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Reasons for an ostomy 

Cancers of the abdomen may involve the intestinal tract and the bladder. Sometimes, your surgeon may have to remove some of your intestine or bladder to remove your cancer. 

 

Your surgeon may have to re-route how you go to the bathroom so you can safely pass your urine or stool. 

 

Various reasons include the inability to reconnect due to tumor blockage and the need for re-routing due to injury/inflammation. Sometimes, an ostomy is created to allow for other parts of your body to heal.

 

Think of your surgeon as a plumber. When there are leaking cracked pipes, the damaged pipes are removed and replaced and or re-routed. Sometimes, pipes can be glued back together, while other times, the structural damage may require a new outlet in the wall for the pipes to go.

 

What is an ostomy? What is a stoma?

An ostomy is when a portion of your intestine is surgically brought through your abdominal wall, and sewn to make an outlet, or stoma, for you to pass urine or stool. 

It can be permanent or temporary.

 

The outlet to the ostomy that sits above the skin is called the stoma. It is pink-red in color and made of a material like the inside of your mouth. It is soft and has no nerve endings and lots of blood vessels. A pouch or bag is worn over an ostomy to collect waste and protect the skin.

Abdominal Cancer Alliance

Reference:
Wound, Ostomy and Continence Nurses Society. (n.d.). The WOCN image library [Image database]. Retrieved May 15, 2024, from https://member.wocn.org/page/WOCNImageLibrary
In-text citation:
(Viable budded stoma; Wound, Ostomy and Continence Nurses Society, n.d.)

See United Ostomy Associations of America, Inc. (UOAA) for more information https://www.ostomy.org/what-is-an-ostomy/

Types of ostomies

Ileostomy- a re-routing of the small intestine by surgically making an opening in the abdominal wall, and creating an outlet with the very end portion of the small intestine. Stool from an ileostomy is usually watery to mushy because it is higher up in the digestive tract.

Abdominal Cancer Alliance

Reference:
Wound, Ostomy and Continence Nurses Society. (n.d.). The WOCN image library [Image database]. Retrieved May 15, 2024, from 

https://member.wocn.org/page/WOCNImageLibrary
In-text citation:
(End ileostomy; Wound, Ostomy and Continence Nurses Society, n.d.)

See United Ostomy Associations of America, Inc.(UOAA) for more information https://www.ostomy.org/colostomy/

Colostomy- a re-routing of the large intestine by surgically making an opening in the abdominal wall and creating an outlet with a portion of the large intestine. The stool from a colostomy is usually pasty to semi-formed.

Colostomy

Reference:
Wound, Ostomy and Continence Nurses Society. (n.d.). The WOCN image library [Image database]. Retrieved May 15, 2024, from vhttps://member.wocn.org/page/WOCNImageLibrary
In-text citation:
(End colostomy; Wound, Ostomy and Continence Nurses Society, n.d.)

See United Ostomy Associations of America, Inc.(UOAA) for more information https://www.ostomy.org/colostomy/

Urostomy- involves the removal of the bladder. A piece of the small intestine is detached from the intestine and used to make into a small tube-like bladder that the kidneys empty into. The urine exits the body via the tube of the intestine that is surgically brought up through an opening in the abdominal wall. 

Abdominal Cancer Alliance

Reference:
Wound, Ostomy and Continence Nurses Society. (n.d.). The WOCN image library [Image database]. Retrieved May 15, 2024, from 

https://member.wocn.org/page/WOCNImageLibrary
In-text citation:
(Ileal conduit; Wound, Ostomy and Continence Nurses Society, n.d.)

See United Ostomy Associations of America, Inc. (UOAA) for more information ​https://www.ostomy.org/urostomy/

How to care for your ostomy

You will receive instruction in the hospital to help guide you on how to care for your new ostomy.

 

You will learn how to go to the bathroom differently. It might take some time to adjust, but after a while it will be a part of your normal routine.

A pouch or bag is cut to fit around the shape of the ostomy portion that is above your skin, otherwise known as the stoma. This protects the skin and collects stool or urine. Your stoma may decrease in size over the first 6-8 weeks after surgery. 

You will learn to empty the bag or pouch when it is no more than ½ full of stool, urine, or gas.

Abdominal Cancer Alliance

The outlet of the pouch is emptied into the toilet and then wiped clean with water, moistened paper towel, or toilet paper. You can sit down to empty it, or stand, depending on your preference.  Pouches/bags are disposable and are typically changed every 3-4 days (twice weekly) or more often if there are any skin issues. Maintenance includes making sure that the outlet of your pouch is clean and that the seal around your skin is intact. If your pouch puffs up with gas, and does not escape via the pouch filter, you can open the outlet to let it out. You can shower or bathe with or without your pouch on.

How to change your ostomy pouch or bag

Ostomy pouches or bags are typically changed every 3-4 days, twice a week, or more often if there is an issue. 

When it is time to change your pouch, make sure you have all of your supplies gathered: scissors, a new ostomy pouch/bag, a measuring tool (your stoma changes size over the first 6-8 weeks), a pen, paper towels moistened with warm water, dry paper towels, and a trash bag/trash can. Set yourself up over the toilet, in a chair, or in front of a bathroom mirror.

  1. Empty your ostomy pouch into the toilet.

  2. Gently remove your ostomy pouch. Pull it gently from the skin with one hand as you push the skin away with the other.

  3. Place the old pouch into a small trash bag, tie it closed, and this can be placed in your regular trash.

  4. Cleanse your skin with warm water on a paper towel or wash cloth. 

  5. Dry your skin.

  6. Inspect your skin for any redness or irritation. The skin surrounding your stoma should be free of irritation and redness. **If you are experiencing issues to the skin around your stoma, reach out to your ostomy nurse or surgeon.

  7. Measure your stoma with the measuring tool. Then, trace the tool on the new pouch and cut the new pouch to the desired size.

  8. Make sure the skin around the stoma is dry.

  9. Peel off the backing of the new pouch you have prepared, line it up, and place over the stoma.

  10. Smooth out all edges of your skin, and press the pouch around the stoma.

  11. Hold your hand over the appliance to provide gentle pressure and warmth helping the pouch adhere to the skin. 

  12. Make sure to close the outlet!

Abdominal Cancer Alliance

Remember: If you are experiencing any skin issues to the skin around your ostomy/stoma, that is not normal. Contact your physician or ostomy nurse. You may need a different pouch, or may require a skin treatment. 

 

For individuals who do not have an ostomy nurse resource locally, consider a virtual ostomy nurse consult via United Ostomy Associations of America, Inc. (UOAA)

https://www.ostomy.org/clinic/

Dietary recommendations after ostomy surgery

Immediately after your surgery, your surgeon will slowly advance your diet.  You will start with only fluids at first and then eventually progress to a low-fiber diet for approximately 4-6 weeks. After surgery the abdomen is swollen and sore, making it harder to digest food. Do not expect to eat 3 full meals at first. When you are starting to eat, choose low-fiber, easy-to-digest foods such as bananas, applesauce, white rice, pasta, and crackers. Consider eating small frequent snacks throughout the day as your body adjusts and recovers. Once you tolerate easy-to-digest foods, you can gradually add new foods each day. Make sure to chew well, have small bites, and take your time eating. Fluids are very important to help your bowels and kidneys work. A good goal is to drink 8-10 cups daily. Try to avoid high-sugar drinks and too many drinks with caffeine. 

Abdominal Cancer Alliance
Abdominal Cancer Alliance

Ileostomy-specific dietary tips: patients with ileostomies have a harder time digesting foods that are high in fiber. Sometimes, high-fiber foods can bunch together in the small intestine and form a blockage. Avoid or limit foods such as corn, celery, nuts, potato skins, cabbage, dried fruit, and fruit peels. Additionally, since patients with ileostomies lose more fluid in their stool, it is important to stay well hydrated: 8 to 10 cups of fluid a day is recommended. Patients with ileostomies should incorporate fluid with electrolytes (sports drinks) to help with hydration. 

 

Colostomy-specific dietary tips: patients with colostomies may experience hard stool and constipation issues. Adequate fluids help soften stool. Adding in more fiber from vegetables and fruits is sometimes needed to help promote regularity. Occasionally, your doctor may have to prescribe medication to help soften your stool.  

Urostomy-specific dietary tips: Dehydration and odor can be prevented by drinking adequate fluids throughout the day, with a goal of at least 8-10 cups of fluids per day.

Refer to United Ostomy Associations of America, Inc. (UOAA) for more specifics from the publication entitled: Eating with an Ostomy; Foods and Their Effects Food Reference Chart for People with an Ostomy

https://www.ostomy.org/wp-content/uploads/2022/02/Food_Reference_Chart_2022-02.pdf

 

For a more comprehensive ostomy nutrition guide, refer to United Ostomy Associations of America, Inc. (UOAA) from the publication entitled: EATING WITH AN OSTOMY A Comprehensive Nutrition Guide for Those Living with an Ostomy

Eating with an Ostom https://www.ostomy.org/wp-content/uploads/2022/02/Eating_with_an_Ostomy_2022-02.pdfy

 

**** For resources in Spanish, visit United Ostomy Associations of America, Inc. (UOAA)

Spanish Ostomy Translations l Uhttps://www.ostomy.org/espanol/nited Ostomy Associations of America

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