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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!

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

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