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Colostomy Creation

WHAT YOU NEED TO KNOW:

A colostomy creation is surgery that brings part of your colon (bowel) to the surface of your abdomen. This creates a small opening in your abdomen called a stoma. Bowel movements pass through the stoma into a pouch that is attached to your abdomen.


WHILE YOU ARE HERE:

Before your surgery:

  • Informed consent is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  • Blood tests: You may need blood tests to check how your kidneys are working. The blood may be taken from your hand, arm, or IV.
  • Colon cleansing: The colon must be empty before surgery to prevent infection. You may be given an enema or medicine. An enema is a liquid that is put inside your rectum to help empty your colon. The medicine is given as a drink or as pills.
  • Stoma marking: A caregiver will talk with you about the best place for your stoma. A pen or a small disk is used to mark the stoma site on your abdomen. The caregiver will ask you to sit, lie down, stand, and bend. This helps your caregiver position the stoma to prevent leaks and skin irritation. It will also help your stoma better fit your clothes and ostomy bag
  • An IV is a small tube placed in your vein that is used to give you medicine or liquids.
  • A Foley catheter is a tube put into your bladder to drain urine into a bag. Keep the bag below your waist. This will prevent urine from flowing back into your bladder and causing an infection or other problems. Also, keep the tube free of kinks so the urine will drain properly. Do not pull on the catheter. This can cause pain and bleeding, and may cause the catheter to come out.
  • You may need to wear inflatable boots after surgery. The boots have an air pump that tightens and loosens different areas of the boots. This device improves blood flow and helps prevent clots.
  • Antibiotics: You may be given antibiotics before or during surgery to help prevent infection in your abdomen.
  • General anesthesia will keep you asleep and free from pain during surgery. Anesthesia may be given through your IV. You may instead breathe it in through a mask or a tube placed down your throat. The tube may cause you to have a sore throat when you wake up.

During your surgery:

  • You will lie on your back. Your feet may be in stirrups. If you are having an open surgery, your caregiver will make 1 long incision in the middle of your abdomen. During laparoscopic surgery, 3 to 4 small incisions are made on your abdomen. The laparoscopic tools are placed inside the incisions, and your abdomen is filled with carbon dioxide (a gas). The gas lifts the abdominal muscles away from the colon and other organs during surgery. Your caregiver will cut through the muscles in your abdomen to the colon. He will carefully check your colon for disease or injury.
  • Your caregiver will cut your colon into 2 or more parts. Some diseased or injured parts of your colon may be removed. One end of your colon will be pushed through the muscle on your abdomen. The end will be stitched to the skin on your abdomen to create a stoma. The other part of your colon may be stitched closed or a second stoma will be made. You may have a rod placed under the stoma to keep it above your skin if your colostomy has 2 openings. The other incisions are closed with stitches or staples. Your caregiver will attach an ostomy bag around your stoma to collect fluids and bandage your incisions.

After your surgery:

You will be taken to a recovery room where caregivers will watch you until you are alert. You will then be taken to your room. You will have bandages over your wounds to help prevent infection. Do not get out of bed until your caregiver says it is okay. You may also have the following:

Monitoring:
  • Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.
  • A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine.
  • Intake and output: Caregivers will collect and measure your urine to make sure you are getting enough liquids.
Medicines:
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
    • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
    • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.
  • Blood thinners: You may need to take medicine to thin your blood. This helps prevent blood clots from forming in your veins. This medicine makes it easier for a person to bruise and bleed. You will need regular blood tests while you take this medicine. Tell your caregiver if you have a bleeding disorder or a history of bleeding or blood clots.
Devices:
  • Pressure stockings: These are long, tight stockings that put pressure on your legs to prevent clots after surgery.

Activity:

You may need to walk around the same day of surgery, or the day after. Movement will help prevent blood clots. You may also be given exercises to do in bed. Do not get out of bed on your own until your caregiver says you can. Talk to caregivers before you get up the first time. They may need to help you stand up safely. When you are able to get up on your own, sit or lie down right away if you feel weak or dizzy. Then press the call light button to let caregivers know you need help.

  • Take deep breaths and cough 10 times each hour. This will decrease your risk for a lung infection. Take a deep breath and hold it for as long as you can. Let the air out and then cough strongly. Deep breaths help open your airway. You may be given an incentive spirometer to help you take deep breaths. Put the plastic piece in your mouth and take a slow, deep breath, then let the air out and cough. Repeat these steps 10 times every hour.
  • Diet: Your caregiver will listen to your stomach using a stethoscope. You may be able to eat when bowel sounds (stomach growlings) are heard. You may not be able to eat solid food for several days. Ice chips are usually given first. You may be allowed liquids such as water, broth, juice, or soda within a few days. Ask your caregiver when you can eat solid foods.

Stoma care:

  • Meet with an enterostomal therapist, ostomy nurse, or specialist about your stoma: These caregivers can tell you what it is like to live with a colostomy. They will show you how to care for your stoma. They can help you choose ostomy equipment that best fits your stoma.
  • Practice changing your ostomy bag and equipment: Your ostomy bag will be changed 1 to 2 days after surgery. The bag is then changed every 3 to 7 days. You must learn how to change the ostomy bag and equipment before you leave the hospital.
  • Keep the skin around your stoma clean and dry: Avoid oils or ointments that may prevent the ostomy bag from sticking to your skin. Your caregiver can help if itching, redness, or a rash develops around your stoma.

RISKS:

  • The condition that led to your colostomy may come back, even with treatment. You may get an infection or bleed more than expected. You may get a blood clot in your arm or leg. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs. A blood clot in your lungs can cause chest pain and trouble breathing. This problem can be life-threatening.
  • Surgery may damage nerves or other organs. Your stoma may narrow, become blocked, or move too far outside or inside your abdomen. You may develop a hernia (weakness in the muscles in your abdomen). Sometimes your stoma tissue does not get enough blood and the tissue may die. A colon incision may come apart or leak bowel movement fluid into your abdomen. This can cause a life-threatening infection. More surgery and other treatments are needed right away to correct these problems.

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.

© 2015 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.

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.

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