Let’s discuss about common ostomy and stoma complications faced by Ostomates.
1) Hernia – Since ostomy surgery affects the abdominal wall, hernias are a common concern among ostomates; hernias occur when the muscles in the abdommen detach or tear and portions of the intestine protrude through these tears in muscle tissue; the skin bulges out and the stoma may also jut out further from the body. Unfortunately, when hernias arise, they’re more likely to be persistent, even for those who have undergone surgery. Hernias can make pouching difficult since the bulge will change in size and shape with standing/sitting/laying down.
It’s best to take the precautions to prevent them from occurring when possible. Talk with a doctor about any physical activity/scenarios you should avoid. There are many reasons claimed why hernias appear so frequently with Ostomy patients; most seem to form within the first 2 years of stoma surgery.
2) Prolapse – A prolapse is when the bowel protrudes through the stoma opening at abnormal lengths. They can vary in length and if untreated are susceptible to infections trauma. A prolapsed stoma can make maintaining the ostomy and pouching increasingly more difficult and extreme cases can lead to blood constriction, which will deteriorate the prolapsed bowel. A prolapsed stoma should be managed with suitable ostomy supplies large enough to accommodate the stoma to prevent further damage. The stoma should be inspected by a doctor to ensure there’s no blockage of output or blood that could result in constipation or abnormal tissue.
Prolapse is typically the result of ostomy surgery and are usually caused by an enlarged opening in the abdominal wall. It’s most common in certain types of temporary Ostomy surgeries. However, prolapsed tissue should be watched carefully, and it is recommended to use transparent pouching to visualize the stoma on a regular basis.
3) Retracted Stomas – A normal stoma has a slight protrusion from the skin level; this allows it to fit with ostomy appliances and the skin is protected from stoma output. Retraction is when the stoma is flush or below skin level. Sometimes the stoma may protrude when standing but disappear in the skin when sitting. Retraction is relatively common, with about 10 – 24% of stoma patients experiencing retraction. It’s also more common with ileostomy than colostomy and tends to affect heavier (or obese) patients more frequently.
Retracted stomas can cause problems with leaking with standard pouching systems. A retracted stoma is far more prone to leaks since the stoma outputs its contents directly to the skin. This can compromise the adhesives on barriers and cause skin irritation if not cleaned regularly. However, there are solutions to help prevent leakage and keep the skin clean and the barrier safe:
- Convex Barriers/Wafers – The curved shape of the barrier helps the stoma protrude enough to keep the contents from leaking under the barrier.
- Ostomy Belt – Helps support the barrier and the pouching system to prevent leaks by supporting the appliance around the waist.
- Adhesives – Some barrier adhesives provide an extra tackiness that is far more waterproof; these adhesives can help prevent the skin and wafer to be compromised by leaks.
In extreme cases, a doctor may recommend surgery to fashion a new stoma through the skin.
3)Blockages – Blockages are most common among those with ileostomy. They are caused by food and contents of the bowel, and they’re usually noticed quickly with cramps combined with no stoma output. Swelling may also occur. Certain foods may cause blockages; see our post on Ostomy and Diet/Nutrition and its resources to learn more about foods.
It is suggested to try a warm bath and drinking warm fliuds to relax the muscles and allow the blockage to pass through. A doctor should be consulted if the blockage is not passed within 24 hours.
4) Peristomal Irritations/Infections – The integrity of the skin surrounding a stoma is under constant stress by adhesives, pouching appliances, and bowel fluids. It requires careful wear and cleaning to ensure the skin stays dry, clean, and safe from inflammation and irritation. If left untreated for too long, these can develop into nasty infections that, in serious cases, can lead to suffering that is often preventable by using the right appliances, adhesives, protective skin creams and cleaners.
The best defense against skin irritations and infections is to know what products you need to prevent them and using them correctly. The correct ostomy supplies for your lifestyle makes a big difference in your quality of care. Talk with your nurse/doctor and check the fantastic ostomy resources online to find more information on the correct use of appliances and to discover the products that have worked well for others.
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Sources & Additional Resources:
Fecal & Urinary Diversions: Management Principles By Janice Colwell, Margaret T. Goldberg, Jane Carmel
Stoma Care Basics – http://www.webwhispers.org/library/StomaCareBasics.asp
Do you have any more tips or experiences with Ostomy complications? Please leave your comments below!