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 1 ColostomyBooklet 8/6/2005 12:12 Page 2 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. 1 ColostomyBooklet 8/6/2005 12:13 Page 3 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 2 ColostomyBooklet 8/6/2005 12:13 Page 4 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. 3 ColostomyBooklet 8/6/2005 12:13 Page 5 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). 4 ColostomyBooklet 8/6/2005 12:13 Page 6 Three types of stoma constructions An end stoma A loop stoma A divided stoma 5 ColostomyBooklet 8/6/2005 12:13 Page 7 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 6 ColostomyBooklet 8/6/2005 12:13 Page 8 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 7 ColostomyBooklet 8/6/2005 12:13 Page 9 notice any swelling, redness or rash, you could have irritated skin.