Skin Care

 

Proper skin care is important to reducing complications. Allergic reactions can occur to pouch adhesive products; in such cases alternates or skin barriers can be used. Cleansers and exposure to feces can cause contact dermatitis. Carefully washing off cleansers and removing fecal matter can reduce the problem. The application of topical steroids may help to reduce the symptoms.

 

Areas that are consistently moist and warm are at risk for fungal and yeast infections. Patients should be made aware of these signs and symptoms, and educated as to how to prevent conditions that favor yeast and fungal growth. Interventions may include additional patient education on the importance of carefully cleaning and drying areas around the colostomy, changing pouches more often, and the use of topical powders (eg lotrimin or miconazole).

 

Foliculitis can result from traumatic hair removal due to pouch adhesives or shaving. Careful pouch removal and appropriate shaving methods along with a skin barrier may help the area to heal.

 

Pouching Systems and Irrigation

 

As stated earlier, the sigmoid colostomy can be maintained with either a pouching system or a cap, which requires irrigation at regular intervals. Irrigation assists in promoting bowel movements. Patient who have regular-interval bowel movements before surgery are likely to be able to return to regular bowel movements within one to two weeks post-surgery. Patients who opt for this method of maintenance are instructed to irrigate their colostomies (much like an enema) at approximately the same time each day. A bag is filled with three to four cups of warm water and attached to the stoma through a cone placed in an irrigation sleeve after any bowel contents are emptied into a toilet. Water is allowed to enter the colon over a period of 5-10 minutes. The patient is advised to monitor for cramping and stop water flow if cramping occurs before resuming at a slow pace. After most of the water is emptied from the bag, it is clamped off. After a couple of minutes, the cone is removed and the irrigation sleeve is closed. Stool and water should then drain for between 10-20 minutes until most has been eliminated. After this process is completed, the patient should carefully clean and dry the equipment for storage until its next use.

 

Irrigation may be contraindicated in children or teenagers (due to the possibility for dependence), during diarrhea, prolapse or with hernia patients (due to the increased risk for prolapse and bowel perforation), and patients treated with pelvic or abdominal radiation.

 

Pouching systems are most commonly used and include several types. In one-piece pouches the adhesive skin barrier is attached to the pouch itself. Two-piece pouches have a separate barrier. There are pre-cut pouches ranging from ¾ to 2 ½ inches and pouches that can be cut to fit the unique size and shape of a stoma. There are both drainable and one-use pouches. The drainable type is drained at the end of the pouch and reused. The disposable type can be used until half-full before disposing of the pouch.

 

Pouches come with measuring guides that suggest finding the smallest hole that will fit around the stoma leaving an eighth of an inch gap. Cut-to-fit pouches may be most appropriate during the first few months when the stoma may be swollen before eventually reducing to its final size.