Bowel Disease: Caring for Your Ostomy

How do I care for my ostomy?

Proper care for your ostomy includes learning how to empty and replace the pouch and knowing what to watch for.

Some people choose to irrigate a colostomy. Irrigation is a procedure in which you stimulate and flush the intestines at a regular time to control when you eliminate solid wastes.

Note: If you are caring for an infant or child with an ostomy, the same information and procedures generally apply. But the ostomy pouch will be smaller and will most likely need to be replaced more often. Different adhesives may be used to attach the pouch because a child's skin is more sensitive than an adult's skin. Your wound, ostomy, and continence nurse (WOCN) will help you learn how to care for your child with an ostomy. Irrigation is not appropriate for children.

Emptying your ostomy pouch

Ostomy pouches can be drainable or closed. A drainable pouch opens at one end to allow you to empty it. A closed pouch is disposed of and replaced with a new one as needed.

The pouch fills with waste and gas. It is best to empty the pouch when it is one-third to one-half full. This prevents the pouch from getting too full and heavy and pulling off. Many people routinely empty the pouch each time they urinate.

• Drainable pouch. Place some toilet paper in the bowl to prevent splashing. Sit down on the toilet with the pouch between your legs. The pouch is usually held shut with a clip system. Simply unclip it and allow its contents to fall into the toilet. Clean the end of the pouch with toilet paper and reclip it.
• Closed pouch. Unsnap the pouch from the barrier and dispose of it. Do not flush it down the toilet. Putting the pouch in a ziplock bag reduces odor. You then need to attach a new pouch.

Replacing your ostomy pouch

How often you change your ostomy pouch depends on many things, including the type of stoma you have and what you prefer. Some pouching systems are changed daily. Others are changed every 3 to 7 days. You may need to change your pouching system more often if there is a leak in the pouch or itching or burning under the barrier. The pouch itself is usually emptied or replaced after each bowel movement.

1. Prepare the new pouch and barrier. Cut an opening in the new barrier slightly larger than the stoma. You may also have a precut barrier. If you have a two-piece system, snap the pouch to the barrier. Remove the paper backing from the barrier so that the adhesive is exposed. You may need to use some skin barrier paste to obtain a better skin seal.
2. Remove the old pouch and barrier. Remove your old pouch by peeling away the barrier and gently lifting the pouch while pressing down on the skin below the pouch. Be sure not to irritate the skin as you remove the barrier and pouch. If the pouch is sticking and is difficult to remove, use an adhesive remover underneath the barrier. Dispose of the old pouch and barrier.
3. Clean your skin. Clean your skin and stoma with a wet washcloth or wipe. You may shower to clean the stoma. You may use soap, but if you do, rinse well. Allow your skin to dry and check your skin and stoma for signs of irritation. See Treating skin irritation below.
4. Measure your stoma, if necessary. After your surgery, the size of your stoma may change. Your doctor may want you to measure it and will provide a measurement guide to help you do this.
5. Put the new pouch on. Position the opening in the barrier around the stoma and apply the sticky side to the skin. Press down until all edges are sealed. If your pouch is open-ended, attach the clip.

Treating skin irritation

If the skin under your pouch is red, irritated, or itchy, you need to treat your skin. Follow these steps:

1. Gently remove the pouch.
2. Clean the skin under the pouch with water.
3. Dry the skin.
4. Sprinkle ostomy protective powder on the skin and then blot it off.
5. Reattach or replace the pouching system.

If you continue to have skin irritation, consult your wound, ostomy, and continence nurse (WOCN) or another nurse or a doctor.

Irrigating a colostomy

Irrigating a colostomy allows more control over the elimination of waste, because it stimulates the intestine to function at a regular time. It is typically done at the same time every day or every other day. If you irrigate, you may need only a cover or pad over your stoma and may not need an ostomy pouch.

Children do not use irrigation.

Only a colostomy can be irrigated. You cannot irrigate an ileostomy.

To irrigate a colostomy, you need to have all of the following equipment and supplies ready, including:

• Lubricant.
• An irrigation set, which includes a container for water, tubing with a cone end (one end of the tubing attaches to the container and the cone end is inserted into the stoma), and a clamp.
• An irrigating sleeve and belt. (The sleeve is a long, clear plastic bag, open at the top and bottom. It snaps onto the barrier.)
• Toilet tissue.
• A toilet to dispose of waste.

A two-piece pouch system is usually used for irrigation. A nurse or doctor will show you how to irrigate your colostomy. The basic procedure is as follows.

Getting ready

1. Place 16 fl oz (473 mL) to 32 fl oz (946 mL) of lukewarm water (cold water can cause cramping) in the container to use as irrigation solution. The exact amount depends on the person. Your nurse or doctor will help you determine the amount you need.
2. Hang the container at about shoulder height— 18 in. (46 cm) to 24 in. (61 cm) above your stoma. You will need a hook or other device to do this.
3. Find a comfortable position, such as in a chair in front of the toilet or on the toilet.

Preparing the equipment

1. Remove your colostomy pouch from the barrier and snap the irrigation sleeve to the barrier. Attach the sleeve belt for security, and place the end of the sleeve in the toilet, bedpan, or other disposal unit.
2. Unclamp the tubing to let some of the irrigation solution flow through the tubing and out the cone. This removes air from the tubing.
3. Reclamp the tube.
4. Lubricate the irrigating cone and gently insert the cone into the stoma through the upper opening in the sleeve. Press the cone firmly but gently. Do not force the cone into the stoma or insert it more than 3 in. (7.6 cm) into the stoma.

Irrigating

1. Unclamp the tube and allow the irrigation solution to flow into the stoma slowly for 5 to 10 minutes. If cramping occurs, stop the flow for a few seconds but leave the cone in place.
2. When the desired amount of solution flows in, or when you feel full, clamp the tubing and remove the irrigation cone from your stoma. Waste will come out of the stoma and empty through the sleeve into the toilet or other disposal unit.
3. It takes 30 to 45 minutes for all the waste to empty. But after the initial flow of waste slows down (10 to 15 minutes), you may clamp the sleeve shut at the bottom and move around. Many people use this time for shaving and other grooming.
4. When the waste return is completed, unsnap the sleeve and put on your usual pouch or covering.
5. Clean all supplies and store for reuse.

What to watch for

Here are some things to watch for. Call your doctor if:

• You have severe abdominal cramping.
• You have little or no waste output into your pouch.
• You have a stoma that:
  • Develops a pale color.
  • Becomes dusky or blue.
  • Swells.
  • Bleeds.
• You are upset about your stoma or think you might have depression.