FAQs

You may have many questions before or after your surgery. Here is a list that we have compiled...

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.

General Information

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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.

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A healthy stoma is red or pink in color, and moist. There are no nerve endings in the stoma, so it will not hurt when touched. It is normal for the stoma to be large and swollen after surgery; however. It will shrink to a smaller size within five to six weeks. Your stoma may move slightly which is a normal process that pushes stool through the colon.2

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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.

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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?

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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

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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

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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

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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

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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

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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

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Because ostomy surgery is a body-altering procedure, many people worry about sex and intimacy, and about 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

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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

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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.

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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.

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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!

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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.

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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.

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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.

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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.

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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.

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Colostomy

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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.

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

1) Diverticulitis (Diverticulitis is small, bulging sacs or pouches of the inner lining of the intestine (diverticulosis) that become inflamed or infected) or abscess

2) Injury to the bowel or rectum

3) Rectal or Colon Cancer

4) Wounds or fistulas in the perineum

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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 semi-formed. A descending colostomy is located within the descending colon. Output is semi-formed to formed. A sigmoid colostomy is located within the sigmoid colon. Output has a normal, formed consistency.1

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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

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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

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

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Ileostomy

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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.

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A few reasons are:

1)    Crohn’s Disease or Ulcerative colitis

2)    Familial adenomatous polyposis

3)    Colorectal Cancer

4)    Trauma

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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.

Usually a food blockage is located just behind the stoma at the muscle layer as seen here. This is the side view of the abdomen:

Signs of a Food Blockage:

  • Small amounts of “dish water-like ” stool
  • 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.

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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!

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Urostomy

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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

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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

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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.

1) 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

2) “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.

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The urinary system is one of the important filtering systems in our bodies. The kidneys make and filter urine, which travels to the bladder for “holding” until you choose to empty your bladder. For others who have a urostomy, the external pouching system acts as the “holding chamber”.

Urine should be:

  • Colourless or light yellow – dark yellow urine can mean you are dehydrated Note that certain medications can alter the colour of urine. Talk to your pharmacist.
  • Clear – with a urostomy it is normal to have some strands of mucus
  • Generally odourless or have a slight, inoffensive odour. This may vary depending on foods you eat, like coffee or asparagus or from certain medications.
  • Slightly acidic in orderto reduce the opportunity for bacterial growth – normal urine pH ranges from  4.6 (acidic) to 8.0 (alkaline). Neutral is a pH of 7.0
  • Quantity: 1-2L per day

Kidney stones and Urostomy:

The most common kind of kidney stone for people with a urostomy is the struvite stone (Note for biochemists: These stones are made up of ammonium magnesium phosphate NH4MgPO4·6H2O). These stones are commonly known as “infection stones” and can form quickly when bacteria alkalizes the urine (pH is higher), allowing the formation of the struvite stone. These stones often need to be removed surgically due to the “stag horn” shape they make inside the kidney. This is why you must drink, drink, drink plenty of fluids!

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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.

o   Female gender: nothing you can do, sorry! ( Men can get it too.)

o   Alkaline urine: talk to your doctor about taking Vitamin C to keep your urine acidic

o   Constipation: things that promote regular bowel movements include adequate fluid intake, exercise and eating enough fiber (whole grains, vegetables and fruits)

o   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

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References:

  1. Living with Confidence After Colostomy Surgery ©ConvaTec
  2. Life after Colostomy ©Coloplast Corp. edited by Sharon C. Evans, RN, MS, CWOCN et al
  3. Living with Confidence After Ileostomy Surgery ©ConvaTec
  4. Life after Ileostomy ©Coloplast Corp. edited by Sharon C. Evans, RN, MS, CWOCN et al
  5. Managing Your Colostomy ©Hollister Limited
  6. Managing 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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