Colostomy: A Guide

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Colostomy problems

Hernia

The most common problem after colostomy surgery (other than skin irritation) is herniation around the colostomy. A hernia is the bulging of a loop of organ or tissue through the belly (abdominal) muscles (called an abdominal hernia). This bulging can happen around a stoma.

Signs of a hernia may be a bulge in the skin around the stoma, problems irrigating, partial obstruction (blockage, discussed further on), and sometimes prolapse of the colon (the bowel pushes itself out through the stoma). These changes tend to happen slowly over time. But let your doctor know about any changes you see or feel. There are things you can do to better support the area around the stoma and keep the hernia from getting worse. If the hernia is bad, you may need to have it repaired with surgery.

Many of these problems can be avoided if the stoma site is marked before surgery at a place that lies within the rectus abdominus muscle (the "6-pack muscle") near the middle of the abdomen. The ostomy nurse can be of great help with this.

Severe skin problems

Large areas of skin that are red, sore, and weeping (always wet) will keep you from getting a good seal around your stoma. It is important to treat minor irritations right away. If you have a large irritated area, contact your doctor or ostomy nurse. They may prescribe medicine to help dry out and heal your skin.

For deep pressure ulcers caused by a very tight ostomy belt, loosen or remove the belt and call your doctor or ostomy nurse right away. You will need treatment.

Constipation, loose stools, and diarrhea

In a normal state of health, the form of stool that the bowel puts out is related to what is put in. Timing and frequency of meals, emotional states, medicines, and sickness also play a role.

Constipation is often the result of an unbalanced diet or not drinking enough liquids. Certain medicines may also be the cause. Fear may be at the root of it, or problems with the irrigation process. These are matters to talk over with your ostomy nurse or doctor. If you have had constipation problems in the past, before surgery, remember how you solved them and try the same things now. But DO NOT use laxatives without talking to your doctor first.

Diarrhea is usually a warning that something is not right. Diarrhea is defined as frequent, loose, or watery bowel movements in greater amounts than usual. Diarrhea is different from loose bowel movements. Loose stools are common in transverse and ascending colostomies. This is because of the shortened length of the colon and is not a sign of sickness or disease. Certain foods or drinks may cause diarrhea. If this happens, you should try to figure out what these foods are and avoid them.

Talk with your doctor or ostomy nurse if you have ongoing diarrhea or constipation. Discuss the foods and liquids you take in, your eating schedule, how much you usually eat, and any medicines you might be taking. You may be given medicine to help slow things down or to stimulate the bowel. Remember, no matter what, you need a well-balanced diet and good fluid intake to have a good output.

Blockage (obstruction)

If you have cramps, vomiting and/or nausea, belly swelling, stoma swelling, little to no output, or gas from your stoma the intestine could be blocked (the medical word is obstructed). Call your doctor or ostomy nurse right away if this happens.

There are some things you can do to help move things through your colostomy.

  • Drink enough fluids. Talk to your doctor or nurse about how much is enough for you.
  • Watch for swelling of the stoma and adjust the opening of the pouch as needed until the swelling goes down.
  • Take a warm bath to relax your abdominal muscles.
  • Sometimes changing your position, such as drawing your knees up to your chest, may help move along the food in your gut.
  • Do NOT take a laxative.

High-residue foods (foods high in fiber) such as Chinese vegetables, pineapple, nuts, coconut, and corn can cause obstruction. Obstruction can also be caused by internal changes such as adhesions (scar tissue that forms inside your abdomen after surgery).

Phantom rectum

Phantom rectum is much like the "phantom limb" of amputees who feel as if their removed limb is still there. It is normal for you to have the urge to move your bowels the way you did before surgery. This can happen for years after surgery. If the rectum has not been removed, you may have this feeling and also may pass mucus when sitting on the toilet. Some who have had their rectum removed say that the feeling is helped by sitting on the toilet and acting as if a bowel movement is taking place.

When you should call the doctor

You should call the doctor or ostomy nurse if you have:

  • Cramps lasting more than 2 or 3 hours
  • Continuous nausea or vomiting
  • Bad or unusual odor lasting more than a week (This may be a sign of infection.)
  • Unusual change in your stoma size or color
  • Blockage at the stoma (obstruction) and/or the inner part of the stoma coming out (prolapse)
  • A lot of bleeding from the stoma opening (or a moderate amount in the pouch that you notice several times when emptying it) (NOTE: Eating beets will cause some red discoloration.)
  • Injury to the stoma
  • A cut in the stoma
  • Continuous bleeding where the stoma meets the skin
  • Bad skin irritation or deep ulcers (sores)
  • Watery output lasting more than 5 or 6 hours
  • Anything unusual going on with your ostomy

A stoma can become narrowed with time, usually over many years. This narrowing or tightness of the stoma is called stenosis and it may cause obstruction (blockage). Stenosis may also be caused by injury from irrigation or a short-term poor blood supply right after surgery. It can usually be corrected with a minor operation if it becomes a problem.

Rupture or perforation of the colon is also possible. This is when the colon wall breaks and stool leaks into the abdomen. Now that we use irrigation cones, rupture or perforation of the colon is rarely seen. They can still happen, though, if the irrigation cone is not carefully put into the stoma.


Last Medical Review: 03/17/2011
Last Revised: 03/17/2011