PATIENT EDUCATION GUIDELINES STOMA MANAGEMENT IN THE HOME

Stoma is a Greek word that means mouth. A stoma is an opening in the abdominal area that is surgically made to change the usual pathway for stool or urine elimination. The stoma is normally red, moist and produces mucus.

Your stoma is part of your intestinal tract. It has the same type of mucous membrane as the inside of your mouth. Your stomas may slightly enlarge or become smaller with digestion and movement of stool through the intestine. Your stoma may bleed slightly when rubbed because of the rich blood supply to the area. This is no cause for alarm.

EMPTYING AND CHANGING THE POUCH

1. Change the pouch as soon as it leaks. Do not tape a leaking pouch to the skin as this may cause skin irritation where moisture and stool are trapped under the pouch.

2. Burning or itching around the stoma may mean that the skin is irritated. In this case the pouch needs to be changed immediately.

3. Empty the pouch when it is 1/3 full to prevent the weight from breaking the seal and causing leakage.

WASHING

1. Wash the skin around the stoma (peristomal skin) with a mild soap to cleanse the area. The peristomal skin should then be rinsed well to avoid any soap residue that could also cause irritation.

2. Ivory and Dial are mild soaps. Do not use soaps that contain lotion, creams or oils.

3. Pat the skin dry, as moisture will keep the pouch from sticking. Gently wipe, do not rub the stoma.

4. A bath or shower may be taken with or without the pouch.

HAIR

Remove hair on the peristomal skin as needed with a blunt-type scissors or an electric razor. Never use a straight or safety razor or razor blades because they could cut delicate tissue and cause bleeding.

Formulated 07/96 CLOTHING

1. Avoid a tight belt because this may cause skin irritation. Pad the belt tabs for a comfortable fit.

2. Wear belts above or below the ostomy pouch to prevent rubbing.

GAS

1. Gas and stool cannot be controlled when you have a stoma because a muscle sphincter is not part of the stoma. The sound of passing gas may possibly be muffled by pressing a hand against the stoma.

2. Release gas in your pouch either by opening the end of the pouch or through the pouch gas-relief valve.

3. Excessive gas can be caused by air swallowing, eating too rapidly, talking while eating, chewing gum, drinking through a straw, drinking carbonated beverages, eating gas-forming foods, and smoking.

FOODS

1. Add foods to your diet gradually, adding one different food at a time to determine how the food affects you.

2. If a food causes problems, stop it and try again later. If it still causes problems, avoid eating that food. You will usually be able to eat the same kinds of food that you ate before your surgery.

3. During the summer and with vigorous exercise, you sweat more, so you may need more liquids and salt. Be sure to ask your physician about recommended liquid intake. Gatorade and chicken bouillon are helpful to replace liquid and salt losses.

ODOR CONTROL

1. A liquid deodorizer can be dropped on a piece of tissue and placed into your pouch. There are deodorizers in pill form.

2. Check with your physician before taking any medications by mouth for odor control.

Formulated 07/96 MEASURING FOR POUCH FIT AND SUPPLIES

1. Remeasure your stoma before ordering a new supply of pouches in case the stoma has become smaller after surgery.

2. The pouch opening should be 1/8-inch larger than the stoma.

3. Skin barriers, if used, should be 1/8-inch larger than the stoma.

4. Always take ostomy supplies with you when you travel. Carry supplies on you and do not check them through with the luggage. Carry an emergency pouch at all times.

IRRIGATION

Ostomy irrigation may vary because of individual differences and types of surgery. Ask your physician and home health nurse for information about ostomy irrigation.

CARE FOR SOR SKIN

When the skin is red and weepy do the following:

1. Wash the skin and pat dry. Do not use alcohol or hydrogen peroxide to clean around the stoma because this can damage the tissue.

2. Paint sore skin very thinly with a liquid antacid, such as Maalox. Allow the liquid antacid to dry until it is chalky. You can use a hair dryer on a low setting to dry the skin. Do not use antacid on healthy skin to prevent skin problems.

3. Dust with Karaya or Stomadhesive powder; rub in the powder, and brush off the excess.

4. Use a skin barrier past, such as Stomadhesive or Hollihesive.

5. Put on the pouch as usual.

6. Consider more frequent pouch changes if the skin is red and irritated.

7. If the skin is red from an improper fit of the pouch, you may need to add convexity. (See Convexity.)

8. Do not use Benzoin on skin around your stoma. Skin preparations should not be used under wafer type barriers because this can result in redness and itching and can actually interfere with the integrity of the barrier.

Formulated 07/96 9. If itching and redness surround the stoma, this can be the sign of a yeast infection. Talk to your physician, as you may need an antifungal powder. Brush off the excess powder before applying the pouch.

CONVEXITY

1. Convexity pouches are used when the stoma is retracted or is flush with the abdomen and has leakage problems. Convexity helps improve the seal.

2. Some pouching systems have built-in convexity; others use a separate, disposable plastic convex insert ring. These are pressed into the flange skin barrier until they are seated under the flange.

WHEN TO CALL YOUR PHYSICIAN

Notify your physician if the following occurs:

1. Your stoma becomes swollen or bleeds constantly (a small amount of blood is normal.)

2. Your stoma changes color or becomes dark purple or black.

3. You do not have a bowel movement for 48 hours.

4. You experience forceful vomiting.

OSTOMY CLUB

You may with to join your local ostomy club. Meetings are held once a month. For information about your local club contact the following organization:

United Ostomy Association 1111 Wilshire Boulevard Los Angeles, CA 90017

SPECIAL TIPS FOR ILEOSTOMIES

1. Expect frequent drainage from ileostomies, especially 30 minutes to 1 hour after a meal. The consistency of the drainage may be somewhat like oatmeal.

2. It is best to change the appliance when the stoma is not draining, such as in early morning before breakfast, or 3 to 4 hours after eating.

Formulated 07/96 3. If the stool is thinner and more watery than usual for 48 hours, notify your physician for an antidiarrheal medicine. Eat bland foods, such as applesauce, rice, bananas, and cereals to thicken the stool.

4. Laxatives should never be taken. If you are taking medicines, check the pouch for pills that have not been digested. Time-release capsules do not work with an ileostomy. Ask your physician to prescribe a liquid form of the medicine.

5. Undigested foods may cause your ileostomy to stop draining. Limit food high in cellulose fiber such as corn, popcorn, nuts, mushrooms, fruit skins and pulp, celery, olives, and Chinese vegetables. If these types of food are eaten, drink extra amounts of liquids.

6. Signs of food blockage include swelling of the stoma, cramping, vomiting, and drainage changes from semisolid to liquid or to no drainage. If you have these symptoms and have eaten fibrous foods in the last 24 hours, suspect food blockage. Drink 2 to 3 cups of hot tea or 8 ounces of grape juice. Lie down and relax for 30 minutes. Check your pouch for stool drainage. If there is no drainage, notify your physician or go to the emergency room. Do not irrigate the stoma or take a laxative.

SPECIAL TIPS FOR UROSTOMIES

1. The normal color of urine is yellow. The amount of liquids that you drink can often change the lightness or darkness of the urine. A dark urine means that you should drink more liquids.

2. Medicines may also change the color urine.

3. Mucus may cause the urine to look cloudy. If there is a lot of mucus, the urinary pouch can become clogged. Drinking increased amounts of water will help thin the mucus.

4. The stoma continuously drains urine. When changing the pouch, a wick may be placed on the stoma to soak up urine. Make the wick out of a rolled piece of gauze, paper towel or tampon.

5. A reusable pouch may be washed and reused approximately 3 or 4 times. Clean the reusable pouches with a mild soap and tepid water, followed by a vinegar rinse. Air dry the pouch, using a folded towel stuffed inside the pouch to keep the sides from sticking together. Permanent faceplates may be scrubbed with a brush and soaked in 1:1 vinegar and tap water solution.

6. During the night connect the pouch to a drainage container. Clean this container as you would the pouch. When hooking the pouch to the night drainage tubing,

Formulated 07/96 leave a little urine in the pouch to start drainage and to keep a vacuum from forming. Place night drainage bags toward the foot of your bed.

7. Urine should be normally acidic. Alkaline urine that constantly bathes the skin and stoma can cause white, gritty skin deposits or a gray, warty look to your skin and stoma. If your physician agrees, taking vitamin C, 500mg 4 times a day, drinking at least 2 quarts of liquid a day, and applying a vinegar solution soak to the stoma will maintain urine acidity and help prevent urinary infection and skin irritation.

8. Vinegar solution is made with white, distilled vinegar and is mixed with equal parts of tap water. A vinegar soak to the stoma is done by placing a small washcloth, wet with the vinegar solution, on the stoma for 20-30 minutes during a pouch change.

9. Report signs of a skin rash, a foul odor of urine, elevated temperature, bloody urine, and side or back pain to your physician.

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