Learning about Ostomy Complications

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.

Ostomy Guide sponsor STLMedical.com now accepts Product Reviews for all Ostomy supplies. Reviews are presented below each product. So if you’re an experienced ostomate with comments, suggestions, and tips on using your ostomy supplies, submitting a product review helps others make informed decisions and find the best supplies they need.

You can get $5 off of a purchase of $25 or more on STLMedical.com Use promo code IREVIEWEDAPRODUCT for your ostomy supply purchase to get the discount.

Sources & Additional Resources:

Fecal & Urinary Diversions: Management Principles By Janice Colwell, Margaret T. Goldberg, Jane Carmel

http://books.google.com/books?id=u7x6AII_zdMC&pg=PA314&lpg=PA314&dq=stoma+injury&source=bl&ots=9jc4oD47kQ&sig=q2mrKx1przQtyTSalLXuCOz62p8&hl=en&ei=pF2jTPOKH4WjnQfl1cGIBA&sa=X&oi=book_result&ct=result&resnum=4&ved=0CCAQ6AEwAw#v=onepage&q=stoma%20injury&f=false

Stoma Care Basics - http://www.webwhispers.org/library/StomaCareBasics.asp

Stoma Care - http://hcd2.bupa.co.uk/fact_sheets/html/stoma_care.html

---

Do you have any more tips or experiences with Ostomy complications? Please leave your comments below!

A Guide to Sex with an Ostomy

Before we get started, let’s cut to the chase and let it be known that for most ostomates, a stoma has little effect over the ability to enjoy sex, regardless of sexual preferences or lifestyle before surgery.

Sexuality and ostomy are complex subjects with many facets: the physical, emotional, and psychological pressures are major influences in ones’ life. Let’s break down these issues down to discuss the physical considerations (both after surgery and ongoing) and then the psychological and emotional considerations for sex and ostomy.

Physical (Post-Surgical)

There are many potential physical issues with sex within the first few months after surgery for a new ostomate. Depending on the type of surgeries done, medications administered, and what parts were affected is going to determine the viability of your sex life. But most of the anxieties of post-surgery ostomates about sex are alleviated after a few months and most find they can have sex just the same as before they had their surgery.

Some of the issues faced by post-op ostomates are:

1) Initial anxiety due to physical changes & fear of injury
2) Feelings of loneliness or a sense of rejection
3) Inability to achieve an erection / lubrication / orgasm.

Sex Tips for Post-Op Ostomates

- For a partner of a new Ostomate, being supportive and patient are the best things you can do.
- Be patient, sex drive and the bits-and-pieces will usually rebound to full function again.
- Intercourse can be painful the first couple times after surgery, especially if you haven’t had any for several weeks/months.
- Sex doesn’t have to mean penetration. Oral, petting (foreplay), masturbation, toys, and any number of other sexual activities can be enjoyed.

Physical (Ongoing)

Over time, after a full recovery from surgery and regular sexual function returns, more thoughts & concerns arise about sex. Here are some of the common concerns and some information about them:

1) Fertility / Ability to Have Children - Most women can still conceive after Ostomy surgery without any problem. Most men will remain fertile, even if they cannot achieve an erection for a period after their surgery, so artificial insemination may be an alternative if sexual ability has been limited by surgery affecting the urological system and sexual nerve pathways.

2) Injury to the Stoma - Ensure your partner that having sex will not damage the stoma.

3) Sexual Positions - Most ostomates will find they can still enjoy sex in most positions. But if some positions are uncomfortable or compromise the appliance, try something different until you find the best ones for you.

4) Odor - Many ostomates worry about odor & this can be a psychological factor as well. Before sex: don’t eat foods that create odors/gas, clean the skin around the stoma and wear a fresh pouch or empty and clean a drainable pouch prior to sex.

Sex Tips for Physical Issues and Ostomy

- Communication is key in any sexual relationship. Ostomy and sex is no different. Let your partner know they won’t injure your stoma by having sex and if something is uncomfortable.
- No sex in or around the stoma. No anal sex.
- For odor management, also try DEVROM internal odor control tablets and Hollister’s m9 Drop Deodorizer for pouches. Burn candles and/or incense.
- Empty the pouch beforehand when time allows. Keep everything clean and neat beforehand.
- Check all fasteners and adhesives to ensure they’re secure.

Psychological & Emotional

Ostomy can be hard for both the patient and the healthy partner. In some instances where a patient has had surgery for dibilitating health problems like cancer, the healthy partner helps to take care of the ostomate and “certain” bodily functions. Working through these hard times without sex can take a toll on the sex life, and it can take time for these couples to adjust and recoup to a healthy sexual lifestyle again.

But there are also far more common psychological considerations for ostomates and sexuality. And they mainly have to do with…

- Desirability/Attractiveness: “Will my partner still want to have sex with me?” or “I don’t look like I used to.” The truth is, We put a lot of pressure on ourselves to appear a certain way and become sensitive to our differences when compared to others. A step further is when we feel others judge us the same way we judge ourselves. But imagine if your partner, someone you care about, had the same condition and how you would feel about them. What would you be thinking, or how would you react? Most find their partner has a sensitivity and understanding towards the ostomy.

- Breaking the Ice/Fear of Rejection: At some point, a single Ostomate has to tell a potential partner about their ostomy. But when and how? And what do you say? The best advice would be to tell someone earlier than later. When it comes to one’s health, it’s best to present the facts at face value with confidence and understanding that the person you’re telling may not understand what an ostomy is and how it affects your life. Explain the surgery and how it affects your physical ability for intercourse. Let them ask questions, don’t judge them and be patient. Typically this understanding tone will be returned in full, but even if you are rejected, don’t blame it on your stoma - simply do what all single folks do and go fishing again.

Sex Tips for Psychological Issues and Ostomy

Below are some things many ostomates do to increase confidence for intimacy:

1) Wear a small, low-profile pouch such as Convatec’s Mini Pouch or stoma cap before intimacy. These pouches are more discreet, so they’ll be less invasive.
2) Wear a pouch cover such as C&S Pouch Covers or satin My Heart Ties for the ladies.
3) Many ladies also choose to wear a comfortable satin slip or camisole to bed with them. Men may wear a belt or similar support along with a pouch cover.

A Few Last Thoughts…

There are some cases where physical impairment may prevent one from having sex. This can happen sometimes based on previous health and the types of surgery needed. Some types of colorectal cancer can result in removal of the nerve pathways that cause erections. In some cases, colorectal surgery can result in the vagina changing shape and structure. All of these physical changes can limit some types of sexual activities.

Homosexual couples deal with all of the same issues as straight couples. And, due to the surgical implications of the colostomy or ileostomy surgery, it can influence what sexual activities are permissible.

No matter what the sexual preferences and difficulties you’re facing, consult these issue candidly with a health care professional that understands your surgery. They can provide you with advice specific to your personal needs.

Some Resources on Sex and Ostomy:
http://www.o-wm.com/article/5339
http://www.hollister.com/uk/ostomy/resource/love.html
http://www.ostomyok.org/ostomy_care_guides/uoa_facts_sexmale_en.pdf
http://www.outsiders.org.uk/leaflets/sex-and-ostomy
http://www.ostomyinternational.org/Facts/Sex%20and%20the%20Single%20Ostomate.pdf
http://www.colonandrectalsurgery.com/html/patientedu/sub/ped2/disease13.htm

Please feel free to leave your comments with additional tips, suggestions and thoughts!

What is a Parastomal Hernia? (An Ostomy Hernia)

What is a Hernia?
A hernia is when there is a rip/tear in muscle tissue that causes a portion of the abdomen (particularly, the intestine) to bulge through. This causes pain when standing up, moving the abdomen, or any kind of tension on the abdomen including coughing, sneezing, laughing, bending over, picking up objects, etc.

What is a parastomal hernia?
Having a stoma can develop into an ostomy specific type of hernia called a parastomal hernia. Since a Stoma passes through the abdomen, it can compromise the strength of the muscular abdomen wall. These weakened muscles can come away from the stoma, weakening its integrity and causing the intestine to bulge.

A stoma hernia is typically not painful, but can be very uncomfortable and unnerving, not to mention more difficult to mange and care for. As the stoma grows, it can become more difficult to attach ostomy wafers and pouches. It can also eventually lead to intestinal twisting/kinking that can cause serious damage to the intestine by cutting off blood vessels. (This, of course, requires immediate medical attention as being left untreated can be very dangerous.)

What Causes Parastomal Hernia?
Coughing, sneezing, heavy lifting and being overweight all put pressure on the abdominal wall & a stoma. Over time, muscles can weaken to the point a stoma begins to protrude and push out due to the pressure of the guts behind it.

There are many possible origins for parastomal hernia to develop. Some are related to surgery and a poorly placed stoma or a developing infection around the border. Other causes are related to an individuals health, such as being overweight, heavy lifting, or any kind of physical strain, or a combination of these factors.

How common is parastomal hernia?
In the 1990′s, the United Ostomy Association found that a hernia is one of the most common complications for Ostomy patients. Ostomy hernias happen to about 30% of all stomas. It’s more common with Colostomy than Ileostomy and Urostomy.

How is Parastomal Hernia treated?
Surgery is the most common repair for any type of large hernia.

Typically, if the hernia is not recurring, doctors will recommend a Hernia Belt and appliance changes before recommending surgery. A hernia belt is designed for individuals with small hernias or those where surgery can be risky or further compromise one’s health. A hernia belt is a firm, wide belt that helps support the stoma and muscle tissue around it externally.

As for surgery, doctor opinions vary based on their preferences for proper care and an individual’s needs. There are two options for the surgeon:

1. 1) To repair the muscle tissue around the stoma (either with stitching or mesh).
2. 2) Create a new opening in a health spot and close off the old one.

In some cases, Option 1 isn’t applicable; either hernia is too large or the surgery is too risky. And some surgeons will choose to re-locate the stoma first and install mesh if the problem persists.

However, today, often a mesh is implanted instead of stitches. This is the ideal method of repairing a hernia.

A mesh is laid across the herniated muscle tissue, helping to hold the muscle together and increasing its strength & integrity. The mesh also speeds recovery times over other methods and and reinforces the tissue; patients can often be mobile again within a matter of days.

Summary
An Ostomy certainly increases the risk of a hernia. Discuss with a doctor and nurses for the facts and tips to manage your individual stoma - even if you do not recognize any pain. As with any hernia, this lessens the chances of developing a more cumbersome and large hernia requiring surgery.

Resources:
http://www.o-wm.com/article/2207
http://www.hernia.org/stoma.html
https://health.google.com/health/ref/Hernia

Managing Ostomy Accidents – Leaks, Sleeping, Odors...

Ostomy accidents can happen - leaks, blowouts, strong odors; you name it, if its prone to causing embarrassing situations, it’s probably going to happen at some point. But with some help (and experience), you’ll soon learn how to manage the potential disasters prone to any situation.

Maintain a good outlook of things, learn to laugh through life’s hardships and not to take it too seriously and you’ll live longer and happier. Obvious common-sense aside, here are some tips to better manage accidents with Ostomy.

Ostomy & A Nutritional Diet – Know Your Guts!...

Most folks generally don’t think too much about what/how they eat and how it affects their waste (short of feeling ill or diarrhea). The reasons for this are simple - it’s generally a minor duty or inconvenience in a typical day, just like sleeping or eating or personal hygiene.

When it comes to what foods to eat, one thing is certain: nobody understands how foods affect digestion or how food travels through the body like an Ostomate does.

That’s because for an ostomate, there is no control when a pouch fills with waste and gas without the intelligent management of diet & nutrition. With this in mind, one needs to consider questions about their diet so pouching needs become more predictable and therefore can be handled with optimal health and minimal complications: What makes things move too quickly? What stops things from moving (food blockages)? Are there foods that can’t be digested properly? What causes pouch output to be more liquid or more solid? Which foods create more odors? Which foods produce more gas?

Being able to answer these questions for yourself will make life much easier!

Basic tips about diet and nutrition for ostomy:

Chew Yer Food - It helps digestion and slows your eating down a bit. It’s a good general diet tip anyway; you’ll know more reliably when you’re full so you don’t overeat and swallow less gas-producing air. Like your mother always aid: Don’t talk with your mouth full. You will also have less likely chances for intestinal blockages around the stoma.

Eat Adequate Portions and Do It Often - Avoid overeating in one sitting and avoid skipping meals, both of these activites can result in producing excess gas.

Stay In Shape - Stay in shape and you’ll avoid a lot of stoma problems. Being overweight puts unnecessary pressure on your guts and your stoma.

Drink Lots of Fluids - Fluid loss is especially common in those who have lost much of their large intestine, so drink lots of water.

Make Scheduled Alterations to Diet - When you find foods you can digest well, test trying different types of foods and adding them to your diet one at a time. This way you’ll notice the changes that particular food can cause. Which leads into the next tip…

Monitor Movement - Keep a log of what you eat and when, and then make a note of the condition of your stoma and pouch output. This way you can start to see patterns and determine the best diets with all the foods you like. If you notice a change in pouch output, try a food several times to be sure its a consistent change and you’ll have a pretty good idea of how it affects you.

---

Foods to Avoid - Food Blockages

Generally it’s accepted that fiber aids digestion, but especially with illeostomy (small intestine), undigested fiberous foods can cause complications and food blockages. So can not checking your food enough. (See the tips above).

Some examples of foods that can cause these blockages are: corn, dried fruit, hotdogs/sausages, pineapple, skins from fruits and vegetables. If you or your child experiences belly cramps, watery stool, a swollen stoma, or nausea it could be a sign of food blockage, consult a nurse and physician.

---

Foods to Avoid - Odors

Ostomy odor is created by bacteria breaking down certain foods, turning it into odorous waste and also sometimes creating odorous gases. This gas, like the stool, also makes it way into a pouch, filling it with air that must be released to prevent pressure from developing a leak, or worse, a pouch blowout.

While some pouches have integrated filters or can have a filter added to them, it is also a good idea to avoid odor-causing and gas-forming foods. Below are some examples of foods that affect most individuals:

Some foods that do cause odors:
Asparagus, coffee, garlic, prunes, beans, cucumbers, green peppers, radishes, brussel sprouts, eggs, milk, turnips, cabbage, fish, onions, vitamins/certain drugs, alcoholic beverages.

Some foods that help decrease odors:
Buttermilk, parsley, yogurt, cranberry juice, spinach.

Some foods that produce more gas:
Apples, soda, dairy products, onions, asparagus, drinking straws & chewing gum (you’ll swallow more air), melons, beans, mushrooms, corn, broccoli, spinach, nuts, cabbage.

One final note about digestive odors: Another product that may help with gas and odors are Devrom Tablets. Taken up to four times daily, they help control the odors of digestive gases with bismuth subgallate. This is, of course, not meant as a replacement to intelligent dieting, but if certain foods you enjoy make you gassy then a couple of Devrom tablets right before you eat should do the trick.

---

More Food for Thought - Thickening and Thinning

Some foods will also change the consistency of the stool, and depending on the type and adhesion of a skin barrier you’re using, more liquid can harm the adhesion of the barrier and cause it to leak, never a pleasant experience! Here are some examples of foods, take note how they affect you:

Some foods that will thicken pouch output:
Yogurt, bananas, milk (preferably boiled), creamy peanut butter, breads, cheeses, pastas, potatoes, rice.

Some foods that thin pouch output:
Fruits and fruit juices, chocolate, green beans

---

When Diarrhea Happens

Sometimes diarrhea happens, which for anyone results in fluid loss and loss of two essential minerals needed for good health: potassium and sodium. Dehydration is always a concern with diarrhea for anyone, and fluid retention can be even more serious for an Ostomy patient. When diarrhea happens, it’s good to get plenty of fluids along with potassium and sodium to stay healthy, so the foods below should be considered:

Some more foods high in potassium:
Milk, Chicken, beef, fish, pork, turkey, lima beans, V8 Juice, apricots, bananas, avocado, tomato juice, potatoes, broccoli, grapefruit juice, oranges and orange juice, watermelon, strawberries.

Foods high in salt:
Salt is definietly not hard to find. Simple table salt will get you sodium, along with most pre-packaged foods, canned soups, and seasonings.

This guide from the University of Pittsburg Medical Center (and the source for some of the data in this article) gives many suggestions on foods that are safe for those with diarrhea and ostomy, along with a beverage recipe to help keep you hydrated and make sure you’re not losing potassium and sodium: http://www.upmc.com/HealthAtoZ/patienteducation/Documents/OstomyNutrition.pdf

Here’s the recipe:

• 1 teaspoon salt
• 4 teaspoons corn syrup
• 1 teaspoon baking soda
• 1 6-oz can of frozen orange juice
• Enough water to make 1 quart of beverage.

---

Stay Informed and Stay Healthy!

I suggest reading this thorough and useful guide on ostomy and nutrition from UOAA as well. It’s a PDF you access and even save to your computer for reference: http://www.uoaa.org/ostomy_info/pubs/uoa_diet_nutrition_en.pdf

The Best Colostomy and Illeostomy Supplies for Dif...

Colostomy surgery isn’t taken lightly. Bad news about health, combined with frightening surgery, a stoma, and a pile of necessary medical equipment for daily life is nothing taken lightly. It is a life-changing event that at times is cumbersome, embarrassing and difficult.

Those of us who have experienced the pain and suffering of colon cancer, Crohn’s, ulcerative colitis or other digestive diseases understand without question a Stoma is preferred over illness, and wearing ostomy appliances are an easy exchange to a potentially fatal health condition.

Whether need for an ostomy is temporary or permanent, there are thousands of ostomates living out their lives happily, many with little thought of their Stoma or the extra work required to manage ostomy appliances every day. And thanks to modern ostomy products, everyone can go about their daily business with less thought of their stoma and more about living life.

Below are links to a series of articles based on lifestyle and situations where specific types of ostomy supplies come in handy.

Ostomy Supplies for Active People
Ostomy Supplies for Intimacy
Ostomy Supplies for Overweight People
Ostomy Supplies for Children and Pediatrics
Ostomy Supplies for Cleanliness and Odor Preventions
Interesting Ostomy Products You Haven’t Seen Before