is likely that you will return to a fulfilling lifestyle. With the skill and support of a colon and rectal surgeon and ET nurse, one can cope with either a temporary or permanent ostomy and resume a normal life. You Don't Have to Put Up with Skin Irritation Preventing skin irritation is much better than treating it. Generally speaking, skin irritation is caused by one of three things: an improperly fitting pouching system, poor adhesion, or irritation from the adhesive. Whenever your pouching system does not keep drainage from getting on the skin, the skin may become irritated. Irritated skin makes it difficult to get good adhesion. Poor adhesion lets drainage leak onto the skin – and you're caught in a vicious circle. If you develop skin irritation, seek professional help immediately. The problem must be corrected...it won't just go away by itself. Improperly Fitting Pouching System While your stoma is in the process of shrinking to its permanent size, you will need to measure it frequently. Be on the safe side–measure your stoma every time you purchase supplies. If you gain several pounds (those who have had ulcerative colitis prior to surgery usually do), you may need to check the fit of your pouching system. The same goes if you lose weight. Poor Adhesion Irritation right around the stoma can be a sign of poor adhesion, which permits leakage of body waste. Your skin barrier should be changed as soon as it starts to leak. The time you can wear it comfortably will vary depending on your activities. You may need to change it more frequently when you exercise strenuously or when the weather is hot and you are perspiring. Irritation from Adhesive Itching, redness, or rash may be caused by constantly pulling the adhesive away from the skin. It may also indicate that you are allergic to the adhesive. Report any such reaction to the doctor, nurse, or ET nurse immediately. There are several types of skin barriers available. You should be able to use at least one of these with no problem. Preventing Skin Irritation Just remember, you don't have to put up with irritated skin. A properly fitting pouching system changed as needed will prevent skin irritation in most instances. |
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