The Ostomy Association of the Houston Area

Most patients wonder initially how they will feel and act being an ostomate. Due to having an ostomy myself and because the surgeons who use my professional service know that I have an ostomy, many of my patients have already been told that I will be instructing them in their ostomy care and that I have an ostomy. Consequently, they look at me to see if they can see my prosthetic device “Bag” under my clothes. “Will I bulge?” is uppermost in the minds of new ostomates or people who are scheduled for an ostomy procedure.

No you won’t IF you keep your ostomy device emptied as often as needed. If you allow your prosthetic device to become too full you may experience a “bulge” under your clothes and also place yourself at risk for leakage. This especially applies to Ileostomates and Urostomates.

You can expect to wear, with little exception, what you wore before surgery. This includes tight clothing and bathing suits (except for bikinis).

Those with ileostomies or urinary diversions will be fitted with prosthetic devices that are completely odor-proof. Colostomates control odor with diet and for colostomates who irrigate daily or every other day, there are odor-free stick on pouches or odor-free opaque stoma caps with deodorizing filters.  There are also various brands of drop deodorants which can be place in drainable pouches.

Everyone produces gas, especially if he is an air-swallower.  You do not make noises so often that you can’t pretend that your stomach is growling.  Be the fastest elbow in the West (i.e.: place your arm across your stoma).  You may also turn your head and look behind you making others think you are searching from where the noise is coming from.  Women can wear pantyhose or a girdle with no stays (always purchase a girdle one size larger than you would normally wear so as not to put too much pressure on you stoma).

   You will not experience the urge to have a BM nor to urinate. The intestines have very little feeling, but you will notice contents being expelled into your bag. This applies to Ileostomates, Urostomates, and those with colostomies who choose to wear a drainable pouch vs. irrigation of their colostomies to provide more control over their output. New ostomates empty their prosthetic devices more often than needed usually because they are not used to the warmth felt by the plastic pouch against their body. A pouch cover helps to prevent this feeling.

Disclaimer: The information contained within this column is presented expressly for informational purposes only and may not be applicable to everyone. It should not be substituted for professional medical care or attention by a qualified practitioner. Always check with your doctor if you have any question or concerns about your condition.

Ostomates who have gained an excessive amount of weight post operatively (especially those with Ileostomies or Urostomies) or those whose stomas that are flush or receded with abdomens that protrude above and below their stomas or whose abdomens protrude entirely around their stomas, are candidates for the use of a one or two piece prosthetic device with convexity. Also, in the process of construction of the J-pouch (internal pouch vs. standard Brooke’s Ileostomies), Loop Ileostomies are created initially at the time the J-Pouch is created internally out of a portion of the small intestine this leaving less intestine for the surgeon to bring out on the abdomen while the J-Pouch is healing and not activated. This can be done in a two or (occasionally) three step procedure. Loop Ileostomies often require management by the use of a convex prosthetic device which pushes the stoma out more allowing the effluent expelled by the stoma to go into the pouch instead of under the wafer. It is important to keep in mind that convex prosthetic device generally have pre-cut openings for the stoma from ¾” to 2” openings. Coloplast does provide a one piece cut-to-fit prosthetic device with convexity (15-45 mm) which is called their New Generation series and is provided with Easy Close outlets. Please note that the Loop Ileostomies mentioned above in the creation of a J-Pouch are temporary and taken down surgically in either the 2^nd or 3^rd stage of this procedure when the internal pouch has had sufficient time to heal. Some Colon and Rectal surgeons are now able to create a Loop Ileostomy in certain cases of rectal cancer when the surgeon determines that the malignant tumor can be removed and the sphincter muscle can be preserved. Sometimes these types of Loop Ileostomies also are best managed by a convex prosthetic device. I recommend that in most cases a Convex Prosthetic device should be fitted by the ostomate’s E.T. nurse for proper evaluation of the opening size needed.

In order to answer this question appropriately, the cause of the leakage must be determined. A well fitting ostomy device should last from 5-7 days without leakage. However, many factors have to be taken in consideration.

1. Is the ostomy device the most appropriate one for the person experiencing the frequent leakage?
2. Is the opening being cut to the correct opening size? If the ostomate is wearing a cut-to-fit wafer, the stoma should be measured and the opening should be cut to accommodate the stoma with no abdominal skin showing between the wafer and the stoma. Conversely, the opening should not be cut too small which could make it cover a portion of the stoma thereby causing the effluent expelled by the stoma to go under the wafer.
3. Chemotherapy treatments can effect the wear time of the wafer.
4. Inappropriate peristomal skin preparation can be a cause for leakage (i.e., Use of soaps containing oil or use of baby wipes to clean the skin can contribute to wafer leakage problems).

My recommendation to ostomy patients is the use of plain warm water only to clean the peristomal skin. If any residue from the previous wafer, stoma paste, etc. remains on the skin after removing the wafer, clean the skin with a Remover Wipe such as All Care by ConvaTec or Uni-Solve by Smith Nephew, and then cleanse the peristomal skin with plain warm water and pat it dry with a soft towel. Use of stoma paste around the opening cut out for the stoma on the skin side of the wafer (after removal of the paper covering from that portion of the wafer) and the use of a Barrier Wipe (there are many brands of both of these products on the ostomy market-ConvaTec, Hollister, Coloplast are the primary brands used) are helpful in skin preparation and will generally promote better wear time. An ostomate with a flabby abdomen or crease to the right and left of the stoma may need a convex prosthesis. (See answer to “When should I use a convex prosthetic device?")

They do for some ostomates. Each person’s body is different. What works well for one ostomate does not necessarily work for all people living life with an ostomy. I, personally, recommend deodorant drops to be used in the pouch. M-9 by Hollister is very effective for most ostomates. It is a matter of each ostomate obtaining samples (if possible) of oral and drop deodorants and then determining for him or herself which is the most effective.

Each new ostomate must ask this question of his/her surgeon. The rectus muscle is severed in ostomy surgery and the intestine used to create the stoma is brought through this muscle for support. This causes that muscle to be weakened but it does not mean that the muscle wall will close in on the stoma. Do not do abdominal workouts until you have discussed this matter with your surgeon. In general, heavy lifting (over 5-10 lbs.) and strenuous abdominal workouts are prohibited immediately following ostomy surgery.

When the peristomal skin continues to be irritated, the cause is not generally due to changing the prosthesis too often. Sensitivity to the wafer or other products used in skin care around the stoma can contribute to skin irritation. If the ostomate resides in Houston or surrounding areas, the hot humid summer weather can cause a heat rash, especially under the wafer or where the drainable pouch covers and touches the abdomen. This is noticed in those who either work outdoors in the occupations or those who work outside in the summer in their own yards or those who participate in outdoor sports during the summer months. Getting hot and sweaty definitely can contribute to skin irritation and also cause poor adherence of the prosthetic device. Sometimes when an ostomate is taking an antibiotic over an extended period of time, a monilia fungal rash can occur under the appliance. This type of rash must be treated with prescription medication by the name of Mycostatin Topical Powder or Nystop (Nystatin Topical Powder). The ostomate experiencing skin irritation should consult his E.T. I recommend doing a skin test of all products used in ostomy care in order to determine what is causing the skin irritation when skin sensitivity to products used appears to be the cause of the irritation. This is generally done under the direction of the ostomate’s ET.

The ostomy equipment used for long trips, cruises, air plane trips, etc. should be no different than what one normally uses. In my opinion, the issue is not the type of ostomy device that one should wear for traveling, but how one disposes or empties the device. I think that a person should empty their urinary, ileostomy, or colostomy device as one normally does. There is an available product, which can be used by both colostomates and ileostomates, which gives the ostomate traveling long distances an option that he or she might want to consider. This product is called “Colo-Majic (Flushable) Ostomy Pouch Liner”. It is quick and easy to change. It requires no water, and extends pouch life. It may be carried in a pocket or in a handbag. The manufacturer is Colo-Majic Liners, Inc. The toll free number is 1-888-808-1177 or more information may be obtained on their web site which is www.colostomymajic.com.

Personally, when I first sit in my seat I check the tightness of the seatbelt. The length may vary from airline to airline. If it appears to be too tight, many of the airlines will have “expanders” which will length the belt. If you are traveling often, then you may want to check with a travel store to see if they might have one that you can purchase to carry with you. Seat belts in any automobile have never been a problem for me. However, others have had a problem. I have suggested that one could place a small, thin pillow or foam rubber cushion between the seat belt and the ostomy site. This would relieve the pressure or possible discomfort caused by the position of the seat belt on the ostomy site. When a person lives life with an ostomy, he or she must realize that improvising in some situations becomes a necessity, not an option.

Yes, it is possible. I have been involved in the provision of ostomy care for some women who were pregnant and delivered healthy, normal babies. I have also known other women with ileostomies, one a Wound Ostomy Care Nurse, who have had babies. If possible, the woman who has an ileostomy and wants to have a child should discuss this matter with her obstetrician before the decision is made to try to become pregnant. Some obstetricians decline to take on this added responsibility. There are some issues that develop with the expansion of the abdomen as the fetus grows, particularly those related to the stoma and the device worn. The stoma will expand in most cases, therefore the expectant mother will need to see an ostomy nurse for assistance with this issue. Other internal changes in the body should be carefully monitored by her obstetrician. Other problems may develop that require the attention of a Colon and Rectal Specialist.

This is a “loaded” question. Many factors must be considered in answering it appropriately. It depends on what type of ostomy surgery has been performed, the diagnosis requiring the surgery, and whether the patient is male or female. The age of the patient and other health issues also must be considered in consultation with a physician. There is no single answer that is appropriate for all patients who have undergone ostomy surgery. There are psychological issues as well as the physical ones involved in the recovery from ostomy surgery of any kind. Time for physical healing must be considered and the psychological issues must be resolved before satisfactory sexual relations can be successfully resumed. The attitude and action of the ostomate’s sexual partner are important factors to be considered in satisfactory sexual adjustments following ostomy surgery. Some couples who do not get along well prior to the surgery will use the surgery as an excuse to reduce or cease sexual relations. It has been observed that couples who had a warm loving relationship before surgery usually work out an accommodation to sexual problems following surgery. Literature which has been written to assist ostomates, both male and female, with sexual issues and/or problems following ostomy surgery is available from the United Ostomy Association. Information on these booklets may be obtained by calling the UOA National Office at 1-800-826-0826. The UOA’s website www.uoa.org would also list the literature available.

I have known other ostomates who have gone scuba diving. The request for a prescription may be related to a liability issue. Scuba diving is done in the ocean, and there should not be a problem if leakage should occur. It can and has been an issue for some who have needed water therapy in pools at some Physical Therapy facilities. I would suggest not eating much prior to this activity and to make certain the ostomy device was well secured with a water proof tape. With a securely attached appliance a person with an ostomy can participate in almost any sport or activity which he or she feels capable and enjoys doing. Other than lifting extremely heavy weights an ostomate should live a full, normal life and participate in all activities he or she desires.