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Leaving hospital following colostomy surgery. Information to help you live a full and productive life with an ostomy

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Leaving hospital following colostomy surgery Information to help you live a full and productive life with an ostomy Table of contents Living with your colostomy 3 Taking care of your colostomy Skin care
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Leaving hospital following colostomy surgery Information to help you live a full and productive life with an ostomy Table of contents Living with your colostomy 3 Taking care of your colostomy Skin care and cleaning your stoma 4 Removing hair from around your stoma 4 Skin irritation and sensitivities 4 Preventing infection and avoiding leaks 5 Step- by-step: Changing your pouch One-piece pouching system 6 Two-piece pouching system 9 Disposing of used supplies 12 Living with your ostomy Personal hygiene: Bathing or having a shower 13 Other water activities 13 Returning to work or school 13 Clothing 14 Nutrition and diet 14 Avoiding constipation or diarrhea 14 Managing odor 14 Managing gas 15 Travel 15 Sexual activities and intimacy 16 Managing stress 16 Help at home and in your community Who to call for help 19 Making a follow-up appointment with your surgeon 20 Purchasing ostomy supplies 20 Financial assistance and resources 20 Community supports and information 20 Resource lists and contacts Ostomy supply manufactures 21 Local suppliers 21 Ostomy clothing and accessories 22 Financial assistance and resources 22 Community support groups 23 Glossary 24 Note pages 25 2 Leaving hospital following colostomy surgery Living with your colostomy Undergoing ostomy surgery will result is some changes to your life. With support and training on how to take care of your ostomy, you will find that life can be as full as it was before your surgery. This booklet provides information to help you learn to live with a colostomy. Following your surgery, you will begin to recover and become involved in the care of your ostomy. Before you leave the hospital, your care team will begin the process of teaching you how to take care of your ostomy. The care and support that you received in hospital will continue once you are discharged home. Community nurses will be arranged to visit you at home to continue on with the teaching process. Be sure to ask your hospital care team and your community nurse as many questions as you need so that you feel as comfortable as possible with your ostomy. Once you are home, you may also find it helpful to connect with an ostomy support group. Meeting other people who have adjusted their lifestyles after this surgery and have managed to return to their regular activities can be reassuring. Over time you will become more confident and comfortable with caring for your ostomy. Most people living with an ostomy can return to a full and active life. Leaving hospital following colostomy surgery 3 Taking care of your colostomy Skin care and cleaning your stoma Keeping your stoma and surrounding areas clean is important. To clean the skin around your stoma, all you need to use is warm water and a washcloth, or good quality paper towels. It is not necessary to use soap to clean the area around your stoma. If you prefer to use soap, use a very mild soap. Be sure to rinse the soap off the skin around your stoma very well because any soap film may keep your pouching system from sticking and may cause skin irritation. Always dry your skin well before putting on your new pouching system. Sometimes you may see a small amount of blood on your cloth. The stoma tissue contains small blood vessels and may bleed a small amount when cleaned. If you notice any bleeding that does not stop, you should contact your health care provider. Things to avoid Avoid using soaps and cleansers with oils, perfumes, or deodorants since these can sometimes cause skin problems or keep your skin barrier from sticking. The stoma has no nerve endings, so you are not able to feel if you are rubbing too hard. Use a gentle touch when cleaning around your stoma do not scrub. Do not use alcohol or any other harsh chemicals to clean your skin or stoma. They may irritate your skin. Do not use moistened wipes, baby wipes or towelettes that contain lanolin or other oils. These can interfere with the skin barrier sticking and may irritate your skin. Unless recommended, do not apply powders or creams to the skin around your stoma because they can keep your skin barrier from sticking. Removing hair from around your stoma Shaving or clipping excess hair around the stoma in the direction of hair growth can help keep your stoma clean and may limit skin irritation. You may shave with an electric razor or dry shave with an ostomy skin barrier powder and safety razor. Always wash the skin well with water after shaving. To protect the stoma when shaving, place an empty toilet paper roll over the stoma. Skin irritation and sensitivities The best way to limit skin irritation is by having a well-fitted and comfortable pouching system. Your Enterostomal Therapy (ET) nurse in the hospital or health care professional will help you choose the system that fits and works best for you. It is also important for you to identify any issues with your pouch and be aware when something is wrong or if your pouch does not fit properly. The opening of your skin barrier should be no more than 1/8 of an inch away from the edge of your stoma. Measure your stoma once a week for the first six to eight weeks after your surgery. Your stoma shrinks while it is healing and you need to keep measuring so you can make sure that the opening in the skin barrier is the right size for your stoma. Re-measure your stoma if any irritation develops between the stoma and flange. 4 Leaving hospital following colostomy surgery Check your skin and the back of your skin barrier each time you change your pouching system. You can use a mirror to check your skin under the stoma. Look for any places where stool may have leaked under the skin barrier and onto your skin. When you apply your next pouching system, these areas may need some extra reinforcement with skin barrier strips, rings or paste. Your Enterostomal Therapy (ET) nurse or health care professional will advise you when this is recommended. It is helpful to hold your skin smooth as you put your pouching system on to avoid wrinkles that may lead to leakage. (See the step-by-step instructions for changing your pouch in this booklet on page 6). Sensitive skin If your skin is sensitive, it is helpful to tell your Enterostomal Therapy (ET) nurse or health care professional. A skin patch test may be necessary to see if you have any reaction to the different skin barriers and tapes. Usually the ingredients in the skin barriers do not cause skin irritation. Itching or burning under the skin barrier may indicate that you have leakage, a skin rash, or a skin infection. If you feel itching or burning, remove your pouching system as soon as possible to check your skin for irritation. Preventing infection and avoiding leaks A stoma rarely becomes infected. The most important thing is to protect the skin around your stoma. The best way to prevent an infection is to make sure the pouching system fits properly. Always change your pouching system at the first signs of leakage. Do not try to patch the pouching system with tape or paste. Leaving a leaking pouch on can cause skin irritation. To prevent leaking, always empty your pouch before it is half-full. Release the gas before the pouch gets too full. If you have a lot of gas, you may want to consider using a pouch with a vent or filter. You will know if you are having a reaction to the skin barrier or tape most of the time, because you will see skin changes that match the shape of the product. Inform your Enterostomal Therapy (ET) nurse or health care professional so they can determine the cause of the irritation and recommend another product if needed. Leaving hospital following colostomy surgery 5 Step-by-step: Changing your one-piece pouching system 1. Organize your supplies What you need: Pouch Measuring guide Scissors Marker Barrier ring (as required) Disposal bag to discard your used product Wet and dry cleaning cloths 2. Caring for your stoma & skin Gently cleanse your stoma and surrounding skin with a wet, warm cloth. A mild soap may be used as long as all skin is rinsed well. Pat skin dry. Your stoma will be swollen after surgery. It may take six to eight weeks for your stoma to reduce to its permanent size. Your stoma should be light pink or red in colour. Your stoma will be moist and may bleed slightly when washed. The skin around your stoma should not have any signs of redness or a rash. 6 Leaving hospital following colostomy surgery 3. Measuring your stoma Measure your stoma using the measuring guide - it is important that there is a small amount of space between the cut opening and stoma. This allows room for your stoma to expand and pass stool through the opening. After a six-week period, measurement is generally not required and flanges may be precut in advance. It is recommended that you re-measure your stoma every two to three months to be certain that there have not been any changes. 4. Creating and applying a barrier ring Trace the pattern of your stoma onto the paper backing of the pouch. Cut the pouch to match the pattern. Put your fingers inside the pouch to avoid cutting through the pouch. Remove the paper backing from the skin barrier portion of the pouch and set aside. Gently stretch and apply the barrier ring around the cut opening of the sticky side of the skin barrier portion of the pouch (if using). Leaving hospital following colostomy surgery 7 5. Securing the pouch in place Place the skin barrier opening around your stoma. Make sure the pouch is hanging in the correct position, normally downward. Gently press the barrier onto your skin. Remove the remaining tape backing. 6. Closing the opening Roll up the pouch three times in the same direction (towards your) and press the seal from the middle out, until secure. General guidelines Empty the pouch when 1/3 to 1/2 full of stool/gas. The pouching system should be changed two to three times a week during the first six to eight weeks. Long -term, the system is generally changed twice weekly. This will vary with each individual. Make sure you: Change your pouching system if there are signs of leakage or if you feel a burning or itchy sensation. Notify your Enterostomal Therapy (ET) nurse or health care professional if you have questions or concerns. 8 Leaving hospital following colostomy surgery Step-by-step: Changing your two-piece pouching system 1. Organize your supplies What you need: Flange Pouch Measuring guide Scissors Marker Barrier ring (as required) Wet and dry cleaning cloths Disposal bag for your used product 2. Caring for your stoma & skin Gently cleanse your stoma and surrounding skin with a wet, warm cloth. A mild soap may be used as long as all skin is rinsed well. Pat skin dry. Check your stoma and surrounding skin condition. Your stoma will be swollen after surgery. It may take six to eight weeks for your stoma to reduce to its permanent size. Your stoma should be light pink or red in color. Leaving hospital following colostomy surgery 9 3. Measuring your stoma For the first six to eight weeks after surgery, your stoma should be measured and the opening in the flange adjusted accordingly. It is important that there is a small amount of space between the cut opening and stoma. This allows room for your stoma to expand and pass stool through the opening. After a six-week period, measurement is generally not required and flanges may be precut in advance. It is recommended that you re-measure every two to three months to be certain that there have not been any changes. 4. Creating and applying a barrier ring Trace the pattern of the stoma shape onto the back of the flange. Cut the flange to match the pattern. Remove the clear plastic backing on the flange and set the flange aside. Gently stretch and apply the the barrier ring around the cut opening of the sticky side of the flange if using. 10 Leaving hospital following colostomy surgery 5. Remove remaining tape backing Place the skin barrier opening around your stoma and press it gently onto your skin. Remove the remaining tape backing. A mirror may be helpful to centre the flange. 6. Secure pouch in place Place the pouch onto the base ring of the flange. Place your fingers under the flange for support while attaching the pouch to the flange. Move your fingers clock-wise. Gently tug downward on the pouch to make sure it is attached securely. 7. Close the opening Roll up the pouch three times in the same direction (always towards you). Place the flap down and press the seal from the middle out, until secure. Leaving hospital following colostomy surgery 11 General guidelines Empty the pouch when it is 1/3 to 1/2 full of stool or gas. The pouching system needs to be changed two to three times a week during the first six to eight weeks. Long-term, the system should be changed twice weekly. This may vary with each individual. Make sure you: Change the complete system if there are visible signs of leakage. Notify your Enterostomal Therapy (ET) nurse or health care professional with any concerns or questions. Disposing of used supplies Put your soiled pouching system into a regular plastic bag or a disposal bag provided by your ostomy supplies company. These bags can be thrown away with your regular garbage. 12 Leaving hospital following colostomy surgery Living with your ostomy An ostomy should not affect your ability to resume your lifestyle. Many people find they can continue all of the activities that they enjoyed before their illness and/or surgery. It will take time before you will be physically and emotionally ready to resume normal activity. Allow yourself the recovery time. Be good to yourself and take the extra time to regain your strength and energy. Personal hygiene: Bathing or having a shower You can shower or bathe with or without your pouching system in place. Pouching systems are waterproof. You may find it convenient to plan your pouching system change around your shower or bath. Water, soap or shampoo cannot harm or enter your stoma. If the water pressure is very strong, be careful not to let it hit your stoma directly. It is a good habit to empty the pouch before you shower, bathe or participating in other water activities, such as swimming. Other water activities It is important to check your pouching system before and after you have exposed it to water including activities such as swimming. If you are in water for a long period, the pouching system may start to loosen from your skin. Pouching systems are waterproof. However, you may feel more secure if you wear skin-friendly tape around the edges of your skin barrier when you are in the water. While swimming, you may want to consider wearing tight biking style shorts to keep the pouch close to your body and help keep it from floating. Other options may include a swimming belt or layering a tighter athletic style bathing suit under a trunk style bathing suit. Gas filters do not work after they get wet. It is best to protect the filter with waterproof tape before water activities. Many ostomy supply companies provide filter seals with the pouches. After bathing or swimming, you may use a towel or a hairdryer (on the coolest setting) to dry the tape and cloth backing of the pouching system. This can also help prevent skin irritation from wetness. You may find it helpful to wait approximately an hour after changing your pouching system before swimming. Returning to work or school Many people have concerns about returning to work or school activities. Will I smell? Will there be noises? Will they see it? What if someone asks? These are common concerns. Ostomy pouches are designed to hold stool and to manage odor. There should be no odor, but you can consider using deodorant drops or air fresheners to add confidence and comfort. Noises associated with your pouch are often muffled by clothing. By placing an arm across your stoma site, you can further muffle noises. Your pouch should not be visible once you are fully dressed. Remember, as a person you have not changed. You have a surface change that has given you back your health. The decision to share with others is personal. You only need to tell people you have an ostomy if you want to. Leaving hospital following colostomy surgery 13 Clothing You can continue to wear the same clothing that you wore before your ostomy surgery. Some people may prefer wearing suspenders instead of a belt, pants with pleats and patterned clothing. A full, snug undergarment is recommended to give support to the pouching system and create a smooth line under your clothing. Snug-fitting clothing can be worn without fear of harming the stoma or interfering with stoma functioning. Nutrition and diet Dietary change will depend on the type of surgery you have had. Generally, there are no food restrictions following colostomy surgery. In the long-term it is important to include fiver in your diet so that your colostomy continues to function well. Here are some examples of high fibre foods: Fruit: pears, figs, blueberries, apples Grains, cereals and pastas: whole wheat pastas, bran flakes, oatmeal, rye or whole wheat/grain bread Legumes, nuts and seeds: lentils, black beans, lima beans, almonds, peanuts Vegetables: peas, artichokes, brussel sprouts, turnips, potatoes, broccoli. Avoiding constipation or diarrhea You may experience constipation or diarrhea with your colostomy. You would treat them the same way you would whether you have a colostomy or not. Diarrhea - if you experience diarrhea, it is important to increase your fluids, eat bland food and get extra rest. Constipation - if you experience constipation, it is important to increase your fluids, add extra fibre into your diet and take a stool softener (such as Colace or a natural bulking agent such as Metamucil.) If diarrhea or constipation persists, seek medical advice. Managing odour Your pouch is designed to control odour. When it is secure and in place, there should be no odour. Stool odour is a result of a person s body chemistry. If you have concerns, here are some things that you can do to help reduce any odor when changing your pouch: Use deodorizing tablets or liquids for deodorizing the inside of the pouch Use neutralizing sprays or wicks to freshen the bathroom Foods that tend to produce odour: Fish Chicken Eggs Beans Onions Vegetables of the cabbage family Foods and liquids that may reduce odor: Cranberry juice Yogurt Buttermilk Fresh parsley 14 Leaving hospital following colostomy surgery Managing gas Following your surgery, you may notice increased gas and noise because your bowel is now empty and has been handled during your surgery. It is important to get back to eating regular balanced meals to reduce gas. Skipping meals is more likely to increase gas production. Here are some tips to avoid gas build-up: Eat slowly and chew food well. Avoid gum chewing, smoking, mouth breathing, carbonated drink and sucking on ice chips or candies. All of these things encourage swallowing large amounts of air, which produces more gas. To help thicken stool: applesauce, oatmeal, bananas, cheese, creamy peanut butter, boiled rice, tapioca, and boiled milk. Drink at least six to eight glasses of non-caffeinated liquids each day. Caffeine may cause a looser output. Beverages with caffeine include coffee, tea, chocolate and cola drinks. Yogurt helps to control gas formation and buttermilk helps soothe an irritated bowel. Be aware of foods that can produce more gas. Experiment by excluding these foods from your diet. Troublesome foods may include: Vegetables of the cabbage family Asparagus Sweet potatoes Onions Milk and milk products Melons Dried beans and peas Spicy foods Beer Cheeses (roquefort, brie and other strong cheeses) Travel People with an ostomy travel just like anyone else. Here are some travel tips: Carry identification with your medical contact information, ostomy product codes and Enterostomal Therapy (ET) nurse s name and phone number. Your ostomy chapter, ostomy retailer or company will often carry ostomy identification cards. M
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