COLOSTOMY CARE

COLOSTOMY

 an operation to divert 1 end of the colon (part of the bowel) through an

opening in the tummy. The opening is called a stoma. A pouch can be placed
over the stoma to collect your poo (stools). A colostomy can be permanent or
temporary.
 A colostomy is a surgical procedure that changes the trajectory of food waste
through your bowels. When part of the colon needs to be bypassed for
medical reasons, surgeons make a new opening in your abdominal wall for
poop to come out. With a colostomy, you poop into a colostomy bag. The
operation can be temporary or permanent
Why would you need a colostomy?

 You may need a colostomy if you have a medical condition that requires you
to stop using your colon or anus normally. It may be a temporary intervention
that allows your body to heal, or it may be a permanent solution for an
irreversible condition.
Some conditions that may require a
temporary colostomy include:
 Serious infection, such as diverticulitis.
 Acute inflammation from inflammatory bowel disease (IBD).
 Acute injury to your colon.
 An obstruction (or blockage) in your colon or anus.
 Anal fistula (a tunnel leading from your anal cavity through to your skin or
another organ).
 Partial colectomies (when the remaining ends of the bowels can be
reattached later).
Some conditions that may require a
permanent colostomy include
 Incurable fecal incontinence.
 Advanced colorectal cancer.
 Permanent removal of the rectum and/or anus.
What's the difference between a
colostomy and an ileostomy?
 The colon and the ileum are two different parts of the bowels, also called the
intestines. The colon is part of the large intestine, and the ileum is part of
the small intestine. In your body, food waste normally passes from your ileum
into your colon, where it forms into solid stool. But if the first part of your
colon that the ileum feeds into is removed or inactive, this pathway is
interrupted
 In this case, an ileostomy redirects your ileum to a stoma in your abdominal
wall. When you have an ileostomy, you expel liquid waste from your small
intestine through your stoma into an ostomy bag. Like a colostomy, an
ileostomy may be either temporary or permanent, depending on your
condition. Sometimes, when the colon is permanently unusable, surgeons can
create an internal “ileal pouch” to replace it, and close the stoma.
What happens before a colostomy?

 Before the surgery:

 You’ll have what’s called a pre-operation assessment meeting with your
surgeon.
 They’ll make sure you fully understand the procedure, the risks involved and
the lifestyle changes you’ll have to make afterward before you sign your
consent forms.
 You may also discuss your pain management options at this time. A nurse will
take a blood sample to check that you are well enough for surgery.
 They may also have an EKG test to check that your heart is in good health.
 A stoma specialist nurse will determine the best site on your body for your
stoma and mark it for your surgeon
 On the day of the surgery:
 You’ll need to avoid eating or drinking for six hours before surgery.
Sometimes, you may be given an enema or bowel prep (like before a
colonoscopy) to take at home.
 When you arrive at the hospital, you’ll change into a hospital gown.
 You’ll then be taken to a pre-op room to wait for your operation.
 Once you are in the operating room, you'll receive your anesthetic for surgery
What happens during the colostomy
procedure?
 Colostomies may be performed through either laparoscopic surgery or open
surgery
Laparoscopic surgery

 is a newer, less invasive method than traditional open surgery.

 It’s done using a tiny lighted camera called a laparoscope. Your surgeon
makes a small incision in your abdomen and inserts the laparoscope, which
shows your abdominal organs on a screen.
 Your surgeon can then complete the surgery using one or more smaller
incisions to access your organs.
 Because the incisions are smaller, laparoscopic surgery is associated with
fewer complications, less pain and a faster recovery time.
 But not every surgery can be successfully carried out this way. Sometimes, a
complicated case may require a planned laparoscopic surgery to convert to
open surgery.
Open surgery

 In an open surgery, the surgeon uses one long incision to open up your
abdominal cavity.
 This the traditional way to access your abdominal organs, and it allows for
better access, which is sometimes required. But it is considered a major
surgery and carries a longer recovery time.
 Whether you have an open or a laparoscopic colostomy may depend on the
condition you are treating and what else the surgeon needs to accomplish
during the surgery besides the colostomy.
 In most cases, you’ll know in advance which type you’ll have and be able to
plan accordingly.
There are 2 general types of colostomy
operations performed:
 Loop colostomy
 is often the method of choice when a colostomy is meant to be temporary
because it's easier to reverse.
 In this procedure, your surgeon identifies the section of your bowel that
needs to be turned into the colostomy and pulls that section as a loop
through an incision in your abdomen.
 The surgeon then snips the loop and places the two open ends side by side in
your abdominal opening, creating two ends of the stoma.
 One is where your poop will come out through the remaining active part of
your bowel.
 The other is connected to the remaining inactive part of your bowel, leading
to your anus. This opening allows mucus to be discharged.
 Loop transverse colostomy (Figures 2 and 3): The loop colostomy may look like one very large stoma, but
it has 2 openings. One opening puts out stool, the other only puts out mucus. The colon normally makes
small amounts of mucus to protect itself from the bowel contents. This mucus passes with the bowel
movements and is usually not noticed. Despite the colostomy, the resting part of the colon keeps making
mucus that will come out either through the stoma or through the rectum and anus. This is normal and
expected.
End colostomy

 An end colostomy is often done when the colostomy is expected to be

permanent.
 In this procedure, after your bowel is cut, the end of your remaining
active bowel is stitched to the opening in your abdominal wall, and
the end of the remaining inactive bowel is sealed.
 You’ll have one stoma for poop to come out, and if you still have
your anus intact, you'll discharge mucus through your anus instead of
a stoma.
 What happens after the procedure?

 The colon has four different sections where it may have been cut,
depending on where the problem was.
 Colostomies in each section will have slightly different outcomes.
Ascending colostomy
 The ascending colon is the first section of colon that your small intestine feeds
into.
 It’s called “ascending” because it travels up the right side of your abdomen. If
you have an ascending colostomy, only a small segment of your colon will be left
active.
 This means that the remaining colon will not have much chance to do what the
colon does with food waste.
 Food waste that passes from the small intestine into the ascending colon is still
very liquid and not fully digested.
 In the ascending colon, there are a lot of digestive enzymes in the mix to help
break the waste down further.
 This is the liquid waste that will pass through your stoma after an ascending
colostomy.
 You’ll have to take special care to prevent leakage and protect your skin from
the abrasive enzymes in the poop
Transverse colostomy
 The transverse colon is the second segment of the colon, which travels
horizontally across your abdomen from the right side to the left side.
 This is also roughly the middle of your bowel.
 Transverse colostomies are often done to give the lower half of your bowel a
rest, and sometimes to bypass it permanently.
 If you have a transverse colostomy, your poop will be a little more solid and
have fewer digestive enzymes in it, but it still won’t be like the stool you’re
used to.
 Because this is the high point of the colon, your colostomy may also be placed
relatively high on the abdomen, which can make it more challenging to
conceal.
Descending and sigmoid colostomies

 The descending and sigmoid colon are the lower segments of the colon.
 The descending segment travels down the left side of your abdomen, and the
short sigmoid “tail” end curves a little to the right and down.
 If you have a colostomy in either of these sections, you’ll have most of your
colon left active.
 This means the poop that comes out of your stoma will be more familiar. It
will have had time to solidify and the digestive enzymes will have been
absorbed, so it won’t be irritating to the skin.
 You might even have a natural reflex to poop at a regular time of day and be
able to plan around your bowel movements.
What are the advantages of colostomy?

 the surgery as a whole is typically a life-saving intervention. A colostomy

makes that intervention possible. If you require a colectomy or similar
operation, a colostomy allows your body to continue functioning with the loss
of a major organ.
 to give their colon a temporary rest to heal from illness or injury.
 Your survival and long-term health are the primary purposes of a colostomy.
For some, it also improves their quality of life.
 If you have suffered a long time from chronic bowel diseases, having a
colostomy can mean freedom from being ruled by your bowels. Now, you no
longer have to live in the bathroom, attending to a temperamental colon.
COLOSTOMY
What are the risks of the surgery?

 Colostomy is a common and straightforward surgery. It’s generally safe, but

there are always some risks.
 These include:

 Reactions to the anesthesia.

 Breathing problems under anesthesia.
 Injury to nearby organs.
 Infection.
What complications might occur while
living with a colostomy?
 Skin irritation from contact with stool, especially the acidic, liquid
stool of the upper colon. This is the most common stoma complication.
It can usually be solved with a better-fitting bag.
 Bowel obstructions from scar tissue or from paralytic ileus (slow-
moving bowels) after your surgery, preventing poop from passing. This
can usually be solved with home constipation remedies.
 Stoma retraction or prolapse. A retracted stoma sinks back below the
skin surface level. A prolapsed stoma sticks out too far. Both of these
situations can make it difficult to fit your colostomy bag securely to
your stoma. If you can’t find a bag that fits, your surgeon may have to
re-site or revise your stoma.
 Parastomal hernia. This type of hernia occurs when loops of bowel
bulge through the weakened abdominal muscles around your stoma.
 A hernia forms a visible bulge next to the stoma and can grow over
What is the recovery time from a
colostomy?
 You’ll need to recover in the hospital for the next 3 to 7 days.
 During this time, you’ll :
 Resume normal eating gradually. You’ll probably be fed a clear liquid diet for
the first day after surgery, then progress to a full liquid diet or soft diet before
resuming solid food.
 Learn all about colostomy care. A wound ostomy continence nurse (WOCN) will
teach you about living with a colostomy bag and how to care for your stoma.
 Gradually wean from your pain medications. You may be given a short-term
prescription to take home with you.
 Heal from your wounds, and your bowel movements will begin to regulate. It
may take several days before your first one.
  The first time you look at your stoma,
it may appear bruised, red and
swollen. This will subside over the
next few weeks. It will shrink and
fade to a soft red or pink. Since it is
the inside of a tube (your intestines)
you're looking at, it will be roundish in
shape. It may look a little different
from person to person. It may stick
out a little or be flat against the skin.

What does a stoma look like?

STOMA
When should I see my healthcare
provider about my colostomy?
 Persistent constipation or diarrhea.
 Persistent nausea or vomiting.
 Blood in your stool.
 A change in your stoma’s regular size or color.
 Any strange foul odors coming from your stoma.
 A blockage in your stoma.
STOMA
 CHECKLIST : CHANGING A POUCHING
SYSTEM/OSTOMY APPLIANCE (ILEOSTOMY OR
COLOSTOMY)
 Disclaimer: Always review and follow your hospital policy regarding this specific skill.
 Safety considerations:
 Pouching system should be changed every 4 to 7 days, depending on the patient and type of pouch.
 Always consult a wound care specialist or equivalent if there is skin breakdown, if the pouch leaks, or if
there are other concerns related to the pouching system.
 Patients should participate in the care of their ostomy, and health care providers should promote patient
and family involvement.
 Encourage the patient to empty the pouch when it is one-quarter to one-half full of urine, gas, or feces.
 Ostomy product choices are based on the patient’s needs and preference.
 Follow all post-operative assessments for new ostomies according to agency policy.
 Medications and diet may need adjusting for new ileostomies/ colostomies.
 An ostomy belt may be used to help hold the ostomy pouch in place.
 Factors that affect the pouching system include sweating, high heat, moist or oily skin, and physical
exercise.
 Always treat minor skin irritations right away. Skin that is sore, wet, or red is difficult to seal with a
flange for a proper leakproof fit.
 EquipmentS
 1. Pouch
 2. Pouch closure device
 3. Waste basket
 4. Tape(opt)
 5. Towel
 6.Scissors/Pen
 7.Skin Barrier( Sealant wipes or wafers)
 8. Gloves
 9. Gauze or washcloths
 10. Adhesive remover
 11. Basin with warm water
 12. Measuring guide
WATCH THIS FOR FURTHER INFO

 https://www.youtube.com/watch?v=Brq3NpJNpIU
 https://www.youtube.com/watch?v=8f9mtoXHfsg
 https://www.youtube.com/watch?v=2ZvWaLst-E8
COLOSTOMY CARE