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Caring for Your Ostomy What You Should Know

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Caring for Your Ostomy What You Should Know Caring For Your Ostomy What You Should Know Name: ______________________________________________________ £ I have an ileostomy £ I have a colostomy Please bring this booklet with you to the hospital when you come for your surgery. FK.235.Os7.PHC (Nov-16) 1 Introduction We encourage you to use this booklet as one essential component of your ostomy resources. We do not expect you to learn everything while you are in the hospital. While you are here we will do our best to provide you with the knowledge you need to care for yourself after an ostomy. We also encourage you to take time before your surgery to identify some people you can talk to about your feelings. You are also welcome to discuss your thoughts and concerns with an ostomy nurse. An ostomy nurse has special education so they can answer your questions and direct you to the right resource. Caring For Your Ostomy - What You Should Know © 2016 Providence Health Care The information in this book has been adapted from a number of sources – our thanks to all. References available upon request. In particular, we would like to acknowledge the Canadian Association of Enterostomal Therapists (CAET). And thanks also to members, past and present, of the PHC Wound Ostomy team - Pam Bocquentin, Neal Dunwoody, Aleza Moyer, B.J. Paproski, Corina Tezcan, Bethany Thomas, Pam Turnbull and Gwen Varns Edited by Hedda Eyben Illustrations & layout by Gary Cody If you have suggestions for improving this book, please write to: 2 [email protected] Table of contents The digestive tract . 1 What is a stoma? . 2 Types of stomas . 3 Comparing ileostomy and colostomy (table) . .4 Before your ostomy surgery . 6 After surgery . .6 Going home from hospital . .7 Support after you go home . .7 - follow up (surgeon, community care nursing, ostomy nurse) . .7 Learning to care for your ostomy . .8 What is a pouching system? . 8 How long can I wear my pouch, and when should I change it? . .9 When I change my pouch, how do I clean the skin and my stoma? . .10 Emptying your pouch . 11 Bathing and showering . .11 Choosing your pouching system . .12 Supplies . 12 Paying for your supplies . 12 BC Fair Pharmacare Plan . .12 Extended health benefits . 13 Ordering supplies . .13 Supplier information . .13 Considerations for daily living . 14 Going out and about . .14 Activities after surgery (first 6 to 8 weeks) . 14 Activities after surgery (after 8 weeks) . .14 Going back to work . 14 When to get help after discharge . 15 3 Table of contents, continued Skin irritation . .15 Preventing skin irritation . .16 Treating skin irritation . 16 Crusting technique, instructions . .16 Parastomal hernias . .17 What is a parastomal hernia? . .17 Are you at risk for a parastomal hernia? . .17 What are signs of a parastomal hernia? . .18 What should I do if I think I have a hernia? . .18 How do I prevent a parastomal hernia? . 18 Exercises to prevent a parastomal hernia . .19 Living with a parastomal hernia . .20 Dietary considerations . .20 Ileostomy patients: food blockages . .22 - signs of a partial and complete blockage chart . .22 Dehydration . 23 What is dehydration? . 23 How to know when you are dehydrated . .23 How to prevent dehydration . 24 Ileostomy: medications . .24 Colostomy irrigations . 25 What to wear . 25 Changing weight and your ostomy system . .25 Swimming and hot tubs . 25 Intimacy . 26 Travel . 26 Glossary . 27 Resources . .29 “To do” list before coming to hospital for surgery . back cover 4 The digestive tract You will notice changes in your body and your bodily functions after your surgery. To understand your surgery and how it will affect your body, it’s helpful to know how a healthy digestive tract works. The digestive tract consists of the mouth, esophagus, stomach, small intestine (small bowel), large intestine (colon or large bowel), rectum, and anus. Digestion can take from several hours to several days. This is the general process: • as you chew, enzymes in your saliva (spit) start to break down food • when you swallow, food goes from your mouth, down your esophagus, and into your stomach • in your stomach, food is churned and mixed with gastric juices • this mixture is called chyme. It passes through your stomach into your small intestine. In the small intestine the digestion continues. Your body absorbs nutrients. • the small intestine has three parts: duodenum, jejunum, and ileum. In total, it is about 6 meters (20 feet) long. • as the chyme moves through your small intestine, it is digested further. Your body continues to absorb nutrients. By the time it reaches your colon (large intestine) digestion is almost complete. • the large intestine is about 2 meters (6 feet) long and ends at the rectum • in your large intestine, fluid and salts are absorbed, and stool is formed • the stool then passes into your rectum. The urge to have a bowel movement happens when the nerves in the rectum esophagus send a message to your brain. large bowel • your anus is at the end of your rectum stomach small bowel that contains your transverse colon sphincters. This is where your bowel ends ascending descending colon and where your stool colon comes out. small bowel rectum sigmoid colon anus 1 What is a stoma? The terms ostomy and stoma are often used to refer to the same thing but they do have different meanings. An ostomy is part of the digestive tract where part of your bowel is brought through a small opening in your abdomen to empty waste from the body. The stoma is the part of the bowel that you will see on your abdomen. The location of the opening in the bowel identifies the type of stoma. For example: • an ileostomy is a stoma made from the small intestine (small bowel) • a colostomy is a stoma made from the large intestine (large bowel or colon) The stoma is warm, moist and pink or red in color. It looks similar to the inside of your cheek. The stoma does not have any feeling. After surgery, some patients feel discomfort in the abdomen around the stoma. After surgery, the stoma is often swollen. It will become smaller as it heals. This usually takes from 6 to 8 weeks after surgery. The final size of the stoma is different for everyone. The stoma has many tiny blood vessels close to its surface. It may bleed during cleaning. This is normal and should happen less frequently over time. The stoma does not have a sphincter (a muscle to hold it closed). This means that you cannot control the movement of stool or gas. Because of this, the normal practice is to wear an ostomy appliance at all times. End stoma 2 Types of stomas Your surgeon will make either an ileostomy or colostomy. Which one depends on your diagnosis and your medical history. The stoma can be either a loop stoma or an end stoma. A loop stoma is one stoma with two openings: fecal and mucus. The loop stoma is used when the main part of the operation is on the lower bowel. The fecal opening leads from the upper part of the digestive tract (your mouth) to the stoma. It drains stool and gas. The mucus opening leads from the stoma to the anus at the end of the digestive tract. It will sometimes drain mucus. This type of stoma is done so that stool does not go through the lower part of the bowel. This allows the lower bowel to heal after surgery. This surgery is usually temporary. An end stoma has one opening to drain stool and gas. These types of stomas can be temporary or permanent. Your surgeon or ostomy nurse can tell you what type of stoma you have. Loop stoma End stoma 3 Comparing ileostomy and colostomy Ileostomy Colostomy • Opening made in a part of • Opening made in the large the small intestine called the intestine or colon Definition ileum • Can be temporary or • Can be temporary or permanent permanent • May develop a regular pattern • Can happen without warning of bowel movements • Usually a regular flow of stool • Varies between pasty and Bowel • Varies from watery to pasty to formed thick movements • Might also pass mucus (stool • If the rectum remains intact, through the rectum if it has you may occasionally pass output) not been removed mucus from the anus • 1 or 2 bowel movements per • Average 4 to 8 bowel day movements per day • Risk of constipation • Can take laxatives or stool softeners • No risk of constipation • May be possible to irrigate. Constipation • Must never use laxatives • Irrigation is using an enema- like process to empty your bowels routinely. This helps regulate bowel movements. Food • Risk of food blockage (see • Low risk of food blockage blockages page 22) • Restrictions on what you can • No restrictions on what you eat. Your dietitian will give you can eat unless your doctor or more information. dietitian has asked you not to • Important to chew food well. eat certain foods. Eating plan • Do not take enteric or time- • See the handout from the release capsules. dietitian • Talk to your pharmacist before • Important to chew food well. you start a new medication. 4 Ileostomy Colostomy • Very important to increase the amount you drink every day • You should drink 2 to 3 cups • Should drink the same (500 – 750 ml) more fluids amount of fluid in a day as every day after your surgery. people without a colostomy Drinking • Risk of dehydration (see • Exception: If you have a fluids section on dehydration on page medical condition requiring 23) you to drink more or less. • If output is high, your electrolytes can become imbalanced.
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