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After Surgery
This article discusses what to expect following surgery in the way of stoma and peristomal skin care, appliances, diet, etc. Includes photos. • Article added July 21, 2003
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Lifestyle Changes
Ostomy surgery is a life-altering event. After colostomy or ileostomy surgery, patients no longer have control over bowel movements, and after urostomy surgery, patients no longer control urination. Discharge from the stoma enters a pouch system, also known as an appliance.
Stoma Care
After an ostomy procedure, the stoma is shiny, wet and red. It is usually round or oval, and gradually shrinks in size during the first few months. It is important that the pouch system fits correctly, so the stoma must be measured frequently, especially during the recovery period. The stoma does not have nerve endings, therefore, it does not transmit sensations (e.g., pain). It is rich in blood vessels and may bleed slightly if rubbed or irritated. If bleeding is prolonged, or if the stool from the stoma contains blood, a physician should be notified. Water cannot enter the stoma, so it is not necessary to cover it while bathing or showering. |
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Urostomy patients should test the pH level of their urine frequently and can usually maintain the proper level with diet adjustments. Urine that has a strong ammonia odour lacks acidity and may cause irritation and the formation of white, crystallized deposits around the stoma. These deposits can be removed using a solution of 50% vinegar and 50% water. [Top]
Peristomal Skin Care
The skin surrounding the stoma (peristomal skin) must be protected from irritating stool. Stool that is rich in digestive enzymes, such as from an ileostomy or an ascending colostomy, is particularly irritating to peristomal skin. Carefully cleaning and drying the skin with soap that is residue-free every time the pouch system is changed is the best way to prevent skin irritation. Moisturizing soaps leave a residue that can interfere with the adhesion of the skin barrier of the pouch system.
Peristomal skin infections (e.g., yeast infection) can result from an increase in the normal fungi on the skin and the accumulation of moisture. Persistent irritation such as redness, rash, breakdown of the skin, and swelling should be reported to a physician.
It is also important to avoid the build-up of adhesives on the peristomal skin. The adhesives used to attach the pouch system are removed using gentle solutions that do not irritate the skin of the majority of ostomates. [Top]
Pouches and Appliances
While in the hospital, an enterostomal therapist or ET nurse instructs ostomy patients how to change the pouch and care for the stoma and peristomal skin. Many patients experiment with different types of pouch systems to determine which one best suits their needs and their daily routine. The location and type of the stoma affect the choice of pouch system.
It is important that the pouch system is the correct size and the stoma should be measured every time supplies are purchased and whenever the patient’s weight fluctuates. The pouch should be emptied several times a day, for example, after each meal and when it is one-third full).
Ostomy pouches are lightweight, made of an odour-barrier material, and are available in one-piece and two-piece systems that include an adhesive skin barrier and a pouch. They can be transparent or opaque, and are designed to maintain a low profile under clothing and to provide comfort, flexi-bility, and security. Drainable pouches are equipped with a clip that can be released to allow stool to drain through an opening at the bottom. Disposable or closed-end pouches are convenient because they are discarded after use. Both types of pouches are available in one- and two-piece systems. There are special pouch covers that may provide ostomates more comfort in social situations.
Urostomy pouches have a valve at the bottom for drainage and an antireflux valve that prevents urine from flowing back against the stoma. Nighttime drainage systems include flexible tubing attached to the valve at the bottom of the pouch that allows urine to flow into a container, preventing the need to empty the pouch during the night. Antireflux valves and nighttime drainage systems reduce the risk for urinary tract infections in urostomy patients. [Top]
Diet
Patients who have had an ostomy may gradually resume eating a balanced diet, unless instructed otherwise by their physician. Foods and beverages that cause odour and gas and those that are hard to digest should be avoided. Examples of these include the following:
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Ostomy patients may experience constipation and diarrhea. Increasing fluid intake (e.g., 6 to 8 glasses a day) and adding fiber to the diet (e.g., fresh fruits, vegetables, whole grains) helps to alleviate constipation. To reduce diarrhea, limit the dietary intake of fiber and eat white rice, applesauce, bananas, peanut butter, and pasta. Abdominal cramping, prolonged diarrhea, nausea, and vomiting should be reported immediately to a physician.
A reduction in the absorption of fluids and electrolytes following an ostomy and prolonged diarrhea may lead to dehydration. Symptoms of dehydration include the following:
- Dark-coloured urine
- Decreased urine output
- Dry mouth
- Muscle cramps
- Nausea and vomiting
Ileostomy patients must chew food thoroughly and avoid high fiber foods for 6 to 8 weeks. Foods that are high in fiber may cause blockages in the small intestine, especially after surgery, and should be added to the diet one at a time. High fiber foods include the following:
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Urostomy patients should drink plenty of water (64 ounces daily) to reduce the risk for urinary tract infections. Symptoms of infection include the following:
- Back pain
- Fever
- Change in urine pH (e.g., from acidic to alkaline)
- Cloudy, strong-smelling urine
- Loss of appetite
- Nausea and vomiting
Foods such as asparagus, fish, and spices increase urine odour and cranberry juice, yogurt, and buttermilk decrease odour. Various foods, beverages, and medications affect the color of stool and urine. Opaque pouches can be used, if this is a concern. [Top]
Activities
Most ostomates are able to return to work and their other activities after recovery. The recovery period varies, and a physician should be consulted before activity is resumed. It may be helpful to return to work initially on a part-time basis. Ostomy patients may be more comfortable returning to work if relatively private restroom facilities are available and they are able to keep a change of clothes and spare pouches at work.
Sports and leisure activities can also be resumed, with a physician’s permission. Ostomates are not limited in their choices, but special protection for the stoma is necessary for heavy lifting and contact sports.
Patients who travel should keep the ostomy supplies in their hand luggage, store them in a cool location, and pack twice as many supplies as they anticipate needing. Seat belts should not be worn directly across the stoma. [Top]
Support
Because ostomy surgery affects many aspects of life, ostomates may have personal and social concerns. Patients are often unsure about informing casual friends, acquaintances, and co-workers about their surgery. Concerns about intimacy and sexual relationships are also common. Enterostomal therapists (aka ET nurses who specialize in care for ostomy patients) are valuable resources for all concerns following an ostomy. They can often recommend support groups for ostomates, such as LDOA. [Top]
Sources and Credits
Excerpts in this article were obtained from:
Health Communities web site
Oncology Channel pertaining to ostomy lifestyle
Oncology Channel pertaining to ostomy management
Disclaimer • This site and its contents are presented expressly for informational purposes only about London & District Ostomy Association (LDOA) and gastrointestinal and/or urinary diversions in general. In no way are any of the materials presented here meant to be a substitute for professional medical care or proper attention by a qualified physician, nor should they be construed as such. Always check with your doctor or ET if you have any questions or concerns about your condition or before starting a new program or treatment. The Webmaster and LDOA are not responsible or liable, directly or indirectly, for any form of damages whatsoever resulting from the use (or misuse) of information contained in or implied by this site.
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