It would be useful if patients could receive the adequate training and general education they need for managing their ilesotomy after, for instance, surgery for Crohn's and before their discharge from hospital. Unfortunately, because of costs, time restraints, and sometimes ignorance, that doesn't always happen. The result is unnecessary anxiety, frustration, embarrassment, and a loss of dignity. How do I know these things? I was the caregiver for an ostomate during a five-month stay in hospital and found myself teaching some nurses the most effective management practices. Here are my top ten tips by categories.
Appropriate Supplies and Pertinent Knowledge are Paramount
Understand this about an ileostomy: the discharge is often wet, and it is very acidic. As a result:
- Tip #1: Always pay close attention to the condition and hygiene of the skin, and treat it accordingly: cleanse with water, use creams such as Atrac-Tain by Coloplast for extremely dry, cracked skin on the outside of the flange, and a spray such as Flovent HFA 250 mcg for sores. For peristonal skin protection, apply Karaya Powder by Hollister under the adhesive flange/wafer that holds the pouch.
- Tip #2: Understand the digestive system because you will want to change the apparatus when there is little to no discharge from the stoma. Some suggestions are: finish eating early in the day, particularly if the meal contains beef; and if possible change the bag and wafer early in the morning because by then almost all types of food have been fully digested.
- Tip #3: Consider a product to alleviate the wet discharges; Immodium helps but at night, when you need sleep, a product such as flavored Olestyr by MM Therapeutics is particularly effective for thickening the stool.
Ostomates Need to Acquire Skills
- Tip #4: Sealing. You want to make sure that the stool goes into the pouch. This is dictated by two things: the size of the hole cut in the wafer; and the seal around the stoma. In the hospital setting a paste, such as a product called Adapt by Hollister, is used to surround the stoma and to fill in uneven body contours. One problem is that it can be irritating to the skin; a second is that it takes a practiced hand. An alternative is ready-made moldable circular seals (e.g. Eakin Cohesive Seals by ConveTec and SecuPlast Seals by Salts) that can be adapted to the size of the stoma plus broken into pieces to fill in concave areas of the body.
- Tip #5: Preparing the skin and wafer. You want to remember that the stoma changes size. Too small an opening, for instance, may cause an expanded stoma to lift the wafer and break the seal. In addition, be sure the skin is clean and dry before applying this skin barrier. A product such as Coloplast's Adhesive Remover Wipe can be used to remove residue.
- Tip #6: Choice of pouch. An ileostomy is usually emptied frequently depending on the time of day and the food eaten. Therefore, a lock 'n' roll type of pouch is probably the best option. Just be sure the drain is well secured after every draining.
- Tip #7: Techniques for draining the pouch. When handy, use a toilet but if necessary (e.g toilet on second floor) use a portable urinal similar to that used in hospitals. Later, soak the urinal overnight in Javex.
Strive for Independence
- Tip #8: It is important to become independent and do things for yourself: Why? Because circumstances may demand it. Assuming you are mobile and flexible, the basic management functions (e.g. cutting the flange/wafer, preparing the skin, attaching the pouch, closing the drain) should present no problem.
- Tip #9: Have strategies for social events. Three things to remember: have supplies readily available; be aware of the location of washroom facilities; and change the apparatus, if possible on the morning of the event to decrease the odds of an accident; for example, the general time between changes is about four days – earlier is hard on the skin and later increases the chance of an accident.
The Most Important Precaution
- Tip #10: Be acutely aware of dehydration. This can be caused by a wetter-than-usual stool for a prolonged period of time which is not offset by an equal amount of liquid intake. It is evidenced by such symptoms as cramps, weakness (e.g. dry kidneys), or confusion, and needs to be attended to. Solutions include drinking sport drinks such as Gatorade, and temporarily increasing salt intake, but it may require hydration by infusion at a hospital, particularly if the electrolytes (e.g. sodium, potassium) are out of balance.
An ileostomy is a life-giving device, but it involves a whole new set of knowledge and skills. It would be nice if ostomates and their needs were fully understood and respected but that time has not yet arrived. I've seen ostomates suffering from confusion, for instance, thrown onto mats in the holding areas of hospitals and left to deal with their own excrement. In the meantime, however, resourceful patients and their caregivers need to garner as much knowledge and expertise as possible, and as quickly as possible. To that end, I hope these tips help.
Disclaimer: The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact a doctor for advice.
Sources
- Bowel Diversion Surgeries. NDDIC. (accessed Jan. 24, 2012)
- Dehydration. Body and Health. Canada.com (accessed Jan.24, 2012)
- Paula Erwin-Toth. Peristonal Skin Care. The Oley Foundation (accessed Jan. 24, 2012)
James Gibson - James Gibson is a retired teacher and small business owner. He is a published writer and has a wide spectrum of interests.
