Patient Education Series Managing Your Colostomy ColostomyBooklet 8/6/2005 12:12 Page 1

Table of contents About your colostomy • The human digestive system ...... 1 About your • What is a colostomy? ...... 3 colostomy •Types of colostomies ...... 4 • Three types of stoma constructions ...... 5 Every year, thousands of people have colostomy surgery. For some, the surgery is a lifesaving Colostomy pouching systems procedure. For others, the surgery relieves years of suffering from • One-piece system ...... 6 bowel disease. Whatever the •Two-piece system...... 6 medical reason, anyone who is going to have colostomy surgery •Drainable pouch ...... 6 has many questions and concerns. •Closed pouch...... 7 The purpose of this booklet is to • Irrigation ...... 7 answer some of your questions about colostomy surgery and to ease some of your concerns about Lifestyle living with a colostomy. It will help you manage and understand your • Skin care ...... 7 colostomy. It is important to • Diet ...... 8 remember that you are not alone. • Odour...... 8 This booklet is provided to you by your health care team and • Gas...... 9 supplements other information • Diarrhoea...... 10 given to you by your doctor and ET nurse – a nurse who •Alcohol...... 10 specialises in ostomy care. •Medication...... 11 Remember to write down your questions and discuss these with • Bathing or showering ...... 11 your doctor or ET nurse. • Clothing ...... 11 • Returning to work and travelling...... 12 • Exercise and sports ...... 12 Your ET nurse: •Sex and personal relationships ...... 12 ...... • Religion ...... 13 Contact numbers: • Routine care of your colostomy ...... 14 ...... Glossary ...... 16

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Oesophagus

Stomach

Colon

Small Intestine

Rectum

Anus

The human digestive system

When you chew your food and swallow it, your food goes down your oesophagus into your stomach. Stomach acids and chemicals called enzymes break down the food until it becomes a liquid mixture. From your stomach the liquid food mixture goes into your small intestine.

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The small intestine, which is about six metres (20 feet) long, is where most digestion takes place. The small intestine is divided into three sections. The first section is called the duodenum, the second section is called the jejunum, and the third section is called the ileum. As the liquid food mixture moves through the small intestine, nutrients are absorbed into your body’s blood stream. Vitamins, minerals, proteins, fats and carbohydrates are all absorbed into your body through your small intestine. Any food that is not digested and absorbed in the small intestine goes into the large intestine as liquid waste, or stool. Your large intestine is also called the colon. It is generally about two metres (5-6 feet) long. The purpose of the colon is to absorb water from your stool, and to store the stool until you have a bowel movement. The colon is divided into four parts: the ascending colon, the transverse colon,the descending colon and the sigmoid colon. As the stool moves through your colon, more and more water is absorbed until the stool becomes completely formed. When you have a bowel movement, the stool goes from your colon into your rectum, and then out of your body through your anus. A muscle in your anus, called the anal sphincter, allows you to control when to have a bowel movement.

Transverse colon

Ascending colon

Descending colon

Sigmoid colon Rectum

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What is a colostomy?

A colostomy is a surgically created opening into the colon — through the abdomen. The purpose of a colostomy is to allow stool to bypass a diseased or damaged part of the colon. When a person has a colostomy, stool is no longer eliminated through the anus. Instead, stool is eliminated through the colostomy. The colostomy Stoma does not have a sphincter muscle, so a person • Not painful who has a colostomy has no voluntary control over • Always red and moist bowel movement. Instead, the person wears a • May bleed easily disposable pouch to collect the stool. A colostomy may be temporary or permanent, depending on the medical reason for the surgery. To construct a colostomy, the surgeon brings part of the person’s colon through the abdominal wall. This new opening on the person’s abdomen is called a stoma. The skin around the stoma is called the peristomal skin. Each person’s stoma is unique. Chances are your stoma will look different from another person’s stoma. There are no nerve endings in the stoma, so the stoma is not painful. The stoma is always red and moist – somewhat like the inside of a person’s mouth. The stoma may also bleed easily, especially if it is hit or rubbed. This type of minor, temporary bleeding of the stoma is normal. However, if the bleeding continues, or if the discharge (stool) from the stoma is bloody, you should contact your doctor or ET nurse. Your stoma will probably be swollen after surgery. It may take several weeks for the stoma to shrink to its permanent size. If you have a temporary stoma, it may be a loop or a double barrel. A loop colostomy may have a supporting device that is normally removed after two weeks.

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Types of colostomies

A colostomy can be made at almost any point along the length of the colon. Where your colostomy will be depends on the medical reason for your surgery.

Ascending Ascending colostomy made from the colostomy ascending part of the colon • Output: liquid or paste-like stool • Pouch: one-piece drainable, or two-piece drainable.

Transverse colostomy made from the transverse part of the colon Transverse colostomy • Output: paste-like or semi-formed stool • Pouch: One-piece drainable, or two-piece drainable.

Descending colostomy – made from the descending part of the colon • Output: Almost completely-formed stool Descending • Pouch: One-piece drainable, one-piece colostomy closed, two-piece drainable, or two- piece closed, or stoma cap (if you irrigate).

Sigmoid colostomy – made from the sigmoid part of the colon • Output: Fully-formed stool Sigmoid • Pouch: One-piece drainable, one-piece colostomy closed, two-piece drainable, two- piece closed, or stoma cap (if you irrigate).

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Three types of stoma constructions

An end stoma

A loop stoma

A divided stoma

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Colostomy pouching systems

You can choose the kind of Hollister colostomy pouch you want to use. The two main types are drainable and closed. Both types include a skin barrier. The skin barrier protects your skin and attaches your pouching system. Your pouch may be part of a one-piece or two-piece pouching system.

One-piece system One-Piece Drainable In a one-piece system, the skin barrier is already Pouch attached to the pouch. This means that the one- piece is easy to apply. You just cut, peel and stick.

Two-piece system A two-piece system is the most versatile. It comes with a skin barrier that is separate from the pouch. The pieces snap together with a flange, a part that looks like a plastic ring. It is easy to unsnap the pouch and discard the pouch as often as you like. Two-Piece Drainable Many pouches have clear or beige options. You Pouch can also select pouches that have a soft cover, such as the Hollister ComfortWearTM panel, to increase your comfort. You might choose a pouch with a filter if your Closed drainage is mostly solid. The filter lets the gas out, Poach and not the odour. It also prevents gas from building up, so the pouch does not inflate like a balloon. Hollister provides odour barrier pouches to increase your confidence when wearing a pouch.

Skin Barrier Drainable pouch Drainable pouches are best if you have discharge

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Lifestyle tips: frequently throughout the day. They have a clamp • Eat a balanced diet or closure, so emptying the pouch is quick and easy. • Eat slowly and chew your food well • Add foods to your diet Closed pouch gradually, to see how If you use a closed pouch, you can simply remove those foods agree with it and throw it away. This type works best if your your system discharge is less frequent and your pouch needs • Everything in moderation is a good rule to follow to be emptied just one or two times a day. Closed pouches are not emptied, they are replaced when they are a quarter to half full, or after each bowel movement.

Irrigation Irrigation can sometimes be an option for a person who has a descending colostomy or a sigmoid colostomy. The purpose of colostomy irrigation is to allow the person to have control over a bowel movement. Irrigation trains the colon to empty at a regular time each day. Irrigation is somewhat like an enema through the stoma. It is very important to learn the technique of irrigation from a healthcare professional. If you are interested in irrigation, ask your ET nurse for more information.

Skin care It is very important for the skin around the stoma (the peristomal skin), to remain healthy and free of irritation. The peristomal skin should look just like the skin elsewhere on your abdomen. To prevent skin irritation or other skin problems, you must have a skin barrier and pouch that fit properly. Each time you remove your skin barrier and pouch, look carefully at the peristomal skin. If you

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notice any swelling, redness or rash, you could have irritated skin. Sometimes – but not always – irritated skin is painful. If the problem persists for more than two pouch changes contact your ET nurse.

Diet Having a colostomy does not mean that you will have to be on a special diet. Remember that the actual digestion of food takes place almost entirely in the small intestine – not the colon. Immediately after your surgery, your doctor may prescribe a special diet. However, after your recovery period, you should be able to go back to a normal diet. There are some foods that can cause odour or gas in your system. If that is a concern for you, you may want to eat those foods in moderation.

Odour Odour is a major concern for people who are about to have colostomy surgery. Today, colostomy pouches are made with odour-barrier film, so odour from the stool is contained inside the pouch. If the pouch is clean, and is applied properly, you should notice odour only when you are emptying or changing your pouch. Should you notice odour at any other time, check the pouch seal for leakage. You should empty your pouch when it is necessary and convenient; for many people, that means one to three times a day. Emptying your pouch regularly can help reduce the risk of leakage. Also, regular emptying can help to avoid pouch bulge. Sometimes, certain foods or medications can affect

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the odour of stool. If odour is a concern for you, you may want to avoid foods that increase odour. Foods that may increase odour: • Asparagus • Eggs • Broccoli • Fish • Brussel sprouts • Garlic • Cabbage • Onions • Cauliflower • Some spices

Gas The amount of gas that a person’s system generates depends on the individual. If you had problems with excessive gas before surgery, you will likely have the same problems after your surgery. Intestinal gas can sometimes be the result of swallowing air. Drinking carbonated beverages, smoking, chewing gum and chewing with your mouth open, can all increase the amount of air you swallow. Gas can be caused by the food you eat. If gas is a problem for you, you may want to avoid certain gas-forming foods.

Foods and beverages that may increase gas: • Beans • Cauliflower • Beer • Corn (mealies) • Broccoli • Cucumber • Brussel sprouts • Mushrooms • Cabbage • Peas • Carbonated • Spinach beverages

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Lifestyle tips: Diarrhoea • If you get diarrhoea, increase the amount of Diarrhoea can occur for a variety of reasons. With fluids you drink a colostomy, you can still get diarrhoea, just as • If you irrigate your before your surgery. colostomy, stop irrigating until the diarrhoea stops. Foods and beverages that may thicken your After the diarrhoea stops, stool: you can resume your If you get diarrhoea, there are some foods you can normal schedule of irrigation eat that will help to thicken your stool. • If the diarrhoea continues, call your ET nurse or your • Apple sauce • Peanut butter doctor (creamy not chunky) • Diarrhoea that lasts too long can cause • Bananas • Pretzels dehydration • Buttermilk • Rice • Cheese • Tapioca pudding • Marshmallows • Toast • Milk (boiled) • Yoghurt • Noodles (any type)

Avoid foods and beverages that may cause loose stool.

Foods and beverages that may cause loose stool: • Beer or • Fresh fruits other alcohol (except bananas) • Broccoli • Prunes or prune juice • Green beans • Spicy foods • Grape juice • Spinach

Alcohol Alcohol can still be taken, but in moderation. Over indulgence in alcoholic beverages may cause problems with the emptying or changing of the

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Lifestyle tips: pouch. Carbonated drinks such as beer may cause • Choose a patterned swim an increase in the amount of gas passed. suit, instead of one with a solid colour • Men can wear athletic Medication supporters Any medication you take will work just as • Women can wear panty effectively as before. Prescription drugs, vitamins, hose or girdles aspirin (or aspirin substitutes, such as Tylenol), and other medication will continue to be absorbed into your body just as before your colostomy. Some medications may change the colour, odour or consistency of your stool. Non-prescription medications, like antacids, can cause constipation or diarrhoea. Antibiotics may make your stool thinner than normal, and may even cause diarrhoea. If you have questions about any medications you are taking, ask your doctor, ET nurse, or pharmacist.

Bathing or showering With a colostomy, you can shower or bath just as you did before. Soap and water will not flow into your stoma or hurt it in any way. You may choose to shower or bath with your pouch on or off – the choice is yours. Because soap residue can sometimes interfere with how well the skin barrier or adhesive sticks to your skin, avoid soap that leaves a residue on your skin. Choose a soap or cleanser that is residue-free.

Clothing After colostomy surgery, many people worry that the pouch will be visible under their clothing. Some people think they won’t be able to wear “normal” clothes, or that they will have to wear clothes that are too big for them. The fact is you should be able to wear the same type of clothing

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Lifestyle tips: you wore before your surgery. Also, today’s • When flying, keep your pouches are so thin and fit so close to the body, ostomy products with you chances are no-one will know you are wearing a in your carry-on bag, not pouch – unless you tell them. in your checked luggage • Air pressure in aircraft will not affect your pouch Returning to work and travelling • Fasten the seat belt above or below your stoma As with any surgery, you will need to allow some • Do not leave your ostomy recovery time. Recovery from this type of surgery products in a hot car – can take from six to eight weeks. You should the adhesives can melt check with your doctor before returning to work. • When you are away from home for extended periods After your recovery, you should be able to return of time, know where to to work, or travel just about anywhere. contact a local ET nurse Your colostomy should not limit you. Colostomy • General travellers’ guidelines to avoid an products are available through medical or surgical upset stomach when retailers in nearly every country in the world. Of travelling still apply to course, it is always a good idea to take your own ostomates supplies with you when you travel – and always take more than you think you will need.

Exercise and sports A colostomy should not prevent you from exercising or from being physically active. Other than extremely rough contact sports or very heavy lifting, you should be able to enjoy the same type of physical activities you enjoyed before your surgery. People who have colostomies are able to swim, water ski or snow ski, play golf, tennis, volleyball, or softball, hike, sail or jog just as well after their surgery as they did before.

Sex and personal relationships Because colostomy surgery is a body-altering procedure, many people worry about sex and intimacy, and about acceptance by their spouse or

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Lifestyle tips: loved one. For people who are dating, a big • Before swimming, it is a concern is how to tell someone about the good idea to empty your colostomy. pouch • You may add tape to the It is important to remember that supportive edges of your skin barrier personal relationships can be major sources of before swimming healing after any type of surgery. It is also • You may need to change important to let your partner know that sexual your pouch more often if activity will not hurt you or your stoma. you wear it in a jacuzzi or sauna Colostomy surgery affects both partners in a relationship, and it is something to which both Lifestyle tips: partners must adjust – each in his or her own • Empty your pouch before way. The key, of course, is understanding and having sexual relations communication. • Sexual activity will not hurt you or your stoma If having children is a concern, you’ll be happy to • During sex, you may know that after a satisfactory recovery, it is still prefer to wear a small possible for a woman who has a stoma to have pouch or stoma cap children. Also, many men have become fathers • A beige pouch or pouch cover can help to hide the after having colostomy surgery. If you have pouch contents questions about pregnancy, don’t hesitate to ask • Intimate apparel can hide your doctor or your ET nurse. the pouch and keep it close to your body Religion The Islamic faith has definitive rules that must be followed in preparation for and during the time of prayers. The question has arisen about the wearing of a pouch during the time of prayer. According to Chairman of the Fatawa Commission of AL-AZHAR, Abd Allah Abd-Alkalik Al Mishad, any person who has a stoma is considered to have a legitimate excuse, as a stoma patient cannot replace the pouch for each prayer. The patient may, at the onset of the prayer interval, perform absolution and then pray as many times as he wishes during this prayer interval. At the onset of a new prayer interval, the absolution performed in the last interval is no longer valid and the stoma patient should perform a new absolution for the

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new prayer interval and so on (for each of the five prayer intervals). Reference: J.W. Birkbeck (USA) 2001 Fatwa about preparation for prayer for Muslim ostomates.

Routine care of your colostomy When your doctor says it is appropriate, you can resume your normal activities. You will get used to your Hollister pouch system and develop a schedule that fits your lifestyle. Here are a few guidelines for successful care of your colostomy: • Empty your pouch when it is one-third to one- half full • Replace the skin barrier, the waxy part that sticks to your skin, every three to seven days • If you use soap, make sure your soap does not contain oils or lotions that can interfere with adhesives • Rinse your skin with water, and dry it completely, before you apply the new pouch • After you apply your skin barrier, hold it against your body for 30–60 seconds. The pressure and warmth help activate the adhesive • If you wear a two-piece system, try putting your skin barrier on at an angle, making a diamond shape, for a smoother fit • You can shower or bath with your skin barrier and pouch in place, or you can remove them before bathing. Water will not harm or flow into your stoma • If your skin becomes red and sore, or your pouch is not staying in place, be sure to see your doctor or ET nurse

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Call your ET nurse if you notice the following: • Skin irritation • Recurrent leaks around your pouch or skin barrier • Excessive bleeding of your stoma • Blood in your stool • A change in the colour or consistency of your stool • A bulge in the skin around your stoma • A stoma that appears to be getting longer

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Glossary

Anus The opening of the rectum; the last section of the digestive tract where waste is expelled. Colon Another term for the large intestine or last portion of the gastrointestinal tract. Colostomy An ostomy (surgical opening) created in the colon. Enzymes Digestive enzymes break down the food we eat so it can be used as a source of nutrition. Large intestine Another term for the colon or the last part of the gastrointestinal tract. One-piece The skin barrier is attached to the pouch. Peristomal skin The skin around the stoma. Pouch The bag that collects the discharge from the ostomy. Rectum The lower end of the large intestine, leading to the anus. Skin barrier Part of the pouching system; it protects your skin and adheres to your pouch. Small intestine The section of the gastrointestinal system that first receives food from the stomach. Divided into three sections: duodenum, jejunum and ileum. Sphincter A muscle that surrounds and closes an opening. A stoma does not have a sphincter. Stoma Another term for ostomy, a surgically created opening. Stool Waste material from the bowel. Also known as faeces or bowel movement. Two-piece The skin barrier is separated from the pouch. Both pieces are needed to create a complete pouching system.

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Toll Free: 0800 002 909 Hollister South Africa (Pty) Ltd www.hollister.com PO Box 5097 Halfway House www.ostomyworld.com Johannesburg 1685 Tel: +2711 314 4898 Fax: +2711 314 5365 Hollister and logo, are trademarks of Hollister Incorporated. Toll Free: 0800 002 909 © 2004 Hollister S.A. E-mail: [email protected] 000/2168/10/4 COMMUNICATIONS GRANT-MARSHALL