FAQs

FAQs

The questions and answers below have been reproduced with permission from patient education booklets provided by manufacturers of ostomy products. This information is not meant to provide comprehensive medical information, or to replace the information provided by your doctor, ET Nurse and other members of the health care team. Click on a question to see the answer.

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General Info Colostomy Ileostomy Urostomy Peristomal Hernia

What is an ostomy?

You may know someone who wears a “bag” or pouch on their abdomen or have an ostomy yourself. The term “colostomy” is often the default go-to word when people talk about ostomy care, suggesting that all “ostomies” are “colostomies” and thus created and function equally.  In actual fact, the term colostomy only refers to an ostomy created from the large bowel or colon and only represents one kind of ostomy. An ileostomy is also a fecal stoma (producing stool waste) which the surgeon creates using a portion of the small bowel or ileum. Finally, a urostomyproduces urine in the absence of the bladder as with bladder cancer for example. It is important not only for health professionals to understand and distinguish between the 3 “kinds” of ostomies, but for the ostomy patient themselves as the guidelines for care are very different for each. All 3 will have a stoma or bowel that has been brought to the surface of the abdomen, but anatomically be very different.

Anonymous   July 21, 2014

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What does a stoma look like?

You may know someone who wears a “bag” or pouch on their abdomen or have an ostomy yourself. The term “colostomy” is often the default go-to word when people talk about ostomy care, suggesting that all “ostomies” are “colostomies” and thus created and function equally.  In actual fact, the term colostomy only refers to an ostomy created from the large bowel or colon and only represents one kind of ostomy. An ileostomy is also a fecal stoma (producing stool waste) which the surgeon creates using a portion of the small bowel or ileum. Finally, a urostomyproduces urine in the absence of the bladder as with bladder cancer for example. It is important not only for health professionals to understand and distinguish between the 3 “kinds” of ostomies, but for the ostomy patient themselves as the guidelines for care are very different for each. All 3 will have a stoma or bowel that has been brought to the surface of the abdomen, but anatomically be very different.²

Anonymous   July 21, 2014

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How should I care for the skin around my stoma?

It is very important for the skin around the stoma (the peristomal skin) to remain healthy and free of irritation. The peristomal skin should look just like the skin elsewhere on your abdomen. To prevent skin irritation or other skin problems, you must have a skin barrier and pouch that fits properly. Each time you remove your skin barrier and pouch, look carefully at the peristomal skin. If you notice any swelling, redness or rash, you could have irritated skin. Sometimes-but not always-irritated skin is painful. If the problem persists for more than two pouch changes, contact your ET Nurse.5

Check out an excellent reference guide provided by the WOCN (Wound Ostomy and Continence Nurses Society):

Download (PDF, 648KB)

Anonymous   July 21, 2014

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What is an ET / Ostomy Nurse?

An Enterostomal Therapy (ET) Nurse is a registered nurse with advanced and specialized knowledge and clinical skills in wound, ostomy and continence care. Recognized as Nursing Specialists in wound, ostomy and continence by the Canadian Nurses Association (CNA), ET Nurses are the ONLY nursing specialty with CNA certification in wound, ostomy and continence care. ET Nurses work in acute care hospitals, outpatient clinics, community care, long term care and in independent practice. An ET nurse provides specialized holistic assessment and management as part of an interprofessional team member. He/she functions to meet the needs of individuals/families with ostomies, acute and chronic wounds and urinary and fecal continence problems.

Some nurses will have different “letters” after their name such as WOC Nurse or cWOC Nurse which indicates that they did their wound, ostomy, continence education in the United States. It should be noted that there are different education levels for wound and ostomy health professionals that vary from a 1 day course to the full scope nursing specialty an ET or WOC Nurse. To ensure your best care, be sure you are seeing a nurse with full credentials. To find an ET/WOC Nurse in your area, you can contact the Canadian Association for Enterostomal Therapy (CAET) www.caet.ca.

When to see an ET/Ostomy Nurse:

Do you have a new ostomy and need more teaching after discharge from the hospital?
Do you have regular leaks of your pouching system?
Are you suddenly getting less wear-time of your pouching system?
Have you gained or lost weight?
Does your flange “not stick” to your skin?
Has the shape or size of your stoma changed since surgery?
Are you using powders and sealant sprays frequently?
Do you have questions around nutrition, lifestyle, or intimacy?
Do you have questions about how to better conceal your pouch with clothing or when participating in sports?
Do you want to learn more about hernias?
Do you think you have a hernia and want to learn about support garments?
Do you need feedback about how you are currently managing?
Are there sores or wounds around your stoma?
Have you had your stoma for many years and just want to see “what’s new”?
Is it time for an annual check up?

Anonymous   July 21, 2014

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What about medications?

After ostomy surgery, digestion and absorption of medications, either alone or in combination, may be affected. It is very important to review your medications, both over -the -counter and prescription drugs, with your ET nurse or health care provider and your pharmacist. Over-the-counter treatments can include antacids, antidiarrheal, anti-inflammatory agents, aspirin, laxatives, salt substitutes, sugar substitutes and vitamins. 1

Anonymous   July 21, 2014

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What about bathing and showering?

You may choose to bathe or shower with your pouch on or off. If you shower with your pouch off, choose a soap that is oil-and residue-free. These types of soaps will not interfere with the adhesion of the wafer.2

Anonymous   July 21, 2014

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Will I need special clothing?

Don’t worry-you will not need a new wardrobe. Modern ostomy pouches are inconspicuous are inconspicuous under almost any kind of clothing because they’re designed to lie flat against the body. Ostomy pouches for both men and women can be worn inside or outside underwear; whatever feels most comfortable. Yet if your stoma is at or near the waistline, be sure to avoid pressure from tight-waisted pants or belts. Girdles or panty girdles can be worn, as long as they are soft and stretchy, without a front panel. For men, if you wear an athletic supporter, it is helpful to wear it one size larger.3

Anonymous   July 21, 2014

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Can I exercise and play sports?

An ostomy should not prevent you from exercising or from being physically active. Other than extremely rough contact sports or very heavy lifting, you should be able to enjoy the same type of physical activities you enjoyed before your surgery. People who have ostomies are able to swim., water ski or snow ski, play golf, tennis, volleyball or softball, hike, sail or jog just as well after their surgery as they did before.5

Anonymous   July 21, 2014

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When can I return to work? What about travel?

As with any surgery, you will need to allow some recovery time. Recovery from this type of surgery can take from six to eight weeks. You should check with your doctor before returning to work. After your recovery, you should be able to return to work, or travel just about anywhere. Your ostomy should not limit you. Ostomy products are available through medical or surgical retailers in nearly every country in the world. Of course, it is always a good idea to take your own supplies with you when you travel – and always take more than you think you will need.5

Anonymous   July 21, 2014

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Will other people know?

Very few people, even those you see on a daily basis, will know that you have had ostomy surgery-unless you choose to tell them. Whether you tell others is entirely up to you. Most likely your relatives and friends already know you’ve had a health problem that required surgery. But you may feel uncomfortable about revealing more, fearing they might have negative attitudes about ostomies. It’s true that some people have uninformed ideas, but if these people are important to you, you can either help to educate them or simply not mention your surgery.1

Anonymous   July 21, 2014

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What about intimate relationships? Can I have children?

Because ostomy surgery is a body-altering procedure, many people worry abourt sex and intimacy, and aboput acceptance by their spouse or loved one. For people who are dating, a big concern is how to tell someone about the ostomy. It’s important to remember that supportive personal relationships can be major sources of healing after any type of surgery. It’s also important to let your partner know that sexual activity will not hurt your stoma. Ostomy surgery affects both partners in a relationship, and it’s something to which both partners must adjust-each in his or her own way. The key, of course, is understanding and communication. If having children is a concern, you’ll be happy to know that after a satisfactory recovery it is still possible for a woman who has a stoma to have children. Also many men have become fathers after having colostomy or ileostomy surgery. For men, urostomy surgery can sometimes cause a change in sexual function; however, there are men who have become fathers after having urostomy surgery. If you have questions about pregnancy, don’t hesitate to ask your doctor or ET nurse. For both men and women, it is very important to discuss the surgery openly with your spouse or loved one. Also, don’t hesitate to discuss this aspect of the surgery with your doctor and your ET nurse.5,6

Anonymous   July 21, 2014

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What is a colostomy?

A colostomy is a surgical procedure where the surgeon brings one end of the large intestine out through the abdominal wall, usually on the left side.  The end of the bowel that is brought out to the abdomen is sutured to the skin to form a stoma.

Stool moves through the intestines (or bowels) through the stoma into a pouching system adhered to the abdomen to collect the stool.  Stool from a colostomy is similar to normal stool as it has gone through most of the digestive tract, meaning it can be quite formed or more solid. Colostomies can be permanent or temporary. There are essentially no diet restrictions (unless other medical conditions are present) and bowel patterns often emerge when a patient knows he/she will have 1-2 movements per day for example and see little action in between. If constipation occurs, treatment is generally the same for the colostomy patient as it would be for the patient without an ostomy. It is good to seek advice from your doctor or ostomy nurse if constipation becomes a regular problem.

Anonymous   July 21, 2014

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Why are colostomies performed?

There are many reasons, but the major contributing conditions are:

Diverticulitis (Diverticulitis is small, bulging sacs or pouches of the inner lining of the intestine (diverticulosis) that become inflamed or infected) or abscess
Injury to the bowel or rectum
Rectal or Colon Cancer
Wounds or fistulas in the perineum

 

Anonymous   July 21, 2014

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Can I control bowel movements after colostomy surgery?

Since you will no longer have voluntary control over bowel movements, it is important that you understand the consistency and frequency of discharge after your colostomy. These vary depending upon the location of the colostomy within the colon. An ascending colostomy is located within the ascending colon. Output will be liquid to semiliquid, rich in digestive enzymes and irritating to the skin around the stoma. A transverse colostomy is located within the transverse colon. Output is usually liquid to semiformed. A descending colostomy is located within the descending colon. Output is semiformed to formed. A sigmoid colostomy is located within the sigmoid colon. Output has a normal, formed consistency.1

Anonymous   July 21, 2014

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Do I need to follow a special diet after colostomy surgery? What about diarrhea and constipation?

Unless your doctor has prescribed a special diet, you should not have to change your diet. You may become constipated or have diarrhea just as you did before surgery. If you become constipated, try eating more fiber (vegetables, fruits, and brans) and drinking more water. If constipation becomes a problem, talk to your doctor or ET nurse. If you become ill with a stomach virus, this can give you diarrhea. Treat it the same as before you had surgery, and remember to drink plenty of fluids-you might try one of the ‘sport’ drinks to replace fluids and electrolytes.2

Anonymous   July 21, 2014

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What about gas?

The amount of gas that a person’s system generates depends on the individual. If you had problems with excessive gas before your surgery, you will likely have the same problems after your surgery. Intestinal gas can sometime be the result of swallowing air. Drinking carbonated beverages, smoking, chewing gum, and chewing with your mouth open can all increase the amount of gas you swallow. Sometimes gas can be caused by the foods you eat. Foods and beverages that may increase gas: asparagus, broccoli, Brussels sprouts, cabbage, cauliflower, carbonated beverages, corn, cucumbers, mushrooms, peas and spinach.5

MainAdmin   July 21, 2014

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Will some foods cause odour in the stool?

Foods that can produce odour include asparagus; cabbage family vegetables: broccoli, brussels sprouts, cabbage, cauliflower, onions; cheese; eggs; fish and some spices.1

MainAdmin   July 21, 2014

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What is an ileostomy?

An ileostomy is a surgical procedure where the surgeon brings one end of the small intestine called the ileum out through the abdominal wall, typically though not always on the right side, bypassing the large intestine. Since the ileostomy bypasses the large intestine where fluid is absorbed, ileostomy stool output is the consistency of a paste or pudding. In some cases it is very watery and difficult to differentiate between “normal” output and “diarrhea”. Because of this, dehydration and electrolyte imbalances can occur quickly causing illness and visits to emergency room if not monitored well. Communicating that you have an ileostomy is important whenever you are seeking medical attention. The stool from the small bowel also contains more enzymes that function to break down the foods we eat including protein, carbohydrates etc. Enzymatic stool can damage the skin as it tries to “digest” it as well as in the case of a leaking pouching system where stool is trapped on the skin for a duration of time.

Tough or high fibre foods may be hard to digest in the small intestine and may cause blockages or discomfort when passing through the stoma. Therefore people with ileostomies may need to be more cautious with their diet. Diet counseling is usually done while a new patient is in the hospital, however if you have questions or need further information, contact your local ET (ostomy) nurse or dietitian.

Ileostomies can also be permanent or temporary. Many are done to shunt stool away for several months from a fragile surgical area lower down in the large bowel until it heals and it is safe for stool to pass through the colon again where the ileostomy may be reversed. It should be noted as well, that because stool is exiting the body “early” in the digestive path, certain medications such as those that are enteric coated to protect the stomach or extended release medications (such as certain pain medications) can leave the body without breaking down and being of little used in the body. For this reason, it is important to inform a prescribing physician and your pharmacist that you have an ileostomy.

MainAdmin   July 21, 2014

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Why are ileostomies performed?

A few reasons are:

Crohn’s Disease or Ulcerative colitis
Familial adenomatous polyposis
Colorectal Cancer
Trauma

MainAdmin   July 21, 2014

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What is a blockage?

The small intestine is like a hollow tube or garden hose. Though it is physically impossible to become “constipated“ with an Ileostomy, blockages of the small intestine can happen in two ways. From the inside and from the outside.

The first way is pressure squeezing on the outside of the tube, like stepping on the garden hose to stop water from coming through, or kinking it off. This is what happens when scar tissue or adhesions form. Scar tissue can cause narrowing of the tube whereby slowing down or preventing food from going through.

The second and more common way to block the small intestine, is from undigested food building up and blocking the inside of the “garden hose” or intestine. Food that is not completely chewed, undigestable for most of us under normal circumstances (like corn for instance) or high in fiber acts as a plug and thus prevents stool from moving through the intestine and out the stoma.

Everyone digests food a little differently so there isn’t one list of foods to eat or not to eat. We can give you guidelines on foods that may be difficult to digest, but some people will get blockages from things not on the list. Other people will be able to digest foods on the list without a problem.

Some high fiber foods that may cause a blockage include: popcorn, mushrooms, corn, raw carrots, raw cabbage, celery, nuts, bean sprouts, coconut, dried fruits and dried beans.

For the first 6-8 weeks after surgery your bowel is still swollen and tender which reduces the diameter of the small bowel or “tube” even further. During this time it is more prone to blockage. That’s why you are instructed to eat easy-to-digest, low fiber foods. After the swelling has gone down, you can slowly add small amounts of foods that are higher in fiber to see how you digest them. The important thing is to chew well!  Keeping a food diary can often be helpful.

Signs of a Food Blockage:

No stool is emptying into your pouch (no stool after 4 hours indicates a blockage)
Abdominal pain (may be cramping and come in waves as the body tries to push out the blockage)
Loss of appetite
Vomiting and nausea
Abdominal bloating
Stoma swelling
You can think back to the last 12 hours and recall eating a high fibre food

What to do at home:

Enlarge the opening of your pouching system to accommodate the stoma when it is swollen
Do not eat solid food. Take sips of water only if tolerated
Try to relax: relaxing stomach muscles around your stoma can be the key to releasing a blockage!
Massage around your stoma
Try knees to chest position (fetal position)
Take a warm bath or place a warm heating pad around your abdomen

When to go to the hospital:

If you start vomiting
If you cannot relate the blockage to any foods you ate within the last 12 hours, it could mean it is a blockage due to adhesions or scar tissue
No stool output from your stoma in 12 hours

(**Take all your ostomy supplies with you to hospital)

What the doctor will do at the hospital:

Ask about your medical and surgical history
Bloodwork
Abdominal x-ray or CT scan
Start an IV to give you fluids
Give you pain medication (often after pain medication is given, the abdominal muscles will relax and release the food blockage allowing the undigested food “plug” to pass)
Sometimes it is necessary to do an Ileostomy lavage to clear the blockage (this involves inserting a catheter attached to a syringe into the stoma and trying to physically break apart the food blockage with slightly pressurized fluid)

Once the blockage has been resolved, a clean, drainable pouching system should be applied. Because the stoma may be swollen, the opening in the pouch surrounding your stoma should be cut slightly wider. Stool will be very watery after this procedure.  This can result in dehydration and the need to have IV or fluids while in the hospital. The abdomen will feel tender and almost a bruised feeling which may last a few days. Eat lightly for the next few days. Easy to digest foods are best until the tender abdominal feelings go away and the stoma goes back to its normal size.

MainAdmin   July 21, 2014

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I have read that people with an Ileostomy can be prone to kidney stones. Why?

The most common kind of kidney stone for people with an ileostomy are the uric acid stones. This stone is caused by dehydration and from diet.

Dehydration results when not enough water is being absorbed in the body – either because you are simply not drinking enough, or because too much water from watery stool is lost through your ileostomy. Usually the large colon, which is bypassed when you have an ileostomy, is where the majority of your fluid is absorbed. Over time, the small bowel adapts to absorb some of the fluid when there is an ileostomy, however it is not as efficient at absorption of water as the large bowel was. Therefore, getting 1.5-2L per of fluid per day is very important. Remember, fluid does not have to mean only “water”. Juices, drinks without caffeine or alcohol, low sodium soups, pudding, and popcicles are some other ways of meeting your daily fluid requirements.

Another way increase the amount of fluid your body absorbs is to thicken up your stool whereby reducing the amount of fluid that is lost through watery ileostomy stools. Some foods such as white rice, bread, smooth peanut butter, apple sauce, pasta and marshmallows are known to thicken stool but remember, everyone’s body reacts differently to different foods.

Uric acid stones can also result because of poor fluid intake because less urine is produced and therefore that urine is more acidic and is missing sodium because most of the water and sodium bicarbonate comes out through the stool. Another factor that increases the risk for uric acid stone formation is loss of sodium bicarbonate, which is a compound in your body that is used to regulate electrolytes and the body’s pH.

This is a complex process, but as an easy and basic rule:

Drink, drink, drink, or “you’re in” trouble!

MainAdmin   July 21, 2014

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What is a urostomy?

A urostomy is a surgically created opening-on the abdomen- that allows urine to flow out of the body. A urostomy may also be called a urinary diversion. Many times, the person’s bladder and urethra are surgically removed. When a person has a urostomy, urine is no longer eliminated through the urethra. Instead, urine is eliminated through the urostomy. A urostomy does not have a sphincter muscle, so a person who has a urostomy has no voluntary control over when to urinate. Instead, the person wears a pouch to collect the urine. Your surgeon may select one of several methods to create the urostomy, or urinary diversion. The most common method is called an ileal conduit. To create an ileal conduit, the surgeon removes a short segment of the small intestine(ileum). This short segment of intestine will be used as a pipeline-or conduit-for urine to flow out of the body. The surgeon closes one end of the conduit, inserts the ureters into the conduit, and brings the open end of the conduit through the abdominal wall. This new opening on the person’s abdomen is called a stoma.6

MainAdmin   July 21, 2014

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What about diet after urostomy surgery?

Eating a well-balanced diet, that can include your favorite foods, is important to your health. Be aware that some foods cause an odour to urine including: asparagus, onions, fish and garlic. These foods can still be eaten; however, you may become aware of an unusual odour. You should drink at least 8 glasses of fluid each day, unless you have to limit your fluids due to a medical problem. Be sure to drink extra fluids when exercising or sweating.7

MainAdmin   July 21, 2014

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What’s the best way to get a good urine sample when you have a urostomy?

Rest of the question:  I have a urostomy and think I may have a urinary tract infection (UTI). My urine is cloudy, it has a strong smell, and I see more mucus in my pouch than usual. My doctor wants to have a urine specimen (C&S) to see if I have an infection and which antibiotics may be needed. What’s the best way to get a good urine sample when you have a urostomy?

Answer:

Getting a “good” urine sample is essential to determining IF you have a urinary tract infection AND which antibiotics would be most effective in treating this infection. Simply taking a urine sample from the spout of your pouch is NOT will not get accurate results because, you will have results of what is growing in the POUCH and potentially not what is growing in your own BODY. Inaccurate results can prompt the treatment of the wrong bugs that aren’t actually in your system and you may not have needed antibiotics at all! The urine sample should to come directly from the stoma itself as this will catch “fresh sterile urine” that has not been exposed to outside elements yet and contains whatever “bugs” that may be bugging you~!

 

There are two ways to collect the urine sample.

  The ideal method is using a catheter – To be done by a health professional
a)    Remove the urostomy pouch and clean the area of skin and stoma with warm water (using alcohol is NOT required)
b)    Using sterile technique, gently insert a small lumen catheter (eg 10 Fr) 4-6 cm into the stoma
c)    Place the other end of the catheter into the C&S container to collect urine
d)    Wait until about 10-20 cc of urine is collected
e)    Replace pouching system
“The Next best thing”: Can be done by the patient
a)    Remove the pouching system from your body
b)    Wash the skin and stoma with water (using alcohol is NOT required)
c)    Hold the collection container under your stoma but NOT TOUCHING your stoma or the skin catching while catching urine that dribbles out
d)    Wait until you have 10-20cc of urine collected
e)    Replace your pouching system
f)      After collecting the sample, refrigerate immediately and drop it off to the lab as soon as possible.

Helpful tips:

Take the urine sample at a time you know your stoma will actively be producing urine. Trying to do this first thing in the morning mightnot be the best time, as you have not had much to drink during the night.
Coughing and slightly moving your position may help move urine out of the stoma.

MainAdmin   July 21, 2014

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I have noticed that my night bag / bottle and my urostomy pouch sometimes has a bluish purple tinge to it. Is that normal?

Purple Urinary Bag Syndrome (PUBS)

People using leg bags or night drainage bags or bottles sometimes notice a purple tinge to their equipment.  It was first noted in 1812, when physicians looking after “mad” King George III noticed a blue tinge to his urine. There’s no need to worry; it doesn’t mean you’re “mad”, too. King George suffered from one of the risk factors, constipation.

Other risk factors include female gender (although it is seen with men also), alkaline urine, use of urinary catheters, the “plastics” used to make catheters and drainage bags, and bacteria in the urine (this does not always mean there is infection).

For the biochemists, bacteria in the urine produce the enzyme indoxyl phosphatase which converts indoxyl sulphate in the urine into the red and blue coloured compounds indirubin and indigo.

Keep in mind, PUBS is nothing to worry about. There are simple steps to reduce the risk factors that lead to PUBS.

Female gender: nothing you can do, sorry! ( Men can get it too.)
Alkaline urine: talk to your doctor about taking Vitamin C to keep your urine acidic
Constipation: things that promote regular bowel movements include adequate fluid intake, exercise and eating enough fiber (whole grains, vegetables and fruits)
Bacteria in the urine: increasing fluid intake, cleaning/replacing your drainage equipment (tubing, night drainage or leg bags, bottles and adapters) on a regular basis

See your doctor if you do have signs of infection in your urine:

Dark urine
Cloudy urine
Increased odour to your urine
Fever

MainAdmin   July 21, 2014

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Is my stoma normal?

Whether you have a colostomy, ileostomy or a urostomy you will have a stoma. A stoma or ostomy is a surgically created opening placed somewhere on the abdomen which is the exit point for either stool from the digestive system or urine from the urinary system. A stoma is fashioned from either large or small bowel which is turned inside out and sewn onto the skin. A stoma is red in colour and warm to the touch as it is very vascular, meaning it is well supplied with blood vessels. It is also glossy or wet looking because the bowel continually produces mucous just like the tissue from the inside of your cheeks (mouth).

There are rarely two stomas that look alike. Variations in surgical technique, body shape and composition (thickness of fatty tissue of the abdomen for example) are factors that influence what shape a stoma will take. Some are round, while others are more oval in shape. Some are flat, some protrude well. Some are big and some are small in diameter. Directly after surgery, it will take 6-8 weeks for the swelling to reduce before the stoma takes its “final shape”. But even after this, factors such as weight gain or loss, stoma prolapse or retraction (early on) and peristomal hernias can change the shape and height of a pre-existing stoma. Overall, any stoma should appear, red, wet and warm as a general rule. If there is any gradual or sudden change with the appearance of your stoma, discuss this with your surgeon/physician or ET Nurse.

MainAdmin   July 21, 2014

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Is my skin normal?

The skin around your stoma, or peristomal skin, which is the skin under the adhesive part of your pouching system, should appear similar to the skin everywhere else on your abdomen. However, research indicates that many people with ostomies have skin problems and do not report or recognize them. If you are ever in doubt, it is better to ask questions and seek help from an ET Nurse who can direct you if you need further treatment from another medical professional. Small problems can turn in to big ones quickly, so better to ask sooner than later!

Remember, sometimes your skin may look pinker, redder or darker right after you take off your adhesive pouching system. This should fade away after a few minutes.

MainAdmin   July 21, 2014

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How do I clean around my stoma?

All you need to clean around your stoma is warm water and either a washcloth or a soft disposable paper towel. Using sterile gauze and wearing gloves to change your own pouching system can be expensive and is unnecessary. REMEMBER, YOU ARE NOT DEALING WITH A STERILE AREA. Using alcohol to clean the area is equally unnecessary and can be very drying to the skin. Also, it is not recommended to use baby wipes or pre-moistened towelettes as they may contain chemicals that remain trapped on the skin and can cause a rash.

Soaps, including ones that are moisturizing (Oil of Olay, Dove) are not needed and can actually hinder the pouching system from sticking well on your skin and contribute to leaks. If you are showering without wearing a pouching system and soap flows down onto your stoma and skin, just rinse the area well afterwards. This is not a concern.

When washing your stoma, you may notice small specks of blood on your cloth. This is completely normal and expected. The stoma tissue contains small blood vessels close to the surface that may bleed, especially if you are taking blood thinners.

MainAdmin   July 21, 2014

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Do I need to “air out” my skin when changing my pouching system to keep it healthy?

No, this is not necessary. It may feel good to “air out”, for a while but this is not required in order to have the skin remain healthy. This may also be difficult if your stoma is active!

MainAdmin   July 21, 2014

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How long should it take to change my pouching system?

There is no “set time” for this. Everyone works at their own pace and becomes more and more proficient, confident and comfortable as time goes on. In the end, it shouldn’t take more than 15 minutes to complete a change if your stoma is inactive. If you continue to take a long time to change, it may be time to see an ET Nurse to see if your routine can be simplified.

MainAdmin   July 21, 2014

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Could I be allergic to my ostomy pouching system?

There is less than a 1% incidence of a true allergy to any part of the pouching system. All parts are of the system are latex free, including the belt (if you are using one). There is a multitude of reasons for skin issues, however they are typically due to a leak in the system causing stool or urine to sit on and irritate the skin. Remember, when you first remove your pouching system, your skin may be pink, but this should fade in a few minutes. In any case, it is important to seek help from an ET Nurse sooner than later if you have concerns. Do not assume that you have an allergy or that this cannot be resolved.

MainAdmin   July 21, 2014

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Should I be using stoma powders, skin protective sprays / “prep” wipes, alcohol swabs or wound/skin spray cleansers when I change my pouching system?

No, unless your ET Nurse has suggested this for you as a SHORT TERM treatment. These products are not to be used routinely as they can build up and irritate the skin and actually prevent the pouching system from sticking properly. Statements such as “less is more”, and “keep it simple” stand true in ostomy care so that using “extras” such as wipes and powders should have a reason rather than a routine.

Using stoma powder and a protective skin spray or wipe afterwards to seal in the powder is commonly referred to as “crusting” but is only a SHORT TERM treatment for weepy skin breakdown around the stoma. If this becomes part of your routine because of recurrent skin breakdown, this should be re-evaluated and discussed with your ET Nurse as your pouching system may need to be modified to give you a better fit and actually protect your skin on its own.  “Crusting” should be reserved for the “occasional” skin problem and is a very useful tool for treatment.

Skin protective sprays and wipes such as Skin Prep, Cavilon No Sting, Hollister Skin Gel etc, are overused in general partially because of the name “skin protective” itself. But these products can actually build up on your skin and prevent the adhesive pouching system from sticking. Talk to your ET Nurse to see if these products are appropriate for you.

Wound/Skin cleansers (and alcohol wipes) are expensive and unnecessary because the stoma is not a “wound”, nor is it considered a sterile area. Use of these products can also cause irritation and also hinder adherence of your pouching system. Alcohol will also dry out the skin.

MainAdmin   July 21, 2014

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How does chemotherapy affect my stoma and peristomal skin?

Chemotherapy is a type of cancer treatment that may effect your skin and stoma. The impact of chemotherapy may be create skin problems around your stoma (peristomal skin) and the overall management of your ostomy. There are many different types of chemotherapy treatments, each with its own specific way that it affects the cancer. But not all treatments cause the same side effects to the skin and/or stoma. Your oncologist and chemotherapy nurses are the experts and will advise you about the possible side effects that may occur.  They are an excellent resource to answer your questions and concerns. They can provide you with various patient handouts outlining different chemotherapy drug protocols and patient guidelines. 
 
In general, remember that your stoma is surgically created from bowel tissue, which is very similar to the tissue in your mouth. Some chemotherapy drugs affect the tissue in your mouth resulting in sores, ulcers or causing the tissue in your mouth to bleed easily. Your stoma may react the same way. You may find that your stoma bleeds easily when you are washing it or you may find tiny sores on your stoma.

Your stoma may also swell. This is because the lining of your colon or intestine can become irritated and inflamed from the chemotherapy.

During chemotherapy your skin may be more sensitive. This includes peristomal stoma. The skin around your stoma may become more sensitive by becoming red and sore.  Remember that gentle removal of the pouching system during changes is important when skin is fragile. 
 
If you still have your large colon, you may have an increase of mucous drainage from your anus. Again, this is because the chemotherapy can make the lining of your colon inflamed and irritated causing more mucous to be produced which will pass through the anus.

Recommendations:

Be gentle when changing your pouching system.  Gently remove your pouching system from your skin.
Wash your stoma and skin with warm water and a soft cloth.
If your stoma is swollen or has enlarged, cut a larger opening in your pouching system or speak to an ET ostomy nurse and get a system to accommodate your stoma.
If you have any concerns or questions, do not hesitate to contact an ET ostomy nurse.

MainAdmin   July 21, 2014

1 people found this faq useful.

I have an ostomy and am gay. Is there anyone out there who would understand my concerns?

Your ET or WOCN nurse deal with people from varying backgrounds, beliefs, sexual orientation and cultures. Each one of us is unique.

There is an excellent website that maybe a good resource for you. www.glo-uoaa.org.

The GLO website can be used by individuals seeking information, chapters looking for a trained visitor or for anyone wishing to expand their knowledge of the Gay or Lesbian person with an ostomy.

MainAdmin   July 21, 2014

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What is a peristomal hernia?

The development of a peristomal hernia after ostomy surgery is very common. Statistics show a wide range from 4-48% chance of developing a peristomal hernia.  Most peristomal hernias occur within the first 2 years of surgery.

Some surgeons say that they give you a hernia when they do your ostomy surgery; this is because their definition of a hernia is an opening or hole in the muscle, and to form the stoma the surgeon needed to make a hole in the muscle, to bring the bowel through the skin.

We usually say people have a hernia when we see a bulge around the stoma. It may appear like the stoma is sitting on an orange or grapefruit.  For some people, they don’t feel any different; they just have a bulge on around their stoma. For others, the hernia is uncomfortable and when they are up and about they feel they need to support or hold that side of their abdomen. Sometimes there is a pulling sensation, like a muscle pull, which is relieved by sitting or lying down or holding that area. The bulge or hernia sticks out more when people are standing and when lying down the bulge or hernia may flatten or go away.

hernia 01 hernia 02

MainAdmin   July 22, 2014

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What are the risk factors to developing a peristomal hernia?

Hernias develop when the opening in the muscle, created by the surgeon to bring the bowel through the muscle and skin layers to make the stoma stretches. This allows loops of bowel to come through the enlarged opening. Anything that stretches the muscle opening larger is a risk factor to develop a peristomal hernia.

Activities that increase strain on abdominal muscles and stretch the muscle opening larger include:

Coughing and sneezing
Lifting heavy items using abdominal muscles
Large weight gain after ostomy surgery
Obesity
Other risk factors include
Poor nutritional status
Emergency surgery resulting in an ostomy
Certain drugs that slow healing- such as corticosteroids
Previous abdominal or inguinal hernias which may indicate abdominal wall weakness
Age – as we get older the abdominal muscles lose tone and strength and the opening where the bowel goes through may enlarge.

MainAdmin   July 22, 2014

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What should I watch for if a hernia develops?

–        The contour of the abdomen changes which may affect the seal on your pouching system. This may change wear time, frequency of leakage and a new pouching system may be required.

–        The size of the stoma may enlarge so the opening in the pouching system may need to be adjusted

–        Abdominal and back discomfort as there is a stress or pull on those muscles

–        ** The most serious complication to watch for is a bowel obstruction/strangulation ***

A loop of bowel may get stuck through the muscle wall opening.  If the muscle wall squeezes down on the bowel, it can to block the bowel  so nothing can pass. That is no stool can move through the stoma. More importantly, the blood supply to the bowel and stoma can also be affected.  The colour of the stoma will change from its usual pink/red colour to a dark dusky purple black colour. You may also have abdominal pain and cramping and nothing coming out of your stoma.  Please go to emergency.

MainAdmin   July 22, 2014

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What can be done if I have a hernia?
Surgical Management

Surgeons are hesitant to repair a peristomal hernia, as it is very likely to recur.  There are different surgical techniques for repairing peristomal hernias.  Each surgeon will have their preference for the technique they use. It is a complex surgery to do a hernia repair involving a stoma.

Surgical techniques include suturing the enlarged opening in the muscle wall to make it smaller.  Moving the stoma to the other side of the abdomen is another surgical option. Repairing the hernia by putting a mesh in is another common approach.  There are different types of mesh and surgical techniques to put the mesh in.

Non-surgical management

Surgical repair is usually avoided in people with no or mild symptoms because of the high recurrence rate.  Many people with mild symptoms can be managed with a ostomy hernia belt or support garment.  There are many types of ostomy hernia belts available on the market. Most have an opening to allow the pouch to come through so the urine or stool output is not affected.  ( pictures).  Many women find that a supportive panty is all they need but they need to see that the flow of output is not affected.

It is important to note that the hernia belt or support garment will not “ take the hernia away” or prevent a hernia. It is for comfort and support.

hernia 03

Examples of Nuhope Peristomal Hernia Belts

MainAdmin   July 22, 2014

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What are some exercises to strengthen abdominal muscles?

Physiotherapists are trained to strengthen damaged muscles safely.  It is recommended to see a physiotherapist to assess your abdominal muscles and to recommend a program to help you safely strengthen your core abdominal muscles.

The time to see a physiotherapist is about 8-10 weeks after surgery or when your surgeon lets you resume your normal daily activities.

Marilyn Moore, a physiotherapist, developed the following sets of exercises and she also has an ileostomy. In developing these exercises she stresses the need to take things in steady stages.  Gradually building up to the more challenging exercise is the surest way for you to improve both fitness and general health.

Check out this link to see preventative core abdominal exercises  www.iasupport.org/about/publications/factsheets/exercises-for-ostomates

MainAdmin   July 22, 2014

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How do I prevent from getting a hernia?
Be cautious when lifting- use proper technique and watch how much you are lifting. There is no magic number for the number of weeks after surgery before lifting or exercising or the amount of weight to lift or not lift, as everyone heals at a different rate.  Please check with your surgeon.  If still unsure, do not lift any more than 5 pounds or 2.2   kilograms for 8-10 weeks after surgery then gradually increase.
Contact a physiotherapist to learn how to strengthen your abdominal muscles safely.
Maintain a healthy weight.

MainAdmin   July 22, 2014

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I have an ileostomy now for about a year and could you tell me why when the stool comes out it stays up just where it comes out does not fall down in the bag. What can I do about that. So I do not eat if I am going out as I do not want that to happen. Would it be my diet. I really not to sure what to eat I cannot digest any vegetables except potatoes and sweet potatoes.

Pancaking

This is when the output collects around the stoma and can squeeze between the flange and the skin instead of going into your bag. One of the reasons this happens is because there isn’t enough air in the bag and so the output doesn’t take a downwards turn.

If this happens, try lubricating your bags with baby oil or one of the many products available from the various supply companies. Squirt a little oil or gel in your bag and give it a good rub around before you stick it on. Take care not to get any on the adhesive as this can reduce the effectiveness of the seal.

If you’re wearing clothes that are tight fitting in the stoma area this can also cause pancaking. You may want to try to wear looser fitting clothing in order to prevent a vacuum forming inside the bag. Also, in terms of clothing, make note of where your waistband or belt sits. Does it allow the stool to drop into the pouch or does it restrict the stool so the stool gathers only at the top. Monitor your body positions. If you are sitting for long periods for example driving or at the computer, does the pouch fold onto itself not allowing the stool to drop but remain in the top part of the pouch?

If the pouch has a filter in it, block the filter by either using waterproof tape or the ” tabs” that come in the box of pouches. This will leave air in the pouch, preventing the vacuum effect and allow to stool to drop into the pouch.

Another reason for pancaking is that your output is thick. Each person is an individual and so, each of us has trigger foods that can cause digestion processing issues, and stool issues. It would be helpful to consult your physician for a referral to a nutritionist or dietician to assist you in identifying foods that will work best for you.

[July 22, 2014]

To get additional information or help, find an ET in your area by clicking here…

MainAdmin   July 24, 2014

2 people found this faq useful.

I’m looking for ways to help my grandson, who has an ileostomy that is always leaking.

Leakage

Ostomy leakage is a problem which all ostomates will no doubt encounter at some point during their time with a stoma. For most people it’s a common occurrence in their early weeks of managing an ostomy when you are still finding your ostomy-feet and working out which products are best for you, and which routine gives the best results. It can cause a heck of a mess, not only to our clothes, but to our self-confidence too.

To find out what is causing the leakage start by checking the back of the flange after it’s leaked and you’ve removed it. This holds the biggest clue of all, you will be able to see what path the stool took on its break to freedom. Compare this to your skin and see what problems are present.

Condition of the skin. Is it raw, or does it have a rash all over it, or on part of it? If so, you may be allergic to the flange, and it may be interfering with the adhesive properties of the flange. Also, check to see if the area around where the flange leaks is any worse than elsewhere.
With leakage, the stool will always follow the path of least resistance. Do you have a belly crease which in turn is creasing the flange and creating a nice little tunnel for your stool to escape?
Look at your flange. Was the gap around the stoma too large? Or was it too tight? Or just right? Do you have protruding stitches around your stoma which the flange has trouble moulding around?
Do you have a belly cavity near the stoma? Flanges may struggle to adhere to these dips in your belly and lead to leakage.
Check your stoma. Is it flat/flush to the skin? Is it inverted / pulled in?

Some causes of leakage could be:

Flush to the skin or inverted stoma
Poor fitting flange/odd shaped stoma
Belly cavity around stoma
Parastomal hernia and/or Pancaking

Once you’ve discovered the source of your leakage then you are in a better position to be successful in stopping your leakage in its track, and there are a number of products available on the market which are designed to help reduce opportunities for leakage to occur.

Arrange a visit with an Enterostomal Therapy Nurse, (ET nurse – registered nurse [RN], who has specialized training in treating patients with ostomies), who can assist you in assessing the leakage issue and make equipment product recommendations for ensuring a good seal. One thing to bear in mind with all ostomy products is that our bodies are very individual, and because of that, a product which works great for one person may not work anywhere near as successfully for another, and vice versa. You may need to sample various rings and seals to find the one that works best for you, which the various ostomy product companies will also assist you in finding the seal that will work for you. So there is no reason why you cannot use multiple products to help combat leakage.

[July 23, 2014]

To get additional information or help, find an ET in your area by clicking here…

MainAdmin   July 24, 2014

2 people found this faq useful.

I am not doing very good with my diet. What would be a proper one?

Diet – Healthy Eating With A Stoma

The impact of food and drink on your stoma is hard to predict as diet is very individual. Various surveys suggests that foods can affect people in different ways after stoma surgery. While many people find that they can eat just the same diet as before their surgery, some find there are things that can have an adverse effect on the activity of their stoma. They may then choose to avoid those foods, or include them in their diets and be prepared for the effects.

Many people report that a good way to ascertain which foods and drinks are suitable for them is to keep a food diary so that patterns between diet and stoma output can be identified. You can then base your diet on what you have observed to be agreeable in terms of stoma output. There may be a certain degree of trial and error, especially in the first few months after your stoma is formed when the bowel is swollen. This swelling (or oedema) is the reason why a stoma may look puffy initially and can cause problems digesting food that would otherwise not occur, so it’s sometimes worth trying a food again later on before deciding whether to eliminate from your diet completely.

Information about diet and healthy eating for the general public is often conflicting and difficult to interpret. Add to this a stoma and many people feel confused about what they should and shouldn’t be eating.

Most people with stomas do not need to change their diets and should follow a normal healthy eating pattern like the rest of the population. If you have recently had your surgery or have been unwell, ensuring that you get all the essential nutrients from your diet is even more important and putting unnecessary restrictions on your diet could slow down your recovery and healing.

The purpose of the following information is to offer general information, for further information about diet, ask you physician to refer you to a dietician in order to explore any important factors to take into consideration regarding your individual stoma management and general wellbeing.

A balanced diet is made up of:

Starchy foods such as potatoes, rice & grains, bread and pasta, for energy. Try different varieties, including wholemeal vs refined/white rice and pasta.
Fruit and vegetables provide a wide range of vitamins and minerals and both soluble and insoluble fibre. Soluble fibre is found in the flesh of fruit & veg and can help lower cholesterol as well as make stool thicker, softer and easier to pass (helpful for those with a colostomy or ileostomy who wish to thicken their output). Insoluble fibre is found in the skins of fruit & veg and helps move waste through your bowel, so can help with constipation (helpful for those with a colostomy who experience pancaking and anyone who experiences constipation). If you have a colostomy or ileostomy, immediately after surgery foods containing insoluble fibre may make your stoma behave unpredictably, so you may wish to avoid or limit your intake of them. As your bowel adjusts you can re-introduce them and see how they affect you.
Protein rich foods for growth and healing. Protein comes from meat, fish, eggs, soya and it is the substance we use to heal wounds and regain muscle.
To promote general wellbeing, fatty foods should be limited. However, if you are recovering from surgery or have a small appetite and need to gain weight, including more of these foods in the short term is a good idea.

Individual Differences

The vast majority of people with a urostomy (a stoma that passes urine) find that their food intake is unaffected by having a stoma, however some food and medications can make urine discoloured or smelly (e.g. beetroot can make your urine pink and antibiotics and asparagus can make it smell strange).

Importance of chewing

It sounds very obvious, but it is vitally important to chew food thoroughly when eating. Chewing is the first stage of digestion and in doing this we make more nutrients available from our food. Foods that contain cellulose such as nuts, grain, fruit & vegetables (particularly the skins) cannot be completely broken down in the digestive system. So, you may notice these coming through your stoma looking the way they did when you ate them. Immediately after bowel surgery, your bowel is swollen and this narrows the passageway for food to pass along.

Fluid Intake

It is essential for everyone to drink enough to keep their kidneys healthy and flush out the chemicals that build up in the blood. You should aim to drink enough throughout the day that your urine is a light straw colour. The following information is for the specific stoma types but does not take into account other medical conditions. If you have been given different information from your healthcare professionals please check with them before making any changes.

People with urostomies enjoy a few glasses of water a day. This will help to prevent infections.

If you have a colostomy, your fluid intake can remain as normal unless you are experiencing constipation or pancaking. If you have this problem, increasing your fluid intake can be really helpful.

People with ileostomies, particularly if the stoma is formed higher up in the bowel, can have more difficulties with their fluid intake. This is because it is the role of the large bowel to absorb water (and salt) and for people with ileostomies this is no longer being used. The small bowel will, with time, adapt to absorb more water and more salt, however careful attention should be paid to ensure that you are drinking an adequate, varied fluid intake to maintain kidney health. Remember, you are aiming for light straw coloured urine.

For those who are more active it is even more important to pay attention to your fluid intake. Fluids are lost through sweating that contains electrolytes.

Everyone should bear in mind that alcohol is a dehydrating fluid and caffeinated drinks such as tea and coffee cause you to lose more fluid in your urine. The majority of your fluid intake should therefore be from fluids such as water and fruit cordials.

A little of what you fancy….

Of course, every now and again you will want to enjoy a treat like cake or ice cream and there is no reason why you can’t indulge once in a while! Healthy eating is about moderation and after stoma surgery it is also about trial and error. Take your time to explore how different foods affect your stoma, chew your meals, maintain a varied fluid intake and, most importantly, enjoy your food!

Some foods effect output. The effects may vary.

Basic Food Reference Chart

Stoma ObstructiveGas ProducingOdour ProducingColour ChangesOdour ControlIncreased StoolDiarrhea Control
Apple peelsBeansAsparagusAsparagusButtermilkBran cerealsApplesauce
Cabbage rawCabbageBaked beansBeetsCranberry juiceFresh fruitsBananas
Corn, whole kernelCarbonated beverageBroccoliCoffeeTomato juiceGreen, leafy veggiesPeanut butter
CoconutCauliflourCod liver oilCooked fruitsYogurtMilkTapioca
Dried fruitCucumberEggsFood colourPrunes
MushroomsDairy productsFishIron pillsRaw vegetables
PineappleNutsGarlicStrawberriesWhole grains
PopcornOnionsOnionsTomato sauces
SeedsRadishesPeanut butter
SoyStrong cheese

To get additional information or help, find an ET in your area by clicking here…

MainAdmin   August 10, 2014

1 people found this faq useful.

I’d just like to check out anything new…

What’s New

The newest news about ostomates I’ve noticed, is the latest trend in breaking the taboo of ostomies and ostomy bags through posted photographic images.

Facebook, Instagram, and Twitter are just a few of the social media being used by ostomates to show and share their colostomy, ileostomy and urostomy bags and scars.

They are young, older, male, female, and all of them are plucking up the courage to share themselves and their bags to a wider audience.

I’ve heard some folks take offence to the photographic images, and heard other folks cheer them on.

My take on this new and inspiring trend is; go ahead folks, be proud of who you are, you are amazing, and so, embrace your ostomy, inspire others, and keep spreading awareness!
Jo-Ann L. Tremblay

[July 27, 2014]

MainAdmin   August 11, 2014

1 people found this faq useful.

What clothing tips are there for a person with an ostomy?

Stephanie Hughes from the blog, Stolen Colon, shares a wonderful video on What to Wear With an Ostomy…

 

MainAdmin   August 12, 2014

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What sort of swimsuit options are out there for women with ostomies?

Jessica Grossman of Uncover Ostomy, has a wonderful blog entry titled Itsy Bitsy Ostomy Bikini with several links to swimsuit options.

Also, Stephanie Hughes of Stolen Colon, shares a video showing different swimsuit options as well:

 

MainAdmin   August 12, 2014

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I would like to learn more about colostomy irrigation…

(Disclaimer: Before attempting any irrigation techniques, you must get your doctor’s permission)

* Reprinted with permission from The Phoenix magazine, www.phoenixuoaa.org or call 800-750-9311

Download (PDF, 156KB)

MainAdmin   September 18, 2014

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What is an ostomy?

You may know someone who wears a “bag” or pouch on their abdomen or have an ostomy yourself. The term “colostomy” is often the default go-to word when people talk about ostomy care, suggesting that all “ostomies” are “colostomies” and thus created and function equally.  In actual fact, the term colostomy only refers to an ostomy created from the large bowel or colon and only represents one kind of ostomy. An ileostomy is also a fecal stoma (producing stool waste) which the surgeon creates using a portion of the small bowel or ileum. Finally, a urostomyproduces urine in the absence of the bladder as with bladder cancer for example. It is important not only for health professionals to understand and distinguish between the 3 “kinds” of ostomies, but for the ostomy patient themselves as the guidelines for care are very different for each. All 3 will have a stoma or bowel that has been brought to the surface of the abdomen, but anatomically be very different.

Anonymous   July 21, 2014

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What does a stoma look like?

You may know someone who wears a “bag” or pouch on their abdomen or have an ostomy yourself. The term “colostomy” is often the default go-to word when people talk about ostomy care, suggesting that all “ostomies” are “colostomies” and thus created and function equally.  In actual fact, the term colostomy only refers to an ostomy created from the large bowel or colon and only represents one kind of ostomy. An ileostomy is also a fecal stoma (producing stool waste) which the surgeon creates using a portion of the small bowel or ileum. Finally, a urostomyproduces urine in the absence of the bladder as with bladder cancer for example. It is important not only for health professionals to understand and distinguish between the 3 “kinds” of ostomies, but for the ostomy patient themselves as the guidelines for care are very different for each. All 3 will have a stoma or bowel that has been brought to the surface of the abdomen, but anatomically be very different.²

Anonymous   July 21, 2014

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How should I care for the skin around my stoma?

It is very important for the skin around the stoma (the peristomal skin) to remain healthy and free of irritation. The peristomal skin should look just like the skin elsewhere on your abdomen. To prevent skin irritation or other skin problems, you must have a skin barrier and pouch that fits properly. Each time you remove your skin barrier and pouch, look carefully at the peristomal skin. If you notice any swelling, redness or rash, you could have irritated skin. Sometimes-but not always-irritated skin is painful. If the problem persists for more than two pouch changes, contact your ET Nurse.5

Check out an excellent reference guide provided by the WOCN (Wound Ostomy and Continence Nurses Society):

Download (PDF, 648KB)

Anonymous   July 21, 2014

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What is an ET / Ostomy Nurse?

An Enterostomal Therapy (ET) Nurse is a registered nurse with advanced and specialized knowledge and clinical skills in wound, ostomy and continence care. Recognized as Nursing Specialists in wound, ostomy and continence by the Canadian Nurses Association (CNA), ET Nurses are the ONLY nursing specialty with CNA certification in wound, ostomy and continence care. ET Nurses work in acute care hospitals, outpatient clinics, community care, long term care and in independent practice. An ET nurse provides specialized holistic assessment and management as part of an interprofessional team member. He/she functions to meet the needs of individuals/families with ostomies, acute and chronic wounds and urinary and fecal continence problems.

Some nurses will have different “letters” after their name such as WOC Nurse or cWOC Nurse which indicates that they did their wound, ostomy, continence education in the United States. It should be noted that there are different education levels for wound and ostomy health professionals that vary from a 1 day course to the full scope nursing specialty an ET or WOC Nurse. To ensure your best care, be sure you are seeing a nurse with full credentials. To find an ET/WOC Nurse in your area, you can contact the Canadian Association for Enterostomal Therapy (CAET) www.caet.ca.

When to see an ET/Ostomy Nurse:

Do you have a new ostomy and need more teaching after discharge from the hospital?
Do you have regular leaks of your pouching system?
Are you suddenly getting less wear-time of your pouching system?
Have you gained or lost weight?
Does your flange “not stick” to your skin?
Has the shape or size of your stoma changed since surgery?
Are you using powders and sealant sprays frequently?
Do you have questions around nutrition, lifestyle, or intimacy?
Do you have questions about how to better conceal your pouch with clothing or when participating in sports?
Do you want to learn more about hernias?
Do you think you have a hernia and want to learn about support garments?
Do you need feedback about how you are currently managing?
Are there sores or wounds around your stoma?
Have you had your stoma for many years and just want to see “what’s new”?
Is it time for an annual check up?

Anonymous   July 21, 2014

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What about medications?

After ostomy surgery, digestion and absorption of medications, either alone or in combination, may be affected. It is very important to review your medications, both over -the -counter and prescription drugs, with your ET nurse or health care provider and your pharmacist. Over-the-counter treatments can include antacids, antidiarrheal, anti-inflammatory agents, aspirin, laxatives, salt substitutes, sugar substitutes and vitamins. 1

Anonymous   July 21, 2014

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What about bathing and showering?

You may choose to bathe or shower with your pouch on or off. If you shower with your pouch off, choose a soap that is oil-and residue-free. These types of soaps will not interfere with the adhesion of the wafer.2

Anonymous   July 21, 2014

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Will I need special clothing?

Don’t worry-you will not need a new wardrobe. Modern ostomy pouches are inconspicuous are inconspicuous under almost any kind of clothing because they’re designed to lie flat against the body. Ostomy pouches for both men and women can be worn inside or outside underwear; whatever feels most comfortable. Yet if your stoma is at or near the waistline, be sure to avoid pressure from tight-waisted pants or belts. Girdles or panty girdles can be worn, as long as they are soft and stretchy, without a front panel. For men, if you wear an athletic supporter, it is helpful to wear it one size larger.3

Anonymous   July 21, 2014

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Can I exercise and play sports?

An ostomy should not prevent you from exercising or from being physically active. Other than extremely rough contact sports or very heavy lifting, you should be able to enjoy the same type of physical activities you enjoyed before your surgery. People who have ostomies are able to swim., water ski or snow ski, play golf, tennis, volleyball or softball, hike, sail or jog just as well after their surgery as they did before.5

Anonymous   July 21, 2014

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When can I return to work? What about travel?

As with any surgery, you will need to allow some recovery time. Recovery from this type of surgery can take from six to eight weeks. You should check with your doctor before returning to work. After your recovery, you should be able to return to work, or travel just about anywhere. Your ostomy should not limit you. Ostomy products are available through medical or surgical retailers in nearly every country in the world. Of course, it is always a good idea to take your own supplies with you when you travel – and always take more than you think you will need.5

Anonymous   July 21, 2014

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Will other people know?

Very few people, even those you see on a daily basis, will know that you have had ostomy surgery-unless you choose to tell them. Whether you tell others is entirely up to you. Most likely your relatives and friends already know you’ve had a health problem that required surgery. But you may feel uncomfortable about revealing more, fearing they might have negative attitudes about ostomies. It’s true that some people have uninformed ideas, but if these people are important to you, you can either help to educate them or simply not mention your surgery.1

Anonymous   July 21, 2014

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What about intimate relationships? Can I have children?

Because ostomy surgery is a body-altering procedure, many people worry abourt sex and intimacy, and aboput acceptance by their spouse or loved one. For people who are dating, a big concern is how to tell someone about the ostomy. It’s important to remember that supportive personal relationships can be major sources of healing after any type of surgery. It’s also important to let your partner know that sexual activity will not hurt your stoma. Ostomy surgery affects both partners in a relationship, and it’s something to which both partners must adjust-each in his or her own way. The key, of course, is understanding and communication. If having children is a concern, you’ll be happy to know that after a satisfactory recovery it is still possible for a woman who has a stoma to have children. Also many men have become fathers after having colostomy or ileostomy surgery. For men, urostomy surgery can sometimes cause a change in sexual function; however, there are men who have become fathers after having urostomy surgery. If you have questions about pregnancy, don’t hesitate to ask your doctor or ET nurse. For both men and women, it is very important to discuss the surgery openly with your spouse or loved one. Also, don’t hesitate to discuss this aspect of the surgery with your doctor and your ET nurse.5,6

Anonymous   July 21, 2014

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What is a colostomy?

A colostomy is a surgical procedure where the surgeon brings one end of the large intestine out through the abdominal wall, usually on the left side.  The end of the bowel that is brought out to the abdomen is sutured to the skin to form a stoma.

Stool moves through the intestines (or bowels) through the stoma into a pouching system adhered to the abdomen to collect the stool.  Stool from a colostomy is similar to normal stool as it has gone through most of the digestive tract, meaning it can be quite formed or more solid. Colostomies can be permanent or temporary. There are essentially no diet restrictions (unless other medical conditions are present) and bowel patterns often emerge when a patient knows he/she will have 1-2 movements per day for example and see little action in between. If constipation occurs, treatment is generally the same for the colostomy patient as it would be for the patient without an ostomy. It is good to seek advice from your doctor or ostomy nurse if constipation becomes a regular problem.

Anonymous   July 21, 2014

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Why are colostomies performed?

There are many reasons, but the major contributing conditions are:

Diverticulitis (Diverticulitis is small, bulging sacs or pouches of the inner lining of the intestine (diverticulosis) that become inflamed or infected) or abscess
Injury to the bowel or rectum
Rectal or Colon Cancer
Wounds or fistulas in the perineum

 

Anonymous   July 21, 2014

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Can I control bowel movements after colostomy surgery?

Since you will no longer have voluntary control over bowel movements, it is important that you understand the consistency and frequency of discharge after your colostomy. These vary depending upon the location of the colostomy within the colon. An ascending colostomy is located within the ascending colon. Output will be liquid to semiliquid, rich in digestive enzymes and irritating to the skin around the stoma. A transverse colostomy is located within the transverse colon. Output is usually liquid to semiformed. A descending colostomy is located within the descending colon. Output is semiformed to formed. A sigmoid colostomy is located within the sigmoid colon. Output has a normal, formed consistency.1

Anonymous   July 21, 2014

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Do I need to follow a special diet after colostomy surgery? What about diarrhea and constipation?

Unless your doctor has prescribed a special diet, you should not have to change your diet. You may become constipated or have diarrhea just as you did before surgery. If you become constipated, try eating more fiber (vegetables, fruits, and brans) and drinking more water. If constipation becomes a problem, talk to your doctor or ET nurse. If you become ill with a stomach virus, this can give you diarrhea. Treat it the same as before you had surgery, and remember to drink plenty of fluids-you might try one of the ‘sport’ drinks to replace fluids and electrolytes.2

Anonymous   July 21, 2014

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What about gas?

The amount of gas that a person’s system generates depends on the individual. If you had problems with excessive gas before your surgery, you will likely have the same problems after your surgery. Intestinal gas can sometime be the result of swallowing air. Drinking carbonated beverages, smoking, chewing gum, and chewing with your mouth open can all increase the amount of gas you swallow. Sometimes gas can be caused by the foods you eat. Foods and beverages that may increase gas: asparagus, broccoli, Brussels sprouts, cabbage, cauliflower, carbonated beverages, corn, cucumbers, mushrooms, peas and spinach.5

MainAdmin   July 21, 2014

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Will some foods cause odour in the stool?

Foods that can produce odour include asparagus; cabbage family vegetables: broccoli, brussels sprouts, cabbage, cauliflower, onions; cheese; eggs; fish and some spices.1

MainAdmin   July 21, 2014

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What is an ileostomy?

An ileostomy is a surgical procedure where the surgeon brings one end of the small intestine called the ileum out through the abdominal wall, typically though not always on the right side, bypassing the large intestine. Since the ileostomy bypasses the large intestine where fluid is absorbed, ileostomy stool output is the consistency of a paste or pudding. In some cases it is very watery and difficult to differentiate between “normal” output and “diarrhea”. Because of this, dehydration and electrolyte imbalances can occur quickly causing illness and visits to emergency room if not monitored well. Communicating that you have an ileostomy is important whenever you are seeking medical attention. The stool from the small bowel also contains more enzymes that function to break down the foods we eat including protein, carbohydrates etc. Enzymatic stool can damage the skin as it tries to “digest” it as well as in the case of a leaking pouching system where stool is trapped on the skin for a duration of time.

Tough or high fibre foods may be hard to digest in the small intestine and may cause blockages or discomfort when passing through the stoma. Therefore people with ileostomies may need to be more cautious with their diet. Diet counseling is usually done while a new patient is in the hospital, however if you have questions or need further information, contact your local ET (ostomy) nurse or dietitian.

Ileostomies can also be permanent or temporary. Many are done to shunt stool away for several months from a fragile surgical area lower down in the large bowel until it heals and it is safe for stool to pass through the colon again where the ileostomy may be reversed. It should be noted as well, that because stool is exiting the body “early” in the digestive path, certain medications such as those that are enteric coated to protect the stomach or extended release medications (such as certain pain medications) can leave the body without breaking down and being of little used in the body. For this reason, it is important to inform a prescribing physician and your pharmacist that you have an ileostomy.

MainAdmin   July 21, 2014

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Why are ileostomies performed?

A few reasons are:

Crohn’s Disease or Ulcerative colitis
Familial adenomatous polyposis
Colorectal Cancer
Trauma

MainAdmin   July 21, 2014

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What is a blockage?

The small intestine is like a hollow tube or garden hose. Though it is physically impossible to become “constipated“ with an Ileostomy, blockages of the small intestine can happen in two ways. From the inside and from the outside.

The first way is pressure squeezing on the outside of the tube, like stepping on the garden hose to stop water from coming through, or kinking it off. This is what happens when scar tissue or adhesions form. Scar tissue can cause narrowing of the tube whereby slowing down or preventing food from going through.

The second and more common way to block the small intestine, is from undigested food building up and blocking the inside of the “garden hose” or intestine. Food that is not completely chewed, undigestable for most of us under normal circumstances (like corn for instance) or high in fiber acts as a plug and thus prevents stool from moving through the intestine and out the stoma.

Everyone digests food a little differently so there isn’t one list of foods to eat or not to eat. We can give you guidelines on foods that may be difficult to digest, but some people will get blockages from things not on the list. Other people will be able to digest foods on the list without a problem.

Some high fiber foods that may cause a blockage include: popcorn, mushrooms, corn, raw carrots, raw cabbage, celery, nuts, bean sprouts, coconut, dried fruits and dried beans.

For the first 6-8 weeks after surgery your bowel is still swollen and tender which reduces the diameter of the small bowel or “tube” even further. During this time it is more prone to blockage. That’s why you are instructed to eat easy-to-digest, low fiber foods. After the swelling has gone down, you can slowly add small amounts of foods that are higher in fiber to see how you digest them. The important thing is to chew well!  Keeping a food diary can often be helpful.

Signs of a Food Blockage:

No stool is emptying into your pouch (no stool after 4 hours indicates a blockage)
Abdominal pain (may be cramping and come in waves as the body tries to push out the blockage)
Loss of appetite
Vomiting and nausea
Abdominal bloating
Stoma swelling
You can think back to the last 12 hours and recall eating a high fibre food

What to do at home:

Enlarge the opening of your pouching system to accommodate the stoma when it is swollen
Do not eat solid food. Take sips of water only if tolerated
Try to relax: relaxing stomach muscles around your stoma can be the key to releasing a blockage!
Massage around your stoma
Try knees to chest position (fetal position)
Take a warm bath or place a warm heating pad around your abdomen

When to go to the hospital:

If you start vomiting
If you cannot relate the blockage to any foods you ate within the last 12 hours, it could mean it is a blockage due to adhesions or scar tissue
No stool output from your stoma in 12 hours

(**Take all your ostomy supplies with you to hospital)

What the doctor will do at the hospital:

Ask about your medical and surgical history
Bloodwork
Abdominal x-ray or CT scan
Start an IV to give you fluids
Give you pain medication (often after pain medication is given, the abdominal muscles will relax and release the food blockage allowing the undigested food “plug” to pass)
Sometimes it is necessary to do an Ileostomy lavage to clear the blockage (this involves inserting a catheter attached to a syringe into the stoma and trying to physically break apart the food blockage with slightly pressurized fluid)

Once the blockage has been resolved, a clean, drainable pouching system should be applied. Because the stoma may be swollen, the opening in the pouch surrounding your stoma should be cut slightly wider. Stool will be very watery after this procedure.  This can result in dehydration and the need to have IV or fluids while in the hospital. The abdomen will feel tender and almost a bruised feeling which may last a few days. Eat lightly for the next few days. Easy to digest foods are best until the tender abdominal feelings go away and the stoma goes back to its normal size.

MainAdmin   July 21, 2014

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I have read that people with an Ileostomy can be prone to kidney stones. Why?

The most common kind of kidney stone for people with an ileostomy are the uric acid stones. This stone is caused by dehydration and from diet.

Dehydration results when not enough water is being absorbed in the body – either because you are simply not drinking enough, or because too much water from watery stool is lost through your ileostomy. Usually the large colon, which is bypassed when you have an ileostomy, is where the majority of your fluid is absorbed. Over time, the small bowel adapts to absorb some of the fluid when there is an ileostomy, however it is not as efficient at absorption of water as the large bowel was. Therefore, getting 1.5-2L per of fluid per day is very important. Remember, fluid does not have to mean only “water”. Juices, drinks without caffeine or alcohol, low sodium soups, pudding, and popcicles are some other ways of meeting your daily fluid requirements.

Another way increase the amount of fluid your body absorbs is to thicken up your stool whereby reducing the amount of fluid that is lost through watery ileostomy stools. Some foods such as white rice, bread, smooth peanut butter, apple sauce, pasta and marshmallows are known to thicken stool but remember, everyone’s body reacts differently to different foods.

Uric acid stones can also result because of poor fluid intake because less urine is produced and therefore that urine is more acidic and is missing sodium because most of the water and sodium bicarbonate comes out through the stool. Another factor that increases the risk for uric acid stone formation is loss of sodium bicarbonate, which is a compound in your body that is used to regulate electrolytes and the body’s pH.

This is a complex process, but as an easy and basic rule:

Drink, drink, drink, or “you’re in” trouble!

MainAdmin   July 21, 2014

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What is a urostomy?

A urostomy is a surgically created opening-on the abdomen- that allows urine to flow out of the body. A urostomy may also be called a urinary diversion. Many times, the person’s bladder and urethra are surgically removed. When a person has a urostomy, urine is no longer eliminated through the urethra. Instead, urine is eliminated through the urostomy. A urostomy does not have a sphincter muscle, so a person who has a urostomy has no voluntary control over when to urinate. Instead, the person wears a pouch to collect the urine. Your surgeon may select one of several methods to create the urostomy, or urinary diversion. The most common method is called an ileal conduit. To create an ileal conduit, the surgeon removes a short segment of the small intestine(ileum). This short segment of intestine will be used as a pipeline-or conduit-for urine to flow out of the body. The surgeon closes one end of the conduit, inserts the ureters into the conduit, and brings the open end of the conduit through the abdominal wall. This new opening on the person’s abdomen is called a stoma.6

MainAdmin   July 21, 2014

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What about diet after urostomy surgery?

Eating a well-balanced diet, that can include your favorite foods, is important to your health. Be aware that some foods cause an odour to urine including: asparagus, onions, fish and garlic. These foods can still be eaten; however, you may become aware of an unusual odour. You should drink at least 8 glasses of fluid each day, unless you have to limit your fluids due to a medical problem. Be sure to drink extra fluids when exercising or sweating.7

MainAdmin   July 21, 2014

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What’s the best way to get a good urine sample when you have a urostomy?

Rest of the question:  I have a urostomy and think I may have a urinary tract infection (UTI). My urine is cloudy, it has a strong smell, and I see more mucus in my pouch than usual. My doctor wants to have a urine specimen (C&S) to see if I have an infection and which antibiotics may be needed. What’s the best way to get a good urine sample when you have a urostomy?

Answer:

Getting a “good” urine sample is essential to determining IF you have a urinary tract infection AND which antibiotics would be most effective in treating this infection. Simply taking a urine sample from the spout of your pouch is NOT will not get accurate results because, you will have results of what is growing in the POUCH and potentially not what is growing in your own BODY. Inaccurate results can prompt the treatment of the wrong bugs that aren’t actually in your system and you may not have needed antibiotics at all! The urine sample should to come directly from the stoma itself as this will catch “fresh sterile urine” that has not been exposed to outside elements yet and contains whatever “bugs” that may be bugging you~!

 

There are two ways to collect the urine sample.

  The ideal method is using a catheter – To be done by a health professional
a)    Remove the urostomy pouch and clean the area of skin and stoma with warm water (using alcohol is NOT required)
b)    Using sterile technique, gently insert a small lumen catheter (eg 10 Fr) 4-6 cm into the stoma
c)    Place the other end of the catheter into the C&S container to collect urine
d)    Wait until about 10-20 cc of urine is collected
e)    Replace pouching system
“The Next best thing”: Can be done by the patient
a)    Remove the pouching system from your body
b)    Wash the skin and stoma with water (using alcohol is NOT required)
c)    Hold the collection container under your stoma but NOT TOUCHING your stoma or the skin catching while catching urine that dribbles out
d)    Wait until you have 10-20cc of urine collected
e)    Replace your pouching system
f)      After collecting the sample, refrigerate immediately and drop it off to the lab as soon as possible.

Helpful tips:

Take the urine sample at a time you know your stoma will actively be producing urine. Trying to do this first thing in the morning mightnot be the best time, as you have not had much to drink during the night.
Coughing and slightly moving your position may help move urine out of the stoma.

MainAdmin   July 21, 2014

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I have noticed that my night bag / bottle and my urostomy pouch sometimes has a bluish purple tinge to it. Is that normal?

Purple Urinary Bag Syndrome (PUBS)

People using leg bags or night drainage bags or bottles sometimes notice a purple tinge to their equipment.  It was first noted in 1812, when physicians looking after “mad” King George III noticed a blue tinge to his urine. There’s no need to worry; it doesn’t mean you’re “mad”, too. King George suffered from one of the risk factors, constipation.

Other risk factors include female gender (although it is seen with men also), alkaline urine, use of urinary catheters, the “plastics” used to make catheters and drainage bags, and bacteria in the urine (this does not always mean there is infection).

For the biochemists, bacteria in the urine produce the enzyme indoxyl phosphatase which converts indoxyl sulphate in the urine into the red and blue coloured compounds indirubin and indigo.

Keep in mind, PUBS is nothing to worry about. There are simple steps to reduce the risk factors that lead to PUBS.

Female gender: nothing you can do, sorry! ( Men can get it too.)
Alkaline urine: talk to your doctor about taking Vitamin C to keep your urine acidic
Constipation: things that promote regular bowel movements include adequate fluid intake, exercise and eating enough fiber (whole grains, vegetables and fruits)
Bacteria in the urine: increasing fluid intake, cleaning/replacing your drainage equipment (tubing, night drainage or leg bags, bottles and adapters) on a regular basis

See your doctor if you do have signs of infection in your urine:

Dark urine
Cloudy urine
Increased odour to your urine
Fever

MainAdmin   July 21, 2014

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Is my stoma normal?

Whether you have a colostomy, ileostomy or a urostomy you will have a stoma. A stoma or ostomy is a surgically created opening placed somewhere on the abdomen which is the exit point for either stool from the digestive system or urine from the urinary system. A stoma is fashioned from either large or small bowel which is turned inside out and sewn onto the skin. A stoma is red in colour and warm to the touch as it is very vascular, meaning it is well supplied with blood vessels. It is also glossy or wet looking because the bowel continually produces mucous just like the tissue from the inside of your cheeks (mouth).

There are rarely two stomas that look alike. Variations in surgical technique, body shape and composition (thickness of fatty tissue of the abdomen for example) are factors that influence what shape a stoma will take. Some are round, while others are more oval in shape. Some are flat, some protrude well. Some are big and some are small in diameter. Directly after surgery, it will take 6-8 weeks for the swelling to reduce before the stoma takes its “final shape”. But even after this, factors such as weight gain or loss, stoma prolapse or retraction (early on) and peristomal hernias can change the shape and height of a pre-existing stoma. Overall, any stoma should appear, red, wet and warm as a general rule. If there is any gradual or sudden change with the appearance of your stoma, discuss this with your surgeon/physician or ET Nurse.

MainAdmin   July 21, 2014

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Is my skin normal?

The skin around your stoma, or peristomal skin, which is the skin under the adhesive part of your pouching system, should appear similar to the skin everywhere else on your abdomen. However, research indicates that many people with ostomies have skin problems and do not report or recognize them. If you are ever in doubt, it is better to ask questions and seek help from an ET Nurse who can direct you if you need further treatment from another medical professional. Small problems can turn in to big ones quickly, so better to ask sooner than later!

Remember, sometimes your skin may look pinker, redder or darker right after you take off your adhesive pouching system. This should fade away after a few minutes.

MainAdmin   July 21, 2014

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How do I clean around my stoma?

All you need to clean around your stoma is warm water and either a washcloth or a soft disposable paper towel. Using sterile gauze and wearing gloves to change your own pouching system can be expensive and is unnecessary. REMEMBER, YOU ARE NOT DEALING WITH A STERILE AREA. Using alcohol to clean the area is equally unnecessary and can be very drying to the skin. Also, it is not recommended to use baby wipes or pre-moistened towelettes as they may contain chemicals that remain trapped on the skin and can cause a rash.

Soaps, including ones that are moisturizing (Oil of Olay, Dove) are not needed and can actually hinder the pouching system from sticking well on your skin and contribute to leaks. If you are showering without wearing a pouching system and soap flows down onto your stoma and skin, just rinse the area well afterwards. This is not a concern.

When washing your stoma, you may notice small specks of blood on your cloth. This is completely normal and expected. The stoma tissue contains small blood vessels close to the surface that may bleed, especially if you are taking blood thinners.

MainAdmin   July 21, 2014

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Do I need to “air out” my skin when changing my pouching system to keep it healthy?

No, this is not necessary. It may feel good to “air out”, for a while but this is not required in order to have the skin remain healthy. This may also be difficult if your stoma is active!

MainAdmin   July 21, 2014

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How long should it take to change my pouching system?

There is no “set time” for this. Everyone works at their own pace and becomes more and more proficient, confident and comfortable as time goes on. In the end, it shouldn’t take more than 15 minutes to complete a change if your stoma is inactive. If you continue to take a long time to change, it may be time to see an ET Nurse to see if your routine can be simplified.

MainAdmin   July 21, 2014

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Could I be allergic to my ostomy pouching system?

There is less than a 1% incidence of a true allergy to any part of the pouching system. All parts are of the system are latex free, including the belt (if you are using one). There is a multitude of reasons for skin issues, however they are typically due to a leak in the system causing stool or urine to sit on and irritate the skin. Remember, when you first remove your pouching system, your skin may be pink, but this should fade in a few minutes. In any case, it is important to seek help from an ET Nurse sooner than later if you have concerns. Do not assume that you have an allergy or that this cannot be resolved.

MainAdmin   July 21, 2014

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Should I be using stoma powders, skin protective sprays / “prep” wipes, alcohol swabs or wound/skin spray cleansers when I change my pouching system?

No, unless your ET Nurse has suggested this for you as a SHORT TERM treatment. These products are not to be used routinely as they can build up and irritate the skin and actually prevent the pouching system from sticking properly. Statements such as “less is more”, and “keep it simple” stand true in ostomy care so that using “extras” such as wipes and powders should have a reason rather than a routine.

Using stoma powder and a protective skin spray or wipe afterwards to seal in the powder is commonly referred to as “crusting” but is only a SHORT TERM treatment for weepy skin breakdown around the stoma. If this becomes part of your routine because of recurrent skin breakdown, this should be re-evaluated and discussed with your ET Nurse as your pouching system may need to be modified to give you a better fit and actually protect your skin on its own.  “Crusting” should be reserved for the “occasional” skin problem and is a very useful tool for treatment.

Skin protective sprays and wipes such as Skin Prep, Cavilon No Sting, Hollister Skin Gel etc, are overused in general partially because of the name “skin protective” itself. But these products can actually build up on your skin and prevent the adhesive pouching system from sticking. Talk to your ET Nurse to see if these products are appropriate for you.

Wound/Skin cleansers (and alcohol wipes) are expensive and unnecessary because the stoma is not a “wound”, nor is it considered a sterile area. Use of these products can also cause irritation and also hinder adherence of your pouching system. Alcohol will also dry out the skin.

MainAdmin   July 21, 2014

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How does chemotherapy affect my stoma and peristomal skin?

Chemotherapy is a type of cancer treatment that may effect your skin and stoma. The impact of chemotherapy may be create skin problems around your stoma (peristomal skin) and the overall management of your ostomy. There are many different types of chemotherapy treatments, each with its own specific way that it affects the cancer. But not all treatments cause the same side effects to the skin and/or stoma. Your oncologist and chemotherapy nurses are the experts and will advise you about the possible side effects that may occur.  They are an excellent resource to answer your questions and concerns. They can provide you with various patient handouts outlining different chemotherapy drug protocols and patient guidelines. 
 
In general, remember that your stoma is surgically created from bowel tissue, which is very similar to the tissue in your mouth. Some chemotherapy drugs affect the tissue in your mouth resulting in sores, ulcers or causing the tissue in your mouth to bleed easily. Your stoma may react the same way. You may find that your stoma bleeds easily when you are washing it or you may find tiny sores on your stoma.

Your stoma may also swell. This is because the lining of your colon or intestine can become irritated and inflamed from the chemotherapy.

During chemotherapy your skin may be more sensitive. This includes peristomal stoma. The skin around your stoma may become more sensitive by becoming red and sore.  Remember that gentle removal of the pouching system during changes is important when skin is fragile. 
 
If you still have your large colon, you may have an increase of mucous drainage from your anus. Again, this is because the chemotherapy can make the lining of your colon inflamed and irritated causing more mucous to be produced which will pass through the anus.

Recommendations:

Be gentle when changing your pouching system.  Gently remove your pouching system from your skin.
Wash your stoma and skin with warm water and a soft cloth.
If your stoma is swollen or has enlarged, cut a larger opening in your pouching system or speak to an ET ostomy nurse and get a system to accommodate your stoma.
If you have any concerns or questions, do not hesitate to contact an ET ostomy nurse.

MainAdmin   July 21, 2014

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I have an ostomy and am gay. Is there anyone out there who would understand my concerns?

Your ET or WOCN nurse deal with people from varying backgrounds, beliefs, sexual orientation and cultures. Each one of us is unique.

There is an excellent website that maybe a good resource for you. www.glo-uoaa.org.

The GLO website can be used by individuals seeking information, chapters looking for a trained visitor or for anyone wishing to expand their knowledge of the Gay or Lesbian person with an ostomy.

MainAdmin   July 21, 2014

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What is a peristomal hernia?

The development of a peristomal hernia after ostomy surgery is very common. Statistics show a wide range from 4-48% chance of developing a peristomal hernia.  Most peristomal hernias occur within the first 2 years of surgery.

Some surgeons say that they give you a hernia when they do your ostomy surgery; this is because their definition of a hernia is an opening or hole in the muscle, and to form the stoma the surgeon needed to make a hole in the muscle, to bring the bowel through the skin.

We usually say people have a hernia when we see a bulge around the stoma. It may appear like the stoma is sitting on an orange or grapefruit.  For some people, they don’t feel any different; they just have a bulge on around their stoma. For others, the hernia is uncomfortable and when they are up and about they feel they need to support or hold that side of their abdomen. Sometimes there is a pulling sensation, like a muscle pull, which is relieved by sitting or lying down or holding that area. The bulge or hernia sticks out more when people are standing and when lying down the bulge or hernia may flatten or go away.

hernia 01 hernia 02

MainAdmin   July 22, 2014

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What are the risk factors to developing a peristomal hernia?

Hernias develop when the opening in the muscle, created by the surgeon to bring the bowel through the muscle and skin layers to make the stoma stretches. This allows loops of bowel to come through the enlarged opening. Anything that stretches the muscle opening larger is a risk factor to develop a peristomal hernia.

Activities that increase strain on abdominal muscles and stretch the muscle opening larger include:

Coughing and sneezing
Lifting heavy items using abdominal muscles
Large weight gain after ostomy surgery
Obesity
Other risk factors include
Poor nutritional status
Emergency surgery resulting in an ostomy
Certain drugs that slow healing- such as corticosteroids
Previous abdominal or inguinal hernias which may indicate abdominal wall weakness
Age – as we get older the abdominal muscles lose tone and strength and the opening where the bowel goes through may enlarge.

MainAdmin   July 22, 2014

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What should I watch for if a hernia develops?

–        The contour of the abdomen changes which may affect the seal on your pouching system. This may change wear time, frequency of leakage and a new pouching system may be required.

–        The size of the stoma may enlarge so the opening in the pouching system may need to be adjusted

–        Abdominal and back discomfort as there is a stress or pull on those muscles

–        ** The most serious complication to watch for is a bowel obstruction/strangulation ***

A loop of bowel may get stuck through the muscle wall opening.  If the muscle wall squeezes down on the bowel, it can to block the bowel  so nothing can pass. That is no stool can move through the stoma. More importantly, the blood supply to the bowel and stoma can also be affected.  The colour of the stoma will change from its usual pink/red colour to a dark dusky purple black colour. You may also have abdominal pain and cramping and nothing coming out of your stoma.  Please go to emergency.

MainAdmin   July 22, 2014

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What can be done if I have a hernia?
Surgical Management

Surgeons are hesitant to repair a peristomal hernia, as it is very likely to recur.  There are different surgical techniques for repairing peristomal hernias.  Each surgeon will have their preference for the technique they use. It is a complex surgery to do a hernia repair involving a stoma.

Surgical techniques include suturing the enlarged opening in the muscle wall to make it smaller.  Moving the stoma to the other side of the abdomen is another surgical option. Repairing the hernia by putting a mesh in is another common approach.  There are different types of mesh and surgical techniques to put the mesh in.

Non-surgical management

Surgical repair is usually avoided in people with no or mild symptoms because of the high recurrence rate.  Many people with mild symptoms can be managed with a ostomy hernia belt or support garment.  There are many types of ostomy hernia belts available on the market. Most have an opening to allow the pouch to come through so the urine or stool output is not affected.  ( pictures).  Many women find that a supportive panty is all they need but they need to see that the flow of output is not affected.

It is important to note that the hernia belt or support garment will not “ take the hernia away” or prevent a hernia. It is for comfort and support.

hernia 03

Examples of Nuhope Peristomal Hernia Belts

MainAdmin   July 22, 2014

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What are some exercises to strengthen abdominal muscles?

Physiotherapists are trained to strengthen damaged muscles safely.  It is recommended to see a physiotherapist to assess your abdominal muscles and to recommend a program to help you safely strengthen your core abdominal muscles.

The time to see a physiotherapist is about 8-10 weeks after surgery or when your surgeon lets you resume your normal daily activities.

Marilyn Moore, a physiotherapist, developed the following sets of exercises and she also has an ileostomy. In developing these exercises she stresses the need to take things in steady stages.  Gradually building up to the more challenging exercise is the surest way for you to improve both fitness and general health.

Check out this link to see preventative core abdominal exercises  www.iasupport.org/about/publications/factsheets/exercises-for-ostomates

MainAdmin   July 22, 2014

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How do I prevent from getting a hernia?
Be cautious when lifting- use proper technique and watch how much you are lifting. There is no magic number for the number of weeks after surgery before lifting or exercising or the amount of weight to lift or not lift, as everyone heals at a different rate.  Please check with your surgeon.  If still unsure, do not lift any more than 5 pounds or 2.2   kilograms for 8-10 weeks after surgery then gradually increase.
Contact a physiotherapist to learn how to strengthen your abdominal muscles safely.
Maintain a healthy weight.

MainAdmin   July 22, 2014

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I have an ileostomy now for about a year and could you tell me why when the stool comes out it stays up just where it comes out does not fall down in the bag. What can I do about that. So I do not eat if I am going out as I do not want that to happen. Would it be my diet. I really not to sure what to eat I cannot digest any vegetables except potatoes and sweet potatoes.

Pancaking

This is when the output collects around the stoma and can squeeze between the flange and the skin instead of going into your bag. One of the reasons this happens is because there isn’t enough air in the bag and so the output doesn’t take a downwards turn.

If this happens, try lubricating your bags with baby oil or one of the many products available from the various supply companies. Squirt a little oil or gel in your bag and give it a good rub around before you stick it on. Take care not to get any on the adhesive as this can reduce the effectiveness of the seal.

If you’re wearing clothes that are tight fitting in the stoma area this can also cause pancaking. You may want to try to wear looser fitting clothing in order to prevent a vacuum forming inside the bag. Also, in terms of clothing, make note of where your waistband or belt sits. Does it allow the stool to drop into the pouch or does it restrict the stool so the stool gathers only at the top. Monitor your body positions. If you are sitting for long periods for example driving or at the computer, does the pouch fold onto itself not allowing the stool to drop but remain in the top part of the pouch?

If the pouch has a filter in it, block the filter by either using waterproof tape or the ” tabs” that come in the box of pouches. This will leave air in the pouch, preventing the vacuum effect and allow to stool to drop into the pouch.

Another reason for pancaking is that your output is thick. Each person is an individual and so, each of us has trigger foods that can cause digestion processing issues, and stool issues. It would be helpful to consult your physician for a referral to a nutritionist or dietician to assist you in identifying foods that will work best for you.

[July 22, 2014]

To get additional information or help, find an ET in your area by clicking here…

MainAdmin   July 24, 2014

2 people found this faq useful.

I’m looking for ways to help my grandson, who has an ileostomy that is always leaking.

Leakage

Ostomy leakage is a problem which all ostomates will no doubt encounter at some point during their time with a stoma. For most people it’s a common occurrence in their early weeks of managing an ostomy when you are still finding your ostomy-feet and working out which products are best for you, and which routine gives the best results. It can cause a heck of a mess, not only to our clothes, but to our self-confidence too.

To find out what is causing the leakage start by checking the back of the flange after it’s leaked and you’ve removed it. This holds the biggest clue of all, you will be able to see what path the stool took on its break to freedom. Compare this to your skin and see what problems are present.

Condition of the skin. Is it raw, or does it have a rash all over it, or on part of it? If so, you may be allergic to the flange, and it may be interfering with the adhesive properties of the flange. Also, check to see if the area around where the flange leaks is any worse than elsewhere.
With leakage, the stool will always follow the path of least resistance. Do you have a belly crease which in turn is creasing the flange and creating a nice little tunnel for your stool to escape?
Look at your flange. Was the gap around the stoma too large? Or was it too tight? Or just right? Do you have protruding stitches around your stoma which the flange has trouble moulding around?
Do you have a belly cavity near the stoma? Flanges may struggle to adhere to these dips in your belly and lead to leakage.
Check your stoma. Is it flat/flush to the skin? Is it inverted / pulled in?

Some causes of leakage could be:

Flush to the skin or inverted stoma
Poor fitting flange/odd shaped stoma
Belly cavity around stoma
Parastomal hernia and/or Pancaking

Once you’ve discovered the source of your leakage then you are in a better position to be successful in stopping your leakage in its track, and there are a number of products available on the market which are designed to help reduce opportunities for leakage to occur.

Arrange a visit with an Enterostomal Therapy Nurse, (ET nurse – registered nurse [RN], who has specialized training in treating patients with ostomies), who can assist you in assessing the leakage issue and make equipment product recommendations for ensuring a good seal. One thing to bear in mind with all ostomy products is that our bodies are very individual, and because of that, a product which works great for one person may not work anywhere near as successfully for another, and vice versa. You may need to sample various rings and seals to find the one that works best for you, which the various ostomy product companies will also assist you in finding the seal that will work for you. So there is no reason why you cannot use multiple products to help combat leakage.

[July 23, 2014]

To get additional information or help, find an ET in your area by clicking here…

MainAdmin   July 24, 2014

2 people found this faq useful.

I am not doing very good with my diet. What would be a proper one?

Diet – Healthy Eating With A Stoma

The impact of food and drink on your stoma is hard to predict as diet is very individual. Various surveys suggests that foods can affect people in different ways after stoma surgery. While many people find that they can eat just the same diet as before their surgery, some find there are things that can have an adverse effect on the activity of their stoma. They may then choose to avoid those foods, or include them in their diets and be prepared for the effects.

Many people report that a good way to ascertain which foods and drinks are suitable for them is to keep a food diary so that patterns between diet and stoma output can be identified. You can then base your diet on what you have observed to be agreeable in terms of stoma output. There may be a certain degree of trial and error, especially in the first few months after your stoma is formed when the bowel is swollen. This swelling (or oedema) is the reason why a stoma may look puffy initially and can cause problems digesting food that would otherwise not occur, so it’s sometimes worth trying a food again later on before deciding whether to eliminate from your diet completely.

Information about diet and healthy eating for the general public is often conflicting and difficult to interpret. Add to this a stoma and many people feel confused about what they should and shouldn’t be eating.

Most people with stomas do not need to change their diets and should follow a normal healthy eating pattern like the rest of the population. If you have recently had your surgery or have been unwell, ensuring that you get all the essential nutrients from your diet is even more important and putting unnecessary restrictions on your diet could slow down your recovery and healing.

The purpose of the following information is to offer general information, for further information about diet, ask you physician to refer you to a dietician in order to explore any important factors to take into consideration regarding your individual stoma management and general wellbeing.

A balanced diet is made up of:

Starchy foods such as potatoes, rice & grains, bread and pasta, for energy. Try different varieties, including wholemeal vs refined/white rice and pasta.
Fruit and vegetables provide a wide range of vitamins and minerals and both soluble and insoluble fibre. Soluble fibre is found in the flesh of fruit & veg and can help lower cholesterol as well as make stool thicker, softer and easier to pass (helpful for those with a colostomy or ileostomy who wish to thicken their output). Insoluble fibre is found in the skins of fruit & veg and helps move waste through your bowel, so can help with constipation (helpful for those with a colostomy who experience pancaking and anyone who experiences constipation). If you have a colostomy or ileostomy, immediately after surgery foods containing insoluble fibre may make your stoma behave unpredictably, so you may wish to avoid or limit your intake of them. As your bowel adjusts you can re-introduce them and see how they affect you.
Protein rich foods for growth and healing. Protein comes from meat, fish, eggs, soya and it is the substance we use to heal wounds and regain muscle.
To promote general wellbeing, fatty foods should be limited. However, if you are recovering from surgery or have a small appetite and need to gain weight, including more of these foods in the short term is a good idea.

Individual Differences

The vast majority of people with a urostomy (a stoma that passes urine) find that their food intake is unaffected by having a stoma, however some food and medications can make urine discoloured or smelly (e.g. beetroot can make your urine pink and antibiotics and asparagus can make it smell strange).

Importance of chewing

It sounds very obvious, but it is vitally important to chew food thoroughly when eating. Chewing is the first stage of digestion and in doing this we make more nutrients available from our food. Foods that contain cellulose such as nuts, grain, fruit & vegetables (particularly the skins) cannot be completely broken down in the digestive system. So, you may notice these coming through your stoma looking the way they did when you ate them. Immediately after bowel surgery, your bowel is swollen and this narrows the passageway for food to pass along.

Fluid Intake

It is essential for everyone to drink enough to keep their kidneys healthy and flush out the chemicals that build up in the blood. You should aim to drink enough throughout the day that your urine is a light straw colour. The following information is for the specific stoma types but does not take into account other medical conditions. If you have been given different information from your healthcare professionals please check with them before making any changes.

People with urostomies enjoy a few glasses of water a day. This will help to prevent infections.

If you have a colostomy, your fluid intake can remain as normal unless you are experiencing constipation or pancaking. If you have this problem, increasing your fluid intake can be really helpful.

People with ileostomies, particularly if the stoma is formed higher up in the bowel, can have more difficulties with their fluid intake. This is because it is the role of the large bowel to absorb water (and salt) and for people with ileostomies this is no longer being used. The small bowel will, with time, adapt to absorb more water and more salt, however careful attention should be paid to ensure that you are drinking an adequate, varied fluid intake to maintain kidney health. Remember, you are aiming for light straw coloured urine.

For those who are more active it is even more important to pay attention to your fluid intake. Fluids are lost through sweating that contains electrolytes.

Everyone should bear in mind that alcohol is a dehydrating fluid and caffeinated drinks such as tea and coffee cause you to lose more fluid in your urine. The majority of your fluid intake should therefore be from fluids such as water and fruit cordials.

A little of what you fancy….

Of course, every now and again you will want to enjoy a treat like cake or ice cream and there is no reason why you can’t indulge once in a while! Healthy eating is about moderation and after stoma surgery it is also about trial and error. Take your time to explore how different foods affect your stoma, chew your meals, maintain a varied fluid intake and, most importantly, enjoy your food!

Some foods effect output. The effects may vary.

Basic Food Reference Chart

Stoma ObstructiveGas ProducingOdour ProducingColour ChangesOdour ControlIncreased StoolDiarrhea Control
Apple peelsBeansAsparagusAsparagusButtermilkBran cerealsApplesauce
Cabbage rawCabbageBaked beansBeetsCranberry juiceFresh fruitsBananas
Corn, whole kernelCarbonated beverageBroccoliCoffeeTomato juiceGreen, leafy veggiesPeanut butter
CoconutCauliflourCod liver oilCooked fruitsYogurtMilkTapioca
Dried fruitCucumberEggsFood colourPrunes
MushroomsDairy productsFishIron pillsRaw vegetables
PineappleNutsGarlicStrawberriesWhole grains
PopcornOnionsOnionsTomato sauces
SeedsRadishesPeanut butter
SoyStrong cheese

To get additional information or help, find an ET in your area by clicking here…

MainAdmin   August 10, 2014

1 people found this faq useful.

I’d just like to check out anything new…

What’s New

The newest news about ostomates I’ve noticed, is the latest trend in breaking the taboo of ostomies and ostomy bags through posted photographic images.

Facebook, Instagram, and Twitter are just a few of the social media being used by ostomates to show and share their colostomy, ileostomy and urostomy bags and scars.

They are young, older, male, female, and all of them are plucking up the courage to share themselves and their bags to a wider audience.

I’ve heard some folks take offence to the photographic images, and heard other folks cheer them on.

My take on this new and inspiring trend is; go ahead folks, be proud of who you are, you are amazing, and so, embrace your ostomy, inspire others, and keep spreading awareness!
Jo-Ann L. Tremblay

[July 27, 2014]

MainAdmin   August 11, 2014

1 people found this faq useful.

What clothing tips are there for a person with an ostomy?

Stephanie Hughes from the blog, Stolen Colon, shares a wonderful video on What to Wear With an Ostomy…

 

MainAdmin   August 12, 2014

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What sort of swimsuit options are out there for women with ostomies?

Jessica Grossman of Uncover Ostomy, has a wonderful blog entry titled Itsy Bitsy Ostomy Bikini with several links to swimsuit options.

Also, Stephanie Hughes of Stolen Colon, shares a video showing different swimsuit options as well:

 

MainAdmin   August 12, 2014

1 people found this faq useful.

I would like to learn more about colostomy irrigation…

(Disclaimer: Before attempting any irrigation techniques, you must get your doctor’s permission)

* Reprinted with permission from The Phoenix magazine, www.phoenixuoaa.org or call 800-750-9311

Download (PDF, 156KB)

MainAdmin   September 18, 2014

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What is an ostomy?

You may know someone who wears a “bag” or pouch on their abdomen or have an ostomy yourself. The term “colostomy” is often the default go-to word when people talk about ostomy care, suggesting that all “ostomies” are “colostomies” and thus created and function equally.  In actual fact, the term colostomy only refers to an ostomy created from the large bowel or colon and only represents one kind of ostomy. An ileostomy is also a fecal stoma (producing stool waste) which the surgeon creates using a portion of the small bowel or ileum. Finally, a urostomyproduces urine in the absence of the bladder as with bladder cancer for example. It is important not only for health professionals to understand and distinguish between the 3 “kinds” of ostomies, but for the ostomy patient themselves as the guidelines for care are very different for each. All 3 will have a stoma or bowel that has been brought to the surface of the abdomen, but anatomically be very different.

Anonymous   July 21, 2014

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What does a stoma look like?

You may know someone who wears a “bag” or pouch on their abdomen or have an ostomy yourself. The term “colostomy” is often the default go-to word when people talk about ostomy care, suggesting that all “ostomies” are “colostomies” and thus created and function equally.  In actual fact, the term colostomy only refers to an ostomy created from the large bowel or colon and only represents one kind of ostomy. An ileostomy is also a fecal stoma (producing stool waste) which the surgeon creates using a portion of the small bowel or ileum. Finally, a urostomyproduces urine in the absence of the bladder as with bladder cancer for example. It is important not only for health professionals to understand and distinguish between the 3 “kinds” of ostomies, but for the ostomy patient themselves as the guidelines for care are very different for each. All 3 will have a stoma or bowel that has been brought to the surface of the abdomen, but anatomically be very different.²

Anonymous   July 21, 2014

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How should I care for the skin around my stoma?

It is very important for the skin around the stoma (the peristomal skin) to remain healthy and free of irritation. The peristomal skin should look just like the skin elsewhere on your abdomen. To prevent skin irritation or other skin problems, you must have a skin barrier and pouch that fits properly. Each time you remove your skin barrier and pouch, look carefully at the peristomal skin. If you notice any swelling, redness or rash, you could have irritated skin. Sometimes-but not always-irritated skin is painful. If the problem persists for more than two pouch changes, contact your ET Nurse.5

Check out an excellent reference guide provided by the WOCN (Wound Ostomy and Continence Nurses Society):

Download (PDF, 648KB)

Anonymous   July 21, 2014

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What is an ET / Ostomy Nurse?

An Enterostomal Therapy (ET) Nurse is a registered nurse with advanced and specialized knowledge and clinical skills in wound, ostomy and continence care. Recognized as Nursing Specialists in wound, ostomy and continence by the Canadian Nurses Association (CNA), ET Nurses are the ONLY nursing specialty with CNA certification in wound, ostomy and continence care. ET Nurses work in acute care hospitals, outpatient clinics, community care, long term care and in independent practice. An ET nurse provides specialized holistic assessment and management as part of an interprofessional team member. He/she functions to meet the needs of individuals/families with ostomies, acute and chronic wounds and urinary and fecal continence problems.

Some nurses will have different “letters” after their name such as WOC Nurse or cWOC Nurse which indicates that they did their wound, ostomy, continence education in the United States. It should be noted that there are different education levels for wound and ostomy health professionals that vary from a 1 day course to the full scope nursing specialty an ET or WOC Nurse. To ensure your best care, be sure you are seeing a nurse with full credentials. To find an ET/WOC Nurse in your area, you can contact the Canadian Association for Enterostomal Therapy (CAET) www.caet.ca.

When to see an ET/Ostomy Nurse:

Do you have a new ostomy and need more teaching after discharge from the hospital?
Do you have regular leaks of your pouching system?
Are you suddenly getting less wear-time of your pouching system?
Have you gained or lost weight?
Does your flange “not stick” to your skin?
Has the shape or size of your stoma changed since surgery?
Are you using powders and sealant sprays frequently?
Do you have questions around nutrition, lifestyle, or intimacy?
Do you have questions about how to better conceal your pouch with clothing or when participating in sports?
Do you want to learn more about hernias?
Do you think you have a hernia and want to learn about support garments?
Do you need feedback about how you are currently managing?
Are there sores or wounds around your stoma?
Have you had your stoma for many years and just want to see “what’s new”?
Is it time for an annual check up?

Anonymous   July 21, 2014

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What about medications?

After ostomy surgery, digestion and absorption of medications, either alone or in combination, may be affected. It is very important to review your medications, both over -the -counter and prescription drugs, with your ET nurse or health care provider and your pharmacist. Over-the-counter treatments can include antacids, antidiarrheal, anti-inflammatory agents, aspirin, laxatives, salt substitutes, sugar substitutes and vitamins. 1

Anonymous   July 21, 2014

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What about bathing and showering?

You may choose to bathe or shower with your pouch on or off. If you shower with your pouch off, choose a soap that is oil-and residue-free. These types of soaps will not interfere with the adhesion of the wafer.2

Anonymous   July 21, 2014

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Will I need special clothing?

Don’t worry-you will not need a new wardrobe. Modern ostomy pouches are inconspicuous are inconspicuous under almost any kind of clothing because they’re designed to lie flat against the body. Ostomy pouches for both men and women can be worn inside or outside underwear; whatever feels most comfortable. Yet if your stoma is at or near the waistline, be sure to avoid pressure from tight-waisted pants or belts. Girdles or panty girdles can be worn, as long as they are soft and stretchy, without a front panel. For men, if you wear an athletic supporter, it is helpful to wear it one size larger.3

Anonymous   July 21, 2014

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Can I exercise and play sports?

An ostomy should not prevent you from exercising or from being physically active. Other than extremely rough contact sports or very heavy lifting, you should be able to enjoy the same type of physical activities you enjoyed before your surgery. People who have ostomies are able to swim., water ski or snow ski, play golf, tennis, volleyball or softball, hike, sail or jog just as well after their surgery as they did before.5

Anonymous   July 21, 2014

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When can I return to work? What about travel?

As with any surgery, you will need to allow some recovery time. Recovery from this type of surgery can take from six to eight weeks. You should check with your doctor before returning to work. After your recovery, you should be able to return to work, or travel just about anywhere. Your ostomy should not limit you. Ostomy products are available through medical or surgical retailers in nearly every country in the world. Of course, it is always a good idea to take your own supplies with you when you travel – and always take more than you think you will need.5

Anonymous   July 21, 2014

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Will other people know?

Very few people, even those you see on a daily basis, will know that you have had ostomy surgery-unless you choose to tell them. Whether you tell others is entirely up to you. Most likely your relatives and friends already know you’ve had a health problem that required surgery. But you may feel uncomfortable about revealing more, fearing they might have negative attitudes about ostomies. It’s true that some people have uninformed ideas, but if these people are important to you, you can either help to educate them or simply not mention your surgery.1

Anonymous   July 21, 2014

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What about intimate relationships? Can I have children?

Because ostomy surgery is a body-altering procedure, many people worry abourt sex and intimacy, and aboput acceptance by their spouse or loved one. For people who are dating, a big concern is how to tell someone about the ostomy. It’s important to remember that supportive personal relationships can be major sources of healing after any type of surgery. It’s also important to let your partner know that sexual activity will not hurt your stoma. Ostomy surgery affects both partners in a relationship, and it’s something to which both partners must adjust-each in his or her own way. The key, of course, is understanding and communication. If having children is a concern, you’ll be happy to know that after a satisfactory recovery it is still possible for a woman who has a stoma to have children. Also many men have become fathers after having colostomy or ileostomy surgery. For men, urostomy surgery can sometimes cause a change in sexual function; however, there are men who have become fathers after having urostomy surgery. If you have questions about pregnancy, don’t hesitate to ask your doctor or ET nurse. For both men and women, it is very important to discuss the surgery openly with your spouse or loved one. Also, don’t hesitate to discuss this aspect of the surgery with your doctor and your ET nurse.5,6

Anonymous   July 21, 2014

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What is a colostomy?

A colostomy is a surgical procedure where the surgeon brings one end of the large intestine out through the abdominal wall, usually on the left side.  The end of the bowel that is brought out to the abdomen is sutured to the skin to form a stoma.

Stool moves through the intestines (or bowels) through the stoma into a pouching system adhered to the abdomen to collect the stool.  Stool from a colostomy is similar to normal stool as it has gone through most of the digestive tract, meaning it can be quite formed or more solid. Colostomies can be permanent or temporary. There are essentially no diet restrictions (unless other medical conditions are present) and bowel patterns often emerge when a patient knows he/she will have 1-2 movements per day for example and see little action in between. If constipation occurs, treatment is generally the same for the colostomy patient as it would be for the patient without an ostomy. It is good to seek advice from your doctor or ostomy nurse if constipation becomes a regular problem.

Anonymous   July 21, 2014

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Why are colostomies performed?

There are many reasons, but the major contributing conditions are:

Diverticulitis (Diverticulitis is small, bulging sacs or pouches of the inner lining of the intestine (diverticulosis) that become inflamed or infected) or abscess
Injury to the bowel or rectum
Rectal or Colon Cancer
Wounds or fistulas in the perineum

 

Anonymous   July 21, 2014

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Can I control bowel movements after colostomy surgery?

Since you will no longer have voluntary control over bowel movements, it is important that you understand the consistency and frequency of discharge after your colostomy. These vary depending upon the location of the colostomy within the colon. An ascending colostomy is located within the ascending colon. Output will be liquid to semiliquid, rich in digestive enzymes and irritating to the skin around the stoma. A transverse colostomy is located within the transverse colon. Output is usually liquid to semiformed. A descending colostomy is located within the descending colon. Output is semiformed to formed. A sigmoid colostomy is located within the sigmoid colon. Output has a normal, formed consistency.1

Anonymous   July 21, 2014

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Do I need to follow a special diet after colostomy surgery? What about diarrhea and constipation?

Unless your doctor has prescribed a special diet, you should not have to change your diet. You may become constipated or have diarrhea just as you did before surgery. If you become constipated, try eating more fiber (vegetables, fruits, and brans) and drinking more water. If constipation becomes a problem, talk to your doctor or ET nurse. If you become ill with a stomach virus, this can give you diarrhea. Treat it the same as before you had surgery, and remember to drink plenty of fluids-you might try one of the ‘sport’ drinks to replace fluids and electrolytes.2

Anonymous   July 21, 2014

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What about gas?

The amount of gas that a person’s system generates depends on the individual. If you had problems with excessive gas before your surgery, you will likely have the same problems after your surgery. Intestinal gas can sometime be the result of swallowing air. Drinking carbonated beverages, smoking, chewing gum, and chewing with your mouth open can all increase the amount of gas you swallow. Sometimes gas can be caused by the foods you eat. Foods and beverages that may increase gas: asparagus, broccoli, Brussels sprouts, cabbage, cauliflower, carbonated beverages, corn, cucumbers, mushrooms, peas and spinach.5

MainAdmin   July 21, 2014

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Will some foods cause odour in the stool?

Foods that can produce odour include asparagus; cabbage family vegetables: broccoli, brussels sprouts, cabbage, cauliflower, onions; cheese; eggs; fish and some spices.1

MainAdmin   July 21, 2014

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What is an ileostomy?

An ileostomy is a surgical procedure where the surgeon brings one end of the small intestine called the ileum out through the abdominal wall, typically though not always on the right side, bypassing the large intestine. Since the ileostomy bypasses the large intestine where fluid is absorbed, ileostomy stool output is the consistency of a paste or pudding. In some cases it is very watery and difficult to differentiate between “normal” output and “diarrhea”. Because of this, dehydration and electrolyte imbalances can occur quickly causing illness and visits to emergency room if not monitored well. Communicating that you have an ileostomy is important whenever you are seeking medical attention. The stool from the small bowel also contains more enzymes that function to break down the foods we eat including protein, carbohydrates etc. Enzymatic stool can damage the skin as it tries to “digest” it as well as in the case of a leaking pouching system where stool is trapped on the skin for a duration of time.

Tough or high fibre foods may be hard to digest in the small intestine and may cause blockages or discomfort when passing through the stoma. Therefore people with ileostomies may need to be more cautious with their diet. Diet counseling is usually done while a new patient is in the hospital, however if you have questions or need further information, contact your local ET (ostomy) nurse or dietitian.

Ileostomies can also be permanent or temporary. Many are done to shunt stool away for several months from a fragile surgical area lower down in the large bowel until it heals and it is safe for stool to pass through the colon again where the ileostomy may be reversed. It should be noted as well, that because stool is exiting the body “early” in the digestive path, certain medications such as those that are enteric coated to protect the stomach or extended release medications (such as certain pain medications) can leave the body without breaking down and being of little used in the body. For this reason, it is important to inform a prescribing physician and your pharmacist that you have an ileostomy.

MainAdmin   July 21, 2014

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Why are ileostomies performed?

A few reasons are:

Crohn’s Disease or Ulcerative colitis
Familial adenomatous polyposis
Colorectal Cancer
Trauma

MainAdmin   July 21, 2014

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What is a blockage?

The small intestine is like a hollow tube or garden hose. Though it is physically impossible to become “constipated“ with an Ileostomy, blockages of the small intestine can happen in two ways. From the inside and from the outside.

The first way is pressure squeezing on the outside of the tube, like stepping on the garden hose to stop water from coming through, or kinking it off. This is what happens when scar tissue or adhesions form. Scar tissue can cause narrowing of the tube whereby slowing down or preventing food from going through.

The second and more common way to block the small intestine, is from undigested food building up and blocking the inside of the “garden hose” or intestine. Food that is not completely chewed, undigestable for most of us under normal circumstances (like corn for instance) or high in fiber acts as a plug and thus prevents stool from moving through the intestine and out the stoma.

Everyone digests food a little differently so there isn’t one list of foods to eat or not to eat. We can give you guidelines on foods that may be difficult to digest, but some people will get blockages from things not on the list. Other people will be able to digest foods on the list without a problem.

Some high fiber foods that may cause a blockage include: popcorn, mushrooms, corn, raw carrots, raw cabbage, celery, nuts, bean sprouts, coconut, dried fruits and dried beans.

For the first 6-8 weeks after surgery your bowel is still swollen and tender which reduces the diameter of the small bowel or “tube” even further. During this time it is more prone to blockage. That’s why you are instructed to eat easy-to-digest, low fiber foods. After the swelling has gone down, you can slowly add small amounts of foods that are higher in fiber to see how you digest them. The important thing is to chew well!  Keeping a food diary can often be helpful.

Signs of a Food Blockage:

No stool is emptying into your pouch (no stool after 4 hours indicates a blockage)
Abdominal pain (may be cramping and come in waves as the body tries to push out the blockage)
Loss of appetite
Vomiting and nausea
Abdominal bloating
Stoma swelling
You can think back to the last 12 hours and recall eating a high fibre food

What to do at home:

Enlarge the opening of your pouching system to accommodate the stoma when it is swollen
Do not eat solid food. Take sips of water only if tolerated
Try to relax: relaxing stomach muscles around your stoma can be the key to releasing a blockage!
Massage around your stoma
Try knees to chest position (fetal position)
Take a warm bath or place a warm heating pad around your abdomen

When to go to the hospital:

If you start vomiting
If you cannot relate the blockage to any foods you ate within the last 12 hours, it could mean it is a blockage due to adhesions or scar tissue
No stool output from your stoma in 12 hours

(**Take all your ostomy supplies with you to hospital)

What the doctor will do at the hospital:

Ask about your medical and surgical history
Bloodwork
Abdominal x-ray or CT scan
Start an IV to give you fluids
Give you pain medication (often after pain medication is given, the abdominal muscles will relax and release the food blockage allowing the undigested food “plug” to pass)
Sometimes it is necessary to do an Ileostomy lavage to clear the blockage (this involves inserting a catheter attached to a syringe into the stoma and trying to physically break apart the food blockage with slightly pressurized fluid)

Once the blockage has been resolved, a clean, drainable pouching system should be applied. Because the stoma may be swollen, the opening in the pouch surrounding your stoma should be cut slightly wider. Stool will be very watery after this procedure.  This can result in dehydration and the need to have IV or fluids while in the hospital. The abdomen will feel tender and almost a bruised feeling which may last a few days. Eat lightly for the next few days. Easy to digest foods are best until the tender abdominal feelings go away and the stoma goes back to its normal size.

MainAdmin   July 21, 2014

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I have read that people with an Ileostomy can be prone to kidney stones. Why?

The most common kind of kidney stone for people with an ileostomy are the uric acid stones. This stone is caused by dehydration and from diet.

Dehydration results when not enough water is being absorbed in the body – either because you are simply not drinking enough, or because too much water from watery stool is lost through your ileostomy. Usually the large colon, which is bypassed when you have an ileostomy, is where the majority of your fluid is absorbed. Over time, the small bowel adapts to absorb some of the fluid when there is an ileostomy, however it is not as efficient at absorption of water as the large bowel was. Therefore, getting 1.5-2L per of fluid per day is very important. Remember, fluid does not have to mean only “water”. Juices, drinks without caffeine or alcohol, low sodium soups, pudding, and popcicles are some other ways of meeting your daily fluid requirements.

Another way increase the amount of fluid your body absorbs is to thicken up your stool whereby reducing the amount of fluid that is lost through watery ileostomy stools. Some foods such as white rice, bread, smooth peanut butter, apple sauce, pasta and marshmallows are known to thicken stool but remember, everyone’s body reacts differently to different foods.

Uric acid stones can also result because of poor fluid intake because less urine is produced and therefore that urine is more acidic and is missing sodium because most of the water and sodium bicarbonate comes out through the stool. Another factor that increases the risk for uric acid stone formation is loss of sodium bicarbonate, which is a compound in your body that is used to regulate electrolytes and the body’s pH.

This is a complex process, but as an easy and basic rule:

Drink, drink, drink, or “you’re in” trouble!

MainAdmin   July 21, 2014

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What is a urostomy?

A urostomy is a surgically created opening-on the abdomen- that allows urine to flow out of the body. A urostomy may also be called a urinary diversion. Many times, the person’s bladder and urethra are surgically removed. When a person has a urostomy, urine is no longer eliminated through the urethra. Instead, urine is eliminated through the urostomy. A urostomy does not have a sphincter muscle, so a person who has a urostomy has no voluntary control over when to urinate. Instead, the person wears a pouch to collect the urine. Your surgeon may select one of several methods to create the urostomy, or urinary diversion. The most common method is called an ileal conduit. To create an ileal conduit, the surgeon removes a short segment of the small intestine(ileum). This short segment of intestine will be used as a pipeline-or conduit-for urine to flow out of the body. The surgeon closes one end of the conduit, inserts the ureters into the conduit, and brings the open end of the conduit through the abdominal wall. This new opening on the person’s abdomen is called a stoma.6

MainAdmin   July 21, 2014

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What about diet after urostomy surgery?

Eating a well-balanced diet, that can include your favorite foods, is important to your health. Be aware that some foods cause an odour to urine including: asparagus, onions, fish and garlic. These foods can still be eaten; however, you may become aware of an unusual odour. You should drink at least 8 glasses of fluid each day, unless you have to limit your fluids due to a medical problem. Be sure to drink extra fluids when exercising or sweating.7

MainAdmin   July 21, 2014

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What’s the best way to get a good urine sample when you have a urostomy?

Rest of the question:  I have a urostomy and think I may have a urinary tract infection (UTI). My urine is cloudy, it has a strong smell, and I see more mucus in my pouch than usual. My doctor wants to have a urine specimen (C&S) to see if I have an infection and which antibiotics may be needed. What’s the best way to get a good urine sample when you have a urostomy?

Answer:

Getting a “good” urine sample is essential to determining IF you have a urinary tract infection AND which antibiotics would be most effective in treating this infection. Simply taking a urine sample from the spout of your pouch is NOT will not get accurate results because, you will have results of what is growing in the POUCH and potentially not what is growing in your own BODY. Inaccurate results can prompt the treatment of the wrong bugs that aren’t actually in your system and you may not have needed antibiotics at all! The urine sample should to come directly from the stoma itself as this will catch “fresh sterile urine” that has not been exposed to outside elements yet and contains whatever “bugs” that may be bugging you~!

 

There are two ways to collect the urine sample.

  The ideal method is using a catheter – To be done by a health professional
a)    Remove the urostomy pouch and clean the area of skin and stoma with warm water (using alcohol is NOT required)
b)    Using sterile technique, gently insert a small lumen catheter (eg 10 Fr) 4-6 cm into the stoma
c)    Place the other end of the catheter into the C&S container to collect urine
d)    Wait until about 10-20 cc of urine is collected
e)    Replace pouching system
“The Next best thing”: Can be done by the patient
a)    Remove the pouching system from your body
b)    Wash the skin and stoma with water (using alcohol is NOT required)
c)    Hold the collection container under your stoma but NOT TOUCHING your stoma or the skin catching while catching urine that dribbles out
d)    Wait until you have 10-20cc of urine collected
e)    Replace your pouching system
f)      After collecting the sample, refrigerate immediately and drop it off to the lab as soon as possible.

Helpful tips:

Take the urine sample at a time you know your stoma will actively be producing urine. Trying to do this first thing in the morning mightnot be the best time, as you have not had much to drink during the night.
Coughing and slightly moving your position may help move urine out of the stoma.

MainAdmin   July 21, 2014

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I have noticed that my night bag / bottle and my urostomy pouch sometimes has a bluish purple tinge to it. Is that normal?

Purple Urinary Bag Syndrome (PUBS)

People using leg bags or night drainage bags or bottles sometimes notice a purple tinge to their equipment.  It was first noted in 1812, when physicians looking after “mad” King George III noticed a blue tinge to his urine. There’s no need to worry; it doesn’t mean you’re “mad”, too. King George suffered from one of the risk factors, constipation.

Other risk factors include female gender (although it is seen with men also), alkaline urine, use of urinary catheters, the “plastics” used to make catheters and drainage bags, and bacteria in the urine (this does not always mean there is infection).

For the biochemists, bacteria in the urine produce the enzyme indoxyl phosphatase which converts indoxyl sulphate in the urine into the red and blue coloured compounds indirubin and indigo.

Keep in mind, PUBS is nothing to worry about. There are simple steps to reduce the risk factors that lead to PUBS.

Female gender: nothing you can do, sorry! ( Men can get it too.)
Alkaline urine: talk to your doctor about taking Vitamin C to keep your urine acidic
Constipation: things that promote regular bowel movements include adequate fluid intake, exercise and eating enough fiber (whole grains, vegetables and fruits)
Bacteria in the urine: increasing fluid intake, cleaning/replacing your drainage equipment (tubing, night drainage or leg bags, bottles and adapters) on a regular basis

See your doctor if you do have signs of infection in your urine:

Dark urine
Cloudy urine
Increased odour to your urine
Fever

MainAdmin   July 21, 2014

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Is my stoma normal?

Whether you have a colostomy, ileostomy or a urostomy you will have a stoma. A stoma or ostomy is a surgically created opening placed somewhere on the abdomen which is the exit point for either stool from the digestive system or urine from the urinary system. A stoma is fashioned from either large or small bowel which is turned inside out and sewn onto the skin. A stoma is red in colour and warm to the touch as it is very vascular, meaning it is well supplied with blood vessels. It is also glossy or wet looking because the bowel continually produces mucous just like the tissue from the inside of your cheeks (mouth).

There are rarely two stomas that look alike. Variations in surgical technique, body shape and composition (thickness of fatty tissue of the abdomen for example) are factors that influence what shape a stoma will take. Some are round, while others are more oval in shape. Some are flat, some protrude well. Some are big and some are small in diameter. Directly after surgery, it will take 6-8 weeks for the swelling to reduce before the stoma takes its “final shape”. But even after this, factors such as weight gain or loss, stoma prolapse or retraction (early on) and peristomal hernias can change the shape and height of a pre-existing stoma. Overall, any stoma should appear, red, wet and warm as a general rule. If there is any gradual or sudden change with the appearance of your stoma, discuss this with your surgeon/physician or ET Nurse.

MainAdmin   July 21, 2014

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Is my skin normal?

The skin around your stoma, or peristomal skin, which is the skin under the adhesive part of your pouching system, should appear similar to the skin everywhere else on your abdomen. However, research indicates that many people with ostomies have skin problems and do not report or recognize them. If you are ever in doubt, it is better to ask questions and seek help from an ET Nurse who can direct you if you need further treatment from another medical professional. Small problems can turn in to big ones quickly, so better to ask sooner than later!

Remember, sometimes your skin may look pinker, redder or darker right after you take off your adhesive pouching system. This should fade away after a few minutes.

MainAdmin   July 21, 2014

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How do I clean around my stoma?

All you need to clean around your stoma is warm water and either a washcloth or a soft disposable paper towel. Using sterile gauze and wearing gloves to change your own pouching system can be expensive and is unnecessary. REMEMBER, YOU ARE NOT DEALING WITH A STERILE AREA. Using alcohol to clean the area is equally unnecessary and can be very drying to the skin. Also, it is not recommended to use baby wipes or pre-moistened towelettes as they may contain chemicals that remain trapped on the skin and can cause a rash.

Soaps, including ones that are moisturizing (Oil of Olay, Dove) are not needed and can actually hinder the pouching system from sticking well on your skin and contribute to leaks. If you are showering without wearing a pouching system and soap flows down onto your stoma and skin, just rinse the area well afterwards. This is not a concern.

When washing your stoma, you may notice small specks of blood on your cloth. This is completely normal and expected. The stoma tissue contains small blood vessels close to the surface that may bleed, especially if you are taking blood thinners.

MainAdmin   July 21, 2014

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Do I need to “air out” my skin when changing my pouching system to keep it healthy?

No, this is not necessary. It may feel good to “air out”, for a while but this is not required in order to have the skin remain healthy. This may also be difficult if your stoma is active!

MainAdmin   July 21, 2014

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How long should it take to change my pouching system?

There is no “set time” for this. Everyone works at their own pace and becomes more and more proficient, confident and comfortable as time goes on. In the end, it shouldn’t take more than 15 minutes to complete a change if your stoma is inactive. If you continue to take a long time to change, it may be time to see an ET Nurse to see if your routine can be simplified.

MainAdmin   July 21, 2014

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Could I be allergic to my ostomy pouching system?

There is less than a 1% incidence of a true allergy to any part of the pouching system. All parts are of the system are latex free, including the belt (if you are using one). There is a multitude of reasons for skin issues, however they are typically due to a leak in the system causing stool or urine to sit on and irritate the skin. Remember, when you first remove your pouching system, your skin may be pink, but this should fade in a few minutes. In any case, it is important to seek help from an ET Nurse sooner than later if you have concerns. Do not assume that you have an allergy or that this cannot be resolved.

MainAdmin   July 21, 2014

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Should I be using stoma powders, skin protective sprays / “prep” wipes, alcohol swabs or wound/skin spray cleansers when I change my pouching system?

No, unless your ET Nurse has suggested this for you as a SHORT TERM treatment. These products are not to be used routinely as they can build up and irritate the skin and actually prevent the pouching system from sticking properly. Statements such as “less is more”, and “keep it simple” stand true in ostomy care so that using “extras” such as wipes and powders should have a reason rather than a routine.

Using stoma powder and a protective skin spray or wipe afterwards to seal in the powder is commonly referred to as “crusting” but is only a SHORT TERM treatment for weepy skin breakdown around the stoma. If this becomes part of your routine because of recurrent skin breakdown, this should be re-evaluated and discussed with your ET Nurse as your pouching system may need to be modified to give you a better fit and actually protect your skin on its own.  “Crusting” should be reserved for the “occasional” skin problem and is a very useful tool for treatment.

Skin protective sprays and wipes such as Skin Prep, Cavilon No Sting, Hollister Skin Gel etc, are overused in general partially because of the name “skin protective” itself. But these products can actually build up on your skin and prevent the adhesive pouching system from sticking. Talk to your ET Nurse to see if these products are appropriate for you.

Wound/Skin cleansers (and alcohol wipes) are expensive and unnecessary because the stoma is not a “wound”, nor is it considered a sterile area. Use of these products can also cause irritation and also hinder adherence of your pouching system. Alcohol will also dry out the skin.

MainAdmin   July 21, 2014

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How does chemotherapy affect my stoma and peristomal skin?

Chemotherapy is a type of cancer treatment that may effect your skin and stoma. The impact of chemotherapy may be create skin problems around your stoma (peristomal skin) and the overall management of your ostomy. There are many different types of chemotherapy treatments, each with its own specific way that it affects the cancer. But not all treatments cause the same side effects to the skin and/or stoma. Your oncologist and chemotherapy nurses are the experts and will advise you about the possible side effects that may occur.  They are an excellent resource to answer your questions and concerns. They can provide you with various patient handouts outlining different chemotherapy drug protocols and patient guidelines. 
 
In general, remember that your stoma is surgically created from bowel tissue, which is very similar to the tissue in your mouth. Some chemotherapy drugs affect the tissue in your mouth resulting in sores, ulcers or causing the tissue in your mouth to bleed easily. Your stoma may react the same way. You may find that your stoma bleeds easily when you are washing it or you may find tiny sores on your stoma.

Your stoma may also swell. This is because the lining of your colon or intestine can become irritated and inflamed from the chemotherapy.

During chemotherapy your skin may be more sensitive. This includes peristomal stoma. The skin around your stoma may become more sensitive by becoming red and sore.  Remember that gentle removal of the pouching system during changes is important when skin is fragile. 
 
If you still have your large colon, you may have an increase of mucous drainage from your anus. Again, this is because the chemotherapy can make the lining of your colon inflamed and irritated causing more mucous to be produced which will pass through the anus.

Recommendations:

Be gentle when changing your pouching system.  Gently remove your pouching system from your skin.
Wash your stoma and skin with warm water and a soft cloth.
If your stoma is swollen or has enlarged, cut a larger opening in your pouching system or speak to an ET ostomy nurse and get a system to accommodate your stoma.
If you have any concerns or questions, do not hesitate to contact an ET ostomy nurse.

MainAdmin   July 21, 2014

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I have an ostomy and am gay. Is there anyone out there who would understand my concerns?

Your ET or WOCN nurse deal with people from varying backgrounds, beliefs, sexual orientation and cultures. Each one of us is unique.

There is an excellent website that maybe a good resource for you. www.glo-uoaa.org.

The GLO website can be used by individuals seeking information, chapters looking for a trained visitor or for anyone wishing to expand their knowledge of the Gay or Lesbian person with an ostomy.

MainAdmin   July 21, 2014

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What is a peristomal hernia?

The development of a peristomal hernia after ostomy surgery is very common. Statistics show a wide range from 4-48% chance of developing a peristomal hernia.  Most peristomal hernias occur within the first 2 years of surgery.

Some surgeons say that they give you a hernia when they do your ostomy surgery; this is because their definition of a hernia is an opening or hole in the muscle, and to form the stoma the surgeon needed to make a hole in the muscle, to bring the bowel through the skin.

We usually say people have a hernia when we see a bulge around the stoma. It may appear like the stoma is sitting on an orange or grapefruit.  For some people, they don’t feel any different; they just have a bulge on around their stoma. For others, the hernia is uncomfortable and when they are up and about they feel they need to support or hold that side of their abdomen. Sometimes there is a pulling sensation, like a muscle pull, which is relieved by sitting or lying down or holding that area. The bulge or hernia sticks out more when people are standing and when lying down the bulge or hernia may flatten or go away.

hernia 01 hernia 02

MainAdmin   July 22, 2014

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What are the risk factors to developing a peristomal hernia?

Hernias develop when the opening in the muscle, created by the surgeon to bring the bowel through the muscle and skin layers to make the stoma stretches. This allows loops of bowel to come through the enlarged opening. Anything that stretches the muscle opening larger is a risk factor to develop a peristomal hernia.

Activities that increase strain on abdominal muscles and stretch the muscle opening larger include:

Coughing and sneezing
Lifting heavy items using abdominal muscles
Large weight gain after ostomy surgery
Obesity
Other risk factors include
Poor nutritional status
Emergency surgery resulting in an ostomy
Certain drugs that slow healing- such as corticosteroids
Previous abdominal or inguinal hernias which may indicate abdominal wall weakness
Age – as we get older the abdominal muscles lose tone and strength and the opening where the bowel goes through may enlarge.

MainAdmin   July 22, 2014

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What should I watch for if a hernia develops?

–        The contour of the abdomen changes which may affect the seal on your pouching system. This may change wear time, frequency of leakage and a new pouching system may be required.

–        The size of the stoma may enlarge so the opening in the pouching system may need to be adjusted

–        Abdominal and back discomfort as there is a stress or pull on those muscles

–        ** The most serious complication to watch for is a bowel obstruction/strangulation ***

A loop of bowel may get stuck through the muscle wall opening.  If the muscle wall squeezes down on the bowel, it can to block the bowel  so nothing can pass. That is no stool can move through the stoma. More importantly, the blood supply to the bowel and stoma can also be affected.  The colour of the stoma will change from its usual pink/red colour to a dark dusky purple black colour. You may also have abdominal pain and cramping and nothing coming out of your stoma.  Please go to emergency.

MainAdmin   July 22, 2014

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What can be done if I have a hernia?
Surgical Management

Surgeons are hesitant to repair a peristomal hernia, as it is very likely to recur.  There are different surgical techniques for repairing peristomal hernias.  Each surgeon will have their preference for the technique they use. It is a complex surgery to do a hernia repair involving a stoma.

Surgical techniques include suturing the enlarged opening in the muscle wall to make it smaller.  Moving the stoma to the other side of the abdomen is another surgical option. Repairing the hernia by putting a mesh in is another common approach.  There are different types of mesh and surgical techniques to put the mesh in.

Non-surgical management

Surgical repair is usually avoided in people with no or mild symptoms because of the high recurrence rate.  Many people with mild symptoms can be managed with a ostomy hernia belt or support garment.  There are many types of ostomy hernia belts available on the market. Most have an opening to allow the pouch to come through so the urine or stool output is not affected.  ( pictures).  Many women find that a supportive panty is all they need but they need to see that the flow of output is not affected.

It is important to note that the hernia belt or support garment will not “ take the hernia away” or prevent a hernia. It is for comfort and support.

hernia 03

Examples of Nuhope Peristomal Hernia Belts

MainAdmin   July 22, 2014

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What are some exercises to strengthen abdominal muscles?

Physiotherapists are trained to strengthen damaged muscles safely.  It is recommended to see a physiotherapist to assess your abdominal muscles and to recommend a program to help you safely strengthen your core abdominal muscles.

The time to see a physiotherapist is about 8-10 weeks after surgery or when your surgeon lets you resume your normal daily activities.

Marilyn Moore, a physiotherapist, developed the following sets of exercises and she also has an ileostomy. In developing these exercises she stresses the need to take things in steady stages.  Gradually building up to the more challenging exercise is the surest way for you to improve both fitness and general health.

Check out this link to see preventative core abdominal exercises  www.iasupport.org/about/publications/factsheets/exercises-for-ostomates

MainAdmin   July 22, 2014

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How do I prevent from getting a hernia?
Be cautious when lifting- use proper technique and watch how much you are lifting. There is no magic number for the number of weeks after surgery before lifting or exercising or the amount of weight to lift or not lift, as everyone heals at a different rate.  Please check with your surgeon.  If still unsure, do not lift any more than 5 pounds or 2.2   kilograms for 8-10 weeks after surgery then gradually increase.
Contact a physiotherapist to learn how to strengthen your abdominal muscles safely.
Maintain a healthy weight.

MainAdmin   July 22, 2014

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I have an ileostomy now for about a year and could you tell me why when the stool comes out it stays up just where it comes out does not fall down in the bag. What can I do about that. So I do not eat if I am going out as I do not want that to happen. Would it be my diet. I really not to sure what to eat I cannot digest any vegetables except potatoes and sweet potatoes.

Pancaking

This is when the output collects around the stoma and can squeeze between the flange and the skin instead of going into your bag. One of the reasons this happens is because there isn’t enough air in the bag and so the output doesn’t take a downwards turn.

If this happens, try lubricating your bags with baby oil or one of the many products available from the various supply companies. Squirt a little oil or gel in your bag and give it a good rub around before you stick it on. Take care not to get any on the adhesive as this can reduce the effectiveness of the seal.

If you’re wearing clothes that are tight fitting in the stoma area this can also cause pancaking. You may want to try to wear looser fitting clothing in order to prevent a vacuum forming inside the bag. Also, in terms of clothing, make note of where your waistband or belt sits. Does it allow the stool to drop into the pouch or does it restrict the stool so the stool gathers only at the top. Monitor your body positions. If you are sitting for long periods for example driving or at the computer, does the pouch fold onto itself not allowing the stool to drop but remain in the top part of the pouch?

If the pouch has a filter in it, block the filter by either using waterproof tape or the ” tabs” that come in the box of pouches. This will leave air in the pouch, preventing the vacuum effect and allow to stool to drop into the pouch.

Another reason for pancaking is that your output is thick. Each person is an individual and so, each of us has trigger foods that can cause digestion processing issues, and stool issues. It would be helpful to consult your physician for a referral to a nutritionist or dietician to assist you in identifying foods that will work best for you.

[July 22, 2014]

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MainAdmin   July 24, 2014

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I’m looking for ways to help my grandson, who has an ileostomy that is always leaking.

Leakage

Ostomy leakage is a problem which all ostomates will no doubt encounter at some point during their time with a stoma. For most people it’s a common occurrence in their early weeks of managing an ostomy when you are still finding your ostomy-feet and working out which products are best for you, and which routine gives the best results. It can cause a heck of a mess, not only to our clothes, but to our self-confidence too.

To find out what is causing the leakage start by checking the back of the flange after it’s leaked and you’ve removed it. This holds the biggest clue of all, you will be able to see what path the stool took on its break to freedom. Compare this to your skin and see what problems are present.

Condition of the skin. Is it raw, or does it have a rash all over it, or on part of it? If so, you may be allergic to the flange, and it may be interfering with the adhesive properties of the flange. Also, check to see if the area around where the flange leaks is any worse than elsewhere.
With leakage, the stool will always follow the path of least resistance. Do you have a belly crease which in turn is creasing the flange and creating a nice little tunnel for your stool to escape?
Look at your flange. Was the gap around the stoma too large? Or was it too tight? Or just right? Do you have protruding stitches around your stoma which the flange has trouble moulding around?
Do you have a belly cavity near the stoma? Flanges may struggle to adhere to these dips in your belly and lead to leakage.
Check your stoma. Is it flat/flush to the skin? Is it inverted / pulled in?

Some causes of leakage could be:

Flush to the skin or inverted stoma
Poor fitting flange/odd shaped stoma
Belly cavity around stoma
Parastomal hernia and/or Pancaking

Once you’ve discovered the source of your leakage then you are in a better position to be successful in stopping your leakage in its track, and there are a number of products available on the market which are designed to help reduce opportunities for leakage to occur.

Arrange a visit with an Enterostomal Therapy Nurse, (ET nurse – registered nurse [RN], who has specialized training in treating patients with ostomies), who can assist you in assessing the leakage issue and make equipment product recommendations for ensuring a good seal. One thing to bear in mind with all ostomy products is that our bodies are very individual, and because of that, a product which works great for one person may not work anywhere near as successfully for another, and vice versa. You may need to sample various rings and seals to find the one that works best for you, which the various ostomy product companies will also assist you in finding the seal that will work for you. So there is no reason why you cannot use multiple products to help combat leakage.

[July 23, 2014]

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MainAdmin   July 24, 2014

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I am not doing very good with my diet. What would be a proper one?

Diet – Healthy Eating With A Stoma

The impact of food and drink on your stoma is hard to predict as diet is very individual. Various surveys suggests that foods can affect people in different ways after stoma surgery. While many people find that they can eat just the same diet as before their surgery, some find there are things that can have an adverse effect on the activity of their stoma. They may then choose to avoid those foods, or include them in their diets and be prepared for the effects.

Many people report that a good way to ascertain which foods and drinks are suitable for them is to keep a food diary so that patterns between diet and stoma output can be identified. You can then base your diet on what you have observed to be agreeable in terms of stoma output. There may be a certain degree of trial and error, especially in the first few months after your stoma is formed when the bowel is swollen. This swelling (or oedema) is the reason why a stoma may look puffy initially and can cause problems digesting food that would otherwise not occur, so it’s sometimes worth trying a food again later on before deciding whether to eliminate from your diet completely.

Information about diet and healthy eating for the general public is often conflicting and difficult to interpret. Add to this a stoma and many people feel confused about what they should and shouldn’t be eating.

Most people with stomas do not need to change their diets and should follow a normal healthy eating pattern like the rest of the population. If you have recently had your surgery or have been unwell, ensuring that you get all the essential nutrients from your diet is even more important and putting unnecessary restrictions on your diet could slow down your recovery and healing.

The purpose of the following information is to offer general information, for further information about diet, ask you physician to refer you to a dietician in order to explore any important factors to take into consideration regarding your individual stoma management and general wellbeing.

A balanced diet is made up of:

Starchy foods such as potatoes, rice & grains, bread and pasta, for energy. Try different varieties, including wholemeal vs refined/white rice and pasta.
Fruit and vegetables provide a wide range of vitamins and minerals and both soluble and insoluble fibre. Soluble fibre is found in the flesh of fruit & veg and can help lower cholesterol as well as make stool thicker, softer and easier to pass (helpful for those with a colostomy or ileostomy who wish to thicken their output). Insoluble fibre is found in the skins of fruit & veg and helps move waste through your bowel, so can help with constipation (helpful for those with a colostomy who experience pancaking and anyone who experiences constipation). If you have a colostomy or ileostomy, immediately after surgery foods containing insoluble fibre may make your stoma behave unpredictably, so you may wish to avoid or limit your intake of them. As your bowel adjusts you can re-introduce them and see how they affect you.
Protein rich foods for growth and healing. Protein comes from meat, fish, eggs, soya and it is the substance we use to heal wounds and regain muscle.
To promote general wellbeing, fatty foods should be limited. However, if you are recovering from surgery or have a small appetite and need to gain weight, including more of these foods in the short term is a good idea.

Individual Differences

The vast majority of people with a urostomy (a stoma that passes urine) find that their food intake is unaffected by having a stoma, however some food and medications can make urine discoloured or smelly (e.g. beetroot can make your urine pink and antibiotics and asparagus can make it smell strange).

Importance of chewing

It sounds very obvious, but it is vitally important to chew food thoroughly when eating. Chewing is the first stage of digestion and in doing this we make more nutrients available from our food. Foods that contain cellulose such as nuts, grain, fruit & vegetables (particularly the skins) cannot be completely broken down in the digestive system. So, you may notice these coming through your stoma looking the way they did when you ate them. Immediately after bowel surgery, your bowel is swollen and this narrows the passageway for food to pass along.

Fluid Intake

It is essential for everyone to drink enough to keep their kidneys healthy and flush out the chemicals that build up in the blood. You should aim to drink enough throughout the day that your urine is a light straw colour. The following information is for the specific stoma types but does not take into account other medical conditions. If you have been given different information from your healthcare professionals please check with them before making any changes.

People with urostomies enjoy a few glasses of water a day. This will help to prevent infections.

If you have a colostomy, your fluid intake can remain as normal unless you are experiencing constipation or pancaking. If you have this problem, increasing your fluid intake can be really helpful.

People with ileostomies, particularly if the stoma is formed higher up in the bowel, can have more difficulties with their fluid intake. This is because it is the role of the large bowel to absorb water (and salt) and for people with ileostomies this is no longer being used. The small bowel will, with time, adapt to absorb more water and more salt, however careful attention should be paid to ensure that you are drinking an adequate, varied fluid intake to maintain kidney health. Remember, you are aiming for light straw coloured urine.

For those who are more active it is even more important to pay attention to your fluid intake. Fluids are lost through sweating that contains electrolytes.

Everyone should bear in mind that alcohol is a dehydrating fluid and caffeinated drinks such as tea and coffee cause you to lose more fluid in your urine. The majority of your fluid intake should therefore be from fluids such as water and fruit cordials.

A little of what you fancy….

Of course, every now and again you will want to enjoy a treat like cake or ice cream and there is no reason why you can’t indulge once in a while! Healthy eating is about moderation and after stoma surgery it is also about trial and error. Take your time to explore how different foods affect your stoma, chew your meals, maintain a varied fluid intake and, most importantly, enjoy your food!

Some foods effect output. The effects may vary.

Basic Food Reference Chart

Stoma ObstructiveGas ProducingOdour ProducingColour ChangesOdour ControlIncreased StoolDiarrhea Control
Apple peelsBeansAsparagusAsparagusButtermilkBran cerealsApplesauce
Cabbage rawCabbageBaked beansBeetsCranberry juiceFresh fruitsBananas
Corn, whole kernelCarbonated beverageBroccoliCoffeeTomato juiceGreen, leafy veggiesPeanut butter
CoconutCauliflourCod liver oilCooked fruitsYogurtMilkTapioca
Dried fruitCucumberEggsFood colourPrunes
MushroomsDairy productsFishIron pillsRaw vegetables
PineappleNutsGarlicStrawberriesWhole grains
PopcornOnionsOnionsTomato sauces
SeedsRadishesPeanut butter
SoyStrong cheese

To get additional information or help, find an ET in your area by clicking here…

MainAdmin   August 10, 2014

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I’d just like to check out anything new…

What’s New

The newest news about ostomates I’ve noticed, is the latest trend in breaking the taboo of ostomies and ostomy bags through posted photographic images.

Facebook, Instagram, and Twitter are just a few of the social media being used by ostomates to show and share their colostomy, ileostomy and urostomy bags and scars.

They are young, older, male, female, and all of them are plucking up the courage to share themselves and their bags to a wider audience.

I’ve heard some folks take offence to the photographic images, and heard other folks cheer them on.

My take on this new and inspiring trend is; go ahead folks, be proud of who you are, you are amazing, and so, embrace your ostomy, inspire others, and keep spreading awareness!
Jo-Ann L. Tremblay

[July 27, 2014]

MainAdmin   August 11, 2014

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What clothing tips are there for a person with an ostomy?

Stephanie Hughes from the blog, Stolen Colon, shares a wonderful video on What to Wear With an Ostomy…

 

MainAdmin   August 12, 2014

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What sort of swimsuit options are out there for women with ostomies?

Jessica Grossman of Uncover Ostomy, has a wonderful blog entry titled Itsy Bitsy Ostomy Bikini with several links to swimsuit options.

Also, Stephanie Hughes of Stolen Colon, shares a video showing different swimsuit options as well:

 

MainAdmin   August 12, 2014

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I would like to learn more about colostomy irrigation…

(Disclaimer: Before attempting any irrigation techniques, you must get your doctor’s permission)

* Reprinted with permission from The Phoenix magazine, www.phoenixuoaa.org or call 800-750-9311

Download (PDF, 156KB)

MainAdmin   September 18, 2014

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What is an ostomy?

You may know someone who wears a “bag” or pouch on their abdomen or have an ostomy yourself. The term “colostomy” is often the default go-to word when people talk about ostomy care, suggesting that all “ostomies” are “colostomies” and thus created and function equally.  In actual fact, the term colostomy only refers to an ostomy created from the large bowel or colon and only represents one kind of ostomy. An ileostomy is also a fecal stoma (producing stool waste) which the surgeon creates using a portion of the small bowel or ileum. Finally, a urostomyproduces urine in the absence of the bladder as with bladder cancer for example. It is important not only for health professionals to understand and distinguish between the 3 “kinds” of ostomies, but for the ostomy patient themselves as the guidelines for care are very different for each. All 3 will have a stoma or bowel that has been brought to the surface of the abdomen, but anatomically be very different.

Anonymous   July 21, 2014

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What does a stoma look like?

You may know someone who wears a “bag” or pouch on their abdomen or have an ostomy yourself. The term “colostomy” is often the default go-to word when people talk about ostomy care, suggesting that all “ostomies” are “colostomies” and thus created and function equally.  In actual fact, the term colostomy only refers to an ostomy created from the large bowel or colon and only represents one kind of ostomy. An ileostomy is also a fecal stoma (producing stool waste) which the surgeon creates using a portion of the small bowel or ileum. Finally, a urostomyproduces urine in the absence of the bladder as with bladder cancer for example. It is important not only for health professionals to understand and distinguish between the 3 “kinds” of ostomies, but for the ostomy patient themselves as the guidelines for care are very different for each. All 3 will have a stoma or bowel that has been brought to the surface of the abdomen, but anatomically be very different.²

Anonymous   July 21, 2014

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How should I care for the skin around my stoma?

It is very important for the skin around the stoma (the peristomal skin) to remain healthy and free of irritation. The peristomal skin should look just like the skin elsewhere on your abdomen. To prevent skin irritation or other skin problems, you must have a skin barrier and pouch that fits properly. Each time you remove your skin barrier and pouch, look carefully at the peristomal skin. If you notice any swelling, redness or rash, you could have irritated skin. Sometimes-but not always-irritated skin is painful. If the problem persists for more than two pouch changes, contact your ET Nurse.5

Check out an excellent reference guide provided by the WOCN (Wound Ostomy and Continence Nurses Society):

Download (PDF, 648KB)

Anonymous   July 21, 2014

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What is an ET / Ostomy Nurse?

An Enterostomal Therapy (ET) Nurse is a registered nurse with advanced and specialized knowledge and clinical skills in wound, ostomy and continence care. Recognized as Nursing Specialists in wound, ostomy and continence by the Canadian Nurses Association (CNA), ET Nurses are the ONLY nursing specialty with CNA certification in wound, ostomy and continence care. ET Nurses work in acute care hospitals, outpatient clinics, community care, long term care and in independent practice. An ET nurse provides specialized holistic assessment and management as part of an interprofessional team member. He/she functions to meet the needs of individuals/families with ostomies, acute and chronic wounds and urinary and fecal continence problems.

Some nurses will have different “letters” after their name such as WOC Nurse or cWOC Nurse which indicates that they did their wound, ostomy, continence education in the United States. It should be noted that there are different education levels for wound and ostomy health professionals that vary from a 1 day course to the full scope nursing specialty an ET or WOC Nurse. To ensure your best care, be sure you are seeing a nurse with full credentials. To find an ET/WOC Nurse in your area, you can contact the Canadian Association for Enterostomal Therapy (CAET) www.caet.ca.

When to see an ET/Ostomy Nurse:

Do you have a new ostomy and need more teaching after discharge from the hospital?
Do you have regular leaks of your pouching system?
Are you suddenly getting less wear-time of your pouching system?
Have you gained or lost weight?
Does your flange “not stick” to your skin?
Has the shape or size of your stoma changed since surgery?
Are you using powders and sealant sprays frequently?
Do you have questions around nutrition, lifestyle, or intimacy?
Do you have questions about how to better conceal your pouch with clothing or when participating in sports?
Do you want to learn more about hernias?
Do you think you have a hernia and want to learn about support garments?
Do you need feedback about how you are currently managing?
Are there sores or wounds around your stoma?
Have you had your stoma for many years and just want to see “what’s new”?
Is it time for an annual check up?

Anonymous   July 21, 2014

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What about medications?

After ostomy surgery, digestion and absorption of medications, either alone or in combination, may be affected. It is very important to review your medications, both over -the -counter and prescription drugs, with your ET nurse or health care provider and your pharmacist. Over-the-counter treatments can include antacids, antidiarrheal, anti-inflammatory agents, aspirin, laxatives, salt substitutes, sugar substitutes and vitamins. 1

Anonymous   July 21, 2014

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What about bathing and showering?

You may choose to bathe or shower with your pouch on or off. If you shower with your pouch off, choose a soap that is oil-and residue-free. These types of soaps will not interfere with the adhesion of the wafer.2

Anonymous   July 21, 2014

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Will I need special clothing?

Don’t worry-you will not need a new wardrobe. Modern ostomy pouches are inconspicuous are inconspicuous under almost any kind of clothing because they’re designed to lie flat against the body. Ostomy pouches for both men and women can be worn inside or outside underwear; whatever feels most comfortable. Yet if your stoma is at or near the waistline, be sure to avoid pressure from tight-waisted pants or belts. Girdles or panty girdles can be worn, as long as they are soft and stretchy, without a front panel. For men, if you wear an athletic supporter, it is helpful to wear it one size larger.3

Anonymous   July 21, 2014

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Can I exercise and play sports?

An ostomy should not prevent you from exercising or from being physically active. Other than extremely rough contact sports or very heavy lifting, you should be able to enjoy the same type of physical activities you enjoyed before your surgery. People who have ostomies are able to swim., water ski or snow ski, play golf, tennis, volleyball or softball, hike, sail or jog just as well after their surgery as they did before.5

Anonymous   July 21, 2014

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When can I return to work? What about travel?

As with any surgery, you will need to allow some recovery time. Recovery from this type of surgery can take from six to eight weeks. You should check with your doctor before returning to work. After your recovery, you should be able to return to work, or travel just about anywhere. Your ostomy should not limit you. Ostomy products are available through medical or surgical retailers in nearly every country in the world. Of course, it is always a good idea to take your own supplies with you when you travel – and always take more than you think you will need.5

Anonymous   July 21, 2014

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Will other people know?

Very few people, even those you see on a daily basis, will know that you have had ostomy surgery-unless you choose to tell them. Whether you tell others is entirely up to you. Most likely your relatives and friends already know you’ve had a health problem that required surgery. But you may feel uncomfortable about revealing more, fearing they might have negative attitudes about ostomies. It’s true that some people have uninformed ideas, but if these people are important to you, you can either help to educate them or simply not mention your surgery.1

Anonymous   July 21, 2014

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What about intimate relationships? Can I have children?

Because ostomy surgery is a body-altering procedure, many people worry abourt sex and intimacy, and aboput acceptance by their spouse or loved one. For people who are dating, a big concern is how to tell someone about the ostomy. It’s important to remember that supportive personal relationships can be major sources of healing after any type of surgery. It’s also important to let your partner know that sexual activity will not hurt your stoma. Ostomy surgery affects both partners in a relationship, and it’s something to which both partners must adjust-each in his or her own way. The key, of course, is understanding and communication. If having children is a concern, you’ll be happy to know that after a satisfactory recovery it is still possible for a woman who has a stoma to have children. Also many men have become fathers after having colostomy or ileostomy surgery. For men, urostomy surgery can sometimes cause a change in sexual function; however, there are men who have become fathers after having urostomy surgery. If you have questions about pregnancy, don’t hesitate to ask your doctor or ET nurse. For both men and women, it is very important to discuss the surgery openly with your spouse or loved one. Also, don’t hesitate to discuss this aspect of the surgery with your doctor and your ET nurse.5,6

Anonymous   July 21, 2014

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What is a colostomy?

A colostomy is a surgical procedure where the surgeon brings one end of the large intestine out through the abdominal wall, usually on the left side.  The end of the bowel that is brought out to the abdomen is sutured to the skin to form a stoma.

Stool moves through the intestines (or bowels) through the stoma into a pouching system adhered to the abdomen to collect the stool.  Stool from a colostomy is similar to normal stool as it has gone through most of the digestive tract, meaning it can be quite formed or more solid. Colostomies can be permanent or temporary. There are essentially no diet restrictions (unless other medical conditions are present) and bowel patterns often emerge when a patient knows he/she will have 1-2 movements per day for example and see little action in between. If constipation occurs, treatment is generally the same for the colostomy patient as it would be for the patient without an ostomy. It is good to seek advice from your doctor or ostomy nurse if constipation becomes a regular problem.

Anonymous   July 21, 2014

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Why are colostomies performed?

There are many reasons, but the major contributing conditions are:

Diverticulitis (Diverticulitis is small, bulging sacs or pouches of the inner lining of the intestine (diverticulosis) that become inflamed or infected) or abscess
Injury to the bowel or rectum
Rectal or Colon Cancer
Wounds or fistulas in the perineum

 

Anonymous   July 21, 2014

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Can I control bowel movements after colostomy surgery?

Since you will no longer have voluntary control over bowel movements, it is important that you understand the consistency and frequency of discharge after your colostomy. These vary depending upon the location of the colostomy within the colon. An ascending colostomy is located within the ascending colon. Output will be liquid to semiliquid, rich in digestive enzymes and irritating to the skin around the stoma. A transverse colostomy is located within the transverse colon. Output is usually liquid to semiformed. A descending colostomy is located within the descending colon. Output is semiformed to formed. A sigmoid colostomy is located within the sigmoid colon. Output has a normal, formed consistency.1

Anonymous   July 21, 2014

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Do I need to follow a special diet after colostomy surgery? What about diarrhea and constipation?

Unless your doctor has prescribed a special diet, you should not have to change your diet. You may become constipated or have diarrhea just as you did before surgery. If you become constipated, try eating more fiber (vegetables, fruits, and brans) and drinking more water. If constipation becomes a problem, talk to your doctor or ET nurse. If you become ill with a stomach virus, this can give you diarrhea. Treat it the same as before you had surgery, and remember to drink plenty of fluids-you might try one of the ‘sport’ drinks to replace fluids and electrolytes.2

Anonymous   July 21, 2014

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What about gas?

The amount of gas that a person’s system generates depends on the individual. If you had problems with excessive gas before your surgery, you will likely have the same problems after your surgery. Intestinal gas can sometime be the result of swallowing air. Drinking carbonated beverages, smoking, chewing gum, and chewing with your mouth open can all increase the amount of gas you swallow. Sometimes gas can be caused by the foods you eat. Foods and beverages that may increase gas: asparagus, broccoli, Brussels sprouts, cabbage, cauliflower, carbonated beverages, corn, cucumbers, mushrooms, peas and spinach.5

MainAdmin   July 21, 2014

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Will some foods cause odour in the stool?

Foods that can produce odour include asparagus; cabbage family vegetables: broccoli, brussels sprouts, cabbage, cauliflower, onions; cheese; eggs; fish and some spices.1

MainAdmin   July 21, 2014

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What is an ileostomy?

An ileostomy is a surgical procedure where the surgeon brings one end of the small intestine called the ileum out through the abdominal wall, typically though not always on the right side, bypassing the large intestine. Since the ileostomy bypasses the large intestine where fluid is absorbed, ileostomy stool output is the consistency of a paste or pudding. In some cases it is very watery and difficult to differentiate between “normal” output and “diarrhea”. Because of this, dehydration and electrolyte imbalances can occur quickly causing illness and visits to emergency room if not monitored well. Communicating that you have an ileostomy is important whenever you are seeking medical attention. The stool from the small bowel also contains more enzymes that function to break down the foods we eat including protein, carbohydrates etc. Enzymatic stool can damage the skin as it tries to “digest” it as well as in the case of a leaking pouching system where stool is trapped on the skin for a duration of time.

Tough or high fibre foods may be hard to digest in the small intestine and may cause blockages or discomfort when passing through the stoma. Therefore people with ileostomies may need to be more cautious with their diet. Diet counseling is usually done while a new patient is in the hospital, however if you have questions or need further information, contact your local ET (ostomy) nurse or dietitian.

Ileostomies can also be permanent or temporary. Many are done to shunt stool away for several months from a fragile surgical area lower down in the large bowel until it heals and it is safe for stool to pass through the colon again where the ileostomy may be reversed. It should be noted as well, that because stool is exiting the body “early” in the digestive path, certain medications such as those that are enteric coated to protect the stomach or extended release medications (such as certain pain medications) can leave the body without breaking down and being of little used in the body. For this reason, it is important to inform a prescribing physician and your pharmacist that you have an ileostomy.

MainAdmin   July 21, 2014

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Why are ileostomies performed?

A few reasons are:

Crohn’s Disease or Ulcerative colitis
Familial adenomatous polyposis
Colorectal Cancer
Trauma

MainAdmin   July 21, 2014

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What is a blockage?

The small intestine is like a hollow tube or garden hose. Though it is physically impossible to become “constipated“ with an Ileostomy, blockages of the small intestine can happen in two ways. From the inside and from the outside.

The first way is pressure squeezing on the outside of the tube, like stepping on the garden hose to stop water from coming through, or kinking it off. This is what happens when scar tissue or adhesions form. Scar tissue can cause narrowing of the tube whereby slowing down or preventing food from going through.

The second and more common way to block the small intestine, is from undigested food building up and blocking the inside of the “garden hose” or intestine. Food that is not completely chewed, undigestable for most of us under normal circumstances (like corn for instance) or high in fiber acts as a plug and thus prevents stool from moving through the intestine and out the stoma.

Everyone digests food a little differently so there isn’t one list of foods to eat or not to eat. We can give you guidelines on foods that may be difficult to digest, but some people will get blockages from things not on the list. Other people will be able to digest foods on the list without a problem.

Some high fiber foods that may cause a blockage include: popcorn, mushrooms, corn, raw carrots, raw cabbage, celery, nuts, bean sprouts, coconut, dried fruits and dried beans.

For the first 6-8 weeks after surgery your bowel is still swollen and tender which reduces the diameter of the small bowel or “tube” even further. During this time it is more prone to blockage. That’s why you are instructed to eat easy-to-digest, low fiber foods. After the swelling has gone down, you can slowly add small amounts of foods that are higher in fiber to see how you digest them. The important thing is to chew well!  Keeping a food diary can often be helpful.

Signs of a Food Blockage:

No stool is emptying into your pouch (no stool after 4 hours indicates a blockage)
Abdominal pain (may be cramping and come in waves as the body tries to push out the blockage)
Loss of appetite
Vomiting and nausea
Abdominal bloating
Stoma swelling
You can think back to the last 12 hours and recall eating a high fibre food

What to do at home:

Enlarge the opening of your pouching system to accommodate the stoma when it is swollen
Do not eat solid food. Take sips of water only if tolerated
Try to relax: relaxing stomach muscles around your stoma can be the key to releasing a blockage!
Massage around your stoma
Try knees to chest position (fetal position)
Take a warm bath or place a warm heating pad around your abdomen

When to go to the hospital:

If you start vomiting
If you cannot relate the blockage to any foods you ate within the last 12 hours, it could mean it is a blockage due to adhesions or scar tissue
No stool output from your stoma in 12 hours

(**Take all your ostomy supplies with you to hospital)

What the doctor will do at the hospital:

Ask about your medical and surgical history
Bloodwork
Abdominal x-ray or CT scan
Start an IV to give you fluids
Give you pain medication (often after pain medication is given, the abdominal muscles will relax and release the food blockage allowing the undigested food “plug” to pass)
Sometimes it is necessary to do an Ileostomy lavage to clear the blockage (this involves inserting a catheter attached to a syringe into the stoma and trying to physically break apart the food blockage with slightly pressurized fluid)

Once the blockage has been resolved, a clean, drainable pouching system should be applied. Because the stoma may be swollen, the opening in the pouch surrounding your stoma should be cut slightly wider. Stool will be very watery after this procedure.  This can result in dehydration and the need to have IV or fluids while in the hospital. The abdomen will feel tender and almost a bruised feeling which may last a few days. Eat lightly for the next few days. Easy to digest foods are best until the tender abdominal feelings go away and the stoma goes back to its normal size.

MainAdmin   July 21, 2014

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I have read that people with an Ileostomy can be prone to kidney stones. Why?

The most common kind of kidney stone for people with an ileostomy are the uric acid stones. This stone is caused by dehydration and from diet.

Dehydration results when not enough water is being absorbed in the body – either because you are simply not drinking enough, or because too much water from watery stool is lost through your ileostomy. Usually the large colon, which is bypassed when you have an ileostomy, is where the majority of your fluid is absorbed. Over time, the small bowel adapts to absorb some of the fluid when there is an ileostomy, however it is not as efficient at absorption of water as the large bowel was. Therefore, getting 1.5-2L per of fluid per day is very important. Remember, fluid does not have to mean only “water”. Juices, drinks without caffeine or alcohol, low sodium soups, pudding, and popcicles are some other ways of meeting your daily fluid requirements.

Another way increase the amount of fluid your body absorbs is to thicken up your stool whereby reducing the amount of fluid that is lost through watery ileostomy stools. Some foods such as white rice, bread, smooth peanut butter, apple sauce, pasta and marshmallows are known to thicken stool but remember, everyone’s body reacts differently to different foods.

Uric acid stones can also result because of poor fluid intake because less urine is produced and therefore that urine is more acidic and is missing sodium because most of the water and sodium bicarbonate comes out through the stool. Another factor that increases the risk for uric acid stone formation is loss of sodium bicarbonate, which is a compound in your body that is used to regulate electrolytes and the body’s pH.

This is a complex process, but as an easy and basic rule:

Drink, drink, drink, or “you’re in” trouble!

MainAdmin   July 21, 2014

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What is a urostomy?

A urostomy is a surgically created opening-on the abdomen- that allows urine to flow out of the body. A urostomy may also be called a urinary diversion. Many times, the person’s bladder and urethra are surgically removed. When a person has a urostomy, urine is no longer eliminated through the urethra. Instead, urine is eliminated through the urostomy. A urostomy does not have a sphincter muscle, so a person who has a urostomy has no voluntary control over when to urinate. Instead, the person wears a pouch to collect the urine. Your surgeon may select one of several methods to create the urostomy, or urinary diversion. The most common method is called an ileal conduit. To create an ileal conduit, the surgeon removes a short segment of the small intestine(ileum). This short segment of intestine will be used as a pipeline-or conduit-for urine to flow out of the body. The surgeon closes one end of the conduit, inserts the ureters into the conduit, and brings the open end of the conduit through the abdominal wall. This new opening on the person’s abdomen is called a stoma.6

MainAdmin   July 21, 2014

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What about diet after urostomy surgery?

Eating a well-balanced diet, that can include your favorite foods, is important to your health. Be aware that some foods cause an odour to urine including: asparagus, onions, fish and garlic. These foods can still be eaten; however, you may become aware of an unusual odour. You should drink at least 8 glasses of fluid each day, unless you have to limit your fluids due to a medical problem. Be sure to drink extra fluids when exercising or sweating.7

MainAdmin   July 21, 2014

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What’s the best way to get a good urine sample when you have a urostomy?

Rest of the question:  I have a urostomy and think I may have a urinary tract infection (UTI). My urine is cloudy, it has a strong smell, and I see more mucus in my pouch than usual. My doctor wants to have a urine specimen (C&S) to see if I have an infection and which antibiotics may be needed. What’s the best way to get a good urine sample when you have a urostomy?

Answer:

Getting a “good” urine sample is essential to determining IF you have a urinary tract infection AND which antibiotics would be most effective in treating this infection. Simply taking a urine sample from the spout of your pouch is NOT will not get accurate results because, you will have results of what is growing in the POUCH and potentially not what is growing in your own BODY. Inaccurate results can prompt the treatment of the wrong bugs that aren’t actually in your system and you may not have needed antibiotics at all! The urine sample should to come directly from the stoma itself as this will catch “fresh sterile urine” that has not been exposed to outside elements yet and contains whatever “bugs” that may be bugging you~!

 

There are two ways to collect the urine sample.

  The ideal method is using a catheter – To be done by a health professional
a)    Remove the urostomy pouch and clean the area of skin and stoma with warm water (using alcohol is NOT required)
b)    Using sterile technique, gently insert a small lumen catheter (eg 10 Fr) 4-6 cm into the stoma
c)    Place the other end of the catheter into the C&S container to collect urine
d)    Wait until about 10-20 cc of urine is collected
e)    Replace pouching system
“The Next best thing”: Can be done by the patient
a)    Remove the pouching system from your body
b)    Wash the skin and stoma with water (using alcohol is NOT required)
c)    Hold the collection container under your stoma but NOT TOUCHING your stoma or the skin catching while catching urine that dribbles out
d)    Wait until you have 10-20cc of urine collected
e)    Replace your pouching system
f)      After collecting the sample, refrigerate immediately and drop it off to the lab as soon as possible.

Helpful tips:

Take the urine sample at a time you know your stoma will actively be producing urine. Trying to do this first thing in the morning mightnot be the best time, as you have not had much to drink during the night.
Coughing and slightly moving your position may help move urine out of the stoma.

MainAdmin   July 21, 2014

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I have noticed that my night bag / bottle and my urostomy pouch sometimes has a bluish purple tinge to it. Is that normal?

Purple Urinary Bag Syndrome (PUBS)

People using leg bags or night drainage bags or bottles sometimes notice a purple tinge to their equipment.  It was first noted in 1812, when physicians looking after “mad” King George III noticed a blue tinge to his urine. There’s no need to worry; it doesn’t mean you’re “mad”, too. King George suffered from one of the risk factors, constipation.

Other risk factors include female gender (although it is seen with men also), alkaline urine, use of urinary catheters, the “plastics” used to make catheters and drainage bags, and bacteria in the urine (this does not always mean there is infection).

For the biochemists, bacteria in the urine produce the enzyme indoxyl phosphatase which converts indoxyl sulphate in the urine into the red and blue coloured compounds indirubin and indigo.

Keep in mind, PUBS is nothing to worry about. There are simple steps to reduce the risk factors that lead to PUBS.

Female gender: nothing you can do, sorry! ( Men can get it too.)
Alkaline urine: talk to your doctor about taking Vitamin C to keep your urine acidic
Constipation: things that promote regular bowel movements include adequate fluid intake, exercise and eating enough fiber (whole grains, vegetables and fruits)
Bacteria in the urine: increasing fluid intake, cleaning/replacing your drainage equipment (tubing, night drainage or leg bags, bottles and adapters) on a regular basis

See your doctor if you do have signs of infection in your urine:

Dark urine
Cloudy urine
Increased odour to your urine
Fever

MainAdmin   July 21, 2014

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Is my stoma normal?

Whether you have a colostomy, ileostomy or a urostomy you will have a stoma. A stoma or ostomy is a surgically created opening placed somewhere on the abdomen which is the exit point for either stool from the digestive system or urine from the urinary system. A stoma is fashioned from either large or small bowel which is turned inside out and sewn onto the skin. A stoma is red in colour and warm to the touch as it is very vascular, meaning it is well supplied with blood vessels. It is also glossy or wet looking because the bowel continually produces mucous just like the tissue from the inside of your cheeks (mouth).

There are rarely two stomas that look alike. Variations in surgical technique, body shape and composition (thickness of fatty tissue of the abdomen for example) are factors that influence what shape a stoma will take. Some are round, while others are more oval in shape. Some are flat, some protrude well. Some are big and some are small in diameter. Directly after surgery, it will take 6-8 weeks for the swelling to reduce before the stoma takes its “final shape”. But even after this, factors such as weight gain or loss, stoma prolapse or retraction (early on) and peristomal hernias can change the shape and height of a pre-existing stoma. Overall, any stoma should appear, red, wet and warm as a general rule. If there is any gradual or sudden change with the appearance of your stoma, discuss this with your surgeon/physician or ET Nurse.

MainAdmin   July 21, 2014

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Is my skin normal?

The skin around your stoma, or peristomal skin, which is the skin under the adhesive part of your pouching system, should appear similar to the skin everywhere else on your abdomen. However, research indicates that many people with ostomies have skin problems and do not report or recognize them. If you are ever in doubt, it is better to ask questions and seek help from an ET Nurse who can direct you if you need further treatment from another medical professional. Small problems can turn in to big ones quickly, so better to ask sooner than later!

Remember, sometimes your skin may look pinker, redder or darker right after you take off your adhesive pouching system. This should fade away after a few minutes.

MainAdmin   July 21, 2014

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How do I clean around my stoma?

All you need to clean around your stoma is warm water and either a washcloth or a soft disposable paper towel. Using sterile gauze and wearing gloves to change your own pouching system can be expensive and is unnecessary. REMEMBER, YOU ARE NOT DEALING WITH A STERILE AREA. Using alcohol to clean the area is equally unnecessary and can be very drying to the skin. Also, it is not recommended to use baby wipes or pre-moistened towelettes as they may contain chemicals that remain trapped on the skin and can cause a rash.

Soaps, including ones that are moisturizing (Oil of Olay, Dove) are not needed and can actually hinder the pouching system from sticking well on your skin and contribute to leaks. If you are showering without wearing a pouching system and soap flows down onto your stoma and skin, just rinse the area well afterwards. This is not a concern.

When washing your stoma, you may notice small specks of blood on your cloth. This is completely normal and expected. The stoma tissue contains small blood vessels close to the surface that may bleed, especially if you are taking blood thinners.

MainAdmin   July 21, 2014

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Do I need to “air out” my skin when changing my pouching system to keep it healthy?

No, this is not necessary. It may feel good to “air out”, for a while but this is not required in order to have the skin remain healthy. This may also be difficult if your stoma is active!

MainAdmin   July 21, 2014

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How long should it take to change my pouching system?

There is no “set time” for this. Everyone works at their own pace and becomes more and more proficient, confident and comfortable as time goes on. In the end, it shouldn’t take more than 15 minutes to complete a change if your stoma is inactive. If you continue to take a long time to change, it may be time to see an ET Nurse to see if your routine can be simplified.

MainAdmin   July 21, 2014

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Could I be allergic to my ostomy pouching system?

There is less than a 1% incidence of a true allergy to any part of the pouching system. All parts are of the system are latex free, including the belt (if you are using one). There is a multitude of reasons for skin issues, however they are typically due to a leak in the system causing stool or urine to sit on and irritate the skin. Remember, when you first remove your pouching system, your skin may be pink, but this should fade in a few minutes. In any case, it is important to seek help from an ET Nurse sooner than later if you have concerns. Do not assume that you have an allergy or that this cannot be resolved.

MainAdmin   July 21, 2014

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Should I be using stoma powders, skin protective sprays / “prep” wipes, alcohol swabs or wound/skin spray cleansers when I change my pouching system?

No, unless your ET Nurse has suggested this for you as a SHORT TERM treatment. These products are not to be used routinely as they can build up and irritate the skin and actually prevent the pouching system from sticking properly. Statements such as “less is more”, and “keep it simple” stand true in ostomy care so that using “extras” such as wipes and powders should have a reason rather than a routine.

Using stoma powder and a protective skin spray or wipe afterwards to seal in the powder is commonly referred to as “crusting” but is only a SHORT TERM treatment for weepy skin breakdown around the stoma. If this becomes part of your routine because of recurrent skin breakdown, this should be re-evaluated and discussed with your ET Nurse as your pouching system may need to be modified to give you a better fit and actually protect your skin on its own.  “Crusting” should be reserved for the “occasional” skin problem and is a very useful tool for treatment.

Skin protective sprays and wipes such as Skin Prep, Cavilon No Sting, Hollister Skin Gel etc, are overused in general partially because of the name “skin protective” itself. But these products can actually build up on your skin and prevent the adhesive pouching system from sticking. Talk to your ET Nurse to see if these products are appropriate for you.

Wound/Skin cleansers (and alcohol wipes) are expensive and unnecessary because the stoma is not a “wound”, nor is it considered a sterile area. Use of these products can also cause irritation and also hinder adherence of your pouching system. Alcohol will also dry out the skin.

MainAdmin   July 21, 2014

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How does chemotherapy affect my stoma and peristomal skin?

Chemotherapy is a type of cancer treatment that may effect your skin and stoma. The impact of chemotherapy may be create skin problems around your stoma (peristomal skin) and the overall management of your ostomy. There are many different types of chemotherapy treatments, each with its own specific way that it affects the cancer. But not all treatments cause the same side effects to the skin and/or stoma. Your oncologist and chemotherapy nurses are the experts and will advise you about the possible side effects that may occur.  They are an excellent resource to answer your questions and concerns. They can provide you with various patient handouts outlining different chemotherapy drug protocols and patient guidelines. 
 
In general, remember that your stoma is surgically created from bowel tissue, which is very similar to the tissue in your mouth. Some chemotherapy drugs affect the tissue in your mouth resulting in sores, ulcers or causing the tissue in your mouth to bleed easily. Your stoma may react the same way. You may find that your stoma bleeds easily when you are washing it or you may find tiny sores on your stoma.

Your stoma may also swell. This is because the lining of your colon or intestine can become irritated and inflamed from the chemotherapy.

During chemotherapy your skin may be more sensitive. This includes peristomal stoma. The skin around your stoma may become more sensitive by becoming red and sore.  Remember that gentle removal of the pouching system during changes is important when skin is fragile. 
 
If you still have your large colon, you may have an increase of mucous drainage from your anus. Again, this is because the chemotherapy can make the lining of your colon inflamed and irritated causing more mucous to be produced which will pass through the anus.

Recommendations:

Be gentle when changing your pouching system.  Gently remove your pouching system from your skin.
Wash your stoma and skin with warm water and a soft cloth.
If your stoma is swollen or has enlarged, cut a larger opening in your pouching system or speak to an ET ostomy nurse and get a system to accommodate your stoma.
If you have any concerns or questions, do not hesitate to contact an ET ostomy nurse.

MainAdmin   July 21, 2014

1 people found this faq useful.

I have an ostomy and am gay. Is there anyone out there who would understand my concerns?

Your ET or WOCN nurse deal with people from varying backgrounds, beliefs, sexual orientation and cultures. Each one of us is unique.

There is an excellent website that maybe a good resource for you. www.glo-uoaa.org.

The GLO website can be used by individuals seeking information, chapters looking for a trained visitor or for anyone wishing to expand their knowledge of the Gay or Lesbian person with an ostomy.

MainAdmin   July 21, 2014

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What is a peristomal hernia?

The development of a peristomal hernia after ostomy surgery is very common. Statistics show a wide range from 4-48% chance of developing a peristomal hernia.  Most peristomal hernias occur within the first 2 years of surgery.

Some surgeons say that they give you a hernia when they do your ostomy surgery; this is because their definition of a hernia is an opening or hole in the muscle, and to form the stoma the surgeon needed to make a hole in the muscle, to bring the bowel through the skin.

We usually say people have a hernia when we see a bulge around the stoma. It may appear like the stoma is sitting on an orange or grapefruit.  For some people, they don’t feel any different; they just have a bulge on around their stoma. For others, the hernia is uncomfortable and when they are up and about they feel they need to support or hold that side of their abdomen. Sometimes there is a pulling sensation, like a muscle pull, which is relieved by sitting or lying down or holding that area. The bulge or hernia sticks out more when people are standing and when lying down the bulge or hernia may flatten or go away.

hernia 01 hernia 02

MainAdmin   July 22, 2014

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What are the risk factors to developing a peristomal hernia?

Hernias develop when the opening in the muscle, created by the surgeon to bring the bowel through the muscle and skin layers to make the stoma stretches. This allows loops of bowel to come through the enlarged opening. Anything that stretches the muscle opening larger is a risk factor to develop a peristomal hernia.

Activities that increase strain on abdominal muscles and stretch the muscle opening larger include:

Coughing and sneezing
Lifting heavy items using abdominal muscles
Large weight gain after ostomy surgery
Obesity
Other risk factors include
Poor nutritional status
Emergency surgery resulting in an ostomy
Certain drugs that slow healing- such as corticosteroids
Previous abdominal or inguinal hernias which may indicate abdominal wall weakness
Age – as we get older the abdominal muscles lose tone and strength and the opening where the bowel goes through may enlarge.

MainAdmin   July 22, 2014

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What should I watch for if a hernia develops?

–        The contour of the abdomen changes which may affect the seal on your pouching system. This may change wear time, frequency of leakage and a new pouching system may be required.

–        The size of the stoma may enlarge so the opening in the pouching system may need to be adjusted

–        Abdominal and back discomfort as there is a stress or pull on those muscles

–        ** The most serious complication to watch for is a bowel obstruction/strangulation ***

A loop of bowel may get stuck through the muscle wall opening.  If the muscle wall squeezes down on the bowel, it can to block the bowel  so nothing can pass. That is no stool can move through the stoma. More importantly, the blood supply to the bowel and stoma can also be affected.  The colour of the stoma will change from its usual pink/red colour to a dark dusky purple black colour. You may also have abdominal pain and cramping and nothing coming out of your stoma.  Please go to emergency.

MainAdmin   July 22, 2014

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What can be done if I have a hernia?
Surgical Management

Surgeons are hesitant to repair a peristomal hernia, as it is very likely to recur.  There are different surgical techniques for repairing peristomal hernias.  Each surgeon will have their preference for the technique they use. It is a complex surgery to do a hernia repair involving a stoma.

Surgical techniques include suturing the enlarged opening in the muscle wall to make it smaller.  Moving the stoma to the other side of the abdomen is another surgical option. Repairing the hernia by putting a mesh in is another common approach.  There are different types of mesh and surgical techniques to put the mesh in.

Non-surgical management

Surgical repair is usually avoided in people with no or mild symptoms because of the high recurrence rate.  Many people with mild symptoms can be managed with a ostomy hernia belt or support garment.  There are many types of ostomy hernia belts available on the market. Most have an opening to allow the pouch to come through so the urine or stool output is not affected.  ( pictures).  Many women find that a supportive panty is all they need but they need to see that the flow of output is not affected.

It is important to note that the hernia belt or support garment will not “ take the hernia away” or prevent a hernia. It is for comfort and support.

hernia 03

Examples of Nuhope Peristomal Hernia Belts

MainAdmin   July 22, 2014

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What are some exercises to strengthen abdominal muscles?

Physiotherapists are trained to strengthen damaged muscles safely.  It is recommended to see a physiotherapist to assess your abdominal muscles and to recommend a program to help you safely strengthen your core abdominal muscles.

The time to see a physiotherapist is about 8-10 weeks after surgery or when your surgeon lets you resume your normal daily activities.

Marilyn Moore, a physiotherapist, developed the following sets of exercises and she also has an ileostomy. In developing these exercises she stresses the need to take things in steady stages.  Gradually building up to the more challenging exercise is the surest way for you to improve both fitness and general health.

Check out this link to see preventative core abdominal exercises  www.iasupport.org/about/publications/factsheets/exercises-for-ostomates

MainAdmin   July 22, 2014

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How do I prevent from getting a hernia?
Be cautious when lifting- use proper technique and watch how much you are lifting. There is no magic number for the number of weeks after surgery before lifting or exercising or the amount of weight to lift or not lift, as everyone heals at a different rate.  Please check with your surgeon.  If still unsure, do not lift any more than 5 pounds or 2.2   kilograms for 8-10 weeks after surgery then gradually increase.
Contact a physiotherapist to learn how to strengthen your abdominal muscles safely.
Maintain a healthy weight.

MainAdmin   July 22, 2014

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I have an ileostomy now for about a year and could you tell me why when the stool comes out it stays up just where it comes out does not fall down in the bag. What can I do about that. So I do not eat if I am going out as I do not want that to happen. Would it be my diet. I really not to sure what to eat I cannot digest any vegetables except potatoes and sweet potatoes.

Pancaking

This is when the output collects around the stoma and can squeeze between the flange and the skin instead of going into your bag. One of the reasons this happens is because there isn’t enough air in the bag and so the output doesn’t take a downwards turn.

If this happens, try lubricating your bags with baby oil or one of the many products available from the various supply companies. Squirt a little oil or gel in your bag and give it a good rub around before you stick it on. Take care not to get any on the adhesive as this can reduce the effectiveness of the seal.

If you’re wearing clothes that are tight fitting in the stoma area this can also cause pancaking. You may want to try to wear looser fitting clothing in order to prevent a vacuum forming inside the bag. Also, in terms of clothing, make note of where your waistband or belt sits. Does it allow the stool to drop into the pouch or does it restrict the stool so the stool gathers only at the top. Monitor your body positions. If you are sitting for long periods for example driving or at the computer, does the pouch fold onto itself not allowing the stool to drop but remain in the top part of the pouch?

If the pouch has a filter in it, block the filter by either using waterproof tape or the ” tabs” that come in the box of pouches. This will leave air in the pouch, preventing the vacuum effect and allow to stool to drop into the pouch.

Another reason for pancaking is that your output is thick. Each person is an individual and so, each of us has trigger foods that can cause digestion processing issues, and stool issues. It would be helpful to consult your physician for a referral to a nutritionist or dietician to assist you in identifying foods that will work best for you.

[July 22, 2014]

To get additional information or help, find an ET in your area by clicking here…

MainAdmin   July 24, 2014

2 people found this faq useful.

I’m looking for ways to help my grandson, who has an ileostomy that is always leaking.

Leakage

Ostomy leakage is a problem which all ostomates will no doubt encounter at some point during their time with a stoma. For most people it’s a common occurrence in their early weeks of managing an ostomy when you are still finding your ostomy-feet and working out which products are best for you, and which routine gives the best results. It can cause a heck of a mess, not only to our clothes, but to our self-confidence too.

To find out what is causing the leakage start by checking the back of the flange after it’s leaked and you’ve removed it. This holds the biggest clue of all, you will be able to see what path the stool took on its break to freedom. Compare this to your skin and see what problems are present.

Condition of the skin. Is it raw, or does it have a rash all over it, or on part of it? If so, you may be allergic to the flange, and it may be interfering with the adhesive properties of the flange. Also, check to see if the area around where the flange leaks is any worse than elsewhere.
With leakage, the stool will always follow the path of least resistance. Do you have a belly crease which in turn is creasing the flange and creating a nice little tunnel for your stool to escape?
Look at your flange. Was the gap around the stoma too large? Or was it too tight? Or just right? Do you have protruding stitches around your stoma which the flange has trouble moulding around?
Do you have a belly cavity near the stoma? Flanges may struggle to adhere to these dips in your belly and lead to leakage.
Check your stoma. Is it flat/flush to the skin? Is it inverted / pulled in?

Some causes of leakage could be:

Flush to the skin or inverted stoma
Poor fitting flange/odd shaped stoma
Belly cavity around stoma
Parastomal hernia and/or Pancaking

Once you’ve discovered the source of your leakage then you are in a better position to be successful in stopping your leakage in its track, and there are a number of products available on the market which are designed to help reduce opportunities for leakage to occur.

Arrange a visit with an Enterostomal Therapy Nurse, (ET nurse – registered nurse [RN], who has specialized training in treating patients with ostomies), who can assist you in assessing the leakage issue and make equipment product recommendations for ensuring a good seal. One thing to bear in mind with all ostomy products is that our bodies are very individual, and because of that, a product which works great for one person may not work anywhere near as successfully for another, and vice versa. You may need to sample various rings and seals to find the one that works best for you, which the various ostomy product companies will also assist you in finding the seal that will work for you. So there is no reason why you cannot use multiple products to help combat leakage.

[July 23, 2014]

To get additional information or help, find an ET in your area by clicking here…

MainAdmin   July 24, 2014

2 people found this faq useful.

I am not doing very good with my diet. What would be a proper one?

Diet – Healthy Eating With A Stoma

The impact of food and drink on your stoma is hard to predict as diet is very individual. Various surveys suggests that foods can affect people in different ways after stoma surgery. While many people find that they can eat just the same diet as before their surgery, some find there are things that can have an adverse effect on the activity of their stoma. They may then choose to avoid those foods, or include them in their diets and be prepared for the effects.

Many people report that a good way to ascertain which foods and drinks are suitable for them is to keep a food diary so that patterns between diet and stoma output can be identified. You can then base your diet on what you have observed to be agreeable in terms of stoma output. There may be a certain degree of trial and error, especially in the first few months after your stoma is formed when the bowel is swollen. This swelling (or oedema) is the reason why a stoma may look puffy initially and can cause problems digesting food that would otherwise not occur, so it’s sometimes worth trying a food again later on before deciding whether to eliminate from your diet completely.

Information about diet and healthy eating for the general public is often conflicting and difficult to interpret. Add to this a stoma and many people feel confused about what they should and shouldn’t be eating.

Most people with stomas do not need to change their diets and should follow a normal healthy eating pattern like the rest of the population. If you have recently had your surgery or have been unwell, ensuring that you get all the essential nutrients from your diet is even more important and putting unnecessary restrictions on your diet could slow down your recovery and healing.

The purpose of the following information is to offer general information, for further information about diet, ask you physician to refer you to a dietician in order to explore any important factors to take into consideration regarding your individual stoma management and general wellbeing.

A balanced diet is made up of:

Starchy foods such as potatoes, rice & grains, bread and pasta, for energy. Try different varieties, including wholemeal vs refined/white rice and pasta.
Fruit and vegetables provide a wide range of vitamins and minerals and both soluble and insoluble fibre. Soluble fibre is found in the flesh of fruit & veg and can help lower cholesterol as well as make stool thicker, softer and easier to pass (helpful for those with a colostomy or ileostomy who wish to thicken their output). Insoluble fibre is found in the skins of fruit & veg and helps move waste through your bowel, so can help with constipation (helpful for those with a colostomy who experience pancaking and anyone who experiences constipation). If you have a colostomy or ileostomy, immediately after surgery foods containing insoluble fibre may make your stoma behave unpredictably, so you may wish to avoid or limit your intake of them. As your bowel adjusts you can re-introduce them and see how they affect you.
Protein rich foods for growth and healing. Protein comes from meat, fish, eggs, soya and it is the substance we use to heal wounds and regain muscle.
To promote general wellbeing, fatty foods should be limited. However, if you are recovering from surgery or have a small appetite and need to gain weight, including more of these foods in the short term is a good idea.

Individual Differences

The vast majority of people with a urostomy (a stoma that passes urine) find that their food intake is unaffected by having a stoma, however some food and medications can make urine discoloured or smelly (e.g. beetroot can make your urine pink and antibiotics and asparagus can make it smell strange).

Importance of chewing

It sounds very obvious, but it is vitally important to chew food thoroughly when eating. Chewing is the first stage of digestion and in doing this we make more nutrients available from our food. Foods that contain cellulose such as nuts, grain, fruit & vegetables (particularly the skins) cannot be completely broken down in the digestive system. So, you may notice these coming through your stoma looking the way they did when you ate them. Immediately after bowel surgery, your bowel is swollen and this narrows the passageway for food to pass along.

Fluid Intake

It is essential for everyone to drink enough to keep their kidneys healthy and flush out the chemicals that build up in the blood. You should aim to drink enough throughout the day that your urine is a light straw colour. The following information is for the specific stoma types but does not take into account other medical conditions. If you have been given different information from your healthcare professionals please check with them before making any changes.

People with urostomies enjoy a few glasses of water a day. This will help to prevent infections.

If you have a colostomy, your fluid intake can remain as normal unless you are experiencing constipation or pancaking. If you have this problem, increasing your fluid intake can be really helpful.

People with ileostomies, particularly if the stoma is formed higher up in the bowel, can have more difficulties with their fluid intake. This is because it is the role of the large bowel to absorb water (and salt) and for people with ileostomies this is no longer being used. The small bowel will, with time, adapt to absorb more water and more salt, however careful attention should be paid to ensure that you are drinking an adequate, varied fluid intake to maintain kidney health. Remember, you are aiming for light straw coloured urine.

For those who are more active it is even more important to pay attention to your fluid intake. Fluids are lost through sweating that contains electrolytes.

Everyone should bear in mind that alcohol is a dehydrating fluid and caffeinated drinks such as tea and coffee cause you to lose more fluid in your urine. The majority of your fluid intake should therefore be from fluids such as water and fruit cordials.

A little of what you fancy….

Of course, every now and again you will want to enjoy a treat like cake or ice cream and there is no reason why you can’t indulge once in a while! Healthy eating is about moderation and after stoma surgery it is also about trial and error. Take your time to explore how different foods affect your stoma, chew your meals, maintain a varied fluid intake and, most importantly, enjoy your food!

Some foods effect output. The effects may vary.

Basic Food Reference Chart

Stoma ObstructiveGas ProducingOdour ProducingColour ChangesOdour ControlIncreased StoolDiarrhea Control
Apple peelsBeansAsparagusAsparagusButtermilkBran cerealsApplesauce
Cabbage rawCabbageBaked beansBeetsCranberry juiceFresh fruitsBananas
Corn, whole kernelCarbonated beverageBroccoliCoffeeTomato juiceGreen, leafy veggiesPeanut butter
CoconutCauliflourCod liver oilCooked fruitsYogurtMilkTapioca
Dried fruitCucumberEggsFood colourPrunes
MushroomsDairy productsFishIron pillsRaw vegetables
PineappleNutsGarlicStrawberriesWhole grains
PopcornOnionsOnionsTomato sauces
SeedsRadishesPeanut butter
SoyStrong cheese

To get additional information or help, find an ET in your area by clicking here…

MainAdmin   August 10, 2014

1 people found this faq useful.

I’d just like to check out anything new…

What’s New

The newest news about ostomates I’ve noticed, is the latest trend in breaking the taboo of ostomies and ostomy bags through posted photographic images.

Facebook, Instagram, and Twitter are just a few of the social media being used by ostomates to show and share their colostomy, ileostomy and urostomy bags and scars.

They are young, older, male, female, and all of them are plucking up the courage to share themselves and their bags to a wider audience.

I’ve heard some folks take offence to the photographic images, and heard other folks cheer them on.

My take on this new and inspiring trend is; go ahead folks, be proud of who you are, you are amazing, and so, embrace your ostomy, inspire others, and keep spreading awareness!
Jo-Ann L. Tremblay

[July 27, 2014]

MainAdmin   August 11, 2014

1 people found this faq useful.

What clothing tips are there for a person with an ostomy?

Stephanie Hughes from the blog, Stolen Colon, shares a wonderful video on What to Wear With an Ostomy…

 

MainAdmin   August 12, 2014

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What sort of swimsuit options are out there for women with ostomies?

Jessica Grossman of Uncover Ostomy, has a wonderful blog entry titled Itsy Bitsy Ostomy Bikini with several links to swimsuit options.

Also, Stephanie Hughes of Stolen Colon, shares a video showing different swimsuit options as well:

 

MainAdmin   August 12, 2014

1 people found this faq useful.

I would like to learn more about colostomy irrigation…

(Disclaimer: Before attempting any irrigation techniques, you must get your doctor’s permission)

* Reprinted with permission from The Phoenix magazine, www.phoenixuoaa.org or call 800-750-9311

Download (PDF, 156KB)

MainAdmin   September 18, 2014

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What is an ostomy?

You may know someone who wears a “bag” or pouch on their abdomen or have an ostomy yourself. The term “colostomy” is often the default go-to word when people talk about ostomy care, suggesting that all “ostomies” are “colostomies” and thus created and function equally.  In actual fact, the term colostomy only refers to an ostomy created from the large bowel or colon and only represents one kind of ostomy. An ileostomy is also a fecal stoma (producing stool waste) which the surgeon creates using a portion of the small bowel or ileum. Finally, a urostomyproduces urine in the absence of the bladder as with bladder cancer for example. It is important not only for health professionals to understand and distinguish between the 3 “kinds” of ostomies, but for the ostomy patient themselves as the guidelines for care are very different for each. All 3 will have a stoma or bowel that has been brought to the surface of the abdomen, but anatomically be very different.

Anonymous   July 21, 2014

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What does a stoma look like?

You may know someone who wears a “bag” or pouch on their abdomen or have an ostomy yourself. The term “colostomy” is often the default go-to word when people talk about ostomy care, suggesting that all “ostomies” are “colostomies” and thus created and function equally.  In actual fact, the term colostomy only refers to an ostomy created from the large bowel or colon and only represents one kind of ostomy. An ileostomy is also a fecal stoma (producing stool waste) which the surgeon creates using a portion of the small bowel or ileum. Finally, a urostomyproduces urine in the absence of the bladder as with bladder cancer for example. It is important not only for health professionals to understand and distinguish between the 3 “kinds” of ostomies, but for the ostomy patient themselves as the guidelines for care are very different for each. All 3 will have a stoma or bowel that has been brought to the surface of the abdomen, but anatomically be very different.²

Anonymous   July 21, 2014

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How should I care for the skin around my stoma?

It is very important for the skin around the stoma (the peristomal skin) to remain healthy and free of irritation. The peristomal skin should look just like the skin elsewhere on your abdomen. To prevent skin irritation or other skin problems, you must have a skin barrier and pouch that fits properly. Each time you remove your skin barrier and pouch, look carefully at the peristomal skin. If you notice any swelling, redness or rash, you could have irritated skin. Sometimes-but not always-irritated skin is painful. If the problem persists for more than two pouch changes, contact your ET Nurse.5

Check out an excellent reference guide provided by the WOCN (Wound Ostomy and Continence Nurses Society):

Download (PDF, 648KB)

Anonymous   July 21, 2014

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What is an ET / Ostomy Nurse?

An Enterostomal Therapy (ET) Nurse is a registered nurse with advanced and specialized knowledge and clinical skills in wound, ostomy and continence care. Recognized as Nursing Specialists in wound, ostomy and continence by the Canadian Nurses Association (CNA), ET Nurses are the ONLY nursing specialty with CNA certification in wound, ostomy and continence care. ET Nurses work in acute care hospitals, outpatient clinics, community care, long term care and in independent practice. An ET nurse provides specialized holistic assessment and management as part of an interprofessional team member. He/she functions to meet the needs of individuals/families with ostomies, acute and chronic wounds and urinary and fecal continence problems.

Some nurses will have different “letters” after their name such as WOC Nurse or cWOC Nurse which indicates that they did their wound, ostomy, continence education in the United States. It should be noted that there are different education levels for wound and ostomy health professionals that vary from a 1 day course to the full scope nursing specialty an ET or WOC Nurse. To ensure your best care, be sure you are seeing a nurse with full credentials. To find an ET/WOC Nurse in your area, you can contact the Canadian Association for Enterostomal Therapy (CAET) www.caet.ca.

When to see an ET/Ostomy Nurse:

Do you have a new ostomy and need more teaching after discharge from the hospital?
Do you have regular leaks of your pouching system?
Are you suddenly getting less wear-time of your pouching system?
Have you gained or lost weight?
Does your flange “not stick” to your skin?
Has the shape or size of your stoma changed since surgery?
Are you using powders and sealant sprays frequently?
Do you have questions around nutrition, lifestyle, or intimacy?
Do you have questions about how to better conceal your pouch with clothing or when participating in sports?
Do you want to learn more about hernias?
Do you think you have a hernia and want to learn about support garments?
Do you need feedback about how you are currently managing?
Are there sores or wounds around your stoma?
Have you had your stoma for many years and just want to see “what’s new”?
Is it time for an annual check up?

Anonymous   July 21, 2014

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What about medications?

After ostomy surgery, digestion and absorption of medications, either alone or in combination, may be affected. It is very important to review your medications, both over -the -counter and prescription drugs, with your ET nurse or health care provider and your pharmacist. Over-the-counter treatments can include antacids, antidiarrheal, anti-inflammatory agents, aspirin, laxatives, salt substitutes, sugar substitutes and vitamins. 1

Anonymous   July 21, 2014

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What about bathing and showering?

You may choose to bathe or shower with your pouch on or off. If you shower with your pouch off, choose a soap that is oil-and residue-free. These types of soaps will not interfere with the adhesion of the wafer.2

Anonymous   July 21, 2014

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Will I need special clothing?

Don’t worry-you will not need a new wardrobe. Modern ostomy pouches are inconspicuous are inconspicuous under almost any kind of clothing because they’re designed to lie flat against the body. Ostomy pouches for both men and women can be worn inside or outside underwear; whatever feels most comfortable. Yet if your stoma is at or near the waistline, be sure to avoid pressure from tight-waisted pants or belts. Girdles or panty girdles can be worn, as long as they are soft and stretchy, without a front panel. For men, if you wear an athletic supporter, it is helpful to wear it one size larger.3

Anonymous   July 21, 2014

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Can I exercise and play sports?

An ostomy should not prevent you from exercising or from being physically active. Other than extremely rough contact sports or very heavy lifting, you should be able to enjoy the same type of physical activities you enjoyed before your surgery. People who have ostomies are able to swim., water ski or snow ski, play golf, tennis, volleyball or softball, hike, sail or jog just as well after their surgery as they did before.5

Anonymous   July 21, 2014

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When can I return to work? What about travel?

As with any surgery, you will need to allow some recovery time. Recovery from this type of surgery can take from six to eight weeks. You should check with your doctor before returning to work. After your recovery, you should be able to return to work, or travel just about anywhere. Your ostomy should not limit you. Ostomy products are available through medical or surgical retailers in nearly every country in the world. Of course, it is always a good idea to take your own supplies with you when you travel – and always take more than you think you will need.5

Anonymous   July 21, 2014

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Will other people know?

Very few people, even those you see on a daily basis, will know that you have had ostomy surgery-unless you choose to tell them. Whether you tell others is entirely up to you. Most likely your relatives and friends already know you’ve had a health problem that required surgery. But you may feel uncomfortable about revealing more, fearing they might have negative attitudes about ostomies. It’s true that some people have uninformed ideas, but if these people are important to you, you can either help to educate them or simply not mention your surgery.1

Anonymous   July 21, 2014

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What about intimate relationships? Can I have children?

Because ostomy surgery is a body-altering procedure, many people worry abourt sex and intimacy, and aboput acceptance by their spouse or loved one. For people who are dating, a big concern is how to tell someone about the ostomy. It’s important to remember that supportive personal relationships can be major sources of healing after any type of surgery. It’s also important to let your partner know that sexual activity will not hurt your stoma. Ostomy surgery affects both partners in a relationship, and it’s something to which both partners must adjust-each in his or her own way. The key, of course, is understanding and communication. If having children is a concern, you’ll be happy to know that after a satisfactory recovery it is still possible for a woman who has a stoma to have children. Also many men have become fathers after having colostomy or ileostomy surgery. For men, urostomy surgery can sometimes cause a change in sexual function; however, there are men who have become fathers after having urostomy surgery. If you have questions about pregnancy, don’t hesitate to ask your doctor or ET nurse. For both men and women, it is very important to discuss the surgery openly with your spouse or loved one. Also, don’t hesitate to discuss this aspect of the surgery with your doctor and your ET nurse.5,6

Anonymous   July 21, 2014

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What is a colostomy?

A colostomy is a surgical procedure where the surgeon brings one end of the large intestine out through the abdominal wall, usually on the left side.  The end of the bowel that is brought out to the abdomen is sutured to the skin to form a stoma.

Stool moves through the intestines (or bowels) through the stoma into a pouching system adhered to the abdomen to collect the stool.  Stool from a colostomy is similar to normal stool as it has gone through most of the digestive tract, meaning it can be quite formed or more solid. Colostomies can be permanent or temporary. There are essentially no diet restrictions (unless other medical conditions are present) and bowel patterns often emerge when a patient knows he/she will have 1-2 movements per day for example and see little action in between. If constipation occurs, treatment is generally the same for the colostomy patient as it would be for the patient without an ostomy. It is good to seek advice from your doctor or ostomy nurse if constipation becomes a regular problem.

Anonymous   July 21, 2014

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Why are colostomies performed?

There are many reasons, but the major contributing conditions are:

Diverticulitis (Diverticulitis is small, bulging sacs or pouches of the inner lining of the intestine (diverticulosis) that become inflamed or infected) or abscess
Injury to the bowel or rectum
Rectal or Colon Cancer
Wounds or fistulas in the perineum

 

Anonymous   July 21, 2014

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Can I control bowel movements after colostomy surgery?

Since you will no longer have voluntary control over bowel movements, it is important that you understand the consistency and frequency of discharge after your colostomy. These vary depending upon the location of the colostomy within the colon. An ascending colostomy is located within the ascending colon. Output will be liquid to semiliquid, rich in digestive enzymes and irritating to the skin around the stoma. A transverse colostomy is located within the transverse colon. Output is usually liquid to semiformed. A descending colostomy is located within the descending colon. Output is semiformed to formed. A sigmoid colostomy is located within the sigmoid colon. Output has a normal, formed consistency.1

Anonymous   July 21, 2014

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Do I need to follow a special diet after colostomy surgery? What about diarrhea and constipation?

Unless your doctor has prescribed a special diet, you should not have to change your diet. You may become constipated or have diarrhea just as you did before surgery. If you become constipated, try eating more fiber (vegetables, fruits, and brans) and drinking more water. If constipation becomes a problem, talk to your doctor or ET nurse. If you become ill with a stomach virus, this can give you diarrhea. Treat it the same as before you had surgery, and remember to drink plenty of fluids-you might try one of the ‘sport’ drinks to replace fluids and electrolytes.2

Anonymous   July 21, 2014

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What about gas?

The amount of gas that a person’s system generates depends on the individual. If you had problems with excessive gas before your surgery, you will likely have the same problems after your surgery. Intestinal gas can sometime be the result of swallowing air. Drinking carbonated beverages, smoking, chewing gum, and chewing with your mouth open can all increase the amount of gas you swallow. Sometimes gas can be caused by the foods you eat. Foods and beverages that may increase gas: asparagus, broccoli, Brussels sprouts, cabbage, cauliflower, carbonated beverages, corn, cucumbers, mushrooms, peas and spinach.5

MainAdmin   July 21, 2014

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Will some foods cause odour in the stool?

Foods that can produce odour include asparagus; cabbage family vegetables: broccoli, brussels sprouts, cabbage, cauliflower, onions; cheese; eggs; fish and some spices.1

MainAdmin   July 21, 2014

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What is an ileostomy?

An ileostomy is a surgical procedure where the surgeon brings one end of the small intestine called the ileum out through the abdominal wall, typically though not always on the right side, bypassing the large intestine. Since the ileostomy bypasses the large intestine where fluid is absorbed, ileostomy stool output is the consistency of a paste or pudding. In some cases it is very watery and difficult to differentiate between “normal” output and “diarrhea”. Because of this, dehydration and electrolyte imbalances can occur quickly causing illness and visits to emergency room if not monitored well. Communicating that you have an ileostomy is important whenever you are seeking medical attention. The stool from the small bowel also contains more enzymes that function to break down the foods we eat including protein, carbohydrates etc. Enzymatic stool can damage the skin as it tries to “digest” it as well as in the case of a leaking pouching system where stool is trapped on the skin for a duration of time.

Tough or high fibre foods may be hard to digest in the small intestine and may cause blockages or discomfort when passing through the stoma. Therefore people with ileostomies may need to be more cautious with their diet. Diet counseling is usually done while a new patient is in the hospital, however if you have questions or need further information, contact your local ET (ostomy) nurse or dietitian.

Ileostomies can also be permanent or temporary. Many are done to shunt stool away for several months from a fragile surgical area lower down in the large bowel until it heals and it is safe for stool to pass through the colon again where the ileostomy may be reversed. It should be noted as well, that because stool is exiting the body “early” in the digestive path, certain medications such as those that are enteric coated to protect the stomach or extended release medications (such as certain pain medications) can leave the body without breaking down and being of little used in the body. For this reason, it is important to inform a prescribing physician and your pharmacist that you have an ileostomy.

MainAdmin   July 21, 2014

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Why are ileostomies performed?

A few reasons are:

Crohn’s Disease or Ulcerative colitis
Familial adenomatous polyposis
Colorectal Cancer
Trauma

MainAdmin   July 21, 2014

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What is a blockage?

The small intestine is like a hollow tube or garden hose. Though it is physically impossible to become “constipated“ with an Ileostomy, blockages of the small intestine can happen in two ways. From the inside and from the outside.

The first way is pressure squeezing on the outside of the tube, like stepping on the garden hose to stop water from coming through, or kinking it off. This is what happens when scar tissue or adhesions form. Scar tissue can cause narrowing of the tube whereby slowing down or preventing food from going through.

The second and more common way to block the small intestine, is from undigested food building up and blocking the inside of the “garden hose” or intestine. Food that is not completely chewed, undigestable for most of us under normal circumstances (like corn for instance) or high in fiber acts as a plug and thus prevents stool from moving through the intestine and out the stoma.

Everyone digests food a little differently so there isn’t one list of foods to eat or not to eat. We can give you guidelines on foods that may be difficult to digest, but some people will get blockages from things not on the list. Other people will be able to digest foods on the list without a problem.

Some high fiber foods that may cause a blockage include: popcorn, mushrooms, corn, raw carrots, raw cabbage, celery, nuts, bean sprouts, coconut, dried fruits and dried beans.

For the first 6-8 weeks after surgery your bowel is still swollen and tender which reduces the diameter of the small bowel or “tube” even further. During this time it is more prone to blockage. That’s why you are instructed to eat easy-to-digest, low fiber foods. After the swelling has gone down, you can slowly add small amounts of foods that are higher in fiber to see how you digest them. The important thing is to chew well!  Keeping a food diary can often be helpful.

Signs of a Food Blockage:

No stool is emptying into your pouch (no stool after 4 hours indicates a blockage)
Abdominal pain (may be cramping and come in waves as the body tries to push out the blockage)
Loss of appetite
Vomiting and nausea
Abdominal bloating
Stoma swelling
You can think back to the last 12 hours and recall eating a high fibre food

What to do at home:

Enlarge the opening of your pouching system to accommodate the stoma when it is swollen
Do not eat solid food. Take sips of water only if tolerated
Try to relax: relaxing stomach muscles around your stoma can be the key to releasing a blockage!
Massage around your stoma
Try knees to chest position (fetal position)
Take a warm bath or place a warm heating pad around your abdomen

When to go to the hospital:

If you start vomiting
If you cannot relate the blockage to any foods you ate within the last 12 hours, it could mean it is a blockage due to adhesions or scar tissue
No stool output from your stoma in 12 hours

(**Take all your ostomy supplies with you to hospital)

What the doctor will do at the hospital:

Ask about your medical and surgical history
Bloodwork
Abdominal x-ray or CT scan
Start an IV to give you fluids
Give you pain medication (often after pain medication is given, the abdominal muscles will relax and release the food blockage allowing the undigested food “plug” to pass)
Sometimes it is necessary to do an Ileostomy lavage to clear the blockage (this involves inserting a catheter attached to a syringe into the stoma and trying to physically break apart the food blockage with slightly pressurized fluid)

Once the blockage has been resolved, a clean, drainable pouching system should be applied. Because the stoma may be swollen, the opening in the pouch surrounding your stoma should be cut slightly wider. Stool will be very watery after this procedure.  This can result in dehydration and the need to have IV or fluids while in the hospital. The abdomen will feel tender and almost a bruised feeling which may last a few days. Eat lightly for the next few days. Easy to digest foods are best until the tender abdominal feelings go away and the stoma goes back to its normal size.

MainAdmin   July 21, 2014

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I have read that people with an Ileostomy can be prone to kidney stones. Why?

The most common kind of kidney stone for people with an ileostomy are the uric acid stones. This stone is caused by dehydration and from diet.

Dehydration results when not enough water is being absorbed in the body – either because you are simply not drinking enough, or because too much water from watery stool is lost through your ileostomy. Usually the large colon, which is bypassed when you have an ileostomy, is where the majority of your fluid is absorbed. Over time, the small bowel adapts to absorb some of the fluid when there is an ileostomy, however it is not as efficient at absorption of water as the large bowel was. Therefore, getting 1.5-2L per of fluid per day is very important. Remember, fluid does not have to mean only “water”. Juices, drinks without caffeine or alcohol, low sodium soups, pudding, and popcicles are some other ways of meeting your daily fluid requirements.

Another way increase the amount of fluid your body absorbs is to thicken up your stool whereby reducing the amount of fluid that is lost through watery ileostomy stools. Some foods such as white rice, bread, smooth peanut butter, apple sauce, pasta and marshmallows are known to thicken stool but remember, everyone’s body reacts differently to different foods.

Uric acid stones can also result because of poor fluid intake because less urine is produced and therefore that urine is more acidic and is missing sodium because most of the water and sodium bicarbonate comes out through the stool. Another factor that increases the risk for uric acid stone formation is loss of sodium bicarbonate, which is a compound in your body that is used to regulate electrolytes and the body’s pH.

This is a complex process, but as an easy and basic rule:

Drink, drink, drink, or “you’re in” trouble!

MainAdmin   July 21, 2014

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What is a urostomy?

A urostomy is a surgically created opening-on the abdomen- that allows urine to flow out of the body. A urostomy may also be called a urinary diversion. Many times, the person’s bladder and urethra are surgically removed. When a person has a urostomy, urine is no longer eliminated through the urethra. Instead, urine is eliminated through the urostomy. A urostomy does not have a sphincter muscle, so a person who has a urostomy has no voluntary control over when to urinate. Instead, the person wears a pouch to collect the urine. Your surgeon may select one of several methods to create the urostomy, or urinary diversion. The most common method is called an ileal conduit. To create an ileal conduit, the surgeon removes a short segment of the small intestine(ileum). This short segment of intestine will be used as a pipeline-or conduit-for urine to flow out of the body. The surgeon closes one end of the conduit, inserts the ureters into the conduit, and brings the open end of the conduit through the abdominal wall. This new opening on the person’s abdomen is called a stoma.6

MainAdmin   July 21, 2014

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What about diet after urostomy surgery?

Eating a well-balanced diet, that can include your favorite foods, is important to your health. Be aware that some foods cause an odour to urine including: asparagus, onions, fish and garlic. These foods can still be eaten; however, you may become aware of an unusual odour. You should drink at least 8 glasses of fluid each day, unless you have to limit your fluids due to a medical problem. Be sure to drink extra fluids when exercising or sweating.7

MainAdmin   July 21, 2014

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What’s the best way to get a good urine sample when you have a urostomy?

Rest of the question:  I have a urostomy and think I may have a urinary tract infection (UTI). My urine is cloudy, it has a strong smell, and I see more mucus in my pouch than usual. My doctor wants to have a urine specimen (C&S) to see if I have an infection and which antibiotics may be needed. What’s the best way to get a good urine sample when you have a urostomy?

Answer:

Getting a “good” urine sample is essential to determining IF you have a urinary tract infection AND which antibiotics would be most effective in treating this infection. Simply taking a urine sample from the spout of your pouch is NOT will not get accurate results because, you will have results of what is growing in the POUCH and potentially not what is growing in your own BODY. Inaccurate results can prompt the treatment of the wrong bugs that aren’t actually in your system and you may not have needed antibiotics at all! The urine sample should to come directly from the stoma itself as this will catch “fresh sterile urine” that has not been exposed to outside elements yet and contains whatever “bugs” that may be bugging you~!

 

There are two ways to collect the urine sample.

  The ideal method is using a catheter – To be done by a health professional
a)    Remove the urostomy pouch and clean the area of skin and stoma with warm water (using alcohol is NOT required)
b)    Using sterile technique, gently insert a small lumen catheter (eg 10 Fr) 4-6 cm into the stoma
c)    Place the other end of the catheter into the C&S container to collect urine
d)    Wait until about 10-20 cc of urine is collected
e)    Replace pouching system
“The Next best thing”: Can be done by the patient
a)    Remove the pouching system from your body
b)    Wash the skin and stoma with water (using alcohol is NOT required)
c)    Hold the collection container under your stoma but NOT TOUCHING your stoma or the skin catching while catching urine that dribbles out
d)    Wait until you have 10-20cc of urine collected
e)    Replace your pouching system
f)      After collecting the sample, refrigerate immediately and drop it off to the lab as soon as possible.

Helpful tips:

Take the urine sample at a time you know your stoma will actively be producing urine. Trying to do this first thing in the morning mightnot be the best time, as you have not had much to drink during the night.
Coughing and slightly moving your position may help move urine out of the stoma.

MainAdmin   July 21, 2014

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I have noticed that my night bag / bottle and my urostomy pouch sometimes has a bluish purple tinge to it. Is that normal?

Purple Urinary Bag Syndrome (PUBS)

People using leg bags or night drainage bags or bottles sometimes notice a purple tinge to their equipment.  It was first noted in 1812, when physicians looking after “mad” King George III noticed a blue tinge to his urine. There’s no need to worry; it doesn’t mean you’re “mad”, too. King George suffered from one of the risk factors, constipation.

Other risk factors include female gender (although it is seen with men also), alkaline urine, use of urinary catheters, the “plastics” used to make catheters and drainage bags, and bacteria in the urine (this does not always mean there is infection).

For the biochemists, bacteria in the urine produce the enzyme indoxyl phosphatase which converts indoxyl sulphate in the urine into the red and blue coloured compounds indirubin and indigo.

Keep in mind, PUBS is nothing to worry about. There are simple steps to reduce the risk factors that lead to PUBS.

Female gender: nothing you can do, sorry! ( Men can get it too.)
Alkaline urine: talk to your doctor about taking Vitamin C to keep your urine acidic
Constipation: things that promote regular bowel movements include adequate fluid intake, exercise and eating enough fiber (whole grains, vegetables and fruits)
Bacteria in the urine: increasing fluid intake, cleaning/replacing your drainage equipment (tubing, night drainage or leg bags, bottles and adapters) on a regular basis

See your doctor if you do have signs of infection in your urine:

Dark urine
Cloudy urine
Increased odour to your urine
Fever

MainAdmin   July 21, 2014

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Is my stoma normal?

Whether you have a colostomy, ileostomy or a urostomy you will have a stoma. A stoma or ostomy is a surgically created opening placed somewhere on the abdomen which is the exit point for either stool from the digestive system or urine from the urinary system. A stoma is fashioned from either large or small bowel which is turned inside out and sewn onto the skin. A stoma is red in colour and warm to the touch as it is very vascular, meaning it is well supplied with blood vessels. It is also glossy or wet looking because the bowel continually produces mucous just like the tissue from the inside of your cheeks (mouth).

There are rarely two stomas that look alike. Variations in surgical technique, body shape and composition (thickness of fatty tissue of the abdomen for example) are factors that influence what shape a stoma will take. Some are round, while others are more oval in shape. Some are flat, some protrude well. Some are big and some are small in diameter. Directly after surgery, it will take 6-8 weeks for the swelling to reduce before the stoma takes its “final shape”. But even after this, factors such as weight gain or loss, stoma prolapse or retraction (early on) and peristomal hernias can change the shape and height of a pre-existing stoma. Overall, any stoma should appear, red, wet and warm as a general rule. If there is any gradual or sudden change with the appearance of your stoma, discuss this with your surgeon/physician or ET Nurse.

MainAdmin   July 21, 2014

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Is my skin normal?

The skin around your stoma, or peristomal skin, which is the skin under the adhesive part of your pouching system, should appear similar to the skin everywhere else on your abdomen. However, research indicates that many people with ostomies have skin problems and do not report or recognize them. If you are ever in doubt, it is better to ask questions and seek help from an ET Nurse who can direct you if you need further treatment from another medical professional. Small problems can turn in to big ones quickly, so better to ask sooner than later!

Remember, sometimes your skin may look pinker, redder or darker right after you take off your adhesive pouching system. This should fade away after a few minutes.

MainAdmin   July 21, 2014

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How do I clean around my stoma?

All you need to clean around your stoma is warm water and either a washcloth or a soft disposable paper towel. Using sterile gauze and wearing gloves to change your own pouching system can be expensive and is unnecessary. REMEMBER, YOU ARE NOT DEALING WITH A STERILE AREA. Using alcohol to clean the area is equally unnecessary and can be very drying to the skin. Also, it is not recommended to use baby wipes or pre-moistened towelettes as they may contain chemicals that remain trapped on the skin and can cause a rash.

Soaps, including ones that are moisturizing (Oil of Olay, Dove) are not needed and can actually hinder the pouching system from sticking well on your skin and contribute to leaks. If you are showering without wearing a pouching system and soap flows down onto your stoma and skin, just rinse the area well afterwards. This is not a concern.

When washing your stoma, you may notice small specks of blood on your cloth. This is completely normal and expected. The stoma tissue contains small blood vessels close to the surface that may bleed, especially if you are taking blood thinners.

MainAdmin   July 21, 2014

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Do I need to “air out” my skin when changing my pouching system to keep it healthy?

No, this is not necessary. It may feel good to “air out”, for a while but this is not required in order to have the skin remain healthy. This may also be difficult if your stoma is active!

MainAdmin   July 21, 2014

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How long should it take to change my pouching system?

There is no “set time” for this. Everyone works at their own pace and becomes more and more proficient, confident and comfortable as time goes on. In the end, it shouldn’t take more than 15 minutes to complete a change if your stoma is inactive. If you continue to take a long time to change, it may be time to see an ET Nurse to see if your routine can be simplified.

MainAdmin   July 21, 2014

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Could I be allergic to my ostomy pouching system?

There is less than a 1% incidence of a true allergy to any part of the pouching system. All parts are of the system are latex free, including the belt (if you are using one). There is a multitude of reasons for skin issues, however they are typically due to a leak in the system causing stool or urine to sit on and irritate the skin. Remember, when you first remove your pouching system, your skin may be pink, but this should fade in a few minutes. In any case, it is important to seek help from an ET Nurse sooner than later if you have concerns. Do not assume that you have an allergy or that this cannot be resolved.

MainAdmin   July 21, 2014

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Should I be using stoma powders, skin protective sprays / “prep” wipes, alcohol swabs or wound/skin spray cleansers when I change my pouching system?

No, unless your ET Nurse has suggested this for you as a SHORT TERM treatment. These products are not to be used routinely as they can build up and irritate the skin and actually prevent the pouching system from sticking properly. Statements such as “less is more”, and “keep it simple” stand true in ostomy care so that using “extras” such as wipes and powders should have a reason rather than a routine.

Using stoma powder and a protective skin spray or wipe afterwards to seal in the powder is commonly referred to as “crusting” but is only a SHORT TERM treatment for weepy skin breakdown around the stoma. If this becomes part of your routine because of recurrent skin breakdown, this should be re-evaluated and discussed with your ET Nurse as your pouching system may need to be modified to give you a better fit and actually protect your skin on its own.  “Crusting” should be reserved for the “occasional” skin problem and is a very useful tool for treatment.

Skin protective sprays and wipes such as Skin Prep, Cavilon No Sting, Hollister Skin Gel etc, are overused in general partially because of the name “skin protective” itself. But these products can actually build up on your skin and prevent the adhesive pouching system from sticking. Talk to your ET Nurse to see if these products are appropriate for you.

Wound/Skin cleansers (and alcohol wipes) are expensive and unnecessary because the stoma is not a “wound”, nor is it considered a sterile area. Use of these products can also cause irritation and also hinder adherence of your pouching system. Alcohol will also dry out the skin.

MainAdmin   July 21, 2014

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How does chemotherapy affect my stoma and peristomal skin?

Chemotherapy is a type of cancer treatment that may effect your skin and stoma. The impact of chemotherapy may be create skin problems around your stoma (peristomal skin) and the overall management of your ostomy. There are many different types of chemotherapy treatments, each with its own specific way that it affects the cancer. But not all treatments cause the same side effects to the skin and/or stoma. Your oncologist and chemotherapy nurses are the experts and will advise you about the possible side effects that may occur.  They are an excellent resource to answer your questions and concerns. They can provide you with various patient handouts outlining different chemotherapy drug protocols and patient guidelines. 
 
In general, remember that your stoma is surgically created from bowel tissue, which is very similar to the tissue in your mouth. Some chemotherapy drugs affect the tissue in your mouth resulting in sores, ulcers or causing the tissue in your mouth to bleed easily. Your stoma may react the same way. You may find that your stoma bleeds easily when you are washing it or you may find tiny sores on your stoma.

Your stoma may also swell. This is because the lining of your colon or intestine can become irritated and inflamed from the chemotherapy.

During chemotherapy your skin may be more sensitive. This includes peristomal stoma. The skin around your stoma may become more sensitive by becoming red and sore.  Remember that gentle removal of the pouching system during changes is important when skin is fragile. 
 
If you still have your large colon, you may have an increase of mucous drainage from your anus. Again, this is because the chemotherapy can make the lining of your colon inflamed and irritated causing more mucous to be produced which will pass through the anus.

Recommendations:

Be gentle when changing your pouching system.  Gently remove your pouching system from your skin.
Wash your stoma and skin with warm water and a soft cloth.
If your stoma is swollen or has enlarged, cut a larger opening in your pouching system or speak to an ET ostomy nurse and get a system to accommodate your stoma.
If you have any concerns or questions, do not hesitate to contact an ET ostomy nurse.

MainAdmin   July 21, 2014

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I have an ostomy and am gay. Is there anyone out there who would understand my concerns?

Your ET or WOCN nurse deal with people from varying backgrounds, beliefs, sexual orientation and cultures. Each one of us is unique.

There is an excellent website that maybe a good resource for you. www.glo-uoaa.org.

The GLO website can be used by individuals seeking information, chapters looking for a trained visitor or for anyone wishing to expand their knowledge of the Gay or Lesbian person with an ostomy.

MainAdmin   July 21, 2014

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What is a peristomal hernia?

The development of a peristomal hernia after ostomy surgery is very common. Statistics show a wide range from 4-48% chance of developing a peristomal hernia.  Most peristomal hernias occur within the first 2 years of surgery.

Some surgeons say that they give you a hernia when they do your ostomy surgery; this is because their definition of a hernia is an opening or hole in the muscle, and to form the stoma the surgeon needed to make a hole in the muscle, to bring the bowel through the skin.

We usually say people have a hernia when we see a bulge around the stoma. It may appear like the stoma is sitting on an orange or grapefruit.  For some people, they don’t feel any different; they just have a bulge on around their stoma. For others, the hernia is uncomfortable and when they are up and about they feel they need to support or hold that side of their abdomen. Sometimes there is a pulling sensation, like a muscle pull, which is relieved by sitting or lying down or holding that area. The bulge or hernia sticks out more when people are standing and when lying down the bulge or hernia may flatten or go away.

hernia 01 hernia 02

MainAdmin   July 22, 2014

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What are the risk factors to developing a peristomal hernia?

Hernias develop when the opening in the muscle, created by the surgeon to bring the bowel through the muscle and skin layers to make the stoma stretches. This allows loops of bowel to come through the enlarged opening. Anything that stretches the muscle opening larger is a risk factor to develop a peristomal hernia.

Activities that increase strain on abdominal muscles and stretch the muscle opening larger include:

Coughing and sneezing
Lifting heavy items using abdominal muscles
Large weight gain after ostomy surgery
Obesity
Other risk factors include
Poor nutritional status
Emergency surgery resulting in an ostomy
Certain drugs that slow healing- such as corticosteroids
Previous abdominal or inguinal hernias which may indicate abdominal wall weakness
Age – as we get older the abdominal muscles lose tone and strength and the opening where the bowel goes through may enlarge.

MainAdmin   July 22, 2014

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What should I watch for if a hernia develops?

–        The contour of the abdomen changes which may affect the seal on your pouching system. This may change wear time, frequency of leakage and a new pouching system may be required.

–        The size of the stoma may enlarge so the opening in the pouching system may need to be adjusted

–        Abdominal and back discomfort as there is a stress or pull on those muscles

–        ** The most serious complication to watch for is a bowel obstruction/strangulation ***

A loop of bowel may get stuck through the muscle wall opening.  If the muscle wall squeezes down on the bowel, it can to block the bowel  so nothing can pass. That is no stool can move through the stoma. More importantly, the blood supply to the bowel and stoma can also be affected.  The colour of the stoma will change from its usual pink/red colour to a dark dusky purple black colour. You may also have abdominal pain and cramping and nothing coming out of your stoma.  Please go to emergency.

MainAdmin   July 22, 2014

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What can be done if I have a hernia?
Surgical Management

Surgeons are hesitant to repair a peristomal hernia, as it is very likely to recur.  There are different surgical techniques for repairing peristomal hernias.  Each surgeon will have their preference for the technique they use. It is a complex surgery to do a hernia repair involving a stoma.

Surgical techniques include suturing the enlarged opening in the muscle wall to make it smaller.  Moving the stoma to the other side of the abdomen is another surgical option. Repairing the hernia by putting a mesh in is another common approach.  There are different types of mesh and surgical techniques to put the mesh in.

Non-surgical management

Surgical repair is usually avoided in people with no or mild symptoms because of the high recurrence rate.  Many people with mild symptoms can be managed with a ostomy hernia belt or support garment.  There are many types of ostomy hernia belts available on the market. Most have an opening to allow the pouch to come through so the urine or stool output is not affected.  ( pictures).  Many women find that a supportive panty is all they need but they need to see that the flow of output is not affected.

It is important to note that the hernia belt or support garment will not “ take the hernia away” or prevent a hernia. It is for comfort and support.

hernia 03

Examples of Nuhope Peristomal Hernia Belts

MainAdmin   July 22, 2014

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What are some exercises to strengthen abdominal muscles?

Physiotherapists are trained to strengthen damaged muscles safely.  It is recommended to see a physiotherapist to assess your abdominal muscles and to recommend a program to help you safely strengthen your core abdominal muscles.

The time to see a physiotherapist is about 8-10 weeks after surgery or when your surgeon lets you resume your normal daily activities.

Marilyn Moore, a physiotherapist, developed the following sets of exercises and she also has an ileostomy. In developing these exercises she stresses the need to take things in steady stages.  Gradually building up to the more challenging exercise is the surest way for you to improve both fitness and general health.

Check out this link to see preventative core abdominal exercises  www.iasupport.org/about/publications/factsheets/exercises-for-ostomates

MainAdmin   July 22, 2014

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How do I prevent from getting a hernia?
Be cautious when lifting- use proper technique and watch how much you are lifting. There is no magic number for the number of weeks after surgery before lifting or exercising or the amount of weight to lift or not lift, as everyone heals at a different rate.  Please check with your surgeon.  If still unsure, do not lift any more than 5 pounds or 2.2   kilograms for 8-10 weeks after surgery then gradually increase.
Contact a physiotherapist to learn how to strengthen your abdominal muscles safely.
Maintain a healthy weight.

MainAdmin   July 22, 2014

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I have an ileostomy now for about a year and could you tell me why when the stool comes out it stays up just where it comes out does not fall down in the bag. What can I do about that. So I do not eat if I am going out as I do not want that to happen. Would it be my diet. I really not to sure what to eat I cannot digest any vegetables except potatoes and sweet potatoes.

Pancaking

This is when the output collects around the stoma and can squeeze between the flange and the skin instead of going into your bag. One of the reasons this happens is because there isn’t enough air in the bag and so the output doesn’t take a downwards turn.

If this happens, try lubricating your bags with baby oil or one of the many products available from the various supply companies. Squirt a little oil or gel in your bag and give it a good rub around before you stick it on. Take care not to get any on the adhesive as this can reduce the effectiveness of the seal.

If you’re wearing clothes that are tight fitting in the stoma area this can also cause pancaking. You may want to try to wear looser fitting clothing in order to prevent a vacuum forming inside the bag. Also, in terms of clothing, make note of where your waistband or belt sits. Does it allow the stool to drop into the pouch or does it restrict the stool so the stool gathers only at the top. Monitor your body positions. If you are sitting for long periods for example driving or at the computer, does the pouch fold onto itself not allowing the stool to drop but remain in the top part of the pouch?

If the pouch has a filter in it, block the filter by either using waterproof tape or the ” tabs” that come in the box of pouches. This will leave air in the pouch, preventing the vacuum effect and allow to stool to drop into the pouch.

Another reason for pancaking is that your output is thick. Each person is an individual and so, each of us has trigger foods that can cause digestion processing issues, and stool issues. It would be helpful to consult your physician for a referral to a nutritionist or dietician to assist you in identifying foods that will work best for you.

[July 22, 2014]

To get additional information or help, find an ET in your area by clicking here…

MainAdmin   July 24, 2014

2 people found this faq useful.

I’m looking for ways to help my grandson, who has an ileostomy that is always leaking.

Leakage

Ostomy leakage is a problem which all ostomates will no doubt encounter at some point during their time with a stoma. For most people it’s a common occurrence in their early weeks of managing an ostomy when you are still finding your ostomy-feet and working out which products are best for you, and which routine gives the best results. It can cause a heck of a mess, not only to our clothes, but to our self-confidence too.

To find out what is causing the leakage start by checking the back of the flange after it’s leaked and you’ve removed it. This holds the biggest clue of all, you will be able to see what path the stool took on its break to freedom. Compare this to your skin and see what problems are present.

Condition of the skin. Is it raw, or does it have a rash all over it, or on part of it? If so, you may be allergic to the flange, and it may be interfering with the adhesive properties of the flange. Also, check to see if the area around where the flange leaks is any worse than elsewhere.
With leakage, the stool will always follow the path of least resistance. Do you have a belly crease which in turn is creasing the flange and creating a nice little tunnel for your stool to escape?
Look at your flange. Was the gap around the stoma too large? Or was it too tight? Or just right? Do you have protruding stitches around your stoma which the flange has trouble moulding around?
Do you have a belly cavity near the stoma? Flanges may struggle to adhere to these dips in your belly and lead to leakage.
Check your stoma. Is it flat/flush to the skin? Is it inverted / pulled in?

Some causes of leakage could be:

Flush to the skin or inverted stoma
Poor fitting flange/odd shaped stoma
Belly cavity around stoma
Parastomal hernia and/or Pancaking

Once you’ve discovered the source of your leakage then you are in a better position to be successful in stopping your leakage in its track, and there are a number of products available on the market which are designed to help reduce opportunities for leakage to occur.

Arrange a visit with an Enterostomal Therapy Nurse, (ET nurse – registered nurse [RN], who has specialized training in treating patients with ostomies), who can assist you in assessing the leakage issue and make equipment product recommendations for ensuring a good seal. One thing to bear in mind with all ostomy products is that our bodies are very individual, and because of that, a product which works great for one person may not work anywhere near as successfully for another, and vice versa. You may need to sample various rings and seals to find the one that works best for you, which the various ostomy product companies will also assist you in finding the seal that will work for you. So there is no reason why you cannot use multiple products to help combat leakage.

[July 23, 2014]

To get additional information or help, find an ET in your area by clicking here…

MainAdmin   July 24, 2014

2 people found this faq useful.

I am not doing very good with my diet. What would be a proper one?

Diet – Healthy Eating With A Stoma

The impact of food and drink on your stoma is hard to predict as diet is very individual. Various surveys suggests that foods can affect people in different ways after stoma surgery. While many people find that they can eat just the same diet as before their surgery, some find there are things that can have an adverse effect on the activity of their stoma. They may then choose to avoid those foods, or include them in their diets and be prepared for the effects.

Many people report that a good way to ascertain which foods and drinks are suitable for them is to keep a food diary so that patterns between diet and stoma output can be identified. You can then base your diet on what you have observed to be agreeable in terms of stoma output. There may be a certain degree of trial and error, especially in the first few months after your stoma is formed when the bowel is swollen. This swelling (or oedema) is the reason why a stoma may look puffy initially and can cause problems digesting food that would otherwise not occur, so it’s sometimes worth trying a food again later on before deciding whether to eliminate from your diet completely.

Information about diet and healthy eating for the general public is often conflicting and difficult to interpret. Add to this a stoma and many people feel confused about what they should and shouldn’t be eating.

Most people with stomas do not need to change their diets and should follow a normal healthy eating pattern like the rest of the population. If you have recently had your surgery or have been unwell, ensuring that you get all the essential nutrients from your diet is even more important and putting unnecessary restrictions on your diet could slow down your recovery and healing.

The purpose of the following information is to offer general information, for further information about diet, ask you physician to refer you to a dietician in order to explore any important factors to take into consideration regarding your individual stoma management and general wellbeing.

A balanced diet is made up of:

Starchy foods such as potatoes, rice & grains, bread and pasta, for energy. Try different varieties, including wholemeal vs refined/white rice and pasta.
Fruit and vegetables provide a wide range of vitamins and minerals and both soluble and insoluble fibre. Soluble fibre is found in the flesh of fruit & veg and can help lower cholesterol as well as make stool thicker, softer and easier to pass (helpful for those with a colostomy or ileostomy who wish to thicken their output). Insoluble fibre is found in the skins of fruit & veg and helps move waste through your bowel, so can help with constipation (helpful for those with a colostomy who experience pancaking and anyone who experiences constipation). If you have a colostomy or ileostomy, immediately after surgery foods containing insoluble fibre may make your stoma behave unpredictably, so you may wish to avoid or limit your intake of them. As your bowel adjusts you can re-introduce them and see how they affect you.
Protein rich foods for growth and healing. Protein comes from meat, fish, eggs, soya and it is the substance we use to heal wounds and regain muscle.
To promote general wellbeing, fatty foods should be limited. However, if you are recovering from surgery or have a small appetite and need to gain weight, including more of these foods in the short term is a good idea.

Individual Differences

The vast majority of people with a urostomy (a stoma that passes urine) find that their food intake is unaffected by having a stoma, however some food and medications can make urine discoloured or smelly (e.g. beetroot can make your urine pink and antibiotics and asparagus can make it smell strange).

Importance of chewing

It sounds very obvious, but it is vitally important to chew food thoroughly when eating. Chewing is the first stage of digestion and in doing this we make more nutrients available from our food. Foods that contain cellulose such as nuts, grain, fruit & vegetables (particularly the skins) cannot be completely broken down in the digestive system. So, you may notice these coming through your stoma looking the way they did when you ate them. Immediately after bowel surgery, your bowel is swollen and this narrows the passageway for food to pass along.

Fluid Intake

It is essential for everyone to drink enough to keep their kidneys healthy and flush out the chemicals that build up in the blood. You should aim to drink enough throughout the day that your urine is a light straw colour. The following information is for the specific stoma types but does not take into account other medical conditions. If you have been given different information from your healthcare professionals please check with them before making any changes.

People with urostomies enjoy a few glasses of water a day. This will help to prevent infections.

If you have a colostomy, your fluid intake can remain as normal unless you are experiencing constipation or pancaking. If you have this problem, increasing your fluid intake can be really helpful.

People with ileostomies, particularly if the stoma is formed higher up in the bowel, can have more difficulties with their fluid intake. This is because it is the role of the large bowel to absorb water (and salt) and for people with ileostomies this is no longer being used. The small bowel will, with time, adapt to absorb more water and more salt, however careful attention should be paid to ensure that you are drinking an adequate, varied fluid intake to maintain kidney health. Remember, you are aiming for light straw coloured urine.

For those who are more active it is even more important to pay attention to your fluid intake. Fluids are lost through sweating that contains electrolytes.

Everyone should bear in mind that alcohol is a dehydrating fluid and caffeinated drinks such as tea and coffee cause you to lose more fluid in your urine. The majority of your fluid intake should therefore be from fluids such as water and fruit cordials.

A little of what you fancy….

Of course, every now and again you will want to enjoy a treat like cake or ice cream and there is no reason why you can’t indulge once in a while! Healthy eating is about moderation and after stoma surgery it is also about trial and error. Take your time to explore how different foods affect your stoma, chew your meals, maintain a varied fluid intake and, most importantly, enjoy your food!

Some foods effect output. The effects may vary.

Basic Food Reference Chart

Stoma ObstructiveGas ProducingOdour ProducingColour ChangesOdour ControlIncreased StoolDiarrhea Control
Apple peelsBeansAsparagusAsparagusButtermilkBran cerealsApplesauce
Cabbage rawCabbageBaked beansBeetsCranberry juiceFresh fruitsBananas
Corn, whole kernelCarbonated beverageBroccoliCoffeeTomato juiceGreen, leafy veggiesPeanut butter
CoconutCauliflourCod liver oilCooked fruitsYogurtMilkTapioca
Dried fruitCucumberEggsFood colourPrunes
MushroomsDairy productsFishIron pillsRaw vegetables
PineappleNutsGarlicStrawberriesWhole grains
PopcornOnionsOnionsTomato sauces
SeedsRadishesPeanut butter
SoyStrong cheese

To get additional information or help, find an ET in your area by clicking here…

MainAdmin   August 10, 2014

1 people found this faq useful.

I’d just like to check out anything new…

What’s New

The newest news about ostomates I’ve noticed, is the latest trend in breaking the taboo of ostomies and ostomy bags through posted photographic images.

Facebook, Instagram, and Twitter are just a few of the social media being used by ostomates to show and share their colostomy, ileostomy and urostomy bags and scars.

They are young, older, male, female, and all of them are plucking up the courage to share themselves and their bags to a wider audience.

I’ve heard some folks take offence to the photographic images, and heard other folks cheer them on.

My take on this new and inspiring trend is; go ahead folks, be proud of who you are, you are amazing, and so, embrace your ostomy, inspire others, and keep spreading awareness!
Jo-Ann L. Tremblay

[July 27, 2014]

MainAdmin   August 11, 2014

1 people found this faq useful.

What clothing tips are there for a person with an ostomy?

Stephanie Hughes from the blog, Stolen Colon, shares a wonderful video on What to Wear With an Ostomy…

 

MainAdmin   August 12, 2014

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What sort of swimsuit options are out there for women with ostomies?

Jessica Grossman of Uncover Ostomy, has a wonderful blog entry titled Itsy Bitsy Ostomy Bikini with several links to swimsuit options.

Also, Stephanie Hughes of Stolen Colon, shares a video showing different swimsuit options as well:

 

MainAdmin   August 12, 2014

1 people found this faq useful.

I would like to learn more about colostomy irrigation…

(Disclaimer: Before attempting any irrigation techniques, you must get your doctor’s permission)

* Reprinted with permission from The Phoenix magazine, www.phoenixuoaa.org or call 800-750-9311

Download (PDF, 156KB)

MainAdmin   September 18, 2014

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Check Out Our “Ask The Ostomy Lifestyle Experts” Feature…

We have two UOAC members here to answer your questions – our Ostomy Lifestyle Experts will offer readers a personal outlook on life with an ostomy.

Click here to learn more about our Experts and see all of our Lifestyle FAQs

References:

Living with Confidence After Colostomy Surgery ©ConvaTecLife after Colostomy ©Coloplast Corp. edited by Sharon C. Evans, RN, MS, CWOCN et alLiving with Confidence After Ileostomy Surgery ©ConvaTecLife after Ileostomy ©Coloplast Corp. edited by Sharon C. Evans, RN, MS, CWOCN et alManaging Your Colostomy ©Hollister LimitedManaging Your Urostomy ©Hollister Limited

Life after Urostomy ©Coloplast Corp. edited by Sharon C. Evans, RN, MS, CWOCN et al

Acknowledgements: UOAC wishes to thank Coloplast Canada Corp., ConvaTec, and Hollister Limited and CAET for permission to reprint copyrighted material. If you wish to contact these companies directly, to obtain copies of booklets or other information, please click on the company name.

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