Care of Stoma

The stoma is the opening that was made in your abdomen during your surgery. It works as your colon would, helping digested food exit the body. Following are some tips to help you take care of your stoma.

• Your stoma should be red or pink and moist to the touch. If it swells or turns purple, black, or white, call your surgeon immediately.
• Examine the stoma for any cuts that may be caused by the wafer rubbing against it. To correct this problem, use an appropriately sized appliance and center the opening on the stoma (see figure at right).

Cuts may also be caused by the appliance “riding” off-center during a long physical workout. If this problem occurs, you may try “framing” the wafer using medical adhesive tape or an ostomy appliance belt.

• You may notice slight bleeding while washing the skin around your stoma. This is normal and is due to the stoma’s high concentration of blood vessels. If a lot of bleeding occurs, apply pressure with a dry cloth for 10 minutes. If the bleeding does not stop or occurs frequently, call your surgeon or go to the emergency room for evaluation. Medications that may contribute to bleeding include aspirin, Coumadin, and Ticlid.
• Do not insert suppositories or thermometers into the stoma. Do not use Fleets enema. Ask your doctor or enterostomal nurse about proper colostomy cleaning.

Potential problems

Some problems may arise that may or may not need to be treated. Only your surgeon can make this decision, so it’s important that you call your surgeon if any of the following occur:

• Prolapse, or “falling out,” occurs when the stoma becomes longer. This may occur during pregnancy, or it may be caused by weak abdominal muscles. A cold compress may be applied to help reduce stoma size.
• Retraction occurs when scar tissue pulls the stoma inward toward the body. You may have a hard time getting a good seal for your appliance, because the stool slips under the wafer. Sometimes a convex insert or appliance (one that is rounded outward) helps fill in the gap.
• Parastomal hernias are hernias near the stoma. A hernia occurs when a bulge or tear in the abdominal muscle allows an organ or tissue to squeeze through. Parastomal hernias may occur if the abdominal wall opening becomes larger than the stoma. This would allow another loop of bowel to slip through, causing a bulge around the stoma. These hernias usually are not serious and don’t require any treatment; however, you still need to call your surgeon if this occurs.
• Food blockage (in ileostomies) is caused by eating high-fiber foods (such as popcorn, mushrooms, peanuts, salads, fresh vegetables, and fruits) or foods that have a skin or casing (grapes, nuts, tomatoes, seeds).

Signs and symptoms include:

• No output from the stoma for more than four hours
• Sudden cramping pain in the abdomen
• Nausea or vomiting
• Swelling of the stoma
• High watery output

If you eat foods high in fiber, drink hot tea and increase your fluid intake. This will help flush these foods through your intestine.

If you experience these symptoms, you may try to relieve the blockage by taking a warm bath or shower and massaging your abdomen. Take slow deep breaths. Try to stay calm. This will help relax your abdominal muscles.

If this does not relieve the blockage, call your surgeon or go to the emergency room.

Care of the perineal incision

If your rectum has been removed, you will have a perineal incision. After surgery, you may have drains that remain in this area for about a week. After the drains are removed, a gauze bandage may be used to collect drainage (if there is any). You may notice stitches in this area, and it may be tender. Sitting on a pillow (not an air ring) and taking a bath (if your doctor approves) will help decrease the soreness.

After you go home

After discharge from the hospital, you should call your surgeon if you experience:

• Fever
• Drainage from the incision
• A feeling of heaviness in the rectal area

If your rectum was removed, you may experience “phantom pain”; that is, a sensation of wanting to have a bowel movement through the rectum. This sensation is similar to the feeling amputees have after losing a limb. The feeling occurs because the nerves remain intact and still interpret messages from the missing part. This feeling tends to decrease over time.

If the rectum remains intact, you may still experience the urge to move your bowels. You can sit on the commode, and you may pass mucus. If the anal sphincter muscles are weak, mucus may leak out. A thin protective pad may be worn to protect your clothing.

Call your surgeon if you experience a mucous discharge or if the discharge is bloody.