Colostomy

➢ Introduction

A colostomy is a significant surgical procedure that involves creating an artificial opening in the
abdominal wall to divert the normal flow of feces from the colon to an external pouch or bag. This
is done when the normal passage through the rectum is not possible due to disease, injury, or
congenital conditions. The need for a colostomy may arise in a variety of clinical situations, such
as colorectal cancer, diverticulitis, inflammatory bowel diseases, or bowel trauma.
Colostomy may be temporary or permanent, depending on the underlying medical condition and
the goal of treatment. While the surgery can be lifesaving, it also introduces significant lifestyle
changes that require physical, emotional, and psychological adjustment for the patient. Proper
nursing care, patient education, and stoma management are essential to help individuals live a
normal and independent life post-surgery.
This assignment aims to provide a comprehensive understanding of colostomy, including its
indications, types, surgical management, postoperative care, complications, and the crucial role of
nurses in promoting effective rehabilitation and quality of life for colostomy patients.

➢ What is a colostomy

A colostomy is surgery to create an opening for the colon (large intestine) through the belly
(abdomen). A colostomy may be short-term (temporary) or long-term (permanent). It's often done
after bowel surgery or injury. Most permanent colostomies are end colostomies. Many temporary
colostomies bring the side of the colon up to an opening in the abdomen. This is known as a loop
colostomy.
During an end colostomy, the end of the colon is brought through the abdominal wall. Then it may
be turned under, like a cuff. The edges of the colon are then stitched to the skin of the abdominal
wall to form an opening called a stoma. Poop (stool) drains from the stoma into a bag or pouch
attached to the abdomen. In a temporary loop colostomy, a hole is cut in the side of the colon and
stitched to a matching hole in the abdominal wall. This can be more easily reversed later. This is
done by removing the colon from the abdominal wall. Then the holes are closed so that poop flows
through the colon again.

➢ Definition

Colostomy is an operation in which an artificial opening is made into the colon on the anterior
abdominal wall to permit the escape of faeces and flatus.

➢ Indications of colostomy surgeries

A colostomy is performed when the normal passage of feces through the rectum and anus is
disrupted due to disease, injury, or congenital defects. The primary indications include :
1. Colorectal Cancer
Most common indication
Performed when part of the colon or rectum is removed due to malignant tumors
May be temporary (to protect anastomosis) or permanent (in case of rectal removal)
2. Diverticulitis
Severe or recurrent inflammation of diverticula in the colon
Colostomy may be needed to divert stool and allow the bowel to heal
3. Inflammatory Bowel Diseases (IBD)
Includes Ulcerative Colitis and Crohn’s Disease
Done in severe cases with complications like perforation, fistulas, or obstruction
4. Bowel Obstruction
Caused by tumors, strictures, adhesions, or volvulus
Emergency colostomy may be performed to relieve the obstruction
5. Bowel Trauma or Injury
Penetrating or blunt abdominal injuries
Diverting colostomy allows healing and prevents infection
6. Congenital Anomalies
Conditions like imperforate anus or Hirschsprung’s disease in infants
Temporary colostomy may be done until definitive surgery is performed
7. Fistulas
Abnormal connections between bowel and other organs (e.g., rectovaginal fistula)
Colostomy helps in diverting stool to promote healing
8. Ischemic Bowel Disease
Occurs due to loss of blood supply to part of the bowel
Diseased portion is removed and a colostomy is made
9. Radiation Injury
Radiation therapy for pelvic cancers can damage the bowel
Colostomy may be required for bowel rest and recovery
 ➢ Types of colostomy

1. Types of Colostomy Based on Duration

Colostomies are classified into two main types based on their duration — whether they are
intended to be temporary or permanent.

A. Temporary Colostomy

• Definition: A colostomy created for a short period to allow healing of the bowel or to
bypass a damaged segment.
• Purpose: Diverts feces to protect distal anastomosis or inflamed/diseased bowel.
• Duration: Weeks to months; reversed later by re-anastomosis.
• Indications:
o After bowel surgery (e.g., low anterior resection)
o Diverticulitis
o Colonic trauma
o Inflammatory bowel disease
B. Permanent Colostomy

• Definition: A colostomy that remains for the rest of the patient’s life.
• Purpose: Used when the distal bowel or rectum is permanently removed or
nonfunctional.
• Duration: Lifelong
• Indications:
o Colorectal cancer (especially low rectal cancer)
o Severe congenital anomalies
o Unresectable rectal injury or disease
o Incontinence or failed continence mechanisms

[Link] of Colostomies According to Location

Colostomies are classified based on the segment of the colon used to create the stoma. The
location affects the consistency of stool, stoma care, and nursing management.

1. Ascending Colostomy

• Location: Right side of the abdomen; uses the ascending colon.

• Stool Consistency: Liquid to semi-liquid, rich in digestive enzymes.
• Indications: Obstruction, right-sided colon diseases.
• Characteristics: High output, strong odor, requires a drainable pouch.
• Rarely done due to difficulty in managing liquid stool

2. Transverse Colostomy

• Location: Upper abdomen, middle or right/left side; uses the transverse colon.
• Stool Consistency: Semi-formed to pasty.
• Indications: Inflammatory bowel disease, diverticulitis, bowel obstruction, trauma.
• Types:
o Loop transverse colostomy
o Double-barrel transverse colostomy

3. Descending Colostomy

• Location: Left side of the abdomen; uses the descending colon.

• Stool Consistency: More formed stool.
• Indications: Cancer, injury to the lower colon.
• Easier to manage due to predictable output

4. Sigmoid Colostomy

• Location: Lower left abdomen; uses the sigmoid colon.

• Stool Consistency: Well-formed, solid stool.
• Indications: Colorectal cancer, rectal diseases.
 • Most common type of permanent colostomy.
• Easiest to manage due to near-normal bowel movements

3 .Types of Colostomy Based on the Stoma

Colostomies can be classified based on the structure and number of stomas created during the
surgical procedure. This classification is important for both surgical planning and nursing care.

1. End Colostomy

• Definition: A single stoma is created from the end of the colon.

• Use: Most often permanent, but can also be temporary.
• Indications:
o After bowel resection for cancer
o Rectum or distal colon removal
• Features:
o Only one opening (for stool passage)
o Common in sigmoid or descending colostomies

2. Loop Colostomy

• Definition: A loop of colon is pulled out through the abdominal wall and opened to form
a single stoma with two openings:
o One for stool (proximal)
o One for mucus (distal)
• Use: Usually temporary
• Indications:
o To divert stool away from healing distal bowel
o Emergencies or injuries
o
 • Features:
o Held in place by a plastic rod
o Bulky stoma with two visible lumens

3. Double-Barrel Colostomy

• Definition: The bowel is completely divided, and both ends are brought out as two
separate stomas:
o Proximal stoma for fecal matter
o Distal stoma (mucous fistula) drains mucus
• Use: Usually temporary
• Indications:
o To bypass or rest a diseased bowel segment
• Features:
o Two distinct stomas
o Reversal surgery may reconnect the two ends
 ➢ Characteristics of an Ideal Stoma

An ideal stoma is one that functions well, is easy to care for, and minimizes complications for
the patient. Proper stoma construction is essential for patient comfort, hygiene, and overall
quality of life.

1. Location:
o Positioned in a flat, visible, and accessible area (usually in the lower abdomen).
o Away from skin folds, scars, or bony prominences.
o Marked preoperatively with patient in sitting, standing, and lying positions.
2. Size and Shape:
o Round or oval in shape.
o Protrudes 1–2 cm above skin level to allow proper drainage and appliance
fitting.
o Should not be retracted (sunken) or excessively protruding.
3. Color:
o Bright red or pink in color.
o Indicates good blood supply and healthy tissue.
o Pale, dusky, or black suggests ischemia or necrosis (needs urgent attention).
4. Moisture:
o Moist and shiny appearance (like inside of the mouth).
o Dry or crusted stomas are abnormal.
5. Texture:
o Soft and pliable to touch.
o Not firm, hard, or ulcerated.
6. Lumen (Opening):
o Should be patent and unobstructed to allow easy passage of feces or gas.
o Single, central opening in end stomas; two in loop or double-barrel colostomies.
7. Output:
o Consistency and amount depend on the location (e.g., liquid from ascending, solid
from sigmoid).
o Should be appropriate for the type of colostomy.
8. Skin Around the Stoma (Peristomal Skin):
o Intact, clean, and free of irritation, redness, or rash.
o Protected with barrier creams or wafers to prevent excoriation

➢ Signs of Abnormal Stoma:

• Pale or bluish color (poor blood supply)

• Excessive bleeding
• Retraction or prolapse
• Foul odor or pus (infection)
• Peristomal skin breakdown
 ➢ Purposes of a Colostomy

A colostomy is performed for both therapeutic and preventive reasons, depending on the
underlying medical condition. Below are the main purposes of creating a colostomy:

1. To Divert Fecal Matter

• Diverts stool away from a diseased, injured, or healing part of the colon or rectum.
• Prevents contamination of wounds or surgical sites.

2. To Relieve Intestinal Obstruction

• Provides an alternate pathway for stool in cases of bowel obstruction due to tumors,
strictures, or congenital defects.

3. To Allow Healing of the Distal Bowel

• Gives the distal colon or rectum time to rest and heal in conditions like diverticulitis,
trauma, or fistulas.

4. To Remove Diseased Bowel

• Helps manage conditions where part of the colon has been surgically removed, such as
in colorectal cancer or ischemic bowel.

5. To Protect a Surgical Anastomosis

• Temporary colostomy is used to protect a new surgical connection (anastomosis) in the

bowel and prevent complications.

6. To Manage Congenital Anomalies

• Allows for fecal elimination in newborns with anorectal malformations (e.g.,

imperforate anus or Hirschsprung’s disease).

7. To Control Incontinence

• In patients with severe fecal incontinence, a colostomy may help improve hygiene and
quality of life.

8. To Promote Comfort in Palliative Care

• In patients with advanced cancer or non-repairable bowel conditions, colostomy can

help relieve symptoms and improve comfort.
 Procedure for colostomy care

Purposes:

• To maintain skin integrity around the stoma

• To prevent infection or irritation
• To promote patient comfort, dignity, and self-care
• To observe stoma for signs of complications

Articles Required:

• Clean gloves
• Wash basin with warm water
• Mild soap or stoma cleanser
• Soft washcloth or gauze
• New colostomy bag or appliance
• Adhesive remover (if needed)
• Barrier cream or skin protectant
• Scissors (to cut wafer if needed)
• Waste disposal bag
• Towel and drape
• Record sheet

Preparation of the Patient

• Greet the patient politely and explain the procedure in a calm and respectful manner.
• Ensure privacy by drawing curtains and closing doors.
• Maintain therapeutic communication—encourage the patient to express feelings and
fears.
• Help patient into comfortable supine or semi-Fowler’s position.
• Provide a towel or drape to maintain modesty.

Steps of Colostomy Care Procedure (with Rationales):

Step Nursing Action Rationale

1 Wash hands and wear clean gloves. To prevent cross infection and
maintain asepsis.
2 Explain the procedure to the patient. To reduce anxiety and gain
cooperation.
3 Drape the patient to protect bed linen and Promotes comfort, privacy, and
ensure privacy. cleanliness.
4 Gently remove the used pouch from the Avoids trauma to the stoma and skin.
stoma.
 5 Observe the stoma for color, size, swelling, To assess stoma health and detect
bleeding, or discharge. complications early.
6 Clean the stoma and surrounding skin with Maintains hygiene and prevents skin
warm water and mild soap using gauze or soft irritation.
cloth.
7 Pat the area dry with a soft towel. Moisture can lead to skin breakdown.
8 Apply skin barrier cream or protective film to Prevents skin irritation from stool and
the peristomal area. adhesive.
9 Cut the stoma wafer opening to the correct Ensures secure fit and avoids pressure
size (2–3 mm larger than stoma). on the stoma.
10 Apply the new colostomy appliance carefully, Ensures leak-proof attachment and
pressing gently for adhesion. patient comfort.
11 Dispose of used equipment and waste in Prevents contamination and maintains
appropriate biohazard bag. environmental hygiene.
12 Remove gloves and wash hands. To prevent cross-contamination and
maintain hygiene.
13 Document the procedure, condition of stoma, For continuity of care and legal record-
and patient response. keeping.
14 Educate the patient about self-care, diet, and Promotes independence, dignity, and
warning signs (e.g., bleeding, rash, odor). early identification of complications.

Post-Procedure Care:

• Ensure the patient is clean, comfortable, and dry.

• Offer emotional support and encourage questions.
• Praise and support the patient’s participation in care.

➢ Colostomy Irrigation Procedure

Definition:

Colostomy irrigation is a procedure used to instill fluid (usually warm water) into the colon
through the colostomy to stimulate peristalsis and regulate bowel movements. It is typically done
for sigmoid or descending colostomies.

Purposes:

• To regulate bowel movements at a convenient time

• To empty the colon of feces
• To reduce gas and odor
• To promote patient independence and comfort
• To train the bowel for regular evacuation
Articles Required:

• Irrigation set (cone-tipped catheter, tubing, irrigation bag)

• Lukewarm water (500–1000 ml, around 37–38°C)
• Lubricant (water-soluble)
• Clean gloves
• Waterproof drape
• Irrigation sleeve or pouch
• Bedpan or toilet access
• Gauze pads or washcloth
• Waste disposal bag
• Towel and tissue
• Documentation sheet
Preparation of the Patient (Humanistic Approach):

• Explain the procedure and its purpose to reduce anxiety.

• Ensure privacy and comfort.
• Position the patient sitting on a commode or in semi-Fowler’s or left lateral position if
in bed.
• Provide emotional support—address concerns about bowel control and self-care.

Steps of Colostomy Irrigation (with Rationales):

Step Nursing Action Rationale

1 Wash hands and gather all equipment. Maintains hygiene and organizes
care.
2 Explain the procedure to the patient and gain Builds trust and ensures
consent. cooperation.
3 Place a waterproof drape around the colostomy site. Prevents soiling of bed linen.
4 Fill irrigation bag with 500–1000 ml of lukewarm Ensures correct water
water and hang it about 18–20 inches above stoma temperature and gravity-assisted
level. flow.
5 Attach tubing to cone-shaped catheter and clamp Prepares system and prevents
the tube. premature flow.
6 Lubricate the cone tip and gently insert into the Prevents injury and ensures
stoma (~5–7 cm). smooth insertion.
7 Unclamp tubing to allow water to flow slowly over Promotes gentle filling of colon
5–10 minutes. and prevents cramping.
8 Clamp the tubing and remove the cone when all Signals the end of fluid delivery.
fluid is instilled.
9 Allow the solution and feces to return through an Promotes natural evacuation.
irrigation sleeve into the toilet or container.
10 Observe for color, amount, consistency, and any Assesses bowel function and
unusual discharge. detects abnormalities.
11 Clean stoma and surrounding skin; apply new Maintains skin integrity and
pouch or dressing. prevents infection.
12 Dispose of waste, clean equipment, remove gloves, Maintains infection control.
and wash hands.
13 Document time, volume of water used, type of Ensures continuity of care and
return, and patient response. provides legal record.

Aftercare & Teaching:

• Encourage the patient to relax during irrigation.

• Educate about regular timing (usually once daily or every other day).
• Promote self-care and bowel training.
• Monitor for signs of cramping, bleeding, or dizziness.

Contraindications:

• Prolapsed or irritated stoma

• Active bleeding from stoma
• Colostomies other than sigmoid or descending
• Unstable patient condition
 ➢ Types of Pouching Systems
Pouching systems are designed to collect stool or urine through a stoma. The choice of system
depends on the type of ostomy, stoma location, output consistency, and patient preference.
Classified Based on Design:

1. One-Piece Pouching System

• Description: Skin barrier (wafer) and pouch are combined into a single unit.
• Advantages:
o Easy to apply and remove
o Lower profile under clothing
o Fewer components to manage
• Disadvantages:
o Entire system must be replaced during change
o May irritate skin with frequent removal
• Best for: People who prefer simplicity and have intact peristomal skin

2. Two-Piece Pouching System

• Description: Skin barrier (wafer) and pouch are separate and can be detached and
reattached.
• Advantages:
o Pouch can be changed without removing wafer
o Less frequent skin trauma
o Easier to manage output
• Disadvantages:
o Slightly bulkier than one-piece systems
o Risk of leakage if not fitted properly
• Best for: Individuals with sensitive skin or irregular stomas
Classified Based on Drainage:

3. Drainable Pouch

• Description: Has an opening at the bottom to drain contents; secured with clamp or
Velcro.
• Used for:
o Ileostomies and colostomies with liquid or semi-liquid output
• Advantages:
o Reusable (empty multiple times before changing)
o Convenient for frequent output

4. Closed-End Pouch

• Description: Sealed at the bottom; entire pouch is discarded after one use.
• Used for:
o Colostomies with solid or formed stool
• Advantages:
o Convenient for travel and social outings
o Less odor during disposal
• Disadvantages:
o Not suitable for frequent output

Specialty Pouching Systems:

5. Urostomy Pouch

• Description: Designed for urinary diversion; includes anti-reflux valve and bottom tap
for drainage.
• Used for: Urostomy or ileal conduit
• Feature: Keeps urine from flowing back and causing infection

Complications of Colostomy
Colostomy complications can be early (postoperative) or late (long-term). These complications
may affect the stoma itself, the surrounding skin, or the patient’s physical and psychological
well-being.

1. Stoma-Related Complications

Complication Description Nursing Implication

Stoma necrosis Death of stoma tissue due to poor blood Notify surgeon immediately;
supply (black/pale stoma) emergency management
Stoma Stoma sinks below skin level Risk of leakage and skin irritation
retraction
Stoma Abnormal protrusion of stoma from the May require surgical revision
prolapse abdomen
Stenosis Narrowing of stoma opening Causes difficulty in stool passage
Bleeding Minor bleeding normal; persistent or Monitor and report as needed
heavy bleeding is abnormal

2. Peristomal

Skin Complications

Complication Description Nursing Implication

Irritant Skin irritation due to stool leakage or Use skin barrier; ensure good
dermatitis frequent adhesive removal pouch seal
Allergic Due to adhesives or barrier products Change products and consult
reaction doctor
Fungal Red, itchy rash around stoma, especially Apply antifungal
infection in warm/moist areas powder/cream as prescribed

3. Mechanical Complications

Complication Description Nursing Implication

Parastomal Bulging around stoma due to Educate on wearing support belt,
hernia weakened abdominal muscles avoid heavy lifting
Bowel Blockage due to adhesions or Report signs of abdominal pain,
obstruction improper irrigation no output, vomiting

4. Functional Complications
Complication Description Nursing Implication
Diarrhea Especially in high-output Monitor fluids/electrolytes; review diet
colostomies or due to infection and meds
Constipation Can occur due to dehydration or Encourage fluids and fiber (if allowed)
improper diet
Gas and odor Often caused by certain foods or Teach dietary modifications and use of
poor pouch sealing deodorizing agents
5. Psychological and Social Complications

Complication Description Nursing Implication

Body image issues Patient may feel embarrassed, Provide emotional support and
ashamed, or unattractive stoma care counseling
Depression/anxiety Related to chronic illness and Involve family, refer to mental
lifestyle changes health professionals if needed
Social isolation Fear of leakage, odor, or stigma Encourage support group
participation

Preoperative and Postoperative Care of a Colostomy Patient

A. Preoperative Nursing Care

The goal is to prepare the patient physically, emotionally, and educationally for the surgery and
life with a stoma.

1. Physical Preparation

• Bowel preparation: Laxatives/enemas may be given as prescribed.

• NPO status: Keep the patient nil by mouth before surgery (usually 6–8 hours).
• IV fluids: To maintain hydration if NPO.
• Skin preparation: Clean the abdominal area; shave if necessary.
• Stoma site marking:
o Done by nurse or surgeon.
o Marked in a visible, flat area away from scars, skin folds, and bony prominences.

2. Psychological Preparation

• Allow patient to express fears, anxiety, and body image concerns.

• Provide emotional support and therapeutic communication.
• Introduce the patient to a stoma therapist or an ostomy support group if possible

3. Patient Education

• Explain the purpose and procedure of colostomy.

• Show models or diagrams of a stoma.
• Explain the use of colostomy bags, hygiene, and basic care.
• Emphasize that they can lead a normal life after recovery.
B. Postoperative Nursing Care
Focuses on maintaining healing, preventing complications, and beginning adaptation to stoma
care.

1. Immediate Postoperative Care

Intervention Purpose
Monitor vital signs and general Detect early signs of shock or infection
condition
Assess stoma appearance Should be red/pink, moist, and slightly raised
Check for stoma complications Look for bleeding, retraction, necrosis, or prolapse
Monitor output from stoma Type depends on location; document consistency and
amount
Maintain fluid and electrolyte Especially if output is high or patient is dehydrated
balance

2. Colostomy Care

• Clean stoma and peristomal skin with warm water.

• Apply protective barrier cream or wafer.
• Change pouching system as per hospital protocol or when leaking.
• Empty the bag when 1/3 to 1/2 full to avoid pulling on the stoma.

3. Pain Management

• Administer prescribed analgesics.

• Encourage early mobilization within comfort limits.

4. Dietary Management

• Gradually advance from clear fluids to normal diet.

• Avoid gas-forming and spicy foods initially.
• Encourage fluids and fiber (if allowed) to prevent constipation.

5. Emotional and Psychological Support

• Address feelings of fear, embarrassment, or depression.

• Encourage discussion about body image and lifestyle adaptation.
• Promote independence in colostomy care.

6. Patient and Family Education

• Teach signs of infection or complications.

• Demonstrate how to:
 o Empty and change the pouch
o Clean the stoma
o Protect peristomal skin
• Teach diet modifications and when to seek help.
• Provide written instructions or videos for reference.

➢ Patient Teaching for Colostomy Care:

1. Understanding the Colostomy

• Explain what a colostomy is and why it was performed.

• Clarify whether the colostomy is temporary or permanent.
• Use diagrams, models, or videos to show what a stoma looks like and how it functions.

2. Stoma and Skin Care

• Teach how to inspect the stoma:

o Color: Healthy = pink/red
o Moist, protruding slightly
o Report: pale, black, bleeding, or sunken stoma
• Teach how to clean the stoma and surrounding skin with warm water and gauze/soft
cloth.
• Avoid soap with strong perfumes or alcohol.
• Teach to pat dry and use a skin barrier or stoma powder if needed.

3. Pouching System Use

• Show how to apply and remove the colostomy pouch.

• Teach how to empty the pouch when it is 1/3 to 1/2 full.
• Show how to cut the wafer opening to fit the stoma (2–3 mm larger than stoma).
• Emphasize keeping the seal leak-proof to avoid skin irritation.
• Explain how often to change the pouching system (every 3–5 days or as needed).

4. Diet and Nutrition

• Initially avoid gas-producing foods (e.g., cabbage, beans, onions, carbonated drinks).
• Eat regular, balanced meals and chew food thoroughly.
• Encourage fluids to prevent constipation or blockage.
• Introduce new foods slowly and monitor output.
• Foods that help control odor: parsley, yogurt, cranberry juice

5. Prevention of Complications

• Report immediately if:

o Stoma changes color, shape, or size
o There is unusual pain, bleeding, swelling, or rash
 o Output stops or becomes very watery
• Check for parastomal hernia, prolapse, retraction, or skin breakdown.

6. Psychological and Social Adjustment

• Address body image concerns and coping strategies.

• Encourage open communication with family and caregivers.
• Suggest joining a support group (e.g., Ostomy Association of India).
• Reassure the patient about returning to work, school, and social activities.

7. Clothing and Lifestyle Tips

• Wear loose-fitting, comfortable clothing.

• Avoid tight belts over the stoma.
• Teach how to manage the pouch discreetly in public settings.
• Discuss intimacy concerns if the patient brings them up.

8. Travel and Emergency Preparedness

• Carry extra pouches, wafers, skin barriers, scissors, and disposal bags when going out.
• Carry a stoma care kit and extra clothes while traveling.
• Avoid dehydration on long trips.

9. Follow-Up and Resources

• Schedule regular follow-up visits with surgeon or stoma therapist.

• Provide contact information of ostomy nurse or clinic.
• Give written instructions, illustrations, or videos for reference at home.

Conclusion

Colostomy care involves the regular cleaning and maintenance of the stoma and surrounding
skin to prevent infection, irritation, and other complications. It includes emptying and changing
the colostomy pouch when it is about one-third full, using proper techniques to clean the stoma
with warm water, and ensuring the skin barrier fits well to avoid leakage. Nurses and caregivers
also monitor for signs of complications such as bleeding, discoloration, or unusual discharge.
Patient education is essential, focusing on hygiene, pouching techniques, diet modifications, and
emotional support to help individuals adjust to living with a colostomy and maintain their quality
of life.
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