Question:

I had permanent colostomy surgery in May of this year. I am doing very well other than a few minor issues. Hope you can give me some helpful advice.
Though I have good adherence to the pouch I find after a day with a new pouch I sense a very subtle odour. The vent in the pouch clogs pretty quickly. Also, the stool does not slide down into the bag even though I have tried numerous lubricants and deodorizers. The bag also collapses making it a bit difficult to empty. The stool is of soft muddy consistency. I drink 8 glasses of fluid a day and have a healthy diet. I have most of the colon; the diverticulitis issue I had was in the sigmoid area. I use Coloplast products – a one-piece pouch with strip paste or protective rings.
I hope the above description assists you in “getting the picture” so to speak of these little problems. Overall, I am thankful for the surgery that allows me to carry without pre-op difficulties I was experiencing
Thanks and looking forward to your reply

Response:

Many ostomates worry about odour. If the ostomy pouch fits well there should be no smell except when changing it. If you do notice s smell from your pouch, you should check it as there may be a leak under the flange, and the bag will need changing. Sometimes the area around the flange next to your stoma acts like a wick and absorbs some of the fecal material. If this is happening, you could experience a subtle odour.

Make sure your skin barrier fits properly. A skin barrier that fits well around your stoma helps protect your skin from being irritated or damaged by drainage. It doesn’t really matter whether your stoma is large or small, or whether it protrudes or not, as long as the drainage flows into your pouch without leaking under the skin barrier.

Suggestions:

Measure the stoma using a stoma measuring guide before every barrier application (some manufacturers provide a stoma measuring guide included with flange purchase).

Apply the skin barrier, making sure it fits where the skin and stoma meet.

Verify that no skin is showing between the skin barrier and the stoma.

Change your ostomy pouch on a regular basis. An overfilled or overweight pouch causes undue strain on your skin and the pouch system. Pouching system wear time is based on personal preference, your unique stoma, and output.

Make sure your ostomy pouch is secure during exercise or physical activity. If you are participating in sporting activities or other forms of exercise, you can wear certain clothing or accessories that can help ease your concerns. The same goes for other “physical activities” (i.e. sec).

Find the right product mix for you. There are many ostomy products and accessories that are designed to ensure good skin health and help prevent leakage. Every stoma is unique, so you will need to determine what is best for you by working for you.

If the subtle odour continues I advise that you contact – NSWOC – Nurses Specialized in Wound, Ostomy, and Continence, (formerly called The Canadian Association for Enterostomal Therapy (CAET). They are specialized nurses with the experience and expertise to help you with your ostomy and equipment challenges.

You may be experiencing pancaking which could also be a cause of the subtle odour. The following are helpful suggestions and tips :

I often have to deal with the issue of pancaking, and it is frustrating.  Pancaking is a situation when the output collects around the stoma and can squeeze between the flange (causing wicking),  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 downward turn.

For some people, the lubrication of baby oil or one of the many products available from the various supply companies can help. Some ostomates squirt a little oil or gel in their bag and give it a good rub around before they stick it on.

Another possible approach is to check to see if you’re wearing clothes that are tight-fitting in the stoma area as this can also cause pancaking. You may want to try to wear loose-fitting clothing in order to prevent a vacuum from 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 the 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.

Jo-Ann L. Tremblay
THE OSTOMY FACTOR Blog – joannltremblay.wordpress.com
FACEBOOK – Author Jo-Ann L. Tremblay
TWITTER @joanntremblay
Author of “The Self-Coaching Toolbox” , “Better With A Bag Than In A Bag” , “Another BAG Another DAY”, “BAGs Around the World”, Why Buttercup Wears a BAG!”, “The Sibs Gang Cave of the Golden Heart”
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Member OstomyCanada /Medical Lifestyle Advisory Committee Member- Ostomy Lifestyle Expert
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Website: jo-annltremblay.com

Our friends over at Nurses Specialized In Wound, Ostomy And Continence Canada (formerly called The Canadian Association for Enterostomal Therapy (CAET)) have renamed their handy look-up page on their website. It was formerly called “Find An ET Nurse” and is now called “Find a NSWOC“. Click on the image to the left or link here to go to their site.