The Basics of Ostomy Care
by Linda Woodward RN, BSN, OCN®, CWOCN
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The history of people with ostomies and their surgeries reads like an inspiring story of determination, challenge, and courage. Whether you are an ostomate (a person who has had an ostomy) or a family member of one, it is important to know about the basics of ostomy surgery and care.
To have a stoma is not a disease itself; it is the outcome of disease or trauma. Eighty percent of all stomas are the result of cancer, but there are many other reasons to have a stoma. These include trauma, accidents, noncancerous intestinal diseases, and birth defects. There are over a half million ostomates in the world, so you are not alone.
The acceptance of your ostomy depends on your understanding of how it works. The stoma is made from a piece of bowel, either the small or the large intestine, and it exits the skin through a small incision. The end of the bowel is then “turned up,” much like when you roll up your sleeve. This is then sewn to the skin. The stoma should always be red, shiny, and moist. Most stomas are “budded,” which means they protrude slightly from the abdomen. This makes application of a pouch easy. However, if your stoma is not budded, don’t worry. There are many pouching systems available to make this process easier.
“What sort of bag should I use?” is a common question asked by people facing ostomy surgery. You should take into consideration the ease of application, the type of stoma you have, and the cost before making your decision. Some insurance companies pay for pouches, and some do not.
The acceptance of your ostomy depends on your understanding of how it works.
There are various types of ostomy appliances. In one-piece appliances, the adhesive and the bag are welded together. Individual needs determine what suits the user best. The advantage of using a one-piece appliance is that it is easy to apply and the bag is flexible and soft. If you have visual or dexterity problems, this is a good choice.
The alternative is to use a two-piece system. With these systems, the adhesive does not need to be removed so frequently from the skin and can stay on for several days while the bag can be changed as required. Many of the newer, two-piece systems have adhesive technology, which means that the pouch and the wafer stick together rather than clip together. Wafers, or skin barriers, also come in various sizes and shapes. They are either flat or convex. Convex wafers are recommended for people with flat or non-protruding stomas.
You should try several different pouching systems from different manufacturers. Trying out several options is just like shopping for new clothes. Many manufacturers of ostomy supplies will send you free samples to try if you request them.
You may know someone with an ostomy who does not wear a pouch or just wears a small stoma cap. This person uses a procedure called irrigation. Irrigation is much like taking an enema through the stoma. You will need special equipment for this procedure. Always check with your surgeon or a wound, ostomy, continence nurse before irrigation. Not all ostomies can be irrigated.
It is very important for the skin around the stoma to remain healthy and irritation free. The peristomal skin should look just like the rest of the skin on your abdomen. To prevent skin problems, make sure you have a skin barrier and pouch that fit properly. Every time you remove your pouch and wafer, closely examine the skin.
If you have a colostomy or an ileostomy, there are some dietary guidelines that you might want to follow. The actual digestion of food takes place almost entirely in the small intestine, not the colon. You may want to avoid foods that increase odor and gas. Remember to eat a well balanced diet, drink plenty of fluids, and eat slowly and chew your food well.
You don’t have to buy a special wardrobe after ostomy surgery. You can wear whatever clothes fit best. However, try to avoid tight belts over the stoma or directly underneath.
Your attitude about your ostomy is very important. It is possible to become independent with your ostomy care and to live well with an ostomy.
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Linda Woodward is a certified wound, ostomy, continence nurse at The University of Texas M. D. Anderson Cancer Center, Houston, TX.
For additional information, contact the Wound, Ostomy, Continence Nurses Society at www.wocn.org or (888) 224-WOCN and the United Ostomy Association at www.uoaa.org or (800) 826-0826
This article was published in Coping® with Cancer magazine, May/June 2008.