Colorectal Cancer: Tips for Living with a Colostomy
Some people with colorectal cancer or other problems may need to have a colostomy. This is a change to the way food wastes leave the body. Stool exits through a new opening into a pouch that you change as needed. Living with a colostomy can be a major change. But knowing what to expect and how to deal with it can help you adjust to it.
What is the colon?
The colon is the part of the large intestine that goes from the small intestine to the rectum. Food enters the colon from the small intestine. The remaining nutrients and water are absorbed by the colon as the food passes through it. Then the waste is stored as stool in the rectum until it can be passed out of the body.
The colon has 3 main parts:
Ascending colon. This part goes up the right side of your abdomen. It’s the part of the colon where the food enters from the small intestine.
Transverse colon. This part runs across the upper part of your abdomen.
Descending colon. This part runs down the left side of your abdomen and ends at the sigmoid colon. The sigmoid colon connects to your rectum. As waste moves through the large intestine, water is absorbed.
What is an ostomy?
An ostomy is an opening created with surgery. It is often needed when a person has lost normal function of the bladder or bowel. Function can be lost due to birth defects, disease, injury, or other disorders. Types of ostomy surgery include colostomy, ileostomy, and urostomy. The surgery lets body wastes leave through a new opening (stoma) on the abdominal wall. An ostomy may be either temporary or permanent. When you have an ostomy, you need to wear a special pouch over the stoma to collect the waste. A colostomy may be created at any point along the colon.
You may see a difference in the type of stool. This depends on where your ostomy is located. For example:
If the ostomy is toward the lower end of the colon, more liquid is absorbed and the stools will be more solid.
If the ostomy is very low along the descending colon, near the rectum, stools are well-formed. They are similar to stools from a normal colon.
If the ostomy is on the ascending or transverse colon, less water is absorbed. The stools are looser and more watery. They pass through the stoma more quickly and easily. In some cases, you may need a stool thickener.
Having stoma surgery
In some cases, surgery is done within a few days of the diagnosis. Before the surgery, your bowels will need to be cleaned out. An enterostomal therapy (ET) nurse will speak with you about the ostomy. The ET nurse will train you how to care for it. They will answer questions and address any concerns about ostomy care. After surgery, you will be given pain medicine. You will rest for several days, then begin to sit up and walk short distances. Your stoma’s healing will be checked by the ET nurse. It may take a few days before you are ready to look at the stoma. The ET nurse will be there to answer any questions.
Caring for the stoma
When you go home, you may need a home healthcare nurse to provide instructions on stoma care. He or she will also provide wound care to ensure proper healing. You will be told:
How to clean your skin thoroughly
How to prevent infection
Understanding the pouch system
Most colostomy appliances are a 2-piece pouch system. The system consists of:
A flange. This is a rubbery circle that sticks to your skin over the stoma.
A pouch. This is a small bag that attaches to the flange. It collects the stool. There are several brands to choose from. You may need to try more than 1 may to find what works best for you.
Your home healthcare nurse will teach you:
What supplies you will need and where to buy them
How to change the pouch and flange
How to shower while wearing the pouch
Changing the flange
Your skin must be clean and dry before placing the flange. This is so the flange sticks (adheres) well for a long time. You may dry your skin with a hair dryer on the lowest heat setting, or just wait until your skin air-dries fully. Your flange may need to be changed more often in high heat or humidity, or if you exercise or sweat a lot.
Right after your surgery, you may have problems getting a good seal between the pouch and the flange. This can cause the pouch to come loose. After the wound around the stoma heals, it will be easier to get a good seal.
Living with the pouch
Finding out that you will need an ostomy can be stressful. The idea of living with a bag on your abdomen may be hard to accept. But for many people, an ostomy is not as bad as they thought. It is common for an ostomy and pouch to go undetected. No one will know that you have an ostomy and pouch unless you tell them.
You may choose not to tell many people that you wear an ostomy pouch. You can tell those who need to know. For example, your workplace may need to know that you can’t lift heavy items, or that you need to have frequent bathroom breaks to manage the ostomy pouch.
Wearing loose fitting tops and bottoms can help conceal your pouch when needed. Be careful when letting your pets or young children to jump into your lap where the pouch is located. Also, be careful when putting on your seat belt. The lap belt may cross the area where the stoma is located.
When traveling, pack extra ostomy supplies. If you are flying, never pack all your supplies in the checked baggage. Limit and be aware of what you eat before you travel.
Liquid and solid products are available to help control odor. Some are placed into the pouch, while others can be taken internally. It may help to empty your pouch often as well. There may be times when all is quiet and your stoma decides to let out some gas.
Always carry an emergency kit with extra supplies, such as:
Extra precut flange
Roll of tape
Making changes to your diet
You may want to make changes in your diet. A person with an ostomy should be aware of foods that cause gas. Of course, passing gas is a normal part of the digestive process. Most people pass gas more than 10 times a day to rid the colon of gas and pressure. Gas in the colon is a mix of hydrogen, methane, and carbon dioxide. It is caused by the breakdown of undigested sugars in the lower intestine. Some complex carbohydrates cannot be fully broken down by normal digestive processes. Gas is the result. Altering your diet to limit these foods may help. Foods that can cause gas include:
Dairy foods and drinks with lactose, including cow’s milk and some cheeses
Some fruits and juices
Tracking your stool
Depending on the type of surgery you have, stools may pass at any time. Blockage (constipation) can be a problem for someone with a colostomy. Keep track of bowel movements. Note how hard or soft they are, and how often they occur. You will need to drink plenty of water to keep the stools hydrated for as long as possible while they pass through the colon. An occasional dose of a laxative may help keep the waste softer. But check with your healthcare provider first before taking them. Increasing vegetables, fruits, and juices may also help.
Connect with a local chapter of the United Ostomy Associations of America (UOAA). The UOAA is gives education, information, support, and advocacy for people with ostomies.
January 10, 2018
Routine care of patients with an ileostomy or colostomy and management of ostomy complications, UpToDate
Alteri, Rick, MD,Gersten, Todd, MD