Understanding Colostomy
Understanding Colostomy Surgery
Colostomy Types: Locations and Care Needs
Understanding & Managing Colostomy Surgery Complications
Following a review of colostomy complications, it’s helpful to delve deeper into two specific issues that significantly impact the daily care of colostomy patients: stoma prolapse and stoma retraction. These conditions each present unique challenges in both care practices and the selection of appropriate products, essential for managing patient comfort and reducing the risk of further complications.
What is Stoma Prolapse?
Stoma prolapse occurs when the intestinal loop extends through the stoma opening excessively, typically by 3cm or more. Prolapse can range in severity, from mild swelling to a telescoping effect where the intestine visibly protrudes up to 20cm. It’s most common in transverse colostomies and typically painless but may lead to complications.
Causes of Stoma Prolapse
Understanding the causes of prolapse helps in both prevention and management. Key factors include:
- Surgical Technique: If the abdominal wall opening is too large or the intestine isn’t securely fixed.
- Increased Abdominal Pressure: Heavy lifting, chronic coughing, or other activities that strain abdominal muscles can exacerbate prolapse.
- Weak Abdominal Muscles: Patients with a history of obesity, aging, or previous surgeries may have weakened abdominal walls, increasing the risk.
Symptoms to Watch For
- Swelling and protrusion of the stoma tissue.
- Bleeding or ulceration around the stoma.
- Intestinal obstruction or twisting, which may require medical attention.
Practical Tips for Managing Stoma Prolapse
- Choose the Right Ostomy Product: Avoid Tow piece Colostomy Bags. Opt for One piece, large-capacity pouches that can accommodate the prolapsed tissue comfortably.
- Customize the Baseplate Opening: Cut the baseplate hole to fit the protruding tissue size, preventing friction and leakage.
- Use a Support Belt: Supporting the prolapse with an ostomy belt helps keep the stoma in place. Ensure it’s positioned correctly and periodically release it to allow output evacuation.
- Manual Repositioning: For mild cases, lying down can help the prolapse retract naturally. In cases where manual intervention is required, consult a healthcare provider to avoid complications.
What is Stoma Retraction?
Stoma retraction happens when the stoma sinks below the skin surface, often causing leaks and skin irritation due to poor pouch adhesion. Retraction is seen in roughly 6% of ostomies, with a higher incidence in end stomas than loop stomas.
Common Causes of Stoma Retraction
Retraction often occurs due to surgical issues or secondary conditions, such as:
- Insufficient Stoma Length: The stoma wasn’t pulled far enough through the abdominal wall during surgery.
- Adhesion Problems: Separation of the mucosa from the skin can cause sinking, especially in cases of necrosis or infection.
- Excessive Abdominal Fat: Overweight patients often have increased abdominal pressure, which can push the stoma inward.
Symptoms and Risks
- Frequent leaks due to poor adhesion between the skin and ostomy bag.
- Skin irritation and infections around the stoma from exposure to output.
Solutions for Managing Stoma Retraction
- Use Convex Colostomy bags and Belts: Convexity helps lift the stoma above skin level, improving the bag’s fit. Support belts can also enhance stability.
- Address Leakage Promptly: Clean the area with saline solution and use ostomy barriers rings and skin pastes to prevent further irritation.
- Protect Surrounding Skin: Non-alcohol ostomy skin barriers sprays or ostomy powder can shield the skin from potential infection.
- Consider Reconstructive Surgery: For severe retraction where the stoma retracts into the abdominal cavity, surgical intervention may be necessary.
Important Reminders for Stoma Care
- Routine Monitoring: Check the stoma daily for any changes in size, color, or positioning, which can indicate emerging complications.
- Avoid Abdominal Strain: Minimize heavy lifting and other activities that may increase intra-abdominal pressure.
- Regular Follow-Ups: Schedule periodic visits with a stoma care specialist to ensure proper pouching and address any complications early.
Conclusion
Stoma prolapse and retraction, while concerning, can be effectively managed with the right tools and care techniques. Selecting appropriate products, maintaining good hygiene practices, and collaborating closely with healthcare professionals can significantly enhance comfort and overall quality of life.
We encourage our readers to continue following our expert insights on stoma care and related topics. In our next article, we will explore an important question: Colostomy Reversal: Is it Possible?