Colostomates

Articles Included:

· Hints & Tips for the Colostomate

· The Uncontrolled Colostomy

· Colostomy Hints

· Irrigation Advice

· Transverse Colostomy

· Colostomy Bowel Control

· Irrigations

· Constipation

· Colostomy Irrigation Hints

· Colostomate Bowel Control

· Thoughts from a Colostomate

Hints & Tips for the Colostomate

By The New Outlook

If you use a Stomahesive wafer and cut your own center hole, save the leftover pieces and use them to fill in any skin indentations around the stoma underneath the wafer.

Spray the inside of your pouch with PAM, or some other vegetable oil spray, to help the contents to slide out of the pouch instead of sticking to the top and sides of the pouch.

Apply the pouch standing, lying, or sitting, but; do not allow abdominal wrinkling or this will break the seal when you straighten out.

Colostomy diet is fairly normal. You will discover which foods may not agree with you by trying everything, a little at a time. If it doesn't work the first time, wait a few weeks and try it again. If it doesn't work then, leave it alone for a few months...or forever, if necessary.

If you have difficulty with constipation, a glass of apple juice every morning and night before irrigation may prove helpful. If you prefer, you might try taking your apple juice heated. (Add a little cinnamon...mmm).

If you use a convex insert in your faceplate, and the insert becomes yucky and sticky, try good old Unisolve to remove the guck. It really works great!

Especially in hot weather, wear protection between the pouch and your skin to prevent rash from perspiration. You can make a pouch cover with an old handkerchief, a baby's bib (cloth side to kin), etc. Pouch covers may also be purchased.

If you still have your rectum and have pain or a full feeling, you may have a collection of mucus which should be washed out. Check with your doctor regarding this.

If you are taking a bismuth preparation, try to stop taking it for one day before having an intestinal X-Ray or tell the doctor, because it sometimes shows up opaque on an X-Ray.

Colostomates who take antihistamines during the sneezing season may find that these drugs have a tendency to slow down intestinal action, and the irrigation process becomes slower. Some report relief from the drug reaction by increasing the fluid intake the day before they irrigate, or eating laxative foods in moderation.

If you are irrigating and having problems with leakage between irrigations, try using less water. Too much water may contribute to leakage.

Buttermilk will soothe an irritated digestive tract, and will not cause diarrhea or constipation. Some people find that a large teaspoon of bulk gelatin dissolved in water or lemon juice once a day will firm up a loose stool.

Yogurt is very helpful in controlling gas; the bacteria used in making yogurt helps in digestion and in regulating the bowel action. Yogurt is also nutritious because of the calcium, protein and B vitamin contents, and is low in calories.

A glass of hot water or fruit juice, or a cup of hot coffee before a morning irrigation may initiate gut action.

Do not use water that is too cold or too hot as it may cause cramps, pain, or nausea.

Do allow 45 minutes to one hour for a complete return of water.

Arrange to sit for comfort and relaxation. Do not hurry through irrigation. Anxiety, frustration and spillage may result. Getting "Up Tight" may cause little or no return.

Irrigating action may be stimulated by gently massaging the abdomen, starting at the lower right side, coming up and down the left side.

Tranquilizers can make the colon lazy and can be the cause of incomplete evacuation.

DO NOT IRRIGATE WHEN YOU ARE HAVING A BOUT WITH DIARRHEA.

The Uncontrolled Colostomy

--Okun Montreal, ET

Some people in the medical and nursing profession are under the impression that people who have colostomies have very little difficulty in managing them in comparison to people with ileostomies or ileal conduits. Very often a patient is told that, in time, he/she can learn to train the bowel to evacuate once every 24 to 48 hours. This, he/she is told, can be achieved by either irrigation of the colon, by diet or by both. Then all that is required is a dressing over the colostomy, or an appropriate piece of colostomy equipment to prevent any minor leaking if more protection is desired.

While the above situation is true in a number of cases, there are those who find it an impossibility to regulate the bowel no matter what method they try. These people often become discouraged, especially after hearing other colostomates report how well they manage with a minimal amount of care with no concerns at all.

Usually the person who had an irritable colon prior surgery will experience many of the same issues post-op. Irrigations are recommended in these cases in order to help regulate the colon. Persons in this category should consider being measured for a good appliance. Of course, it should be one that will keep him/her clean, dry and odor-free. There are many manufacturers who make high quality, easy to use ostomy systems for just this purpose.

As a side note, many business people do not want to take the time to irrigate. These people wear an appliance all the time, and simple empty it after the bowel works. This is one possible solution to this particular issue at the present time. But, we always recommend calling your ET to explore satisfactory alternative to increase the quality of your life.

Colostomy Hints

--Metro Maryland & The Osto-mee News, Hamilton, Ohio

· Save money by making your own elastic belts for holding your irrigation sleeve or appliance.

· Save the end attachment from the old worn-out belt and transfer to the new elastic.

· A cup of buttermilk in irrigation water can help control odor.

· If you irrigate, try adding about 1/4 cup of Vaseline Intensive Care Bath Beads into the irrigation sleeve when you are cleaning it. Rinse with clear water. Odors will be gone and fecal matter will slip out easily.

· Water cans with long, curved spouts are excellent for rinsing reusable appliances.

· If you notice a persistent odor after changing your appliance, check to see if you have cleaned the tail piece properly. It isn't necessary to clean the inside of an appliance (as it is acting like the inside of your colon ), but the end of the tail flap is exposed to the outside and will cause odor if fecal material is not removed. A careful swipe with a piece of tissue will do the trick.

· Always carry an extra appliance and an extra closure clip for emergencies. Check it periodically to make sure that it is not showing wear and tear.

· When traveling, carry a collapsible plastic cup for water, a packet of tissues, and a small plastic bag for any other unforeseen need.

· Check your stoma whenever you change your appliance. You want to make sure that you catch any possible problems early. Look for changes in color, shape, or function.

· Look around the stoma for changes in the skin. If you spring a leak while wearing your best "dry clean only" winter whites, get them to the cleaners quickly. Explain the nature of the stain. You can help educate the public and you have the best chance of getting the stain out if you "come clean" as to what caused it.

· If you can't eliminate odor from your faceplate, try taking an old toothbrush and scrubbing the faceplate with toothpaste.

· If you find the scissors sticky when you cut Stomahesive wafers, lubricate the scissors with KY Jelly or clean the blades with rubbing alcohol.

· Try using one of those small seam rippers (available in any fabric store) for cutting the size you need from Stomahesive. It is quick and gives a nice smooth edge...but be careful.

· Be careful with zippers. The pouch can get caught in the zipper when zipped in a hurry.

· Be careful with what you place in your pockets. Ballpoint pens, keys, nail files, tooth picks, and other sharp objects could puncture the pouch.

· Before you leave for travel abroad, call Intermedic, Inc. in New York City at: (212) 486-8974. They can provide you with names of English-speaking doctors abroad.

Irrigation Advice

--Grand Rapids, Michigan Chapter

· It is usual to return a much smaller amount of stool occasionally.

· At times, all the water does not come back. Just drink a lot more water than you have been for the next time.

· Those long white strands you may pass are not worms. They are mucous strands, and simply mean a portion of your bowel was empty before you irrigated.

· Don't let the water temperature get too warm. Very warm water will take forever to return and will not clean you out. Use cool water with the chill taken out of it--room temperature in most homes.

· Don't use a petroleum base lubricant. Use a water-soluble lubricant, i.e., K-Y Jelly, available from most drug stores.

· Never irrigate with a tube or catheter. It may cause bowel perforations…easily. Use a cone or cone-like tip that is specifically design to irrigate a colostomy.

· Don't irrigate with water you wouldn't drink.

· Relax as much as possible while irrigating. Make yourself comfortable, read a book, look at the newspaper, meditate, write a letter, watch TV, talk to friends on the phone, or whatever takes your mind off irrigation. This will make the returns come much faster.

· Irrigate at the same time of the day--not by only the clock, but by your activity. This may be rescheduled on occasions with good results, but try to keep a pattern.

Transverse Colostomy

--The Pouch, North Virginia Chapter

The transverse colostomy (TC) is in the upper abdomen either in the middle or toward the right side of the body. Some conditions of the colon such as those caused by diverticulitis, inflammatory bowel disease, cancer, obstruction, injury or birth defects can lead to a TC. This type of colostomy allow the feces to exit from the colon before they reach the descending colon.

When conditions such as those listed are present in the lower bowel, it may be necessary to give the affected portion of the bowel a rest. A TC may be created for a period of time to prevent feces from passing through the area of the colon that is inflamed, infected, diseased or newly operated on; thus, allowing healing to occur.

Such a colostomy is usually temporary. Depending on the healing process, the TC may be necessary for a few weeks, months or even years. Eventually, given the good health of the patient, the TC is likely to be removed (closed) and normal bowel continuity restored.

A permanent TC is made when the lower portion of the colon must be removed or permanently rested. This may also be the case if other health problems make it unwise for the patient to have further surgery. Such a TC provides a permanent exit for feces, and it will not be closed at any time in the future. There are two types of TC:

Loop TC: The loop TC may appear like one very large stoma. However, it actually has two openings. One opening discharges feces, and the other expels only mucus. A colon normally makes small amounts of mucus to protect itself from the bowel contents.

The mucus passes with the bowel movements and is usually not noticed. Despite the TC, the resting part of the colon continues to make mucus which will come out either through the stoma or through the rectum and anus. This is normal and expected.

Double-barrel TC: When making a double-barrel TC, the surgeon divides the bowel completely. Each opening is brought to the surface as a separate stoma; they may or may not be separated by skin. Here, too, the one opening discharges feces and the other discharges mucus (this stoma is referred to as a "mucus fistula").

Occasionally, the mucus fistula is sewn closed at the time of surgery and then left inside the abdomen. In such a case, only one stoma would be visible on the abdomen (single-barrel TC). Mucus from the resting portion of the bowel should pass out through the stoma.

Right after surgery, a TC may be covered with bandages, or it may have a clear pouch over it. The type of pouch used right after surgery is usually different from those one would use for everyday use. Before a patient looks at the TC for the first time, he/she should keep in mind that it may be quite swollen after surgery. It may have bruises and stitches.

While a stoma normally is moist and red in color initially it may have a deeper color. The stoma will change considerably as it heals. It will get smaller and any discoloration will be resolved leaving a moist red stoma. This process may take several weeks.

The patient will soon notice that, although it is normal to know when the TC is going to pass feces or gas, it cannot be controlled. The TC does not have a sphincter muscle or any other type of control mechanism as your anus does. For this reason, it will necessary to wear a prosthesis over the TC to collect the output.

An ET nurse will assist an ostomate in selecting an ostomy system compatible with the person's individual life style. This system may change from time to time.

When a colostomy is located in the right half of the colon only the short portion of the colon leading to it is active. The consistency of the discharge from a TC varies from person to person and from time to time within one individual. A few TC's discharge a firm movement at infrequent intervals, but most of them move fairly often with a soft or loose stool. The feces contains some digestive enzymes which are quiet irritating to the skin.

Attempts to control a TC with special restrictive diets, medications, enemas or irrigations are generally unsuccessful; therefore, are rarely recommended. Usually, an appliance is worn over a TC at all times. One of the modern lightweight, inconspicuous, odor-proof, reliable and drainable appliances holds the TC's output. It is comfortable to wear and protects the skin from contact with the feces.

Deciding what is best for you is a very individual and personal matter. However, in selecting your appliance, it is best to consult someone who knows how to fit ostomates. Among these, first and foremost, are the ET nurses. Many suppliers and manufacturers have cutting edge knowledge of alternative solutions to ostomy management. Once leaving the hospital the new ostomate should:

· Have a referral to a knowledgeable ET nurse

· Have a clinic for regular care

· Join the local UOA Chapter

· Have a reasonable supply of pouches

· Have supplies to attach and remove pouches

· Know how to change his/her ostomy system

When the TC is made, there may or may not be a plan to close it again. Not all TC's can or should be closed. Some may be candidates for closure. The surgeon may say that he plans to close it in a few weeks or months; or, he/she may not say anything. His/her plan and subsequent decisions are subject to many considerations:

· The original reason for the TC

· The ability of the body to tolerate surgery

· Health since the operation

· Problems which may have appeared during or after surgery, etc.

Colostomy Bowel Control

--Ostomy Hotline

Patient's with a right-sided or upper colostomy do not have as much remaining colon as those with a left-sided or lower colostomy. Because of this, there is usually too little colon left in a lower colostomy to absorb enough water to make a solid stool.

A lower colostomy cannot be controlled by irrigation, but instead behaves very much like an ileostomy with a fairly continuous discharge. The left-sided colostomy is often described as a "dry colostomy" since it usually discharges formed stool. One has the choice of attempting to manage this type of colostomy by either trained control or irrigation control.

Only one-third of the people who attempt to train themselves to control the lower colostomy without irrigation are successful in doing so. This type of training relies very heavily on diet and medication to achieve regularity. Many physicians in this country feel that control is more easily and satisfactorily achieved by irrigation.

However, there are some patients who can't achieve irrigation control because they have an "irritable bowel". This problem has nothing to do with the colostomy. It is just part of some people's makeup.

Some people, even before they have their colostomy surgery, may have had very irregular bowel habits. They retain these habits after the colostomy is performed. Regular irrigation does not assure regularity with irritable bowel syndrome.

When this condition exists, the physician will sometimes suggest that the patient dispense with irrigation, since it will not produce the desired regular pattern. The person may become frustrated trying to achieve this.

People with an irritable bowel situation should treat the colostomy much like an ileostomy; i.e., wearing an ostomy appliance all of the time. This also applies to people with a right-sided or wet colostomy.

Irrigations

--Stillwater-Ponca City OK Chapter

For you own knowledge, here are some general pointers to keep in mind for successful irrigations:

· Have the irrigating container about 18 inches above shoulder height.

· Use about a quart of tepid water—no more and no less.

· Insert the lubricated cone into the stoma very gently. You don't have to push all of the cone in—just enough to create a snug fit so that no water leaks out.

· If you use a catheter tip to irrigate, never insert more that about four inches as there is a danger of perforating the bowel. Press the plastic disc that comes with the catheter tubing against the stoma to prevent leakage. In fact, unless your stoma is so tight or so small that only a catheter will fit, you might consider switching to a cone since comes pose less risk to the bowel.

· Install the water slowly over a period of five to ten minutes. Choose a rate that is comfortable to you and causes no cramping. If cramping does occur, stop the flow, take a few deep breaths, wait for the cramping to stop, and resume the flow at a slower rate.

· When you have installed all the water, remove the cone from the stoma, close the top of the sleeve and wait for the returns. After about 20 minutes, you can wipe off the end of the sleeve, fold it up or clamp it, and do whatever else you want to do for the next 40 minutes or so until the returns are complete.

· Remove the sleeve, cleanse the skin and apply a pouch, cap or gauze pad—whichever you use as a stoma cover.

If you are not having success with your irrigations, seek professional help from an ET.

Constipation

By Dorothy Vaillancourt, RNET, The Pouch

At one time or another, most of us experience the unpleasant condition of constipation. For people with ostomies, this situation pertains mostly to people with a colostomy or a urostomy. Ileostomates should not have this problem because they have no colon.

Many Americans are obsessed with their bowels—and we thought ostomates were the only ones. If they do not move them every day, they think something terrible will happen.

This focus on regularity is fueled by the mistaken idea that feces are poisonous; the colon is full of toxins; and that unless there is at least one elimination every day something dire will happen. As a result, many healthy people use laxatives on a regular basis. Most of them are convinced that they are constipated but really are not. In studies, people with this idea were given placebos, and most had bowel movements anyway. Some take laxatives routinely simply because they believe a regular purging is a good thing.

Feces are not poisonous. They are simply what are left of the food we eat after the body has absorbed the nutrients it needs. If you have fewer than two bowel movements a week, whether or not they are easily passed, you are officially constipated. A better definition is "any reduction in your usual number of bowel movements that continues beyond a week or two".

How often you "go" depends on a variety of factors: your diet, how much liquid you drink, your metabolism, the medications you take; and your elimination habits. A healthy person may have one bowel movement a day, or two or three. Others "go" every second day or even less often. However, if your bowels suddenly stop, and you have a fever, are nauseated or vomiting, and have a severe pain in your belly, call your doctor right away. Also, do so if your bowel habits change and do not return to what is normal for you.

Common Causes of Constipation

--Internet

Drinking too little water—Water is the best drink. We need at least two quarts of liquids a day depending on your profile; i.e. ileostomates, urostomates and those on chemotherapy may need more.

Eating too little fiber—Fiber adds bulk to the stool making it softer and easier to pass. It also speeds up transit time moving the stool down and out fast. We need 30-40 grams of fiber a day. Eat your vegetables!

Lack of exercise—Exercise stimulates the contractions of the intestines.

Medication—Many drugs can cause constipation. Most common are: calcium or iron supplements; diuretics, anti-depressants, anti-cancer drugs; pain killers; codeine, aluminum based antacids, non-steroidal anti-inflammation drugs like ibuprofen, and high blood pressure medications.

Diverticulosis—This condition—the presence of fingerlike projections into the side of the bowel—is common in constipated people. Over 50% of people over 50 years old have this condition. If you are chronically constipated and are found to have diverticulosis, eat more fiber and drink more water.

Neurological problems—A stroke can affect the nerves that give the signal to eliminate, or it can weaken the muscles necessary to do so.

Laxatives—If you take laxatives too often; i.e., more than prescribed, your bowel may stop moving until stimulated by some chemical. In addition, taking laxatives will lead to expansion of the colon; like overfilling an inner tube, weakening it which leads to serious complications like perforation and death.

Travel schedule—Travel may disrupt your normal routine. So, if you either ignore or cannot do anything about signals to "go", this may eventually leave you constipated.

Bowel obstruction—A polyp or tumor is the most worrisome cause of constipation. If a change in your bowel habits persist, see your doctor. He/she will test you to determine the cause by means of an occults blood test or a colonoscopy, etc. Narrowing of the stool may reflect an advanced problem.

Irritable Bowel Syndrome—IBS can be a nervous condition with chronic gas, cramps, bloating and constipation often alternate with diarrhea. Treatment is drinking more water, eating more fiber and reassurance.

Colostomy Irrigation Hints

By Sandy Burns, BSN, ET

Spray the inside of the irrigation sleeve with any liquid soap before the procedure so that the stool will drain easily; the sleeve will clean faster; and less odor will be retained. Disposable sleeves are also available.

During the irrigation, if you experience:

Cramping—This may indicate constipation. Recall the firmness of your last evacuation. Slow or stop the flow of water, relax and deep breathe. Make sure the temperature of the water is not too cold or too hot. Check the height of the irrigation bag. It should be approximately 12 to 20 inches above the stoma level when you are seated—approximately shoulder height when you are seated.

Sluggish Returns—May indicate constipation. Again, recall the firmness of your last evacuation. Look at your diet. You may need to increase the bulk in it by adding more bran, fresh fruits and vegetables. You may be dehydrated. Drink more water just in case. Also, you may need to increase your physical activity to stimulate bowel activity.

Spillage—May indicate constipation. As before, recall the firmness of your last evacuation. Review the volume of water inserted during the enema; i.e., the water instilled during irrigation. Most individuals require about 1000cc or about a quart. Do not use more than a quart of water without your physician's advise. Check to see that the solution does not escape around the cone or shield.

Excessive Gas—Avoid gas-forming foods. Eat regular meals; chew food well. Limit excessive intake of air; i.e., mouth breathing, gum chewing smoking, straws, carbonated beverages and alcohol.

Colostomy Bowel Control

Adapted By The New Outlook

Patients that have had only their rectum or sigmoid colons removed present the best opportunity for bowel control. If you have a right-sided or a transverse colostomy you do not have as much remaining colon as those with a left-sided colostomy. Therefore, there is usually too little colon remaining to absorb enough water to make a solid stool—water recycling and waste storage are the main jobs of the colon.

These types of colostomies cannot be control effectively by training. They behave more like an ileostomy with a fairly continuous action. A left-sided colostomy is often described as a “dry colostomy” because it discharges formed stools.

One has the choice of attempting to mange a dry colostomy by training it with irrigation control. As an aside, only about one-third of the people who attempt to train themselves to control the colostomy without irrigation are successful in doing so. This type of training relies very heavily on diet and medications to achieve regularity and is not usually recommended.

Most doctors feel that control is more easily and satisfactorily achieved by irrigation. However, there are many patients who cannot obtain irrigation control because they have an “irritable bowel”.

This problem has nothing to do with the colostomy. It is just a part of some peoples’ makeup. Some people—even before having ostomy surgery—have very irregular bowel habits. They will retain these habits after colostomy surgery leading to poor results from irrigation.

If a patient becomes diagnosed with having an irritable bowel, doctors may suggest that he/she stop irrigating since it will not product satisfactory results. It is common for some patients to become frustrated trying to achieve control.

People who do not irrigate their colostomy are similar to people with an ileostomy. They simply wear an ostomy system all the time. In fact, many busy people do not want to spent the hour or so it takes every day or so to irrigate, and they also just always wear an ostomy appliance.

Thoughts from a Colostomate

--Metro Maryland

I’ve had a colostomy for more than seven years, but I can still remember that day when I thought my surgeon’s visit was only to “rescue me from that bowl of salt-less mushroom soup”. That was until he said something like, “I’d like to do some exploring”. Before I could get off my “Dr. Livingston, I presume” line, he explained the bad news/good news features.

Even though surgery was indicated there was a possibility he might be able to cut out the cancer and put me back together pretty much like normal. I am a person of faith and knew the best for me would happen, whatever that was. The surgeon proceeded with my surgery. Everything turned out great. My cancer was removed and I was expected to be able to live a long and healthy life, but I would have a “rosebud” for the rest of my life.

Now one of the mixed blessings about this scenario was that there was no time for a pre-op education about that brand new word to my vocabulary—colostomy. But then the good news came, my ET nurse and my ostomy visitor from the Metro Maryland Chapter, Margaret Proctor—bless her soul. My ET undoubtedly labeled me her worst patient and with just cause I might add. I was a slow learner, wallowed in all kinds of self pity and psychologically felt as badly as was my comprehension of this whole new system.

But she didn’t give up on me, thank goodness. And though my role as host left a lot to be desired, my visitor from the Ostomy Association didn’t give up on me either. She tolerated me, sympathized with me and left me some very helpful literature. Now it took me a couple of years to feel comfortable talking with others about a colostomy. But finally, I felt quite good about visiting other patients, offering support, extending an open ear and sharing information I’ve gained from experience.

You know, there seems to be as many different colostomies--and how to handle them—as there are persons who have them. No two of us are the same, although we are so much alike that we can learn a great deal from sharing with each other. There’s a perspective that only “one who’s been there” can convey. And sharing is caring.

For few hours of my week, I volunteer to help out in the local chapter office which our Metro Maryland volunteers are so dedicated to running well. There’s a large volume of administrative work—membership information; mailing lists; the many steps in preparing the newsletter for distribution; arranging speakers for meetings; etc. There are many more details that are necessary to the efficient operation and ultimate usefulness of the whole operation. It requires a lot of time from a lot of people. Another helping hand is most welcome.

My message is—I suppose—that when you see a “Dr. Livingston type” approaching with a scalpel and magnifying glass in hand and exploration in his eyes, check out his back-up facilities. The ET nurse, the follow-up and the local ostomy association may help you as much as the surgery itself. And then you in turn may want to seek the opportunity to serve other new ostomates through your local chapter. That’s what the local ostomy association, and indeed life, is all about.

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