What is an Ostomy?

 

In simplest terms, an ostomy is a surgically created opening in the body for the discharge of body wastes. This opening that you see on the outside of the abdomen is called a stoma.

People need ostomies for many reasons, including cancer (colorectal, bladder), inflammatory bowel diseases like Crohn’s or Ulcerative Colitis, trauma, or birth defects.

While every journey is unique, the basics of care remain similar across the three main types of ostomies.

The Three Main Types of Ostomies

 

It is crucial to know which type you have, as it affects the consistency of output and how you manage it.

Colostomy: This involves the large intestine (colon). Because the waste has traveled further through the digestive tract, the stool is typically more formed.

Ileostomy: This involves the small intestine (ileum). Since waste leaves the body before reaching the colon (where water is absorbed), the output is usually liquid to pasty and more frequent.

Urostomy (Ileal Conduit): This is for urinary diversion. The bladder is bypassed or removed, and a small piece of intestine is used to create a channel for urine to exit the body. The output is strictly urine and perhaps some mucus.

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Understanding Your Stoma

 

A healthy stoma should look similar to the inside of your cheek—moist, shiny, and red or pink in color.

Important Stoma Facts:

• It has no nerve endings: You cannot feel it when you touch it. This is good because it doesn’t hurt, but it also means you need to be careful not to injure it unknowingly.

• It may bleed slightly: Because it is vascular tissue, seeing a small amount of blood on your wipe when cleaning is normal. Heavy bleeding is not.

• Size changes: Your stoma will likely be swollen after surgery. It typically shrinks to its permanent size over the first 6 to 8 weeks.

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Decoding Ostomy Supplies (The Lingo)

 

Walking into a medical supply store can be daunting. Here is a breakdown of the essential terms you need to know.

The Pouching System

 

This is the appliance you wear to collect waste. It has two main parts:

• The Wafer (or Flange/Baseplate): The sticky part that adheres directly to the skin around your stoma. Its job is to protect your skin and hold the pouch on.

• The Pouch (or Bag): The container that collects the stool or urine.

1-Piece vs. 2-Piece Systems:

• 1-Piece System: The wafer and pouch are permanently attached. They are thinner and more flexible, but to change the pouch, you must remove the entire wafer from your skin.

• 2-Piece System: The wafer and pouch are separate. You stick the wafer to your skin, and the pouch snaps or sticks onto the wafer like Tupperware. This allows you to change the bag quickly without disturbing the skin barrier.

Essential Accessories

 

• Barrier Rings: Think of these as a “turtleneck” for your stoma. They mold around the base of the stoma to fill uneven skin dips and prevent leaks.

• Stoma Paste: Similar to caulk, it’s used to fill creases in the skin to create a flat surface for the wafer. (Note: It is not glue).

• Stoma Powder: Used only on weepy, irritated skin to help the wafer stick. It is often used with a barrier wipe in a technique called “crusting.”

• Ostomy Belt: Hooks onto the pouching system to provide extra security and support, especially when active.

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Step-by-Step: How to Change Your Pouch

 

Note: Always consult with your WOCN (Wound, Ostomy, and Continence Nurse) for instructions specific to your needs. This is a general guide.

Preparation:

Gather your supplies first: new wafer/pouch, measuring guide, scissors (if cutting-to-fit), wipes/washcloths, and accessories (rings/paste).

Step 1: Remove the Old Pouch Gently push the skin down away from the wafer rather than ripping the wafer off like a bandage. Use an adhesive remover wipe if necessary.

Step 2: Clean the Skin Use warm water and a soft cloth or paper towel. Do not use baby wipes, lotions, or soaps with oils, as these leave a residue that prevents the new pouch from sticking. Dry the skin completely.

Step 3: Measure the Stoma Use a measuring guide to find the exact size of your stoma. It should fit snugly, like a hug—not choking it, but not leaving skin exposed.

Step 4: Prepare the New Wafer Trace the measurement onto the back of your wafer and cut the hole. If using a barrier ring, apply it to the wafer or directly around the stoma now.

Step 5: Apply the New System Peel the backing off the wafer. Center the hole over your stoma and press firmly against the skin. Use the warmth of your hands over the wafer for about a minute to help the adhesive set. If using a 2-piece system, snap or stick the pouch onto the wafer.

Step 6: Close the Pouch Ensure the bottom of your drainable pouch is securely closed with the clip or Velcro closure.

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Troubleshooting Common Challenges

Managing Gas (Ballooning)

 

Gas is normal, but it can cause the pouch to puff up like a balloon.

• Dietary Causes: Beans, carbonated drinks, cabbage, and onions are common culprits.

• Swallowed Air: Avoid chewing gum and drinking through straws, which cause you to swallow excess air.

• The Solution: Some pouches have filters intended to let gas out automatically, but they often clog. The most reliable method is to manually “burp” the bag by slightly opening the tail (over a toilet) to let the air out.

Skin Irritation

 

Healthy skin around the stoma is crucial for a good seal. The number one cause of irritation is output leaking under the wafer and touching the skin.

• If your skin is red, weepy, or painful, re-measure your stoma to ensure your wafer hole isn’t too big.

• Utilize stoma powder and barrier spray (the “crusting technique”) to help heal broken skin so the pouch can adhere properly.

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Conclusion & Resources

 

Living with an ostomy requires an adjustment period, but you can live a full, normal life. The key is patience and finding the right routine and supplies for your body.

Remember to lean on certified WOCNs (Wound, Ostomy, Continence Nurses)—they are your best resource for individualized care.

Helpful Links Mentioned in This Guide:

• The Frank & Lizzie Show: https://frankandlizzieshow.com/ (For more educational videos and support)

• United Ostomy Associations of America (UOAA): https://www.ostomy.org (Great for finding local support groups)

• WOCN Society: https://www.wocn.org (To locate a specialized nurse near you)

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Disclaimer: This content is for educational purposes only and is not medical advice. Always consult your physician or a certified WOCN for medical guidance regarding your ostomy care.