What is Ostomy Care?
Changing how feces or urine leaves the body is part of an ostomy operation. It can safeguard the belly cavity so that harmed or irritated digestive system elements might recover. Body waste gathers in a pouch that fits outside the body after exiting via a hole in the abdomen.
Difference Between Ostomy and StomaDue to a surgical operation known as an ostomy, the method by which urine or feces leave the body is altered. When the urinary or digestive systems are dysfunctional, bodily waste is diverted from its normal course. An ostomy can be either short-term or long-term. The gap left behind after ostomy surgery is known as a stoma. It is dark pink in hue and is situated on the abdomen. Most ostomies require a pouch worn over the stoma to collect urine or feces. However, it is feasible for certain patients to have a continent diversion, an alternative to a traditional ostomy that does not require a pouch.
Ostomy Surgery is a Life-Saving ProcedureOstomy surgery is a life-saving technique that enables human waste to flow through a surgically produced stoma on the abdomen into an external prosthesis called a “pouch” or “ostomy bag” or an interior medically constructed pouch for continent diversion procedures. Congenital disabilities, cancer, inflammatory bowel disease, diverticulitis, incontinence, and many other medical disorders might necessitate an ostomy. They are also required in situations of serious abdominal or pelvic damage brought on by mishaps or wounds received while serving in the military. Any age can have ostomy or continent diversion surgery, which does not reduce life expectancy but marks the beginning of a “new normal” existence.
Common Types of Ostomies
COLOSTOMYa stoma is a surgically made opening in the colon (large intestine). A colostomy is formed when part of the colon or the rectum is removed, and the remaining colon is brought to the abdominal wall. The colon area affected or its persistence may serve as additional defining characteristics.
UROSTOMYThis is a collective name for a surgical technique that directs urine away from a damaged or ill bladder. The most frequent urostomies are those performed through the ileal or cecal conduit. To create a conduit (passageway) for urine to travel from the kidneys to the outside of the body through a stoma, either a part of the small bowel (ileum) or the beginning of the large intestine (cecum) is surgically removed and repositioned. The infected bladder may also be removed.
ILEOSTOMYA hole made by surgery from the small intestine’s ileum, which is its lowest point. To create a stoma, the intestine is brought through the abdominal wall. Ileostomies, which entail removing all or a portion of the colon, can be either temporary or permanent.
Who Needs an Ostomy?Certain digestive or urinary conditions may necessitate ostomy surgery. You could require an ostomy, for instance, if you have:
- Colon or rectal cancer.
- An injury affecting your small or large intestine.
- A blockage in your bowel.
- Conditions cause GI irritation, such as ulcerative colitis and Crohn’s disease.
- Diverticulitis is characterized by the inflammation of small pouches in your colon.
- Bladder cancer.
What Are the Advantages of Ostomy?Ostomy surgery can often save a person’s life. In other instances, the surgery helps individuals considerably enhance their quality of life while treating various gastrointestinal and urinary illnesses.
Ostomy Care Procedures
POUCHING SYSTEMS (OSTOMY APPLIANCES)People with colostomies, ileostomies, or urostomies cannot regulate the stoma’s frequency or output or even feel it. Patients with ostomies must wear a pouching device to collect stoma effluent and prevent skin irritation. To protect the surrounding peristomal skin and stop effluent from leaking out, the pouching system must be entirely sealed. The flexible disposable pouching system consists of a plastic bag and a flange (skin barrier) that rests against the patient’s skin. It can be a one-piece or two-piece design. For example, the flange might be convex or flat. Together, the ostomy pouch and flange create a single, leak-proof unit. The pouch may be closed with a plastic clip or Velcro strip and includes an open end that can be used to drain sewage. To satisfy various purposes, pouching systems come in various forms. The flange is meant to encircle the stoma without touching it. Many ostomy pouching methods are available based on the kind of stoma, features, location, patient abilities, skin folds, and patient desire. The system can last four to seven days, depending on the pouching method used. If the pouch is leaking, there is an odor. Too much skin is exposed, or if the patient complains of itching or burning behind the skin barrier, it must be changed. With the pouching device activated, patients with pouches can swim and take showers. Every patient is expected to take part in all facets of their ostomy care; if they cannot, a caregiver may be trained to take care of the ostomy. The requirement for an external pouch can be removed depending on the patient, thanks to a surgical technique that creates an inside pouch to collect feces or pee. The continent ileostomy, created using a portion of the ileum, is flushed daily to remove the effluent. An ileoanal ostomy is a pouch produced from a part of the ileum above the anal sphincter. A portion of the intestine can be used to produce two different internal urine diversions. The first is an orthotopic neobladder, in which a bladder is manufactured and implanted in the body where a normal bladder would be. The patient can eventually learn to empty naturally with time and continence training. In the second form, a continent urinary reservoir, a pouch is made from a portion of the intestine. A catheter is inserted many times during the day to remove the urine.
PHYSICAL AND EMOTIONAL ASSESSMENTCo-morbidities may impact patients’ capacity to handle their ostomy care. For example, a patient’s ability to coordinate and function to maintain the ostomy may be hampered by arthritis, visual abnormalities, Parkinson’s disease, or issues following a stroke. Moreover, the emotional strain of living with an ostomy can be excruciating for some patients and negatively impact their self-worth, perception of their bodies, quality of life, and capacity for intimacy. Ostomy patients frequently experience issues with their body image and an altered urination pattern. Ensure the patient receives the proper referrals to social workers, wound and ostomy nurses, and support groups in person or online. When changing an appliance or pouching system, be particularly mindful of non-verbal cues as a healthcare professional. Avoid displaying disgust at the ostomy or any possible stench.
SPECIAL CONSIDERATIONSAs soon as patients leave an acute care facility, make sure they have referrals to a community nurse, can empty their pouch system on their own or with aid from a caregiver, have extra supplies, are aware of problems’ signs and symptoms, and know where to go for assistance. Patients who have new dietary requirements because of an ileostomy or colostomy should be evaluated by wound care or ET nurse and be referred to a dietician. The ostomy bag may fill up with gas from the gut and release an uncontrolled “farting” sound that is typically silent. In a two-piece device, patients can “burp” the bag by opening a corner of the ostomy pouch from the flange to allow the air to escape. Dietary limitations may also reduce the quantity of gas the intestines generate.
Urostomy CareUrostomy patients are unable to manage their pee on their own. Hence a pouching system must be utilized and emptied regularly. Unfortunately, many people empty their urostomy bag every two to four hours or whatever frequency they were accustomed to going to the restroom before their operation. The drain on urostomy pouches should be used only until the pouch is one-third filled. For nocturnal drainage, the pouch can alternatively be fastened to a drainage bag. Urinary tract infections (UTIs) are more common in patients with urostomies. Thus they should be made aware of the symptoms and indicators of these infections.
Risks of OstomyOstomy surgery problems are a possibility, just as with other surgical procedures. They might be moderate or severe, and they could include:
- Ostomates frequently experience this. Drink much water to counteract any undesirable side effects. This keeps your body hydrated and replaces electrolytes that have been lost.
- Foods that are challenging to digest may do this by getting lodged in the digestive tract. However, when you momentarily rest your gut by drinking clear liquids, blockages typically resolve on their own.
- You could get a hernia if the abdominal wall surrounding your stoma weakens. Once they have grown too big, stoma hernias frequently need to be surgically repaired.
- Stoma narrowing: If your stoma gets smaller, it could be more challenging for waste to flow through. Surgery is frequently required to treat this problem.
- Your bowel may occasionally attempt to pass through the stoma. As a result, the bowel may occasionally be pulled back through and secured with a stoma shield. Other times, you might need a bigger ostomy pouch or surgical adjustment.
- Irritated skin. The most frequent problem that ostomy users encounter is this one. Your skin may get red or irritated if your ostomy pouch doesn’t fit properly and waste leaks around the stoma. When changing their bags, many patients use ostomy powder to lessen the possibility of skin irritancy.
- Internal bleeding may occasionally result from ostomy surgery. You may need a blood transfusion if you lose too much blood.
- Countless microorganisms live in your digestive system. During surgery, they may seep out and result in an infection. If this happens, your doctor will prescribe antibiotics to deal with the problem.
- Elevated electrolyte levels Water, electrolytes, and minerals from the food you eat are absorbed via the large intestine. Therefore, an electrolyte imbalance may result from the removal or bypassing of the large intestine. Ask your doctor for nutrition advice that can help you maintain electrolyte balance if you had your large intestine removed.
- A lack of vitamin B12 You might not be able to absorb vitamin B12 as well as you formerly did after your ostomy. Anemia may result from this. Supplements are an effective way to address vitamin B12 insufficiency.
- Phantom rectum syndrome. Even after having their rectum removed, some people still feel the need to urinate. Usually, this ailment gets better on its own. However, your doctor may recommend painkillers if you have discomfort related to phantom rectum syndrome.
- Short bowel syndrome. This is a collection of problems brought on by nutritional malabsorption. The water, vitamins, and minerals required for life support cannot be absorbed by those with this illness in sufficient amounts. Medication, nutritional assistance, and surgery are all possible treatments for small bowel syndrome.
- Rectal Discharge. Those with an ostomy but still have their colon, rectum, and anus may occasionally have rectal discharge. Although there is no cure for this ailment, it may be controlled with the right treatment.
Protecting the Skin Around the StomaThe skin around your stoma should always look the same as anywhere else on your abdomen. But ostomy output can make this skin tender or sore. So here are some ways to help keep your skin healthy:
- Use the proper skin barrier opening and bag size. The stoma may become cut or injured and enlarge if the entrance is too tiny. On the other hand, the outflow could irritate the skin if the hole is too big. Change the skin barrier or pouch in both situations, and put in a well-fitting replacement.
- The pouching system should be changed often to prevent leaks and skin discomfort. It’s crucial to change your pouch regularly. Don’t wait for leaks or other warning indications, including burning or itching.
- Be careful when removing the pouching system from the skin; unless there is a problem, only do it once daily. Instead of ripping the skin barrier away from the skin, gently remove it by pressing your skin away from the sticky barrier.
- Use water to wash the skin surrounding the stoma. Before applying the skin barrier or pouch, the skin must be fully dry.
- Inspect the adhesive, skin barrier, paste, tape, or pouch material for sensitivities and allergies. Because you might get sensitive over time, they may appear after using a product for a few days, several months, or even several years. Try a pouch cover or a different kind of pouch if your skin only becomes inflamed where the plastic pouch meets it. If needed, a stoma nurse can provide suggestions. You may buy pouch covers from supply companies or construct your own. To find out how different products affect your skin, you might need to test them first.