Ostomy Care

What are an ostomy and a stoma?

Sometimes all or part of the bowel or the bladder needs to be removed to treat a disease. The body may then need a new way for bowel movements or urine to leave the body. The surgeon can make a new passageway for bowel movements or urine by making an opening in the belly. The opening is called an ostomy. The surgeon uses part of the bowel (intestine) to create the passageway through this opening. The part of the bowel that is outside the belly and surrounds the opening is called the stoma.

The stoma is protected with an appliance. Many types of ostomy appliances may be used. The appliance may be a cover for the stoma. Or it may be an ostomy bag that collects bowel movements or urine. The type you have depends on your needs and the type of ostomy you have. Discuss the best appliance for your ostomy care with your healthcare provider.

You will need to learn how to care for your ostomy and the appliance.

How do I take care of my ostomy and stoma?

Most hospitals have specially trained staff who will teach you how to change and care for your ostomy. You may want to have family members also learn about your care so they can help you at first and give you support and encouragement.

Changing the ostomy appliance

Some appliances may need to be changed every day. Others can be used for as long as 7 days before needing to be changed. Your healthcare provider will tell you how often you need to change your appliance and show you how to do it.

Covering the stoma

Your provider will teach you how to measure the size of your stoma to make sure you are using the right size of opening in your appliance to cover the stoma. During the first few weeks after surgery, your stoma may get smaller as swelling goes down. You will need to make sure that there is not more than 1/8 of an inch between the stoma and its cover. If there is more space than this, bowel movements or urine may leak onto the skin and irritate it. The appliance will use a sticky material (adhesive) to keep it in place around the stoma. The adhesive may also irritate your skin. You will be able to use a paste, powder, or wipe to help protect your skin from leakage and adhesive. This protective material will also help the adhesive stick to your skin and prevent leaks. If you have skin problems from the adhesive, you may need to use a special belt to keep the appliance in place and support it.

Cleaning the stoma

You will need to clean the area around the stoma well each time you change your appliance. To help prevent skin irritation you will need to make sure all adhesive is removed when you change your appliance. You can do this by taking a shower without the appliance or by cleaning the stoma with warm water. If you use soap to clean your stoma, make sure it is a mild soap. Rinse well to remove all soap before you put on a new appliance.

Emptying an ostomy with a pouch

In most cases, people with an ostomy need to wear an ostomy bag, or pouch, over the stoma to collect stool or urine as it drains. Many ostomy bags have soft coverings so that they will not irritate the skin. Ostomy bags must be emptied regularly so that they do not become too heavy and leak. Some may be opened or unclamped at one end to allow drainage without removing the bag. Other ostomy bags can be removed, emptied, and cleaned before they are reattached. Be sure to follow the manufacturer’s directions for your type of ostomy bag.

Draining an ostomy without a bag

Some types of ostomies allow you to remove bowel movement or urine without using an ostomy bag. They are called continent ostomies. A thin flexible tube called a catheter may be used to drain urine from a urostomy or to drain bowel movement from an ileostomy.

Before you drain your ostomy, wash your hands and remove the stoma cover. Then:

• If you have a urostomy, insert the catheter into your stoma about 3 to 5 inches and let urine drain into the toilet.
• If you have an ileostomy, insert the catheter into the stoma up to a mark set by your ostomy healthcare provider and let bowel movement drain into the toilet.

After draining the ostomy, remove the catheter. Gently clean the stoma with warm water, and place its cover over it. You should then clean the catheter according to manufacturer directions.

Right after surgery, you will need to drain the ostomy with a catheter often. After your body has adjusted to the continent ostomy, you will be able to drain it on a regular schedule but less often.

Irrigation of a colostomy

Some types of colostomies are flushed with water on a regular schedule each day to flush bowel movements from the body. This process of flushing with water is called irrigation. To irrigate the ostomy:

1. Place about 1 quart (1000 cc or mL) of lukewarm water in the irrigation container.
2. Put the cone-shaped end of the irrigation tubing in the stoma.
3. Let the water flow into the ostomy slowly over 5 to 10 minutes. You can control the flow of water by holding the irrigation container no higher than your shoulder. You may also clamp the tubing for a short time if water is flowing into the stoma too fast.
4. After all of the water has flowed into the stoma, you may remove the irrigation tubing and place an irrigation sleeve over the stoma. The irrigation sleeve is a bag with an open end. It lets bowel movements from the stoma drain into the toilet over the next 45 minutes.
5. When you are done, cover the stoma with an appliance. You may choose to use an ostomy bag to protect against any additional drainage. However, some people use an appliance that looks like a bandage, gauze, or a small cap to just protect the stoma. People who choose to use a stoma cover without an ostomy bag should still keep a bag on hand for emergencies.

When should I call my healthcare provider?

Call your provider if:

• You have a fever over 100°F (37.8°C).
• You have unusual drainage from the ostomy site (including bloody drainage).
• Nothing comes out of the ostomy for 4 to 6 hours or more and you have bad abdominal cramps.
• You have a lot of irritation or bleeding where the stoma touches the skin.
• Your stoma has gotten much larger or much smaller than it was.
• Your stoma turns blue or black in color.

For more information, contact:

• The United Ostomy Associations of America
  Phone: (800) 826-0826
  Web site: http://www.uoaa.org
• Wound, Ostomy, and Continence Nurses Society (WOCN)
  Phone: (888) 224-9626
  Web site: http://www.wocn.org