This document discusses colostomies and ostomy care. It describes common medical conditions that may necessitate an ostomy, including imperforate anus, Hirschsprungs disease, inflammatory bowel disease, necrotizing enterocolitis, and spina bifida. It then focuses on ileostomies and colostomies, describing the differences and care involved. The document outlines various types of colostomy pouches, including open-ended and close-ended pouches, one-piece and two-piece systems, and pre-cut versus cut-to-fit pouches. It provides instructions for changing pouches and irrigating a colostomy.
6. Some of the most common conditions that
might necessitate a stoma are:
Imperforate anus: where there is no exit for the
bowel or its contents.
Hirschsprungs disease: where nerves called
the ganglion nerves are missing and waste
matter cannot easily pass.
Inflammatory bowel disease: this includes
Crohns Disease and Ulcerative
Colitis, both inflammatory diseases of the
intestines.
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8. Neonatal necrotising enterocolitis: this occurs
when a portion of the bowel is dead and cannot
function and is most common in premature
babies who weight less than 3 pounds at birth.
In this case a stoma can mean life to a baby.
Spina bifida: where part of the spine fails to
develop properly and in more severe forms of
the disease, the spinal nerves that control the
muscles of the legs, bladder and bowels may be
affected and a stoma needed.
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14. Ileostomy
In an ileostomy the opening is made in the small
intestine – the ileum. An end or loop of the small
intestine is brought through the skin’s surface
on your child’s abdomen and the output then
passes out through the stoma. The ileostomy will
resemble a ‘spout’ because the waste is more
liquid. Due to the fact that ileostomy output
contains digestive enzymes, this can be harmful
to the skin and so requires extra care when
pouching.
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22. What types of products are used for colostomies?
Pouch: There are a variety of sizes and styles of colostomy
pouches. Pouches are lightweight and odor-proof. Pouches
have a special covering that prevents the pouch from sticking
to the body. Some pouches also have charcoal filters which
release gas slowly and help to decrease gas odor. The
following is general information about types of colostomy
pouches:
Open-ended pouch: This type of pouch allows you to open
the bottom of the pouch to drain the output. The open end
is usually closed with a clamp. The open-ended pouch is
usually used by people with ascending or transverse
colostomies. The output from these colostomies is looser
and is unpredictable (does not drain at regular times).
23. Close-ended pouch: This type of pouch is removed and thrown
away when the pouch is filled. Close-ended pouches are usually
used by people with a descending or sigmoid colostomy. The
output from these types of colostomies is firm and does not
need to be drained .
One-piece: A one-piece pouch contains the pouch and adhesive
skin barrier together as one unit. The adhesive skin barrier is the
part of the pouch system that is placed around the stoma and
attached to skin. When the pouch is removed and replaced with
a new one, the new pouch must be reattached to the skin.
24. Two-piece: The two-piece pouch has two parts: an adhesive
flange and pouch. The adhesive flange stays in place while
the pouch is removed and new pouch is attached to the
flange. The pouch does not need to be reattached to the
skin each time. The two-piece system can be helpful for
patients with sensitive skin.
Pre-cut or cut-to-fit pouches: Some pouches have pre-cut
holes so you do not have to cut the opening yourself. Other
pouches can be cut to fit the size and shape of your stoma.
Cut-to-fit pouches are especially useful right after your
surgery because your stoma decreases in size for about
eight weeks.
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28. You will need a plastic irrigating container with a long tube and a
cone to introduce water into the colostomy. You will also need
an irrigation sleeve that will direct the output into the toilet. You will
need an adjustable belt to attach the irrigation sleeve and a tail
closure for the end of the sleeve.
Choose the same time each day when you will not be interrupted to
irrigate your colostomy.
Fill the irrigating container with about 16 to 50 ounces (500 to 1500
mL) of lukewarm water. The water should not be cold or hot. The
amount of water each person needs to put in the irrigating
container varies. Ask your caregiver how much water you will need
to irrigate. Hang the irrigation container at a height in which the
bottom of the container is level with your shoulder. Sit up straight
on the toilet or on a chair next to the toilet.
32. Clean the skin around the stoma with warm water. You may also
use soap but do not use soaps that have oil or perfumes. Pat
your skin dry.
Use a pouch that has an opening that is one-eighth of an inch
larger than the stoma.
Use skin protection products if you have irritated skin around
the stoma. The skin can be treated with these products to
protect your skin and create a dry surface.
Center the pouch over the stoma and press it firmly into place
on clean, dry skin. It may be helpful to hold your hand over the
newly applied pouch for 30 seconds. The warmth of your hand
can help to mold the adhesive skin barrier into place.
Place the old pouch in another plastic bag to be thrown away if
the pouch is disposable. If you use a reusable pouch, talk to
your caregiver about how to clean the reusable pouch.
