There is a risk for complications during ostomy procedures. Complications include adverse reactions to anesthesia, excessive bleeding, infection, and injury to surrounding organs. There is also a risk for complications that develop after ostomy surgery.
Ostomy surgery is a life-altering event; however, most ostomates are able to resume daily activities. After colostomy or ileostomy, patients no longer have control over bowel movements, and after urostomy, patients no longer control urination. Discharge from the stoma enters a pouch system.
After an ostomy procedure, the stoma is shiny, wet, and red. It is usually round or oval, and gradually shrinks in size during the first few months. It is important that the pouch system fits correctly, so the stoma must be measured frequently, especially during the recovery period.
The stoma does not have nerve endings; therefore, it does not transmit sensations (e.g., pain). It is rich in blood vessels and may bleed slightly if rubbed or irritated. If bleeding is prolonged, or if the discharge from the stoma contains blood, a physician should be notified.
Water cannot enter the stoma, so it is not necessary to cover it while bathing or showering.
Urostomy patients should test the pH level of their urine frequently and can usually maintain the proper level with diet adjustments. Urine that has a strong ammonia odor lacks acidity and may cause irritation and the formation of white, crystallized deposits around the stoma. These deposits can be removed using a solution of vinegar and water.
Peristomal Skin Care
The skin surrounding the stoma (peristomal skin) must be protected from irritating discharge. Discharge that is rich in digestive enzymes, such as from an ileostomy or an ascending colostomy, is particularly irritating to peristomal skin. Carefully cleaning and drying the skin with soap that is residue free, every time the pouch system is changed, is the best way to prevent skin irritation. Moisturizing soaps leave a residue that can interfere with the adhesion of the skin barrier of the pouch system.
Peristomal skin infections (e.g., yeast infection) can result from an increase in the normal fungi on the skin and the accumulation of moisture. Persistent irritation such as redness, rash, breakdown of the skin, and swelling should be reported to a physician.
It is also important to avoid the buildup of adhesives on the peristomal skin. The adhesives used to attach the pouching system are removed using gentle solutions that do not irritate the skin.
While in the hospital, an enterostomal therapist or ET nurse instructs ostomy patients how to change the pouch and care for the stoma and peristomal skin. Many patients experiment with different types of pouch systems to determine which one best suits their needs and their daily routine. The location and type of the stoma affect the choice of pouch system.
It is important that the pouch system is the correct size and the stoma should be measured every time supplies are purchased and whenever the patient's weight fluctuates. The pouch should be emptied several times a day (i.e., after each meal and when it is one-third full).
Ostomy pouches are lightweight, made of an odor-barrier material, and are available in one-piece and two-piece systems that include an adhesive skin barrier and a pouch. They can be transparent or opaque, and are designed to maintain a low profile under clothing and to provide comfort, flexibility, and security. Drainable pouches are equipped with a clip that can be released to allow discharge to drain through an opening on the bottom. Disposable or closed-end pouches are convenient because they are discarded after use. Both types of pouches are available in one- and two-piece systems. There are special pouch covers that may provide ostomates more comfort in social situations.
Urostomy pouches have a valve at the bottom for drainage and an antireflux valve that prevents urine from flowing back against the stoma. Nighttime drainage systems include flexible tubing attached to the valve at the bottom of the pouch that allows urine to flow into a container, preventing the need to empty the pouch during the night. Antireflux valves and nighttime drainage systems reduce the risk for urinary tract infections in urostomy patients.