A colostomy bag, also known as an ostomy appliance, is a small, waterproof pouch worn externally on the abdomen. It collects fecal matter diverted from the digestive tract through a surgically created opening called a stoma. This device is used when the lower colon or rectum must be bypassed or removed due to injury or disease. While many people worry about pain, discomfort associated with a colostomy rarely comes from the appliance itself, usually stemming instead from the initial surgery or surrounding skin issues.
Stoma Sensation and Pain Perception
The stoma is the visible part of the large intestine brought through the abdominal wall. It is composed of mucosal tissue, similar to the lining inside the mouth. This tissue lacks the sensory nerve endings present in the skin.
Because the stoma lacks sensory nerves, it cannot register sensations like touch, temperature, or sharp pain. You will not feel output passing through the opening or the bag touching the stoma itself. While the intestine contains nerves that respond to stretching, the stoma tissue is generally insensitive to external stimuli and lacks pain receptors.
Immediate Post-Operative Pain
Any pain experienced immediately following the procedure results from the surgery itself, not the colostomy bag. Creating a colostomy is major abdominal surgery involving an incision and the manipulation of internal organs. This acute discomfort is primarily incisional pain from the surgical wound and the internal healing of the bowel.
Patients receive prescription pain medication in the hospital to control this discomfort. The hospital stay usually lasts between a few days and a week, depending on the surgery type and individual recovery. This surgical pain is temporary; most patients find it significantly subsides within the first week or two post-operation, with full recovery often taking about eight weeks.
Preventing and Treating Skin Irritation
The most frequent source of discomfort or a burning sensation is the skin immediately surrounding the stoma, known as the peristomal skin, not the stoma or the bag. This irritation is often caused by the leakage of effluent (waste), which is highly irritating to the sensitive abdominal skin. Healthy peristomal skin should look just like the skin on the rest of the body.
Improper appliance fit is a major contributor to leakage, as an opening that is too large allows corrosive output to contact the skin. Consistent use of skin barrier products, such as barrier rings, protective pastes, or powders, is highly effective in shielding the skin from moisture. Mechanical trauma from frequent or forceful removal of the adhesive wafer can also lead to irritation and damage.
Regularly measuring the stoma is important because its size can change, especially in the weeks following surgery. The appliance opening must be adjusted for a snug fit. A properly sized appliance forms a tight seal that prevents leakage, which is the most effective way to prevent peristomal skin irritation.