Proctocolectomy and Colectomies

You may wonder what a colectomy or a proctocolectomy are, and here, we’ll go over what each of these are, the differences, and why someone may possibly get one or the other. A proctocolectomy is a removal of the rectum and colon, with a colectomy being a removal of your colon. While they may alleviate the Crohn’s disease symptoms, it does permanently alter the gastrointestinal system in the body. 

Colectomy 

This is usually done if there is a disease within the colon, and it needs to be removed, but your rectum is left unaffected by say Crohn’s disease and the like. The surgeon usually joins the ileum to the rectum, and you’ll be able to pass stool still via your anus without an external pouch. 

Proctocolectomy 

This is something that’s recommended if the large intestine is too diseased and has to be taken out. There are variations, but usually you get this with the end ileostomy that’s there. In the end ileostomy, the end of your small intestine is then inverted through a hole made by your abdominal wall, diverting waste to the ostomy appliance that’s there. Those that have ulcerative colitis may get an ileal pouch and anal anastomosis, which create a j pouch internally using your small intestine end, and usually eliminates an ostomy bag. However, for those who have Crohn’s disease, it isn’t recommended since the disease does recur in that pouch. With a proctocolectomy, the anus, colon, and the rectum are removed and usually you get an ileostomy that creates a stoma to drain out the waste. 

The stoma is about a quarter in size and protrudes a bit from the abdomen area. Usually, it’s pink, and looks shiny and moist. The ostomy pouch attaches to this and is worn all the time to et waste. Usually, the site for ileostomies is your lower abdomen near the right side of the navel, just underneath the belt line. After this, you may feel like you have bowel movements, and it does cause phantom rectum feelings. This is very normal, but it doesn’t need treatment or anything else attached to this. Oftentimes these feelings do usually subside as time goes on too. 

Living with The Ileostomy 

You can actually live a life that’s long, productive, and active, and in a lot of cases, patients can do the same things they did before, including activities outside, various sports, swimming and other water activities, even travel and work outside the home. It is common to feel a little bit self-conscious after this, and you might feel your body image change as well. The bag, however, does lay flat underneath your clothing, and it isn’t visible to other people. Nobody needs to find out that you have an ostomy bag, unless of course you choose to let them know about this. 

It is important however, to keep your mental and emotional health together too, just like with your physical health. If you’re experiencing feelings that you feel would be better discussed with a doctor, remember there is no shame in getting help for this as well. It’s a big change after all. You may struggle at first with the ostomy bag, since you do need to empty it a bit.  There are also different pouch systems as well. Usually, there aren’t any real dietary restrictions to worry about, but you should always make sure to have lots of fluids, so you don’t suffer from electrolyte loss or dehydration as a result of this. Foods high in pectin such as bananas and applesauce also will help you as well. 

Assessing And Managing Stomal Complications

Stoma complications can occur at some point after surgery in some patients. It is the job of nurses to assess the problem quickly, provide an effective solution, and refer the patient to the doctor if necessary.

According to a survey conducted in the year 2002, about 73% of people with a stoma have face skin problems, and about 66% of them try to resolve those problems without consulting to a nurse. Nurse involvement gets necessary in a situation where a patient doesn’t seek help.

Assessment

The job of the nurse is to carry out a detailed assessment before treating the problem. This assessment includes checking symptoms and observing the stoma and the peristomal skin. They also need to get information about how long the problem has been there and any treatments tried in the past. If the problem is not resolvable at the moment, they should refer the patient to the doctor.

Sore skin

One of the most common problems that occur with a stoma is skin soreness. Its symptoms mainly include red skin, which is usually intact. The worsening of this problem can lead to the breakdown of skin, causing skin ulcers. Before starting the treatment, the nurse has to assess the real cause of the problem. The most common reason for skin redness is the skin’s contact with the stomal output.

Another reason for the sore skin is the frequent removal of the skin barrier. This frequent pulling of the skin barrier can cause discomfort to the peristomal skin.

If you have a colostomy, but you have frequent stools, you may want to use a two-piece ostomy pouching system to avoid changing too many skin barriers during a specific period.

Difficulty removing the ostomy appliance

Some people find it difficult to remove the ostomy appliance, resulting in them pulling the skin barrier too hard. It can cause skin stripping, which can be quite painful. Nurses should teach such patients to be gentle with the removal of the skin barrier. Using adhesive remover sprays or wipes can make the removal of the ostomy skin barrier easier. The adhesive remover is particularly useful when the patient has to get rid of the residue left after the removal of a skin barrier.

Appliance leaks

A survey report suggests that about 85% of the patients with ostomies face the problem of leakage. There can be several reasons that can lead to the leakage of a stoma appliance. The most common reason is the ostomy appliance getting too full before the patient replaces or empties it. Teaching patients to change or empty the ostomy appliance when necessary can rectify this issue.

The stoma output that is too watery can leak under the skin barrier. If the problem has been persistent for some time, you may want to give the patient stool thickening medication. A dietary change may also serve the purpose.

The unevenness of the peristomal skin is also the reason for the leakage to occur. The skin barrier fails to form a proper seal with the skin in this regard. Using a stoma seal may help prevent leakage. Another way is to use a convex skin barrier, which has the protruded side that goes against the skin.

How To Conceal Your Ostomy Appliance

An ostomy appliance peeking through underneath the clothes is one of the significant concerns that most people with ostomies have. In this article, we will talk about ways to conceal your ostomy appliance under your clothes.

 

The type of ostomy appliance you wear may be more noticeable than others. It is mainly about how far the pouch is sticking out from your skin. Generally, a two-piece ostomy pouch sticks out more than a one-piece system. The coupling mechanism used in a two-piece ostomy system adds significantly to the amount of hardware used in the system. The good news is that companies have been working on the development of lower profile 2-piece systems that tend to remain discreet in the same as a one-piece ostomy system. This variety of ostomy pouches is available in the market, but it might not be suitable for individuals who need convexity. You may want to talk to your ostomy care nurse regarding whether this option suits you.

Another way to conceal your ostomy appliance is to modify your clothing choices. You don’t have to stick to loose-fitting clothes, as there are a lot more options you can consider. You may opt for clothes that have color patterns. Certain patterns do well to hide the bulge of your ostomy appliance almost entirely. Generally, you will want to wear clothes with dark colors to conceal your ostomy pouch. Men can wear suspenders instead of tight belts.

 

Most people are concerned about their ostomy bags getting visible due to tighter swimming suits. This situation causes them to shy away from swimming, which can be a beginner activity for an ostomate to build enough strength to start a fitness regimen. Swimming suits are tight enough to allow a bulge to occur at the site of the stoma bag. Again, wearing dark-colored swimsuits or the ones with patterns may help you conceal your pouch. You can consider wearing surfer type shorts, which have longer legs and rise in the crotch. If you have an intestinal stoma, you may be able to predict the schedule of your stomal output. Even better, you can set a schedule for bowel movements. It will allow you to wear a small bag or a stoma cap while swimming.

 

The location of the stoma matters a lot when it comes to concealing your ostomy bag. Generally, the ET will want to mark the stoma site above or below the beltline. It means that you may have a choice to select a site for your stoma. You can talk about it with your doctor or ET.

Appliance Wear-Times: Factors To Consider

Individuals with ostomies generally think of wearing their ostomy bags for seven days. However, there is no standard set for wear-time for ostomy appliances. There are several factors to consider when determining the wear-time.

  

Stoma type

The consistency and frequency of your stomal output depend on the type of stoma you have. For instance, ileostomies tend to produce a liquid or pasty stool, and they function 5-6 times a day. Colostomies produce thicker stools, and they function fewer times a day. Stool with liquid consistency has more digestive enzymes, which are corrosive enough to contribute to melt-out of the barrier. A skin barrier no longer adheres to the skin after melting out, resulting in skin irritation. You are going to have to change your ostomy pouching system just before that melt-out.

Stoma age

How often you should change your ostomy pouch also depends on the age of your stoma. If your stoma is a newly constructed one, it will have swelling, and it will cause a lot of moisture in the skin around it. The swelling subsides in six weeks. During this time, the stoma changes its shape more frequently. After this duration, the stoma settles down to a permanent shape and size. During these six weeks, your ET will suggest you change your pouch twice a week every week.

Characteristics of stool

Generally, the more liquefied the stool is, the more frequently you are going to have to change your pouch. The stool output from an ileostomy can be more frequent. You may have to empty your pouch several times a day. With a colostomy, the stool tends to be more firm and less frequent. However, there are certain health conditions and treatments that can permanently change the characteristics of stool passing through a colostomy. Again, it all comes down to the tendency of the stool to cause melt-out of the skin barrier. The sooner the skin barrier melts out, the sooner you will need to replace it.

Stoma construction

A well-construction stoma is the one that protrudes appropriately, and the skin around it is plain enough to allow proper adherence to the skin barrier. In some cases, the stoma might not have enough protrusion, or the skin around it has creases. With these issues, it becomes a challenge to apply the ostomy pouch. It can reduce the wear-time significantly.

 

Type of product

The type of product you use also has a significant impact on the pouch’s wear time. The skin barrier of the pouch you purchase will either be regular wear or extended wear. Regular wear skin barriers do not offer much resistance to melt-outs, and they have less adhesion on their baseplate. These skin barriers are best for users who have colostomies that produce more formed stool. Depending on the protraction of the stoma and the state of peristomal skin, these skin barriers can last up to seven days.

Extended wear skin barriers, on the other hand, offer more resistance to melt-outs, and they use a significantly strong adhesive on their baseplate. These barriers are ideal for people with ileostomies that produce unformed stool that contains a significant amount of corrosive digestive enzymes.

Kid with colostomy

As a young kid, I had issues with bowel movements. My parents thought it was odd that a young child like myself was having such problems. Being the concerned parents they were, they brought me to the doctor to have it check out. When my parents told the doctor everything that was going on, he told them what he thought it could be. He told my parents that he thought it was irritable bowel syndrome or IBS for short. This is a kind of disorder that affects my large intestine. He provided us with some treatments to try before getting serious. After trying the simple treatments but no results showing any real change, my doctor said I had to get a colostomy procedure; I was ten. 

I can remember that day vividly. I was very scared and did not know what was going on. After my parents explained it to me, it did not help that much. I trusted my parents, however. I knew they knew what was going to be the best for me. A few days after that meetup, my parents scheduled my ostomy procedure with the doctor. After about a week, it was time for my procedure. I was terrified because I still did not understand. 

Showing up to the hospital was scary, and when it set in. I was about to be put to sleep for a bit while doctors cut me up, at least as a kid; that’s how I saw it. The surgeon explained the procedure to me as best as he could to a ten-year-old. He told me that my large intestine and colon were not working correctly, and he would help fix that. What he had to do was put me under anesthesia. When this is done, he was going to cut my large intestine and bring it to my tummy. From there, he will make a small hole that the end of the large intestine will come out of. He explained that this part is called a stoma. It will be a pink red color and puffy but do not play with it. After explaining all of this to me, I understood it better and was ready for it to be over. 

When I went into the operating room, I remember seeing all the shiny tools and cabinets, not to mention how clean it looked. The last thing I remember was looking over and seeing my mom with a warming smile on her face; that helped a lot.  After that, the nurse came next to me and put a mask on. She told me to count down from ten to one. I only go to eight. I woke up in a different room in a bed with warm cozy sheets. My parents came in shortly after I woke up with a kind nurse. My parents were smiling ear to ear. The nurse began explaining everything she could to us about my procedure and how to care for it.

As a young kid with an ostomy, it was very scary going into the procedure and hearing about everything, but I am glad I was surrounded by kind doctors who could explain to me in a way I would understand. I did not tell anyone about my procedure for years. On my eighteenth birthday, I told my close friends about it, and not a single one was phased by it. I am very reluctant to be surrounded by people who support me and care for me. I don’t think I would have made it this far in life still sain if it were not for them. 

Enjoying Good Weather With a Stoma

There really is nothing that I love more than being outside and spending that time with my family.  Rather it is spring or fall those time periods seem to fit my preferences for the weather to a tee.  And let's face it pumpkin spice and cucumber water is such a win.  But with this part of the year comes a lot of different foods and drinks and if you have a stoma, it may mean a whirlwind of changes.  Sometimes the extra food you eat can have some rather annoying side effects.  Now that I have a stoma I am a little more conscious of my diet and especially during possible holiday times. 

The first few times I over-eat on the holidays ended up being pretty bad.  First I was frustrated because I was told to not eat most of the foods I really enjoy.  So that is what I did, I literally stuck with my strict diet.  My diet was not very fun and to be honest it made me stand out at my holiday parties and so on.  It was a bit frustrating.  I was flat out ignorant and I learned quickly that is a bad thing. 

I also did not do well on my next holiday season and went to the complete opposite spectrum.   It was certainly a big issue because I went all out.  I just enjoyed all the foods I felt I had been stripped of.  Now I do not suggest this at all. I had so many digestion issues and let's face it I felt super fat.  No way was this a win in any shape and form.  And believe me, it felt like I was shooting out my dinner and snacks like a rock.  But there is always a good and a bad to me and lessons to learn. 

There is always wisdom in learning and it is good to have a nice balanced approach to your ostomy care.  When it comes to the holidays, enjoy it in moderation.  That is what I think is the most important part.  Moderation is good for most things in life.  My ostomy does not hold me back, but the more I learn the more I am able to enjoy life.  I now know what had more fiber in it and it took years to learn.  So feel free to make mistakes.  It is not the end of the world, just bad sounds and feelings.  

Learn from others and be smart enough to not fall where they fell.  What I am talking about is doing self-research.  I think that going online and learning your social media outlets is a great start.  There are entire websites dedicated to diets and food knowledge for all types of ostomies.  It is really incredible how much knowledge we have.  IT is insane the knowledge that is available.  I suggest starting on the web.  Find a few good forums websites and learn what you can and then move on. 

It is always worth it to dive deep into the social media world. I know for a fact it helped me.  Youtube and Instagram are amazing for finding people who are willing to share their life with you.  Remember though that most of those people want to be paid.  Be wise and not super trusting but enjoy the knowledge. 

How to deal with your stoma during the heat of the day

It may be a little chilly right now but soon the whole hemisphere will heat up a bit and we will start thinking about beaches and long hikes.  It doesn't take long before it all happens either.  In my neck of the woods, the weather just jumped about 20 degrees and it is toasty outside.  Now it is time for me to break out of the closet and get things sorted for a different kind of look and feel for me.  What this means is lots of new changes have occurred and should probably happen if you have a stoma.  Now you are going to probably freak out and go on a social media rampage to think about keeping up with the new season's fashion.  It really just means that I am going to be wearing slightly tighter clothes and also that I may be sweating a bit more than normal.  So there are a few  good things you can do to make sure that your stoma is fitting in with your fashion style and allowing you to live your best life. So get your shop on.

Now gear is what drives a lot of the ability for me to be fashionable.  I mus trust my gear and also have the best fitting gear in teh world for my body.  That is the key. Your body is going to be special and your stoma shape may change how you shop or where you get your things from.  The first thing I like to make sure of is that my ostomy care is coming first.  There is nothing worse than actually being in trouble for not planning ahead and taking care of an area that I know I should. So for me, I like to make sure I have the right equipment on when I know I am going to be outside a little more or it's going to be a litt

le hotter.  This means for me that I will likely put a bag on that has belt loops.  This allows me to then get an ostomy belt and protective cover to go around the bag and hold it tighter to my body.  I do a lot of hardcore things so protection matters to me.  It may sound a bit strange but to me, there is nothing better than knowing my body is looking sleek during the summer.  Being able to strap my bag down helps it from moving around and allows me to wear slightly tighter fitting clothing.  Not that is not the most important part but making sure my ostomy care gear is also water moisture wicking is a big deal. I don't like those sweat stains or sticking on my bag and body.

I really don’t like my skin sweating and feeling gross all the time.  So It really matters to me to get some really good moisture-wicking gear. This has always mattered to me though way before I had an ostomy.  Being able to be comfortable in warmer weather is important and you don’t want to rub to occur in areas causing extra friction, especially if you have a stoma.  So rock the summer body and find the right gear that fits your body.  If you don’t have good moisture wicking gear and are getting rashes, you need to contact your healthcare provider to figure out a better solution or simply a safe solution.