Since intestinal contents may irritate the surrounding skin, the patient's stoma should be washed with warm water. A very mild soap should be used, since oil-based or fragrant soaps may cause skin irritation. The soap should be rinsed off the area thoroughly well to prevent skin irritation. Cold water is avoided because it may lead to cramping.
The hole of the appliance surrounding the colostomy pouch should be cut 1/8 inch wider than the stoma. The additional room around the stoma prevents constriction of the skin opening.
A colostomy in the ascending and transverse colon has semiliquid stools, while a colostomy in the sigmoid or descending colon has semi-formed or formed stools. Since drainage is frequent and extremely irritating to the skin, the stoma should protrude at least 1 cm to minimize seepage leading to altered skin integrity.
Full Leakage of intestinal contents will cause skin breakdown and infection. Empty the pouch when it becomes 1/3 to 1/2 full to prevent leakage.
Many patients with a colostomy are unable to establish regularity and must wear a pouch at all times. An open-ended pouch is recommended for easy drainage. The pouch is changed every 3-7 days. If the pouch leaks, it should be immediately removed and replaced with a new colostomy bag.
To minimize gas and body odors, instruct the patient to avoid odor causing foods. Foods that may cause odor include dried beans, asparagus, fish, cabbage, onions, cheese, and eggs. Certain vitamins and medications may also cause odor.
The patient's colostomy should be irrigated at the same time every day to help stimulate emptying of the colon. Irrigating and emptying the colon on a regular basis will prevent stool elimination in between irrigation sessions. Regularity may allow the patient to only need to wear a pad or small pouch over the stoma instead of a bag. A colostomy in the sigmoid or descending colon may be regulated using the irrigation method. However, a pouch should be readily available in case the patient develops diarrhea from food or illness.
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