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Colostomy Care

What is colostomy care?

You or a family member will need to learn to care for your colostomy. It may require changes in your lifestyle. You may work with an ostomy specialist to find the best ways to care for yourself.

How do I change my pouch?

How you change your pouch depends on the type you have. Your caregiver will give you specific instructions on how to change your colostomy pouch. The following is general information about how to change your pouch:

  • Ask how often to change your colostomy pouch: The type of pouch you wear affects the amount of time it can be worn. The kind and amount of bowel movement you have also affects how long the pouch stays on.

  • Remove the pouch: Gently remove the pouch by pushing the skin down and away from the adhesive skin barrier with one hand. With the other hand, pull the pouch up and away from the stoma.

  • Gently clean the skin around your stoma: Use mild soap and water. Do not use soaps that have oil or perfumes. Pat your skin dry.

  • Use a pouch with the right size opening: Use a pouch that has an opening that is ⅛ of an inch larger than your stoma.

  • Use skin products to help reduce irritation: These products can help protect your skin and keep it dry.

  • Use slight pressure to place your pouch: Center the pouch over the stoma and press it firmly into place on clean, dry skin. It may be helpful to hold your hand over the new pouch for 30 seconds. The warmth of your hand can help stick the adhesive skin barrier into place.

  • Dispose of the used pouch correctly: If the pouch is disposable, place the old pouch in another plastic bag and throw it in the trash. If you use a reusable pouch, talk to your caregiver about how to clean it.

How do I empty my pouch?

  • Empty the pouch when it is ⅓ to ½ full: Do not wait until the pouch is completely full. This could put pressure on the seal and cause it to leak or spill.

  • Hold the pouch up by the bottom end: If the pouch has a clamp system, remove the clamp. You may need to roll the end back to keep it from getting soiled.

  • Drain the pouch: Place toilet paper into the toilet before you empty the pouch to reduce splash back. Drain the pouch by squeezing the contents into the toilet.

  • Clean the end of the pouch: Use toilet paper or a moist paper towel. You may also rinse the pouch but it is not necessary. Keep the end of the pouch clean.

  • Close the end of the pouch: Unroll the end of the pouch. Replace the clamp or close the end of the pouch according to your caregiver's instructions.

What is irrigation?

Irrigation is when you put fluid into your stoma to empty your bowel. Your caregiver will tell you if you can irrigate your colostomy. Irrigation allows you to time your bowel movements. Your bowel movements need to be regular and free of problems before you can use a stoma cap and irrigation. Schedule regular times to irrigate your colostomy.

How do I irrigate my colostomy?

Ask an ostomy nurse or someone specially trained in ostomy care how to properly irrigate your colostomy. Below are some general steps for irrigation:

  • Gather your supplies: You will need a plastic irrigating container with a long tube and a cone to put water into your colostomy. You will also need an irrigation sleeve that will direct the output into the toilet. You will need an adjustable belt to attach the irrigation sleeve and a tail closure for the end of the sleeve.

  • Choose the same time every day to irrigate: This will help decrease problems with your colostomy.

  • Know how much liquid to use: Fill the irrigating container with about 16 to 50 ounces (500 to 1500 mL) of lukewarm water. The water should not be cold or hot. Ask your caregiver how much water you will need to irrigate. Hang the irrigation container so that it is level with your shoulder. Sit up straight on the toilet or on a chair next to the toilet.

  • Attach the irrigation sleeve to your stoma: Take the adjustable belt and attach it to the irrigation sleeve. Place the belt around your waist and place the sleeve over your stoma. Place the end of the irrigation sleeve into the toilet bowl.

  • Release air bubbles from the tubing: Release the clamp and allow a small amount of water to flow into the sleeve. Clamp the tubing again.

  • Moisten the end of the cone: Use water or a water-soluble lubricant.

  • Place the tip of the cone 3 inches into your stoma: Make sure the fit is snug, and do not force the cone. Release the clamp on the tubing again and slowly allow the water to flow into the stoma This should take about 5 to 10 minutes. Keep the cone in place for another 10 seconds.

  • Remove the cone: Allow the output to drain into the irrigation sleeve for about 10 to 15 minutes. Dry the end of the irrigation sleeve. Clip the bottom of the sleeve to the top with a clasp or close the end of the sleeve with the tail closure. It may take 30 to 45 minutes to drain. You may move around during this time. Empty the output from the sleeve into the toilet. Clean the area around the stoma with mild soap and water and pat dry.

How do I care for my skin?

Look at the skin around your stoma each time you change your pouch. Your stoma should be pink or red and moist. You may have a small amount of bleeding when you clean your stoma. This is normal. Your stoma will get smaller and become its normal size in about 8 weeks.

  • Make sure the skin barrier opening fits well: The skin barrier is the part of the pouch that sticks to the skin of your abdomen. It should be no more than ⅛ of an inch larger than your stoma. If the opening is too large, bowel movement can leak onto your skin and cause irritation. Measure the size of your stoma with the guide that comes with your colostomy supplies. Make sure you cut the skin barrier smaller as your stoma gets smaller.

  • Soothe irritated skin: If your skin is red, it may mean that the skin barrier was on too long. It is important to find the cause of your skin irritation. Ask your caregiver if you need help finding the cause of your skin irritation.

What types of foods can I eat after a colostomy?

  • Eat a variety of healthy foods: Healthy foods include fruits, vegetables, whole-grain breads, low-fat dairy products, and lean meats. Do not eat foods that give you cramps or diarrhea.

  • Limit foods that may cause gas and odor: These include vegetables such as broccoli, cabbage, and cauliflower. Beans, eggs, and fish may also cause gas and odor. Eat slowly and do not use a straw to drink liquids. Yogurt, buttermilk, and fresh parsley may help control odor and gas.

  • Drink liquids as directed: Ask your caregiver how much liquid to drink each day and which liquids are best for you. This may help reduce constipation.

What are some problems that can happen with a stoma?

Most stoma problems happen during the first year after your surgery.

  • Stoma retraction: This is when the height of the stoma goes down to or below the skin level. Retraction may happen soon after surgery if the colon does not become active soon enough. Retraction may also happen if you gain weight. The type of pouch you use may need to be changed to fit the stoma shape.

  • Peristomal hernia: This is when a part of your large intestine bulges into the area around the stoma. A hernia may be more obvious when you sit, cough, or strain. Hernias may make it difficult to create a proper pouch seal or irrigate. You may need to change the type of pouch you use or wear a hernia belt. You may need surgery to repair the hernia.

  • Prolapse: This is when a part of your bowel pushes out of your stoma. The stomal prolapse may be caused by increased abdominal pressure. Surgery may be done to fix the prolapse.

  • Stenosis: Your stoma may become more narrow. Your caregiver may be able to stretch your stoma if it has mild stenosis. Severe stenosis can cause blockage and surgery is usually needed.

Where can I find support and more information?

  • United Ostomy Associations of America, Inc.
    P.O. Box 512
    Northfield , MN 55057-0512
    Phone: 1- 800 - 826-0826
    Web Address: http://www.ostomy.org
  • Wound Ostomy and Continence Nurses Society
    15000 Commerce Parkway
    Mount Laurel , NJ 08054
    Web Address: www.wocn.org

When should I contact my caregiver?

Contact your caregiver if:

  • You have a fever.

  • You have a foul odor coming from your colostomy bag or stoma that lasts longer than a week.

  • Your skin around the stoma becomes red and irritated.

  • You have nausea, vomiting, pain, cramping, or bloating.

  • You do not have regular bowel movements through your stoma.

  • The size of your stoma changes.

  • You have questions or concerns about your condition or care.

When should I seek immediate care?

Seek care immediately or call 911 if:

  • Your bowel movements are black or bloody.

  • Your stoma is bleeding and you cannot stop the bleeding.

  • You are too weak to stand up.

  • You have severe abdominal pain.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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