Those with stomas can face some challenging events, some minor, some major. The minor episodes can be treated easily while the major incidents may require more serious treatments.
The most common challenge is frequent leakage of the pouching system. Many factors can lead to leakage such as:
Another issue is something called “pancaking". This is when thick pasty stool remains at the top of the pouch at the level of the stoma. When this happens, stool is pushed under the opening of the wafer.
The first resolution is to increase fiber in your diet. This will bulk up the stool, creating form. This should prevent the stool from remaining at the level of the stoma. The second option is to take a stool softener daily (MiraLax or Colace are good choices). This will thin the stool, allowing it to fall into the pouch. Keep in mind, the stool should not be watery. If it is, decrease the amount of stool softener you are taking. Another option is to try a Lubricating Deodorant such as Hollister’s Adapt or Coloplast’s Brava.
With frequent leakage, skin irritation will occur. In order to improve the condition of the skin, we need to correct the reason for leakage. Skin irritation and breakdown will heal quickly once stool no longer comes in contact with the skin. When redness occurs, stoma powder can be applied to the redness (tap off the excess to avoid creating an uneven surface on the skin). Apply a skin barrier film over the powder, spray form is easier but if you have a wipe, dab over the powder (there is enough on the pad to soak into the powder). 3M Cavilon No Sting Barrier Film is one of the best.
A parastomal hernia is very common for ostomates. It is a hernia that develops at the stoma site. Most all ostomates will eventually develop one. This happens because the muscle in the abdomen is cut to allow the portion of the intestine (bowel) to be pulled through the abdominal wall, creating the stoma. Since the muscle is cut, there is a weakness there.
Should you develop a parastomal hernia, you should avoid activities that cause strain on the abdominal muscles. This includes lifting, pulling or pushing greater than 20 pounds. Coughing and sneezing create a strain on the abdominal muscles. It is recommended to guard the area by placing your hand over the hernia and applying some pressure to counteract the internal pressure. If you need to participate in activities that strain the abdominal muscles, consider wearing a support belt made for stomas. Coloplast makes a support belt, Brava Ostomy Support Belt. Nu-Hope offers multiple sizes and comfort levels from 3” to 9” along with a “cool comfort” material. The opening for the stoma is made to offer support where you need it.
Ulceration of the skin under the wafer can occur. It often is related to a parastomal hernia and using a convex wafer. This can cause friction between the convex wafer and the intestine (bowel) that is herniated. The friction breaks the skin down and causes openings called ulcers. These can be treated by adding a Protective Barrier sheet (Coloplast) under the wafer. Adding this layer prevents friction and allows the ulcer to heal.
Parastomal hernias do not require surgical intervention for repair often. You may need to change the type of pouching system to accommodate the hernia. Coloplast Convex Flip works great for parastomal hernias. Surgical intervention is reserved for those that cannot achieve acceptable wear time with the pouch or if the hernia becomes incarcerated. Symptoms of incarceration include severe pain at the stoma site, redness around the stoma site, no stool output, and nausea with vomiting. This is an emergent situation and you should call your surgeon immediately.
A prolapsed stoma can be an emergent situation if it cannot be reduced. It occurs more often with a colostomy placed in the ascending (right side) and transverse (upper right or left) colon. A prolapse is a telescoping of the bowel out of the skin, making the stoma protrude from the skin greater than 2-3 inches. The stoma can become swollen and painful. Reducing the stoma will improve pain. This can be done by lying down flat for a few minutes and applying gentle pressure on the stoma. Sometimes gravity can reduce it without applying pressure (pushing it back in). If the stoma does not reduce or retract due to swelling with these interventions, you can apply table sugar to the stoma. This will pull out the fluid which creates swelling. Once the fluid is leached out, the stoma can often be reduced.
It is important to monitor your stoma and peristomal skin with each pouch change. Treatment of minor problems can prevent them from developing into major ones. If you are changing the pouch too frequently or note changes in the skin or stoma, call your surgeon or ostomy nurse for evaluation. Making changes early on will help minimize major problems.
Author Profile: Christine Kijek, Registered Colorectal Nurse
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