What Is A Colostomy
In simple terms, a colostomy is when the colon is cut in half and the end leading to the stomach is brought through the wall of the abdomen and attached to the skin. The end of the colon that leads to the rectum is closed off and becomes dormant. This is known as a "Hartmann's Colostomy". There are other types of colostomy procedures, but this one is the most common.
Usually a colostomy is performed for infection, blockage, or in rare instances, severe trauma of the colon. This is not an operation to be taken lightly. It is truly quite serious and demands the close attention of both patient and doctor. A colostomy is often performed so that an infection can be stopped and/or the affected colon tissues can heal. The alternative to the colostomy is often pretty grim, death. Just be glad you are here. It is important realize that, with a few exceptions, you can look forward to having the colostomy reversed.
The Operation
The operation usually takes between two and four hours depending on difficulty, infection, and the severity of trauma if that is the case. Most of the reasons for a colostomy are: diverticulitis, other inflammatory bowel conditions, or cancer.
Since you are having the operation, you should discuss with your doctor whether or not you should have the appendix removed at the same time, since they are going to be in there anyway. It is not a necessary organ and, if removed, it can never cause you problems in the future.
It is normal practice to open the abdomen with an incision from just below belt line to just below the sternum. This gives open access to the internal organs. If you have infection, the doctor will suction and flush out the contaminates until you are clean.
Your colon is retrieved and inspected to locate the bad area. The bad area is then removed and the rectal end of the colon is sealed off. The end of the colon that comes from the stomach is cleaned and brought through the abdominal wall through another incision to provide an opening for the colon to expel gas and stool. After the colon is sutured in place, the first incision is either sutured or stapled together and the entire area is taped to protect the sutures or staples. A colostomy bag is applied to the area where the colon comes through the abdomen. This area is called a stoma.
During the operation there will be a catheter installed to drain the urine. This usually stays in for a couple of days. You will also have an intravenous (IV) line for medication and fluids. This will stay in for several days.How To Deal With Your Colostomy Bag
There are different types of colostomy bags. Some strap on, some stick on. I preferred the stick on type because they required less fussing with. I tried the strap on type and it was uncomfortable around my abdomen. You may not agree. The strap on bag fits over the stoma and a belt goes around you to hold it in place. The stick on bag fits over the stoma and is held on by a wax that adheres to you. The stick on bag requires more attention during installation. Both bags require that you shave the area of the skin around the stoma. I shaved about two inches around the stoma. The reason you have to shave this area is twofold. One is for sanitary purposes and the other is, if you use the stick on bag, so you don't feel as if you are pulling the hairs out when you remove the bag after a few days. It is bad enough after a few days when the hairs have had a chance to grow a little and attach themselves to the wax. You can't stop this, you can only minimize it. In the process of shaving around the stoma, you may touch the stoma with the razor unit and the stoma may begin to bleed. This may also occur if you wash the stoma a little too aggressively. Don't worry, the stoma is very sensitive and bleeds easily if scrapped or nicked. The stoma does not have pain sensors for this so you must be careful and watchful of what you are doing. If the bleeding is severe or won't stop, call your doctor or get medical assistance. Most of the time when you have bleeding it will be minimal and stop rather quickly.
After you have shaved and washed the stoma area you are ready to install a new bag. If you choose the strap on style, strap it on and you are done. If you choose the stick on style you will need to cut the wax area to fit your stoma size. Fitting the stoma is not very hard. The box that the bag came in will have a cardboard piece with a series of holes in it. Find the hole that most closely fits your stoma, but does not pinch the edges of the stoma. Place the hole selected over the back of the bag and note the area that has to be removed. Remove with scissors. Peel the protective cover off the wax and put a thin bead of stoma paste around the very edge of the hole you just cut. This acts as a seal and a fluid barrier. Don't use too much as the more paste you use the less wax you will have sticking to you. Apply the bag to clean, dry skin so that the opening for draining the bag hangs straight down, this makes it easier to clean out between changes. Clamp the bottom of either bag and you are done. This sounds complicated but it isn't after you have done it a few times. You should be able to change the bag in about 5 to 7 minutes. Always carry an extra bag with you, JUST IN CASE. They fit easily into a back pocket or purse and in an emergency you will be glad you have it.
Now the hard part - cleaning out the bag. This is not a pleasant task at first. If you are sensitive you will not like it but you will get used to it. When I changed my first bag I thought I would gag from the smell. You are closer to the stomach and the smell isn't good. I got a swimming nose plug from the sporting goods store so I didn't have to smell it. After a couple of weeks you get used to it and it won't bother you. First you may need to bleed gas off from the bag. You still pass gas, but now it goes into the bag and slowly inflates it like a balloon. To bleed the gas off tip the bottom of the bag up to provide an air passage to release the gas but not the stool, if there is any, and press gently on the bag until it deflates. If there is enough stool to require emptying, use the gas to your advantage. I sat backwards on the toilet so that I had a better shot at the bowl. Open the clamp on the bottom of the bag, hold the bag downward, apply light pressure to the top of the bag and let the gas push the stool down and out. After this you can use a good spray bottle to clean out the bag. wipe off the bottom with a piece of toilet paper, install the clamp and you're done. It may sound difficult but it isn't and you'll get the hang of it after a couple of times. You'll be amazed at how long a roll of toilet paper will last.
Sometimes you will notice that the area under the wax on your bag itches. There isn't a lot you can do about this short of removing the bag and scratching it. One way to ease this is to apply pressure to the spot that itches, this will help.
Another thought about changing your bag is to do it before you have a meal or well afterwards. The reason for this is when your stomach is full it expands your belly. If you apply the bag under this condition you may find that when this expansion is gone, your skin wants to be smaller and the bag wont let it, thus being a little uncomfortable. Also, when you install the bag, be sure to stand up straight so you don't fold the skin. Standing and sitting flex the bag enough without these extra dimensions coming into play.
