Introduction
A colostomy is a surgical procedure that involves creating an opening (stoma) from the large intestine (colon) to the outside of the abdomen. This opening provides an alternate pathway for feces to leave the body, bypassing the lower parts of the digestive system. The procedure is typically performed when part of the colon or rectum is diseased or damaged and needs to be removed or bypassed.
Purpose of a Colostomy
A colostomy may be necessary for a variety of medical conditions, including:
- Colon Cancer: When part of the colon is removed due to cancer, a colostomy may be created to allow normal bowel function.
- Diverticulitis: Severe cases of diverticulitis, an inflammation of the diverticula (small pouches) in the colon, may require a colostomy.
- Inflammatory Bowel Disease (IBD): Conditions such as Crohn’s disease or ulcerative colitis may necessitate a colostomy if they cause severe damage to the colon.
- Trauma: Injuries to the abdomen that damage the colon may require a temporary or permanent colostomy.
- Congenital Defects: Some babies are born with abnormalities in the colon that require a colostomy.
Types of Colostomies
There are different types of colostomies depending on the location of the stoma and the portion of the colon involved:
- Ascending Colostomy: The stoma is created in the ascending colon. This type is rare and usually temporary.
- Transverse Colostomy: The stoma is located in the transverse colon, resulting in semi-formed stool. It can be either temporary or permanent.
- Descending Colostomy: The stoma is in the descending colon, and the stool is typically more formed. This is often a permanent colostomy.
- Sigmoid Colostomy: The stoma is created in the sigmoid colon, leading to normal-formed stool. This is the most common type of permanent colostomy.
The Colostomy Procedure
Preoperative Preparation
Before surgery, patients undergo a thorough medical evaluation, which includes blood tests, imaging studies, and consultations with healthcare professionals. Patients are also educated about the procedure, the stoma, and life after surgery.
Surgical Procedure
The surgical procedure for a colostomy involves the following steps:
- Anesthesia: The patient is given either general or regional anesthesia to ensure they are pain-free during the operation.
- Incision: The surgeon makes an incision in the abdomen to access the colon.
- Creation of Stoma: A portion of the colon is brought through the abdominal wall to create the stoma.
- Securing the Stoma: The edges of the colon are sutured to the skin, and the remainder of the colon is either removed or left in place, depending on the underlying condition.
- Closure: The abdominal incision is closed, and the area around the stoma is cleaned and dressed.
Postoperative Care and Recovery
Immediate Postoperative Care
After surgery, patients are closely monitored in the hospital. They receive pain management, intravenous fluids, and antibiotics to prevent infection. The healthcare team also provides education on stoma care, including how to empty and change the colostomy bag.
Long-Term Care
Living with a colostomy requires adjustments, but most people can return to their normal activities with time. Key aspects of long-term care include:
- Stoma Care: Proper cleaning and maintenance of the stoma are essential to prevent infection and irritation.
- Dietary Adjustments: Patients may need to modify their diet to manage stool consistency and prevent blockages.
- Hydration: Adequate fluid intake is crucial to prevent dehydration, especially if a significant portion of the colon has been bypassed.
- Emotional Support: Adjusting to life with a colostomy can be challenging, and support from family, friends, and healthcare professionals is important.
Potential Complications
Although colostomy surgery is generally safe, there are potential complications, including:
- Infection: The risk of infection is present with any surgical procedure.
- Stoma Prolapse: The stoma may protrude excessively from the abdomen.
- Stoma Retraction: The stoma may retract into the abdomen, making it difficult to attach the colostomy bag.
- Hernia: A hernia may develop around the stoma site.
- Skin Irritation: The skin around the stoma can become irritated due to frequent contact with stool.
Living with a Colostomy
Physical Activity
Most colostomy patients can resume physical activities, including exercise, once they have recovered from surgery. It is important to avoid heavy lifting and contact sports that could damage the stoma.
Traveling with a Colostomy
Traveling is possible with a colostomy, but it requires some planning. Patients should carry extra colostomy supplies, be aware of restroom locations, and inform security personnel about their condition if traveling by air.
Intimacy and Relationships
A colostomy can affect a person’s self-image and intimate relationships. Open communication with partners and seeking support from healthcare professionals or support groups can help individuals navigate these changes.
Nursing Care of Patients with Colostomy
Caring for patients with a colostomy involves specialized knowledge and skills to manage the stoma and address the physical and emotional needs of the patient. This document provides an overview of essential nursing care practices for colostomy patients.
A.Preoperative Care
Patient Education
Before surgery, it is crucial to educate patients about the colostomy procedure, the stoma, and postoperative care. This education should include:
- Explanation of the surgery and expected outcomes
- Demonstration of colostomy appliances and their use
- Discussion of lifestyle changes and adaptations
B.Postoperative Care
Stoma Assessment
Regular assessment of the stoma is essential to ensure proper healing and identify any complications. Nurses should observe for:
- Color: A healthy stoma is pink or red. Any change to dark red, purple, or black may indicate compromised blood supply.
- Size and shape: The stoma should protrude slightly from the abdomen.
- Output: Monitor the type, consistency, and amount of stool.
- Signs of infection: Look for redness, swelling, or discharge around the stoma site.
Skin Care
Proper skin care around the stoma is vital to prevent irritation and infection. Recommendations include:
- Cleaning the skin with mild soap and water, avoiding abrasive materials
- Using stoma powder or barrier creams to protect the skin
- Ensuring a secure fit of the colostomy appliance to prevent leakage
Managing Complications
Nurses should be vigilant in identifying and managing common colostomy-related complications, such as:
- Stoma retraction: Address retraction by using convex appliances or consulting a stoma nurse for further interventions.
- Hernia: Support the stoma with a hernia belt and monitor for signs of strangulation.
- Skin irritation: Treat irritation with appropriate wound care products and adjust the colostomy appliance as needed.
Patient Support
Physical Activity
Encourage patients to resume physical activities gradually after surgery. Advise them to avoid heavy lifting and contact sports to protect the stoma.
Traveling
Provide patients with tips for traveling with a colostomy, such as:
- Carrying extra colostomy supplies
- Being aware of restroom locations
- Informing security personnel about their condition if traveling by air
Intimacy and Relationships
A colostomy can impact a patient’s self-image and intimate relationships. Support patients by:
- Encouraging open communication with partners
- Providing resources for counseling or support groups
- Addressing any concerns or questions they may have
REFERENCES
- American Cancer Society. Caring for a Colostomy (https://www.cancer.org/cancer/managing-cancer/treatment.types/surgery/ostomies/colostomy/management.html). Last revised 10/16/2019.
- American Cancer Society. What Is a Colostomy?https://www.cancer.org/cancer/managing-cancer/treatment.types/surgery/ostomies/colostomy/management.html Last revised 10/02/2019.
- Living with an ostomy: FAQs. United Ostomy Associations of America. https://www.ostomy.org/living-with-an-ostomy.
- Colostomy nutrition therapy. Nutrition Care Manual. Academy of Nutrition and Dietetics. https://www.nutritioncaremanual.org.
- Burgess-Stocks J. Eating with an ostomy. United Ostomy Associations of America. https://www.ostomy.org/diet-nutrition.
- Ileostomy nutrition therapy. Nutrition Care Manual. Academy of Nutrition and Dietetics. https://www.nutritioncaremanual.org.
- Landmann RG, et al. Ileostomy or colostomy care and complications. https://www.uptodate.com/contents/search.
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