Applying the
Pouch
Articles Included:
·
Applying the Pouch
·
Centering Your Barrier
·
Powder
·
Those
First Few Changes
·
Paste
(Caulk)
·
Too
Much of a Good Thing
·
Defective
Ostomy Products
·
Factors
Affect Ostomy Function
·
Tips
for Better Living
·
Common
Questions Asked of ET’s
·
What’s
Normal for Your Stoma
·
Measuring
Your Stoma
·
Powder
Your Stoma
·
Helpful
Ostomy Hints
Applying the
Pouch
This article was assembled from material
obtained from sources such as manufacturers instructions, interviews with members
and presentations by ET nurses. Editing
by Renard Narcaroti.
Method:
Included in every package of
ostomy supplies are instructions on how to apply that particular prosthetic
devise. Over time people develop their
own way to change the appliance most effectively. We have obtained some additional descriptions
from our members that we hope may benefit you.
We present information regarding the newer adhesive barriers only. Non-adhesive systems, which are an
alternative for less active people, have there own set of issues which are not
specifically discussed here.
Cleanliness:
Before handling any ostomy
product, make sure you wash your hands well.
It is not necessary to sterilize the environment. Cleanliness is all that is required. This is also true when touching peristomal
skin.
Skin Preparation:
Make sure your skin is
dry. Today's modern barriers will not
stick to moist skin. If your skin is
healthy, and you have just washed the peristomal skin, many dry it using an
ordinary hair dryer set to blow cold.
Always be extra careful when using any electrical device around water
because of the potential for serious injury due to electric shock. Cold air should dry the skin and close the
pores leaving you ready to apply the barrier.
Most ET nurses do not recommend
washing the peristomal skin with soap.
It leaves a drying film, removes valuable nutrients from you skin, and
will increase skin irritation and itching.
Companies do manufacture special washes for this purpose for those with
special needs. Wash your skin with clean
water only. This is all that is usually
needed. Clean dry skin without any soap
residue is the best environment to apply the barrier.
There are many different skin
types like oily skin, sensitive skin, dry skin, damaged skin. You must prepare your skin in the way that
will best suit your exact skin type.
There is not one best way of doing this, and this is an important point
to make. We want you to realize there are
many alternatives available. ET's and
dermatologists are experts that should be used to obtain optimal results. We do not recommend self-diagnosis of serious
or persistent conditions only self-education.
If you have a problem with your
skin, treat it first. If your skin is
moist due to an irritation, ostomy powders like Hollihesive or Stomahesive are
made to dry the skin so a barrier will stick.
If there are red dots on your
skin, you may have a fungus infection.
We all get these. Your ET or
pharmacist can recommend a micro-granulated anti-fungal powder and show you how
to use it. This will usually clear up
the infection.
There are creams that are made
to help with adhesion and/or mild skin irritation from barrier chemicals. Never use anything that leaves an oily
film. The barrier won't stick like it
should to oil, chalk or greasy creams.
If you just had surgery, you
have chemicals temporarily in your body that will cause you to itch, especially
skin covered by a barrier. Although there
are situations where one has an allergic reaction to a product, most of the
time it is our own bodies causing the problem.
You will probably notice a sensitivity to certain products at various
times during your new life. This is
normal.
There are many of good products
on the market. Try them. Go to a UOA meeting and talk to others. There is a plethora of ideas on how to solve
minor skin problems that if left untreated will make you miserable. See a dermatologist. They have easily implemented solutions for
most of these problems. Don't accept
anything less than perfect, un-irritated peristomal skin. In most circumstances, ET's and doctors will
help you find alternatives that will greatly improve your life.
Measuring Your Stoma:
Measuring your stoma correctly
is important. Use the guide provided in
the product package, or make your own.
Stomas come in many different shapes.
Some are perfectly round with a one inch diameter and one inch
long. They may be three inches around or
a half inch, oval in diameter, mushroom
or pear shaped in length, protracted or recessed. Some are sitting next to scars, hernias,
fistulas or ulcers.
The goal is to cut the barrier
opening as close as possible to the stoma without actually touching it. This is harder than it sounds. You may cut the perfect opening in the
barrier, put it on just a hair crooked and have it touching the stoma. The barrier may cut the stoma, or give you an
uncomfortable feeling, or pinch you.
People will sometimes complain
about stoma pain. The stomas has no
actual sensing nerves and cannot hurt as such, but the barrier may push on it
and hurt the skin attached to it. The
peristomal skin is extremely sensitive.
When the stoma moves, it effects the attached skin. Having a barrier in contact with it restricts
its movement and may hurt you. Of
course, smashing it with clothes that are too tight sometimes hurts it. In fact, some people use two-piece systems
because the flange protects the stoma to a certain degree from being
smashed. Most of us cut the barrier a
little bit bigger than the exact stoma size, 1/8 to 1/4 of an inch, to give us
a margin of error.
Paste:
The newer, extended wear
barriers, ConvaTec's Durahesive and
Hollister's Flextend, will actually swell around the stoma with an extremely
soft substance to fill in any gap. All
other hard barriers, meaning those with adhesives that melt, use a paste or
other product to fill in the gap.
Even extended wear products
benefit from paste because they fill in the gap until the barrier swells. Those with a nearly flat or recessed stoma
may benefit from convexity. The barrier
is made to push down on the surrounding skin helping the stoma to
protrude. A protruding stoma works
better because the discharge from it is directed more easily into the
pouch. Many use a belt when using a
convex barrier to secure it. It is under
pressure and may pop off. The ostomy
belt keeps it secure.
Now your skin is clean and dry,
and your barrier has been selected and cut to the size desired. If you use a two-piece barrier with a
rectangle shape, rotate it every time you apply a new flange. Try to avoid covering the same skin. Paste may be applied at this time. Paste is actually caulk. It is especially made to fill indentations on
the skin, fill imperfections around the stoma, and mostly to protect the skin
in-between the barrier and the stoma.
Paste is made chemically neutral to be extremely non-irritating. Coloplast, ConvaTec Stomahesive, Hollister
Karaya and Premium pastes are examples of quality products you could use
regularly.
When applying paste to protect
peristomal skin, you may apply the paste on the barrier first. This would be a thin bead, about 1/8" in
diameter, around the stoma opening only.
Never spread paste around like paint on the barrier or your skin. It is not made to be a base for the barrier
and will cause unsatisfactory results if used this way. Some place the paste in a thin bead around
the stoma itself. This works great, but
there may be occasional, momentary stinging because of the alcohol carriers
used. These solvents are made to
evaporate quickly. Let the paste set up
a minute before applying the barrier.
Companies are offering seals to
apply before the barriers. Some of these
can be molded exactly to your skin contours right up to the stoma. These are presented as alternatives to people
who are having problems with wear time, leaks, skin irritation, etc. ConvaTec, Eakin, and Hollister all have seals
for special needs. Remember, you can
always contact the ostomy manufacturers directly. We have found them to have on staff leading
experts who are happy to help with your individual circumstances. If you are in pain or uncomfortable, call
someone immediately. If he/she cannot
assist you, he/she is sure to refer you to someone else. Your probability of having a satisfactory
prosthetic is very high. Don't settle.
Applying the Barrier:
Now the paste is on, your skin
in dry, and you're ready to apply the barrier.
When using a two-piece system, most put on the barrier first without
attaching the pouch because you can see how the stoma is placed better. Your body should be in an extended
position. This means standing up if
possible.
Wheelchair ostomates may place
it on in a sitting position, and still receive excellent results because their
limited mobility won't stretch the barrier like it will with walking
people. Place the barrier over your
stoma very carefully. Try and center it
the best you can. Press it down gently
upon your skin. A barrier is made
special. You probably noticed it doesn't
seem too sticky. It is made to melt onto
the body. So if you put it on and it
doesn't seem to be sticking, yet your skin is dry, just hold it in place for a
while. Your body will warm the adhesive
and you'll find it sticks just fine.
If there is tape on the
barrier, make sure it doesn't fold back on itself. It ruins the barrier if it does. The instructions say to make sure the tape is
not wrinkled, but this is sometimes hard to do.
Depending on the hardness of the attached tape, manufactures make a
variety of high quality tapes for ostomy appliances to be used for individual
preferences, wrinkles can straighten out by themselves. Other tapes may actually cut the skin if put
on wrinkled because of their hardness.
Some of the hard tapes actually
have less irritating qualities than soft porous types. New appliances take a little time to set so
the adhesive heats to your body temperature and adheres well. If you get red bumps or a rash under the
tape, you may be having a reaction to the tape.
You may react to a manufacturer's tan tape, because of the dyes, and not
to the white tape, without dyes. Some
manufacturers produce barriers without tape.
We have member's that cut the tape off the barriers and use them
plain. But be careful, if you are active
you may need better protection and not less.
Pouch Positions:
If you use a one-piece
drainable ostomy system, you need to be careful when you put it on so that it
is in the correct position. A few people
like the pouch to hang straight down.
Men especially find if the pouch is tilted outward a bit, it doesn't
poke sensitive areas. Two-piece users
make this decision when the pouch is snapped onto the barrier's flange.
Clips:
Manufactures have different
types of clips to secure the bottom of drainable systems. Don't worry
about them falling off, if you
use them correctly. Always wrap the tail
piece only once around the clip so you don't spring the clip. This technique is demonstrated in every
manufacturer's directions.
Change the clip every month as
needed. Manufacturers include a clip for
every 10 pouches, which is usually about a month's worth. Don't be too concerned. Some people get up to a year out of clip without
problems. Use the correct clip on each
particular brand. e.g. Convatec makes a clear pouch that is thin and
slippery. If you use a two month old
clip that you were using on a Hollister pouch, which is made with a heavier material, it has a
good chance of slipping off.
When you put on a clip, be sure
you take the extra second to make sure it secured correctly. Have the clip as high on the tailpiece as you
can without clamping any comfort material that may be on it. Tug on the clip while holding the pouch. If it slips, it may fall off. If it doesn't slip, it will stay put. Don't take a chance.
Cultural Differences:
Just a note about the
differences with products made for the U.S. market and those made
elsewhere.
In the United States, ostomy
supplies are paid for by private insurance, Medicare, Medicaid or
personally. Most products are made with
more aggressive adhesives for longer wearing times. In fact, ConvaTec and Hollister have
developed extended wear products for ileostomates and urostomates so they don’t
have to change as often. Changing these
products often may tear skin because of the aggressiveness of the
adhesive.
In Australia, supplies are provided at no charge to those
who belong to the Ostomy Association,
therefore, people change more often.
Most products have weaker
adhesives so as not to pull on the skin when removing.
In Germany and France, where
there is socialized medicine, people use disposable one piece closed pouches
for colostomies and ileostomies, and do a complete change as often as they need
empting. The adhesives are designed for
this type of use. Companies do not put
recommendations on the product literature.
You need to find out from them or your ET if a certain product would
benefit you for the application you have in mind.
Most importantly, we all have
different body types. Our body is
constantly transforming. You may require
a different technique, product or service to obtain optimal results for ostomy
management. Also, change your appliance
as often as needed. Don't be a
hero. Don't try to get that one extra
day wear time. When your body tells you
to change, listen to it. After wearing
an ostomy system, we all find out what that means, pretty much. Some people are comfortable changing every
two weeks, and some have reasons where they change every four hours. You should ask your ET to show you how to
physical inspect a used barrier to measure the wear you got from it. Your exact body chemistry, the activities you
engage, the season etc. determine reliable, safe and comfortable wear
times. Do what is best for you. You've been given the gift of a new life,
enjoy it.
Centering Your Barrier
-- Metro Halifax News
A well-fitted barrier does not allow for much margin of
error. Consider this: The correct opening size is determined by
measuring your stoma's diameter or ellipse with a measuring card and adding
about 1/16 to 1/8 of an inch depending on the type of wafer you use; e.g.,
Durahesive vs. Stomahesive. This means
that your barrier must enter exactly and carefully every time.
How do you do this?
Good lighting is important, preferably from both above and the
side. If you are able, stand sideways to
the light source for better visibility.
A wall or hand mirror is a help to see that the barrier is applied
straight.
Also, a pouch that is applied crooked may exert uneven
pressure on the skin and stoma, and may lead to trouble. Although, many men
wear their pouch to the side to avoid injuring sensitive areas with excellent
results. Even more care needs to be
taken when using a one-piece appliance.
Don't rush. Take
your time to check the placement carefully before allowing your skin barrier to
make contact. No time is saved if you
must do the whole thing again because the barrier is crooked, touching the
stoma or just plain uncomfortable.
Remember, if your barrier feels out of place, hurts or is
uncomfortable … take it off. Don't wait
for an injury to occur or suffer with an poor application. It is better to change unnecessarily than to
risk damaging the precious stoma or living in pain. You have to live with your stoma for a long
time so make it as comfortable and irritation free as possible.
Powder
By Karen Schankweiler,
RNET
Powder is used to treat irritated skin or a fungal
infection. Yeast (fungal) infections are
very common, especially in the summer or when you perspire from regular
exercise.
Micro granulated anti-fungal powder is used only when there
are signs of a yeast infection present; i.e., an itchy rash, raised red
bumps. Discontinue use when the fungus
infection clears.
Powders with a pectin base—like Holihesive
or Stomahesive—or karaya type powders are used to treat irritated skin.
To apply any powder:
Clean the peristomal skin well with plain water and dry. The skin should be completely dry before
applying the powder. Dust the skin with
the powder, gently rub it around and then brush off any excess.
The barrier can be applied directly over the powder. You may also seal-in the powder by applying a
skin sealant over the powder and allowing it to dry. Be careful…skin sealants retard the adhesion
of the new extended wear barriers and are not recommended. The barrier is applied over the sealant
covering the powder.
Powder is not needed routinely. Most modern, disposable barriers are designed
to adhere to the skin by themselves. But
keep some powder on hand for when you do need it.
By an “Old
Timer”, Up Front
Zinging through another change of appliance
the other day my mind wandered, as it often does when I am doing some routine
chore. I’ve had an ileostomy for more
than ten years and have gone through more than 600 appliances. I use the typical two-piece ostomy system
with a flexible, adhesive wafer that
sticks nicely to my abdomen.
What I recently thought about was a
problem I had with my first few appliances—getting the old one off. To work correctly, the wafer must stick
really well; otherwise, it will come loose and make a mess, usually at the
worst time and place. The problem I
encountered was that it hurt to pull off the used wafer.
I still remember the first one I had to
remove. It was only a few days after
surgery, and the nurse came in to teach me about changing the appliance. After she left, I went to work. But, every time I tugged at the wafer, it
hurt like hell, just like pulling a giant bandage off tender skin. It took a
half-hour ouching the whole time. I was
extremely depressed when I finally removed the old barrier.
“How am I ever going to live with
this?” I thought. Nowadays, removing the
wafer takes about three seconds and is so routine there’s almost no sensation;
in fact, my problem is keeping my mind on what I am doing. One detail that has made a big difference was
a tip from my nurse, “Instead of grabbing the wafer and pulling on it, you hold
one edge in one hand and push the skin away with the other hand.”
Believe me ... it works. The reason I am writing this note is to
reassure all of you who are just starting out with an ostomy. Every appliance you change will get easier,
and the pain of getting each appliance off your tender skin keeps getting less
and less. Stick with it—with a little
perseverance, you will overcome this minor obstacle.
Paste (Caulk)
--Stillwater-Ponca City
(OK) Ostomy Outlook
Paste?
There are a number of quality
brands of paste available on the market today.
They include popular brands such as Coloplast, ConvaTec Stomahesive, Hollister
Premium, Hollihesive and Karaya.
This ostomy product is often
misused. The name does not actually
present the reason for of using it. One
purpose of paste is to fill in any uneven areas on the skin under the wafer to
make the area level. This will help to
gain a good seal of the wafer to the skin.
It is also a good caulking material around the base of the stoma to keep
discharge from leaking from around the base and going under the wafer. Paste should not be used as an adhesive. Never spread it around the wafer or your
skin. You will not obtain optimum
results.
About Paste:
Paste is made to be extremely
non-irritating. Although each type has
its own chemical composition, it should not cause a reaction. If it does, try another type, it may work
fine. All pastes contain solvents to
keep them soft. They have essentially an
alcohol base. This may sting your skin
when applied directly to it. It is minor
and passes quickly as it dries.
If you fill deeper depressions from on the skin
surface, it is recommended to layer the paste.
Paste
will start to set up in about
a minute. Additional layers may be added
as each preceding layer sets. As a
practical tip, dampen your finger or wet the tool used if you tap the paste
into place. This will help prevent the
paste from sticking to your finger or tool.
Otherwise, you will have paste all over everything within reach.
At this point, paste becomes
a cement which attaches to anything dry.
It is frustrating when paste is sticking to things it shouldn't. Recap the paste tube immediately after use to
prevent it from drying out and becoming hard.
For those of you extra sensitive to any stinging from the alcohol
carrier, Coloplast Paste contains no alcohol, does not burn, and does not dry
out as easily in the tube. It is a bit
firmer in texture than the others which may offer longer wear time but be more
firm around the stoma.
Applications:
Some people will have scars
from surgery or skin folds that are right under the wafer. These issues can sometimes be handled by
applying paste to the area. The goal is
to cover this area so the wafer may be laid flat. If the wafer is flat it will perform better.
New products such as
Durahesive Wafers, Eakin Seals and Hollister Flextend Rings provide a more
durable alternative for these applications.
These barriers may be used under a wafer to fill in gaps so that the
chance of leakage from around the wafer is reduced. These seals are not recommended
for normal applications, but for people who have challenges providing a
flat even surface for the wafer. If you
have smooth skin to apply the wafer, these products may not offer you any
value.
Paste may be applied as a
caulk between the stoma and wafer. Most
people benefit from this application.
Put a thin bead, about 3/16", either around the hole in the wafer
or around the stoma itself. Paste may actually touch the stoma. It is made so soft that it should not cause
any damage from abrasiveness.
This allows you to have a
slightly larger opening in the wafer, and makes it easier to apply the wafer
without it touching the stoma. You never
want to do this. When you apply the
wafer, press down gently to allow the paste to fill in all the gaps. If you use a two-piece system, you should make
sure the paste is nicely presses around the stoma on the inside of the wafer.
This will improve comfort and
wear time. Some people found a wafer
lasts them longer than the paste. The
paste usually melts in a few days. They
clean it out and use new paste. This
involves removing the pouch, using something like a Q-Tip to thoroughly clean
the skin between the stoma and the wafer, and then applying a new coat of
paste.
This application is used for
hard wafers only. The newer extended
wear appliances will "turtleneck" around the stoma so that paste is
not needed. Paste is only used on these
new wafers when they are first applied, to fill the gap between the wafer and
the stoma. Once the wafer swells there
is no longer a need to fill a gap because there isn't any.
As with any ostomy product,
it is recommended to discuss all applications with your ET. They will be able to provide a knowledgeable
interface to develop an ostomy system that will offer you the best performance
available.
Too Much of a Good Thing
By Wanda Herdzina, RN/ET
Do you need an hour and a
half to change your ostomy system? Does
your stock of supplies resemble the store front of the local pharmacy? Do you need a road-map to remember what
product goes on first, second, etc.? If
so, you may be the victim of the “too much of a good thing” syndrome.
Occasionally, an individual
will come to a stoma clinic carrying a large sack with a vast array of skin
care products. He/she explains, “all
these items are needed in order for me to apply my appliance”.
Unfortunately, the reason
he/she usually needs assistance is due to a problem with the adhesion of the
barrier—usually due to scars, skin folds or weight changes; skin irritation or
skin breakdown. One particular gentleman
who comes to mind was utilizing a special skin cleaner and cream, two types of
skin cement, a double-faced tape disc, a paste and a popular skin-barrier wafer
before the pouch was applied.
He had started out with a
fairly simple ostomy system right after surgery. However, in his quest to achieve what he felt
should be a seven-day wearing time, he had been adding product after
product. Besides the many items he was
now using, he had what he described as a “closet full of products at home”.
After checking his abdomen,
it became obvious that what he needed was a product change in the convexity of
his barrier and not the addition of another product. He also needed a more realistic view of
wearing time for his particular situation.
Practically speaking, not
everyone may be able to achieve a seven-day, leak-free wearing time with no
skin irritations. It is much better to
anticipate leakage and establish a regular changing time prior to this. You know, there are ostomy systems for
colostomates designed to be changed in about 30 seconds, whenever full—even
several times a day. Europeans prefer
this method. Here are a few hints to
remember to help achieve a successful ostomy management system:
Keep it simple. Do not use extra cement, skin-care products
or whatever unless medically necessary.
Usually, extra products actually interfere with barrier adhesion or
create skin problems—especially with the new extended wear systems. And as far as washing your peristomal skin,
plain water is still the best cleaning agent.
Do not continue to use
therapeutic products after a problem has been solved. As an example: A steroidal cream and an anti-fungal micro-granulated
powder should not be used routinely when changing the barrier. These products are prescribed for particular
skin problems. A steroidal cream is
usually recommended for its anti-inflammatory effects, chronic skin itching and
systematic relief of the discomfort associated with skin irritation.
However, continued and
prolonged use of steroidal creams after the problem is resolved may lead to
thinning of the outer layer of skin.
This will lead to a greater susceptibility to skin irritations. Also, stop using an anti-fungal powder when
the fungus—also called a yeast infection—is gone.
Defective Ostomy Products
Adapted By The
New Outlook
There is a possibility that
someday you will come across a defective ostomy product. If you ever do, it will probably be a pouch
with a leak in it. You will usually not
discover the leak until you find it has soiled your clothing.
If this ever happens to you,
don’t get mad. Change your defective
product with a new one yet save the defective one. Clean the defective item thoroughly and put
it in a plastic zip-lock bag, Using a permanent marker—like a felt-tip pen—mark
the area where the problem is located.
Attach a detailed note explaining the problem and mail these directly to
the manufacturer.
It is normally not a good
idea to return a defective product to the place where you bought it. Your retailer may not handle it efficiently
and may find it cheaper to just refund your money or exchange the defective
product and then throw the item away.
Or, he may keep it on a shelf for months until enough items have been
accumulated to make a return shipment to a manufacturer cost effective.
In the meantime, the
manufacturer may continue sending out defective items without knowing it. Make no mistake, most manufacturers of ostomy
products want to produce the highest quality item possible. They take defective products very seriously,
if they know about them. They will not
allow a defective product to continue to be distributed. They will fix the problem.
For speedy action and to
help prevent other ostomates from running into the same problem in the future,
the best action is to go to the manufacturer directly to report defective
products.
Factors Affect Ostomy Function
Adapted By The
New Outlook
Ostomy function may be changed by a variety of medications and medical
treatments. This is common. The following are examples:
Antibiotics—These often cause diarrhea, even in patients without an
ostomy. Make sure your doctor knows about
your ostomy, and inform him/her of problems as they occur. Drink plenty of liquids and drinks which will
help maintain your electrolyte balance if diarrhea strikes.
Pain Medications—These are often constipating. Extra irrigations or laxatives or stool
softeners might be required for colostomates to combat the side effects of pain
medications. Perhaps the dosage of pain
reliever may be reduced to eliminate the situation. Again, be sure to drink plenty of liquids.
Chemotherapy—Many cancer patients have follow-up chemotherapy after
surgery or as an alternative to surgery.
that often produces nausea and/or vomiting. You need to drink fluids that help you
maintain your body chemistry balance.
Radiation Therapy—This often produces the same effects as
chemotherapy.
Travel—Travel may cause constipation in some people and diarrhea in
others. Be aware of that these are
possibilities. Altered diet when
traveling accounts for some of this, plus the excitement of new
surroundings. Allow sufficient time for
irrigations and take along an anti-diarrhea medication.
Antacids—Some types of antacids may cause diarrhea—usually those with
magnesium. There are many fine new
products on the market. Find out which
is best for you.
Drink plenty of liquids. You need
to maintain your electrolyte balance in case of diarrhea. Tea, orange juice and even Coca Cola are
sources of potassium. Bouillon cubes
mixed in hot water are a source of
sodium. Remember that some of the signs
of electrolyte imbalance are irritability, nausea and drowsiness.
Tips for a Better Life
Many of us wear a two-piece
ostomy system. Always take that extra
second to make sure the pouch is snapped on firmly to the flange on the
barrier. It only takes a second or two
to make sure it is on correctly, but it can save you considerable aggravation
if it is done correctly.
Start snapping it together
at the bottom or the pouch and then work your way to the top. Give a little tug on the pouch to test that it
is locked securely, but make sure you hold the barrier while you do this so
that you don’t break the seal.
Note: this is very similar to the procedure we use
with a drainable pouch when we apply the clip.
Take the extra second to make sure the clip is attached securely. It will assure that you never have an
unattached clip accident.
Fatty foods should be kept
to a minimum by most people with fecal ostomies. Fats induce an increased flow of bile into
the intestines. This makes the body wastes
more liquid and harder to control. The
intake of fats also produces more gas.
If you have a concern about
odor when you open your pouch, try eating some parsley everyday. Parsley is one of natures’ best deodorants.
Always wash your hands before
working with your ostomy system or stoma.
Ileostomies and urostomies are virtually free from bacteria yet are made
to absorb anything that touches them.
Bacteria introduced to your stoma by your hand will be ingested and may
make you sick.
Many of us have bone
loss. Medical experts advise taking
calcium with Vitamin D to build strong bones.
During the night the body depletes calcium stored in the bones—when food
intake stops—to maintain normal blood levels.
Calcium supplements taken at bedtime reduce the calcium taken from the
bones.
Common
Questions Asked of ET’s
Ostomy Insights—American Ostomy Supply
Question:
Do you think it is a good idea to rinse out my colostomy pouch when I
empty it?
Answer:
I usually teach my patients the proper procedure for rinsing the pouch
when emptying it, but leave it up to them if they want to continue to rinse or
not. By proper procedure, I mean rinsing
the pouch up to the level of the bottom of the stoma.
I find sometimes people rinse the pouch too vigorously and cause the
adhesive seal around the stoma to loosen from the inside of the pouch and
introduce water at the seal. Some people
feel more comfortable using an opaque colored pouch and not worry about rinsing
it at all.
Again,
I think it is a personal preference with what you are most comfortable
using. Many people get along just fine
without ever rinsing the pouch.
Question:
I have a urostomy, and my urine always looks cloudy. Is this anything to be concerned about?
Answer:
If you have in ileal conduit or a colon conduit, remember—our urine will
have mucus from the piece of intestine used to create the stoma. Sometimes this causes the urine to look
cloudy. This is perfectly normal.
As an aside, if your adhesive is breaking down faster than usual, or
your urine has a strong odor not caused from any foods which create their own
special odors, you may have an infection.
If you have a suspect an infection, you need to see your regular
doctor—who may refer you to a urologist.
A urine culture sample will then be taken to verify if an infection in
present.
Question:
What can you suggest for a deodorant to use inside the pouch?
Answer:
Usually, ileostomy or urostomy output does not have much odor. For a colostomy, one might want to use a
deodorant. There are many commercial
deodorants available for use in the pouch or taken internally. They are available in liquid or tablet
form. Years ago, aspirin was recommended
to use as a deodorant in the pouch.
Aspirin is not recommended any longer.
It was found that it causes pinpoint bleeding of the stoma if it washes
up onto it. Plus, it has not been shown
to be effective in odor control.
Probably, using a good room spray before opening the pouch could be
partially effective. Remember, everyone
with or without an ostomy has odor in their stools.
Coos Bay Ostomy Association
What is normal for my stoma? This is a frequently asked question. Here are some answers from your stoma to you:
My color should be a healthy red I am the same color as the inside of
your intestine. If my color darkens, the
blood supply might be pinched off. First
make sure your pouch is not too tight.
It should fit 1/ 16 to 1/8 inch from the base of the stoma—although the
new extended wear barriers like the Hollister Flextend and the ConvaTec
Durahesive may touch the stoma. If I
should turn black—very unlikely but it does happen occasionally—seek treatment
at once. Go to your local hospital
emergency room if you cannot readily locate your doctor. Be sure to remove the pouch for them to
examine the stoma and peristomal skin. Always take at least one extra change of
system along.
I might bleed a little when cleaned.
This is to be expected. Do not be
alarmed. And please, just be gentle when
you handle me. If I am an ileostomy, I
will run intermittently just about all the time and stool will be liquid to
semi-solid.
If you should notice that I am not functioning after several hours and
if you develop pain, I might be clogged.
Try sipping warm tea or taking a little mineral oil and then try walking
or getting into a knee-chest position on the floor. Sometimes a hot shower with your barrier
removed will relax you enough to loosen the obstruction. If I do not begin to function after about an
hour of this, call your physician. If you cannot locate him/her, go to the
emergency room. In the meantime, I might
have begun to swell. Remove your barrier
and put on one with a bigger opening.
If I am a colostomy located in the descending or sigmoid colon, I should
function according to what your bowel habits were before surgery. I can be controlled in some cases with diet
and/or irrigation. This is a personal
choice. There is no right or wrong to
it, as long as I am working well, my stool will be fairly solid.
If I am a urinary diversion, I should work constantly. My urine should be yellow, adequate in amount
and will contain some mucous. If my
mucous is very much more excessive than usual, I might have an infection. I will probably also have an odor and
possibly a fever. Consult your physician
if that is the case. If at any time, you
doubt that your stoma is functioning normally, please seek help ... call your
ET. The cause needs to be evaluated. If
your problem is a serious one, it needs correction. If it is not, you will be
relieved to know your stoma is alive and well.
Note:
If you do not have an ET, find one before you ever need help. Have his/her phone number in your wallet at
all times—just in case. In addition, you
should see your ET every year or two or three to have your stoma examined.
By Alice
Bowman and Bob Baumel
We recently visited a patient with a two-year old colostomy, suffering
from severe skin irritation caused by using an appliance with a pre-cut stoma
opening the same size as originally measured in the hospital after
surgery. Immediately after surgery, the
stoma is quite swollen; it then shrinks for about the next six months —
sometimes a year or longer.
During the initial period, while the stoma is shrinking, it is best to
use a cut to-fit appliance and measure your stoma every time you change the
barrier. Once your stoma has stabilized,
you may wish to switch to a pre-cut appliance. However, you should continue to
measure your stoma occasionally to see if you should switch to a different size
and type of ostomy system.
If you fail to adjust your barrier opening as your stoma shrinks, you
will eventually be using a barrier with an opening much bigger than your
stoma. This leaves a large area of
unprotected skin around your stoma, making you a prime candidate for skin
irritation.
How big should the appliance opening be?
For most types of barriers/face-plates/flanges, the opening should
provide clearance of a millimeter or two all around the stoma (about 1/16th
of an inch). On one hand, one should
minimize the area of unprotected skin around the stoma; on the other hand, some
clearance is usually necessary because many barriers contain hard
materials—including plastic films—that can damage the stoma if they come in
contact with it. Paste or a one of the
new barrier strips may be used to fill in the gap between the flange and stoma.
The
new extended wear barriers; such as, ConvaTec’s Durahesive or Hollister’s
Flextend barriers, are engineered to be sized so that they actually touch the
edge of the stoma. Your ostomy supply dealer and your ET nurse can keep you
informed of the new products on the market and alternative options for using
them.
Powder Your Stoma?
By M. Schwankweiler, RN/ET
Powder is normally not
required during the routine servicing of a stoma. As a matter of fact, most modern disposable
barriers are designed to adhere to the skin by themselves.
Powder is used to treat
irritated skin or a fungal infection.
Yeast (fungus, candida) infections are very common, especially during
summer or when one perspires during regular exercise. Micro granulated
anti-fungal powder is used only when there are signs of a yeast infection;
i.e., an itchy rash and raised red bumps.
Use the powder until the
infection clears, then discontinue. Pectin-based powders, like Hollihesive, or
Stomahesive, or Karaya type powders, are used to treat irritated skin. To apply any kind of powder, clean the
peristomal skin well with plain water and then dry. The skin should be completely dry before
applying the powder.
Dust the skin with the
powder, gently rub it around and then brush off the excess. The barrier can be applied directly over the
powder. You may also seal in the powder
by applying a skin sealant over the powder and allowing it to dry.
Be careful. Skin sealants retard the adhesion of the new
extended wear barriers—like ConvaTec’s Durahesive and Hollister’s Flextend—and
are not recommended. If you use a
standard wear barrier, then the barrier is applied over the sealant covering
the powder.
By way of the Internet
Colostomy:
If you use just a pad instead of an appliance, use a little K-Y Jelly
over the stoma to keep things soft and lubricated.
If you irrigate; allowing too much water to enter the stoma too quickly
may cause a sudden evacuation of waste but leave much of the feces still in the
colon, along with most of the water. Periodic evacuation may follow. This is
not really diarrhea, but is simply a delayed emptying of the colon.
Ileostomy:
Usually, people with ileostomies experience hunger more often than
other people. When this happens, drink
fruit juice or water and eat soda crackers, followed by a meal as soon as
possible.
If you need to eat a snack at bedtime or during the day in order to
ward off nausea, try to cut down on calories somewhere else in the daytime or
you will gain weight.
Never skip meals in order to lose weight. An ileostomy keeps working
whether you have eaten or not.
Urostomy:
If it is necessary to have a urinalysis, remind the nurse to take the
specimen directly from the stoma, not from the appliance.
If you are out of Uri-Kleen, soaking your urinary pouch in straight
white vinegar for thirty minutes will kill all common bacteria found in urine.
Mucous in the urine is normal. The ileal conduit is made of mucous
secreting intestinal tissue. It doesn’t stop doing its job even though it is
transporting urine.
An Added Tip: If you use a two-piece
system, the pouch may not be totally secured when you snap it on and could fall
off when half full. Make sure the pouch
is snapped to the flange securely. Start
snapping it together at the bottom and work your way to the top. Give a little tug on the pouch to test its
lock, but make sure you hold the faceplate/wafer so you don’t break the seal.