General Ostomy Tips
Appliance Adherence Issues
Letting pouch get too full. The weight of the output (aka effluent) pulls at the seal of the skin barrier to your skin.
Empty pouch when 1/3 -1/2 full, preferably when 1/3 full.
If you have high output overnight as some urinary diversions do and some ileostomies, use an extra collection bag that connects the pouch with tubing to a larger bag known as a bedside drainage system.
Use a belt to provide a mechanical support if your stoma is near the waist line. If the stoma is elsewhere on the abdomen a binder or a hernia belt may help.
Moisture under the skin barrier not from output leakage—If you tend to sweat/have moisture under the skin barrier try applying an aluminum chloride hexahydrate antiperspirant to skin prior to a skin barrier application. Example: Drysol, Driclor.
Too much hair on skin- the skin barrier cannot adhere well if there is a lot of hair to pouch over. Use a battery or electric razor to prevent nicks of the skin that can lead to infections. It is preferred to have one razor dedicated for this purpose. There are little wand battery operated razors for roughly $10-20.
Warming the skin barrier and barrier rings next to your skin for a minute or so prior to putting them on. This activates the polymers (which then flow onto the skin filling creased and crevices) and tackifers (the adhesives that provide the stickiness) in the skin barrier. The moldable barriers may not need warming. Skin barriers also need gentle mechanical pressure applied after placed on the skin using your hand and possibly an ostomy belt.
Having clean skin—make sure to clean off old adhesive by using an adhesive remover, rinse off any soaps used, no oily products/ointments on the peristomal skin.
Use of hydrocolloid flange extenders (semi-circle in shape) that go over the edge of the skin barrier backing thus giving extended support to help increase the wear time of the appliance system.
Ostomates can develop this problem when the muscle around the stoma is weak and allows loops of bowel to push up next to the stoma under the skin. It is a defect in the muscle/fascia. A hernia may look like a hump, bulge, or flat area around the stoma.
It can present an issue with getting a good pouch appliance seal.
50% of colostomy patients develop a hernia like this and often in the first 2 years. If there is pain, cramping, nausea/vomiting, abdominal distention in the area, or decreased output with a hernia consult your doctor right away. Urostomy patients aren’t as likely to develop a hernia yet the tips are helpful none the less.
To help prevent a peristomal hernia—support your cough by using your hand to hold your abdomen, use support garments like Spanx, bike shorts, abdominal binders, or a hernia (ostomy support) belt. Make sure none of these items put pressure directly on the stoma. There are ostomy support belts/hernia belts that are made especially for ostomy patients with an opening for the appliance to fit through. If your insurance will cover the support belt, obtain a prescription from your doctor for an “ostomy support belt”. Celebration and Nu-Hope are 2 of the companies that carry ostomy support belts.
Alkaline Encrustations (AE) and Urostomies
These are Crystal-like formations on exposed peri-stomal skin. Associated with alkaline urine and/or concentrated urine that pools on the skin, renal stones, and urinary tract infections.
Tips to combat AE:
Karaya (Hollister) barrier is a hydrophilic which is mildly acidic pH and helps with decreasing encrustations.
Use a pouch with anti-reflux mechanism.
Control moisture leakage— maintain a good seal.
Maintain urine pH as close to 6 as possible by increasing oral fluid intake if no contraindication for this, take ascorbic acid- 1 gram a day is recommended.
Apply vinegar soaks at 33% or 50% strength during pouch changes—2 times for 5 minutes then lightly flick or gently rub the encrustations to loosen them. The skin may bleed some when manipulating the AE with treatment or pouch changes. If bleeding becomes an issue, silver nitrate treatment may be needed at the doctor’s office or wound care center.
High fluid intake to help prevent Urinary Tract Infections –8-10 glasses of water a day
Drink cranberry juice instead of OJ or citrus juices for these juices make urine more alkaline, while cranberry juice tends to make urine more acidotic.
If okay with your doctor, take vitamin C daily.
Eat an Ash Diet—which is more meats and cereals rather than fruits and vegetables which cause alkaline urine. Again, if your doctors are in agreement based on other disease processes you may have, this is a recommended diet.
This mostly affects the colostomy population but can also affect those with ileostomies. The fecal output sticks to the inner walls of the pouch and does not advance into the pouch.
The output can build up over stoma and lift the pouch off the skin.
It is caused by pouch static cling from the two sides of the pouch rubbing together and/or with filtered pouches–the filters on the pouches eliminate the air in the pouch causing a vacuum.
Fixes: pull air in the pouch–with either a 1 or 2 piece pouch system open up the pouch at the end (a 2 piece system can also be opened at the top seal) and pull the plastic layers apart; cover the pouch filter with a sticky patch that should come in the pouch box (except Hollister); use unfiltered pouches; or use a stomal lubricant that prevents static formation.
FLUID AND ELECTROLYTE BALANCE FOR THE ILEOSTOMATE AND ASCENDING/ TRANSVERSE COLOSTOMATES.
Diarrhea occurs when output is 1100 ml or more in 24 hours—roughly 4-5 cups of output. Diarrhea can/will lead to electrolyte wash outs of sodium, potassium, calcium and magnesium. All play a role in cellular function and muscle function. If you experience muscle cramps, muscle spasms, or numbness of extremities not related to diabetic or vascular problems then your electrolyte balance could be off. Don’t forget about the magnesium—it is the forgotten mineral/electrolyte but it has important roles.
Ask your doctor to do blood work looking for all these electrolytes when you are having a hard time keeping your fluid balance, balanced.
What to do if having increased output/diarrhea:
Eat thickening foods: bananas; boiled rice; potatoes without skins; cheese; gelatin products—jello, pudding, marshmallows; creamy peanut butter, tapioca pudding, pumpkin.
Drink fluids with electrolytes in them—be aware while sugar (glucose) is needed to transport the electrolytes into your body through digestion that those products with high glucose will not help as well. High glucose levels in foods can increase output. Consuming sugar substitutes may also cause bowel cramping and increased output.
Use oral re-hydration therapy to replace salt, potassium and other minerals when symptomatic of dehydration and your doctor agrees. You can make your own recipe or buy pre-made packets of powder to dissolve in water.
If not contraindicated by another disease process, add more salt to your diet during high output times.
Take magnesium supplements with food for it can increase output. Magnesium is not found in the sport drinks, but is found in small amounts in bananas and orange juice, chocolate milk.
General diet tips: a low glycemic diet or a FODMAP (from Stanford University studies) may be a diet style that helps decrease output for a high motility bowel. A dietician may also be able to assist in diet issues.
If you have a rectum that is intact after surgery, you will have mucous, old blood, and possibly old stool that will cause pressure and feel like you have to have a bowel movement at times in the post-op period. This is normal. It may cause an urgent feeling, you may have leakage at times, but the good news is– you will be able to develop control of the output. The mucous lining of the bowel/rectum will continue to produce mucous, and at times the output will be mucous like or possibly balled up dry mucous, this too is normal. Until control over the output is obtained, you may want to wear a small peri pad or liner.
When the pouch needs to be changed and there is high output, eating marshmallows 30-60 minutes before the pouch change can help stop output for a short time. Some report needing only 1 marshmallow while others say they have to eat 6. For some it does not work at all. The pectin/gelatin is thought to help slow the output.
A blockage can occur for colostomy or ileostomy patients. It can be caused by scar tissue (adhesions) or food. Food can cause blockages most often for ileostomates. Symptoms of a blockage: pain, cramping, decreased output to no output, stoma changes may also occur.
Tips that may help avoid a blockage:
Remember moderation in food. Alternate between eating each item on your plate.
Chew food well, drink fluids with meal, avoid foods that are high in fiber and known to cause blockages (popcorn, corn, nuts, beans, strawberries, grapes, things with skins/peels that you eat), and limit conversation while eating. If you eat these foods, limit the size of the portion, eat them with other foods and you may want to peel the skins off foods to avoid the food getting impacted in your bowel near the area where the bowel enters the muscle of the abdomen.
After surgery start introducing foods into your diet slowly, adding one food at a time, and use low fiber foods. Also avoid straws for a lot of air will enter your gut by way of the straw causing gas and cramping.
If you notice symptoms of a blockage, try grape juice (can be a laxative effect), draw your knees to your chest to help relax muscles, and take a warm shower/bath or put warm packs on your abdomen avoiding the stoma. These ideas can often work.
If the blockage is not relieved by these methods quickly, then seek medical assistance quickly.
Ideas compiled by Stephanie Short, RN, BSN, OMS
Another Source of Information is the Basic Ostomy Skin Care from the WOCN Society