In recent years, the incidence of colorectal and bladder cancer has shown a continuous increase, and stoma surgery, as one of the important means of treating the disease, has also led to an upward trend in the number of stoma patients. Colostomy surgery is one of the most commonly performed surgical procedures and is often an important tool for saving lives, extending life and improving quality of life. Various stoma complications often occur after enterostomy surgery, which not only aggravate patients’ pain and increase economic expenses, but also seriously affect patients’ quality of life after surgery.
In 2001, Tianjin Medical University Cancer Hospital has started to pay attention to the health needs of stoma patients and took the lead in establishing the first stoma care association in China. Over the past ten years since its establishment, it has enrolled more than 800 members and trained 6 stoma volunteers, sending care and help to more and more stoma patients. However, as the number of stoma patients increases, their health needs have increased and they are in urgent need of more professional stoma care guidance. The Stoma Clinic was created to meet the growing health needs of stoma patients. A lot of work has been done to strengthen health education for patients and their families, teaching patients how to perform self-rehabilitation care during the recovery phase of treatment after stoma surgery and how to care for themselves in the face of common problems in home care.
1. How to clean the stoma and its surrounding skin?
Use gauze, toilet paper, wet paper towels, or cotton balls to wipe with warm water, wipe from the inside out, and then dry thoroughly. There is no need to use alkaline soap or any disinfectant, they will dry out the skin and easily damage it, and they will affect the adhesion of the adhesive.
2. Causes of skin redness and swelling around the stoma and care measures
2.1 Irritant dermatitis caused by prolonged impregnation and irritation of the skin by stool, also known as fecal water dermatitis. If the cut is too large, feces will be stored between the stoma and the chassis, causing skin irritation, and if the cut is too small, it will rub the intestinal mucosa and even cause bleeding. Therefore, the best cut size is the chassis cut to 1-2 mm larger than the stoma can be.
2.2 Frequent changing of the stoma bag, or forcibly peeling off the stoma bag caused by. The adhesive should be peeled off gently and slowly to avoid frequent replacement of stoma products. General two-piece stoma chassis use time is 5 ~ 7 d, a one-piece use time 1 ~ 3 d.
2.3 Excessive body hair around the stoma or sweating causes folliculitis or eczema. Body hair should be removed before applying.
2.4 Allergic dermatitis caused by skin allergy to mucus components can be applied with anti-allergic ointment, while changing the type of stoma bag or using skin protection film.
3. What about bleeding on the surface of the stoma?
The mucosa of the stoma is rich in capillaries, when changing the stoma bag or cleaning the stoma, sometimes the blood vessels will be damaged resulting in a small amount of bleeding, you only need to use clean tissue or cotton balls to slightly compress to stop the bleeding. However, if the bleeding is constant or abnormal in color, or if there is blood flowing from the inside of the stoma, you should see a doctor or go to the stoma clinic for consultation.
4. What should I do if the skin around the stoma bulges?
After stoma surgery, weak abdominal muscles or persistent increase in abdominal pressure may lead to abdominal bulging at the stoma site, which is medically called “stoma hernia”. For mild stoma hernia, a two-piece stoma bag with a lap band can be used to relieve the pressure on the abdomen. For severe stoma hernias, use a one-piece ostomy bag to increase the adhesive strength. Also consult your stoma clinic or surgeon. Avoid actions that increase abdominal pressure in daily life, such as lifting heavy objects, persistent coughing, etc.
5. What should I do if the stoma is protruding more and more?
For various reasons such as increased abdominal pressure and fixation of the intestinal tube, the abdominal muscles weaken, causing the intestinal tube to turn outward from the stoma and the stoma to protrude and grow, which is called “stoma prolapse”. Mild prolapse can be handled without treatment or pushed back into the abdomen by hand, while severe prolapse can cause edema, bleeding, ulcers or even intestinal torsion and other adverse consequences.
6.How to choose the right ostomy bag for you?
At present, there are two main types of ostomy bags sold in the market, one is called one-piece ostomy bag and the other is called two-piece ostomy bag. The two types of ostomy bags are subdivided into open or closed ostomy bags, transparent and opaque ostomy bags, ostomy bags with activated carbon tablets and ostomy bags without carbon tablets. If the patient’s stoma is the right size and the surrounding skin is intact and flat, then you can choose either type of ostomy bag. If the stoma is transverse colonic, you may want to choose a slightly larger diameter ostomy bag for the stoma chassis. Patients can choose one or several stoma pouches suitable for them according to their skin condition, economic situation, different living environment, and convenience of use. The stoma bag should be stored indoors and avoid direct sunlight.
7. Instructions for daily life of stoma patients
7.1 Protect the skin around the stoma. The skin around the stoma can become red, swollen, painful or even ulcerated when stimulated by stool. Therefore, it should be kept clean and dry. Once ulcers appear, skin care products such as protective film and protective powder should be selected according to the skin condition.
7.2 The stoma bag should be checked frequently to see if it is firmly attached, especially before going out to and from work, exercising and sleeping, so as to avoid spillage of the bag contents during activities and turning over. Usually, you should carry a spare bag with you, especially when the stool is thin.
7.3 Clothing should be soft, loose and comfortable. The waist belt should not be too tight and should not press on the stoma.
7.4 Bathing will not damage the mucous membrane of the stoma and water will not enter the body through the stoma. There is no need to cover the stoma in either shower or tub bath. If the stoma is covered with an ostomy bag during bathing, it is recommended to replace the bag with a new one after bathing. A mini pouch or stoma pessary can be used over the stoma when swimming, and a one-piece one-piece swimsuit is appropriate for female patients.
7.5 People with a colostomy cannot fully control the defecation process as normal people do, so the issue of diet is also a major concern for people with a stoma. Some people think that restricting dietary intake can reduce the amount of excretion to reduce the inconvenience caused by the stoma, but this often leads to more problems, such as excessive restriction of diet in cancer patients after surgery will slow down the body’s recovery and put the body in a poor state to affect the wound healing. In fact, enterostomy surgery does not affect the digestion and absorption of food, so there is no need to make special changes to the diet, and a balanced diet is sufficient. Precautions for diet at the early stage after enterostomy surgery: After enterostomy surgery, when the stoma has exhaustion and defecation, and the doctor checks to confirm the recovery of intestinal function, the diet can start to resume, with a gradual transition from liquid – semi-liquid – general food. Dietary precautions during the rehabilitation period: When entering the rehabilitation period, the dietary principles of stoma patients eat according to the patient’s needs, with no contraindications, but they should eat quantitatively and prevent overeating. Also pay attention to the following points: (1) Eat less gas-producing foods, such as beans, cabbage, leeks, peas, onions, carbonated beverages, beer, etc. Certain behaviors such as chewing gum, smoking, and talking while eating can also increase gas in the intestinal tract. Therefore, you should chew and swallow slowly when eating. (2) Eat less food that is prone to odor, such as corn, onion, garlic, garlic, asparagus, spicy condiments, etc. (3) Avoid eating foods that can easily cause constipation or diarrhea. (4) Eating coarse fiber food should be moderate. (5) Ileostomy patients should pay attention to drink more water and eat more vitamin C rich food and fresh vegetables to prevent vitamin C deficiency.
In conclusion, stoma patients should strengthen their self-observation and master their personal diet rules. With a little attention in their daily life, they can enjoy the same quality of life as the general public.
7.6 After stoma surgery, you can still participate in work as long as your energy allows, and the stoma itself will not affect your work. However, frequent lifting of heavy objects should be avoided to avoid the occurrence of stoma hernia.
7.7 After complete physical recovery, you can participate in non-strenuous sports activities such as pool, bowling, bicycling, jogging and traveling. However, strenuous activities should be avoided and care should be taken to avoid damage to the stoma during the activities. If you travel, remember to bring enough stoma care products and carry them with you for easy replacement.