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Colostomy surgery is done to create an opening in the front of the abdomen for stool (faeces) to leave the body through an ostomy (stoma). Part of the large intestine is attached to the stoma. A bag, also called a pouch, is fitted over the stoma. Stool and gas will collect in the bag.

After surgery, you will need to empty and change your colostomy bag as needed. You will also need to care for your stoma.

How to care for the stoma

Your stoma should look pink, red, and moist, like the inside of your cheek. Soon after surgery, the stoma may be swollen, but this swelling will go away within six weeks. To care for the stoma:

• Keep the skin around the stoma clean and dry.
• Use a clean, soft washcloth to gently wash the stoma and the skin around it. Clean using a circular motion, and wipe away from the stoma opening, not toward it.
  • Use warm water and only use cleansers recommended by your healthcare provider.
  • Rinse the stoma area with plain water.
  • Dry the area around the stoma well.
• Use stoma powder or ointment on your skin only as told by your healthcare provider. Do not use any other powders, gels, wipes, or creams on the skin around the stoma.
• Check the stoma area every day for signs of infection. Check for:
  • New or worsening redness, swelling, or pain.
  • New or increased fluid or blood.
  • Pus or warmth.
• Measure the stoma opening regularly and record the size. Watch for changes. (It is normal for the stoma to get smaller as swelling goes away.) Share this information with your health care provider.

How to empty the colostomy bag

Empty your bag at bedtime and whenever it is one-third to one-half full. Do not let the bag get more than half-full with stool or gas. The bag could leak if it gets too full. Some colostomy bags have a built-in gas release valve that releases gas often throughout the day.

Follow these basic steps:

1. Wash your hands with soap and water.
2. Sit far back on the toilet seat.
3. Put several pieces of toilet paper into the toilet water. This will prevent splashing as you empty stool into the toilet.
4. Remove the clip or the hook-and-loop fastener from the tail end of the bag.
5. Unroll the tail, then empty the stool into the toilet.
6. Clean the tail with toilet paper or a moist towelette.
7. Re-roll the tail, and close it with the clip or the hook-and-loop fastener.
8. Wash your hands again.
   
   

How to change the colostomy bag

Change your bag every three to four days or as often as told by your healthcare provider. Also change the bag if it is leaking or separating from the skin, or if your skin around the stoma looks or feels irritated. Irritated skin may be a sign that the bag is leaking.

Always have colostomy supplies with you, and follow these basic steps:

1. Wash your hands with soap and water. Have paper towels or tissues nearby to clean any discharge.
2. Remove the old bag and skin barrier. Use your fingers or a warm cloth to gently push the skin away from the barrier.
3. Clean the stoma area with water or with mild soap and water, as directed. Use water to rinse away any soap.
4. Dry the skin. You may use the cool setting on a hair dryer to do this.
5. Use a tracing pattern (template) to cut the skin barrier to the size needed.
6. If you are using a two-piece bag, attach the bag and the skin barrier to each other. Add the barrier ring, if you use one.
7. If directed, apply stoma powder or skin barrier gel to the skin.
8. Warm the skin barrier with your hands, or blow with a hair dryer for 5–10 seconds.
9. Remove the paper from the adhesive strip of the skin barrier.
10. Press the adhesive strip onto the skin around the stoma.
11. Gently rub the skin barrier onto the skin. This creates heat that helps the barrier to stick.
12. Apply stoma tape to the edges of the skin barrier, if desired.
13. Wash your hands again.

General recommendations

• Avoid wearing tight clothes or having anything press directly on your stoma or bag. Change your clothing whenever it is soiled or damp.
• You may shower or bathe with the bag on or off. Do not use harsh or oily soaps or lotions. Dry the skin and bag after bathing.
• Store all supplies in a cool, dry place. Do not leave supplies in extreme heat because some parts can melt or not stick as well.
• Whenever you leave home, take extra clothing and an extra skin barrier and bag with you.
• If your bag gets wet, you can dry it with a hair dryer on the cool setting.
• To prevent odour, you may put drops of ostomy deodoriser in the bag.
• If recommended by your healthcare provider, put ostomy lubricant inside the bag. This helps stool to slide out of the bag more easily and completely.

Contact a healthcare provider if:

• You have new or worsening redness, swelling, or pain around your stoma.
• You have new or increased fluid or blood coming from your stoma.
• Your stoma feels warm to the touch.
• You have pus coming from your stoma.
• Your stoma extends in or out farther than normal.
• You need to change your bag every day.
• You have a fever.
  
  

Get help right away if:

• Your stool is bloody.
• You have nausea or you vomit.
• You have trouble breathing.
  
  

Summary

• Measure your stoma opening regularly and record the size. Watch for changes.
• Empty your bag at bedtime and whenever it is one-third to one-half full. Do not let the bag get more than half-full with stool or gas.
• Change your bag every three to four days or as often as told by your healthcare provider.
• Whenever you leave home, take extra clothing and an extra skin barrier and bag with you.

References:

Association of Stoma Care Nurses, UK : ASCN stoma care. National clinical guidelines.2016. ASCN the United Kingdom 〈http://ascnuk.com/wp-content/uploads/2016/03/ASCN-Clinical-Guidelines-Final-25-April-compressed-11-10-38.pdf〉

International Affairs & Best Practice Guidelines (iaBPG) : second ed.2019.Registered Nurses Association of Ontario (RNAO)Canada 〈https://rnao.ca/sites/rnao-ca/files/Ostomy_Care__Management.pdf〉

Kann B.R.: Early stomal complications. Clin Colon Rectal Surg 2008; 21: pp. 23-30.

Saunders R.N., Hemingway D.: Intestinal stomas. Surgery 2008; 26: pp. 347-351.

Wound Ostomy and Continence Nurses Society: Basic ostomy skin care: a guide for patients and health care providers.2018.Wound Ostomy and Continence Nurses SocietyMt Laurel, NJ, the United States of America

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