Colostomy and

nursing care
by DOCUMENT
INDICATIONS
FOR
OSTOMY
Imperforate anus is a defect in which the opening to the anus is missing
or blocked. The anus is the opening to the rectum through which stools
leave the body. This is present from birth (congenital)
Diverticulitis is the infection or inflammation of pouches that can form in
your intestines.
 Some of the most common conditions that
might necessitate a stoma are:
 Imperforate anus: where there is no exit for the
bowel or its contents.

 Inflammatory bowel disease: this includes

Crohns Disease and Ulcerative
 Colitis, both inflammatory diseases of the
intestines.
Ileostomy
In an ileostomy the opening is made in the small
intestine – the ileum. An end or loop of the small
intestine is brought through the skin’s surface
on the abdomen and the output then passes out
through the stoma. The ileostomy which contains
the waste is more liquid. Due to the fact that
ileostomy output contains digestive enzymes,
this can be harmful to the skin and so requires
extra care when pouching.
In this procedure, there is an opening in
your belly wall (called a stoma) but no bag.
Your surgeon removes your colon and
rectum and creates an internal reservoir
from your small intestine.
They make an opening in your belly wall
and join the reservoir to your skin with a
nipple valve. To drain the pouch, you insert
a catheter through the valve into the
internal reservoir.
What types of products are used for colostomies?

Pouch: There are a variety of sizes and styles of colostomy

pouches. Pouches are lightweight and odor-proof. Pouches
have a special covering that prevents the pouch from sticking
to the body. Some pouches also have charcoal filters which
release gas slowly and help to decrease gas odor. The
following is general information about types of colostomy
pouches:

Open-ended pouch: This type of pouch allows you to open

the bottom of the pouch to drain the output. The open end
is usually closed with a clamp. The open-ended pouch is
usually used by people with ascending or transverse
colostomies. The output from these colostomies is looser
and is unpredictable (does not drain at regular times).
Close-ended pouch: This type of pouch is removed and thrown
away when the pouch is filled. Close-ended pouches are usually
used by people with a descending or sigmoid colostomy. The
output from these types of colostomies is firm and does not
need to be drained .

One-piece: A one-piece pouch contains the pouch and adhesive

skin barrier together as one unit. The adhesive skin barrier is the
part of the pouch system that is placed around the stoma and
attached to skin. When the pouch is removed and replaced with
a new one, the new pouch must be reattached to the skin.
Two-piece: The two-piece pouch has two parts: an adhesive
flange and pouch. The adhesive flange stays in place while
the pouch is removed and new pouch is attached to the
flange. The pouch does not need to be reattached to the
skin each time. The two-piece system can be helpful for
patients with sensitive skin.

Pre-cut or cut-to-fit pouches: Some pouches have pre-cut

holes so you do not have to cut the opening yourself. Other
pouches can be cut to fit the size and shape of your stoma.
Cut-to-fit pouches are especially useful right after your
surgery because your stoma decreases in size for about
eight weeks.
You will need a plastic irrigating container with a long tube and a
cone to introduce water into the colostomy. You will also need
an irrigation sleeve that will direct the output into the toilet. Youwill
need an adjustable belt to attach the irrigation sleeve and a tail
closure for the end of the sleeve.

Choose the same time each day when you will not be interrupted to
irrigate your colostomy.

Fill the irrigating container with about 16 to 50 ounces (500 to 1500

mL) of lukewarm water. The water should not be cold or hot. The
amount of water each person needs to put in the irrigating
container varies. Ask your caregiver how much water you will need
to irrigate. Hang the irrigation container at a height in which the
bottom of the container is level with your shoulder. Sit up straight
on the toilet or on a chair next to the toilet.
 HOW
TO
CHANGE
POUCH
Clean the skin around the stoma with warm water. You may also
use soap but do not use soaps that have oil or perfumes. Pat
your skin dry.

Use a pouch that has an opening that is one-eighth of an inch

larger than the stoma.

Use skin protection products if you have irritated skin around

the stoma. The skin can be treated with these products to
protect your skin and create a dry surface.

Center the pouch over the stoma and press it firmly into place
on clean, dry skin. It may be helpful to hold your hand over the
newly applied pouch for 30 seconds. The warmth of your hand
can help to mold the adhesive skin barrier into place.

Place the old pouch in another plastic bag to be thrown away if

the pouch is disposable. If you use a reusable pouch, talk to
your caregiver about how to clean the reusable pouch.