Ostomy care is the specialized process of managing a surgically created opening in the abdomen, known as a stoma, which allows bodily waste to exit the body. This opening is created when a portion of the gastrointestinal or urinary tract is diverted to the surface of the skin, where the waste is collected by a disposable pouching system. Effective care maintains skin integrity, prevents leaks, and allows individuals to live a full and active life with confidence.
Understanding the Different Types of Ostomies
The term ostomy covers several different surgical procedures, named for the section of the intestine or urinary tract involved. The three most common types—colostomy, ileostomy, and urostomy—are differentiated by their anatomical location and the type of output they manage. These differences dictate the specific supplies and care required for each type.
A colostomy is created from the large intestine (colon) and is usually situated on the left side of the abdomen. Since waste has traveled through the majority of the colon, the output is semi-formed or formed stool. This type of ostomy is often necessary for conditions affecting the lower colon or rectum, such as diverticulitis or colorectal cancer.
An ileostomy involves diverting the small intestine (ileum) to the abdominal surface, usually located on the right side. Because this opening bypasses the large intestine, the waste product is liquid or paste-like and can be frequent. The liquid output contains high levels of digestive enzymes, making it corrosive to the surrounding skin.
A urostomy, or ileal conduit, is a surgical diversion created to allow urine to flow out of the body when the bladder cannot function properly. This procedure often uses a small segment of the small intestine (ileum) as a channel for the ureters to drain to the stoma. The output is a continuous flow of urine, which may also contain mucus from the piece of bowel used to form the conduit.
Essential Steps for Appliance Management
Routine appliance management involves emptying the pouch and periodically changing the entire system. The pouching system consists of two primary parts: the pouch that collects the waste, and the skin barrier (flange) that adheres to the skin around the stoma. These systems can be a single, combined unit or a two-piece system where the pouch snaps onto a separate barrier.
The collection pouch should be emptied regularly throughout the day, ideally when it is about one-third full, to prevent the weight from compromising the seal. For drainable pouches, release the waste into the toilet, gently clean the outlet, and securely re-seal it. Emptying the pouch when partially full reduces the risk of leaks and strain on the adhesive barrier.
Changing the entire pouching system, including the skin barrier, is done every three to seven days, depending on the product and individual needs. Preparation begins with gathering supplies, including a new barrier, pouch, measuring guide, and cleaning materials. Gently remove the old barrier by peeling it away from the skin while supporting the surrounding area, then clean the stoma and peristomal skin.
Clean the skin around the stoma gently using only warm water, avoiding harsh soaps or products containing oils or residues that interfere with adhesion. The skin must be completely dry before applying any new components. Measure the stoma size at each change to ensure the opening on the new barrier is cut correctly, fitting snugly around the stoma with only one to two millimeters of clearance.
A correctly sized barrier protects the peristomal skin from corrosive output. When applying the new barrier, ensure the skin is wrinkle-free and hold the palm of the hand over the new system for a couple of minutes. The warmth activates the adhesive, ensuring a secure and long-lasting seal.
Preventing and Addressing Peristomal Skin Issues
The health of the peristomal skin is a significant focus of ostomy care, as it is the most common site for complications. This skin should look and feel the same as the skin on the rest of the abdomen, without redness, irritation, or breakdown. The primary cause of irritation is the leakage of effluent (stool or urine) onto the skin under the adhesive barrier.
Preventing skin irritation relies heavily on achieving a proper appliance fit, ensuring the skin barrier protects the area from waste. An opening that is too large or too small can lead to exposure to output or cause friction against the stoma. Regular monitoring of the stoma’s size is important, as it can change shape or retract over time, requiring adjustments to the barrier opening.
Protective products provide an added layer of defense against moisture and leakage. Barrier rings, pastes, or protective powders can be applied directly to the peristomal skin to fill in uneven contours and create a better seal. If irritation occurs, specialized ostomy powder can be lightly dusted onto the affected skin, followed by a protective skin wipe that seals the powder, allowing the new appliance to adhere.
Aggressive barrier removal can cause skin stripping and tearing of the top layers of the epidermis. Utilizing an adhesive remover spray and gently peeling the barrier downward while pressing on the surrounding skin minimizes this trauma. Persistent redness, broken skin, or signs of a fungal infection require attention from a healthcare professional, such as a Wound, Ostomy, Continence (WOC) nurse, who can recommend targeted treatment and product adjustments.
Integrating Ostomy Care into Daily Life
Living with an ostomy involves adapting lifestyle factors to maintain health and quality of life. Dietary considerations are important, especially for those with an ileostomy, due to the liquid and continuous nature of the output. Maintaining adequate hydration is necessary, particularly during physical activity or in hot climates, as the body absorbs less water from the digestive tract.
Specific foods affect the consistency of the output, which individuals learn to manage through careful diet choices. High-fiber foods, for example, should be introduced slowly to prevent blockages or excessive gas. Consulting with a nutritionist or a WOC nurse helps tailor a diet that minimizes output issues while ensuring proper nutrition and electrolyte balance.
Physical activity is highly encouraged, and having an ostomy does not prevent participation in most sports. Patients must avoid heavy lifting (more than seven or eight pounds) for the first six to eight weeks after surgery to minimize the risk of developing a hernia near the stoma. Swimming is safe with a properly sealed pouching system, and specialized swimwear or supportive garments can help secure the appliance during exercise.
Practical daily adjustments include choosing clothing that secures the pouch, such as higher-waisted exercise wear, for comfort and discretion. For travel, pack twice the amount of supplies anticipated and change the appliance approximately 24 hours before a trip to ensure a secure seal. Emotional adjustment is also a significant part of care, and connecting with support groups or mental health professionals provides valuable perspective on adapting to this life change.