Approximately 10-15% of patients with colorectal cancer require a colostomy. Colostomy refers to a surgical procedure where a portion of the large intestine is brought through the abdominal wall to carry stool out of the body. During a colostomy, a surgeon will create an opening between the intestine and the abdominal wall. This opening is referred to as a stoma. The stoma is then attached to the outside of the abdomen so that waste materials can exit the body.
Colostomies may be temporary or permanent. Temporary colostomies are created to divert stool from injured or diseased portions of the large intestine, allowing rest and healing. Permanent colostomies are performed when the distal bowel (bowel at the farthest distance) must be removed or is blocked and inoperable.
Cancer patients with colostomies are faced with several issues, including the management of pouches, dietary adjustments, skin care, and pain management.
Selecting and Managing a Pouch
One of the primary issues with a colostomy is the selection of a pouch. The type of pouch used to collect stool is important because it protects the skin surrounding the stoma and effectively contains stool, which is essential to quality of life. Pouches may be flexible, rigid, flat or convex. In addition, pouches may have features such as skin barriers, gas filters, belts, or tape borders. With so many options available, patients may find it helpful to consult with a nurse who specializes in caring for patients with colostomies.
When using a pouch, it is important to:
Managing the Different Types of Colostomy
There are several different types of colostomy, including ileostomy, transverse colostomy, and sigmoid or descending colostomy. These procedures are performed for different reasons and each presents different management issues.
Management Strategies for Ileostomy: An ileostomy is an opening into the small intestine and typically involves removal of the colon and rectum (portions of the large intestines) because of inflammatory diseases or when there is a mass that is obstructing the colon. However, in some cases an ileostomy may be inserted temporarily to allow wound healing within the large intestine. Fortunately, the small bowel contains little bacteria and produces very little gas, so odor prevention is usually manageable with an ileostomy. Patients with ileostomies are faced with four main issues: skin care, dehydration, fiber consumption, and absorption of medications.
Management Strategies for Descending/Sigmoid Colostomy: A descending or sigmoid colostomy is typically performed when the rectum is removed. For these patients, the stool is a regular consistency and patients will usually have two bowel movements per day. Major issues for patients with descending/sigmoid colostomies include constipation (and gas and odors) and irrigation.
Coping with Cancer Treatment and Colostomy
Cancer treatment can present additional issues for patients with colostomies.
Radiation: Radiation to the stoma may create skin damage if the pouch is removed during radiation, so minimally adhesive systems should be used until the radiation is complete. If the pouch is left intact during radiation, care should be taken to be sure that no metal component or ingredients such as zinc oxide are used.
Stomatitis: Just as patients may develop mouth sores as a side effect of chemotherapy or radiation, the stoma may also be affected by ulcerations, tenderness, and swelling. Patients are encouraged to advise their physicians of any changes that may occur to the stoma during treatment.
Effects of Pain Medication: Pain medication frequently prescribed to cancer patients often results in moderate to severe constipation. Patients may need to increase their fiber intake and fluids. Stronger remedies, such as laxatives and irrigation of the fecal diversion, may be necessary.
In summary, colostomies can present several issues for cancer patients; however, with appropriate management strategies, cancer patients can prevent complications and maintain quality of life. Patients or caregivers coping with the management of colostomies may benefit from access to organizations such as the United Ostomy Association (www.uao.org) for support and product information.