For some medical problems involving the large intestine, also known as the colon, a new passage must be created to allow stool to leave the body. An opening in the abdominal wall is created surgically, through which the colon is connected to the outside abdominal wall. This is known as a colostomy.
Who is a candidate for the procedure?
A person may need a colostomy if he or she has had cancer, an infection, inflammation, or blockage in the bowel. Bowel defects or injuries might also result in a colostomy.
The underlying condition that leads to a colostomy will affect a person's emotional, psychological, and physical recovery from surgery. A colostomy may be temporary or permanent.
How is the procedure performed?
Colostomy education begins before surgery. Diagrams, photographs, and examples of equipment are used to help to explain what the person might expect after surgery. Concerns about upcoming changes in body image, lifestyle, and sexuality are also addressed.
When a person has a colostomy, a team of healthcare professionals provides education and initial care. These may include a doctor, nurse, social worker, and dietitian. An enterostomal therapist, known as an ET, might also help with care. ETs are usually registered nurses who have had specialized training and certification in the care of ostomies and wounds.
People with colostomies are given information and training specific to their needs. Ongoing care may often extend well beyond the initial hospital stay. The colostomy will begin to function 3 to 6 days after surgery. At first, a nurse or ET will take care of the colostomy. This person will also teach the person how to care for the colostomy on his or her own. Gradually, the individual will be able to take over the care of the stoma and the skin around the stoma.
The stoma is red and oval-shaped It resembles the skin on the inside of the lower lip. A drainage bag or pouch is attached to the skin around the stoma, into which the stool drains. The stoma size determines the size of the pouch. The size of the stoma may vary at first due to swelling and weight fluctuation. The stoma is often checked 3 weeks after surgery, when swelling has subsided. The final size and type of pouch used will be set about 3 months after the colostomy, when a person's weight and size are likely to be stable again.
A healthcare professional may suggest using nystatin powder (i.e., Mycostatin, Nyamyc, Pedi-Dri) on the skin around the stoma to combat irritation or yeast growth. A skin barrier, which may be a wafer or paste, is then applied to protect the skin from bowel contents draining through the stoma. The backing of the adhesive surface of the pouch is removed. The bag is then pressed down around the stoma for 30 seconds.
The pouch should be removed and drained when it is one-third to one-fourth full. If the pouch becomes too full, the weight could cause the bag to come off and spill.
Colostomy irrigation, a procedure in which fluid is inserted into the bowel through the stoma, might be used to regulate the passage of stool. This helps avoid constipation. The healthcare professional will advise when and how to perform irrigation.
A registered dietitian can help a person with a colostomy choose a balanced diet.
It may be helpful to avoid some foods, such as those that cause gas and odor. These foods include:
Foods or fluids such as fruits, coffee, carbonated beverages, or high-fiber items may cause diarrhea. Foods with hard-to-digest kernels, such as popcorn, may need to be avoided as well. Non-irritating foods can be substituted for those that must be restricted.
Textbook of Medical-Surgical Nursing, Ninth Edition, 2000, Smeltzer, et al.