Ostomy care is the comprehensive maintenance and management required following ostomy surgery. This procedure involves creating a new pathway for bodily waste to exit the body through a surgically created opening called a stoma. Since the natural route of elimination is bypassed, care focuses on correctly fitting and managing a pouching system, maintaining healthy skin, and adapting to new lifestyle considerations.
Understanding the Need for an Ostomy
An ostomy is medically necessary when disease or injury damages the digestive or urinary tract, requiring waste to be diverted. The stoma is the piece of intestine or urinary tract brought through the abdominal wall, appearing as a moist, reddish-pink opening. Ostomy procedures are categorized based on the part of the body involved, which dictates the type of output and the specific care required.
A colostomy is formed from the large intestine (colon), usually resulting in a more formed or semi-formed stool that may be passed intermittently. An ileostomy uses the small intestine (ileum) and produces a more liquid, continuous output because the water-absorbing large intestine is bypassed. A urostomy diverts urine from the ureters, often using a small segment of the intestine to create a conduit for drainage.
Common Conditions Requiring an Ostomy
These procedures are commonly required due to conditions such as:
- Colorectal cancer
- Severe inflammatory bowel diseases like Crohn’s disease or ulcerative colitis
- Diverticulitis
- Bladder cancer
The Fundamentals of Routine Ostomy Care
Daily ostomy management centers on the proper application and maintenance of the appliance, known as the pouching system. This system consists of a skin barrier, which adheres to the skin around the stoma, and a collection pouch. Routine maintenance involves emptying the pouch when it is approximately one-third to half full to prevent the weight of the contents from compromising the secure seal.
The complete pouching system is changed every three to five days, though this schedule varies based on individual skin health and output type. The procedure begins with gently peeling the used skin barrier away, often using an adhesive remover wipe to avoid skin stripping. The peristomal skin, the area immediately surrounding the stoma, must then be cleaned gently with warm water and patted completely dry before a new system is applied.
Peristomal skin care is fundamental because stoma output, particularly the enzyme-rich output from an ileostomy, can rapidly irritate and damage the skin. The skin barrier must be cut or molded to fit snugly around the stoma, ideally leaving only a one to two millimeter gap. This prevents corrosive waste from contacting the skin surface. Skin barrier pastes, rings, or powder are often used to ensure a flat surface and a secure seal, which promotes long-term skin health.
Controlling odor is managed through modern appliance technology and targeted products. Most contemporary pouches are made with odor-proof materials and often include an integrated charcoal filter, which allows gas to escape while neutralizing the smell. Further odor control is achieved by adding specialized liquid drops or gels, known as in-pouch deodorants, directly into the collection pouch after each emptying.
Integrating Ostomy Management into Daily Life
Successful long-term living with an ostomy involves adapting everyday habits to work seamlessly with the new anatomy. Dietary adjustments are particularly important, especially for those with an ileostomy, where the loss of the large intestine increases the risk of dehydration and electrolyte imbalance. People with an ileostomy must focus on increased fluid intake and may need to incorporate thickening foods, such as starchy items, ripe bananas, or smooth peanut butter, to manage a watery output.
High-fiber foods, especially those that are difficult to digest like corn, mushrooms, and nuts, should be introduced slowly and chewed thoroughly to prevent potential blockages at the stoma site. Those with a colostomy are encouraged to maintain a regular, balanced diet, sometimes focusing on fiber to regulate stool consistency. Identifying personal trigger foods that cause excessive gas or odor helps ensure comfort in social settings.
Physical activity, including swimming and most sports, is entirely possible with a secure pouching system, often aided by supportive belts or specialized clothing to keep the appliance discreet and secure. Psychological adjustment is equally important, as body image concerns and social anxiety are common after surgery.
Seeking support from specialized Wound, Ostomy, and Continence (WOC) nurses is strongly advised. A WOC nurse is a specialized registered nurse who provides personalized education, troubleshooting assistance for appliance issues, and psychological support throughout the adjustment process. They help patients navigate clothing choices, which often involve garments with higher waistbands to conceal the pouch, and prepare for travel by ensuring sufficient supplies are packed in carry-on luggage.