What is a colostomy? A colostomy is an opening made in the colon by surgery. Once this opening has been made, the colon is brought to the surface of the abdomen so that stool can leave your body; this opening on the surface of the abdomen is called a stoma. Stool passes from the colon through this opening into a replaceable, washable bag, which is attached to the skin by its adhesive.
You should know that the colostomy is large and swollen after the operation, and it will become smaller over several weeks as you recover fully. It usually takes about six months to get used to this new situation. How should you look after a colostomy?
- Each time before using a colostomy bag, check carefully around it for any swelling, redness, inflammation or sensitivity, and check the stoma site for bleeding, bruising, infection and unpleasant odour; if you notice any of these, tell your doctor. Note that the opening in the middle of the colostomy should sit exactly in the centre of the colostomy bag.
The opening in the colostomy bag should be the same size as the opening of the bowel on the surface of the abdomen; if the opening in the bag is too small, cut it to the right size.
- Once every three days, open the inside of the stoma with your index finger.
- Your daily routine should be regular: have set times for eating, sleeping, washing out the colostomy and so on, so that your life is not disrupted. Such a routine will help to regulate the times when stool comes out of the colostomy.
- Never pull the bag off forcefully; first moisten the skin around the bag, then remove it gently. Do not massage the surrounding skin at this time, as this will irritate the skin. It is best to wash it with lukewarm water and then dry it with cotton wool.
- Regularly wash out the bowel opening (stoma) made on your abdomen one hour after meals. This stimulates the wave-like movements of the bowel (peristalsis), makes bowel movements easier and helps them happen at regular times. The water used to wash out the colostomy should be at body temperature or slightly below.
- When sticking on the bag, dry any excess moisture around the stoma, then stick on the colostomy bag and press it firmly against the skin for 30 seconds.
- Avoid lifting heavy objects for the first 4–6 weeks after the operation.
- You should know that sexual activity has no particular effect on the colostomy; a woman with a colostomy can also become pregnant without difficulty.
- The skin around the stoma should be washed and cleaned gently, using a soft cloth and plain soap or a safe cleanser. If the colostomy opening is on the left side of the abdomen, it needs to be washed out once every 2–3 days. Keep your X-rays and related test results.
- A balanced, protein-rich diet is essential.
- A low-residue diet is preferable, so that the amount of stool produced over 24 hours is reduced.
- Avoid gas-producing foods such as cauliflower, nuts, corn, pulses, cabbage and salty or sour pickles, as well as fizzy drinks, chewing gum, and swallowing air by eating too quickly.
If a food does not agree with you, persevere with it for a few days before cutting it out,
because the initial intolerance may go away after a few days.
- Foods such as cabbage, onions and fish cause bad odours, while yoghurt, doogh (yoghurt drink), parsley, spinach, orange juice and tomato juice help to reduce odour.
- Because a lot of fluid is lost through sweating and the colostomy in summer, you need to drink more fluids (6–8 glasses a day).
- If your stool is too watery, eat less of foods such as wholewheat (bran) products, pulses, corn and nuts. If your stool is hard, eating more salt will help absorb water and make passing stool easier. If you are constipated, drink pear juice and grape juice.
- If you need or want to eat pulses, it is best to soak the raw pulses in cold water for 45 minutes and then cook them, so that they do not cause bloating.
Changing and washing the bag: you can bathe easily with or without the colostomy bag, but make sure that soap residue does not get into your colostomy; it is better to use oil-free soaps. Having a colostomy does not prevent you from carrying out your daily activities.
The bag should be emptied when it is one-third full, so that its volume and weight do not pull it off.
- The best position for washing out the colostomy is sitting.
- Connect the drip set (tubing) to the bag of irrigation fluid.
- Hang the fluid bag on a hook or drip stand in the toilet. Run fluid through the tubing to remove the air (air getting into the bowel causes pain).
- Put on gloves. Gently remove the old bag.
- Soften the tip of the tubing with lubricating gel and insert it gently into the stoma (do not insert it more than 8 centimetres).
- Let the fluid run slowly into the bowel over 5 to 10 minutes. Use 300 cc of fluid for the first washes, and 500 cc to 1000 cc on later occasions. When the fluid has gone in, close the tap on the tubing, wait 15 seconds and remove the tip of the tubing.
- The contents (stool, water and gas) will drain out over 10 to 15 minutes; bearing down a little can help them drain better.
- Wash the stoma area with water and baby soap and dry it. Cut the new colostomy bag with scissors to match the diameter of the stoma, prepare it and stick it on. Press the adhesive of the colostomy bag for 13 seconds so that it sticks completely.
Prepared by: Zahra Zahiri