Complications with Colostomy

Health Teaching: Complications with colostomy

Patient education is an important part of skilled nursing. Nurses are often required to document patient education on their nurses progress notes. This patient teaching can be used to educate the patient and caregiver about complications that can occur with colostomy. A colostomy is an artificial opening made by a surgeon from the colon, a part of the large intestine. The colon is brought out on to the abdomen, which appears dark pink in color. This nurse teaching can also be added as patient education example to nurses progress notes for documenting them quickly and efficiently. Complications that can occur due to colostomy include:

1. Dehydration and electrolyte imbalance: Individuals on colostomy, depending on the location of stoma, could lose varying amounts of water and electrolytes in the stool. Fluid and electrolytes are significantly absorbed in the large intestine. So, a stoma placed along the length of large intestine will fail to absorb all the water and electrolytes that normally were destined to get absorbed in the large intestine. Also, individuals with surgical excision of the large intestine (mainly colon) too suffer loss of fluid and electrolytes into the stool, as the site of absorption is compromised. Even along the length of large intestine, individuals with proximally located stomas are at increased risk for loss of water and electrolytes into the stool, thus making the stool more fluidy. Consequently, stomas located on ascending colon and transverse colon lose more water and electrolytes into the stool compared to stomas located on descending colon and sigmoid colon. As a result of fluid and electrolyte loss, all these individuals discussed above are at increased risk for presentation with dehydration and electrolyte imbalance. Individuals with stomas located on distal large intestine (descending colon and sigmoid colon) stand the chance of fluid and electrolytes getting absorbed in the proximal segments of large intestine (ascending colon and transverse colon) and consequently, lesser risk to present with dehydration and electrolyte imbalance. Individuals with colostomy must observe closely for signs and symptoms of evolving dehydration, such as, feeling thirsty, dark-colored urine, feeling lightheaded, and dry mouth & lips. These individuals must also observe compliance with increased fluid intake and electrolyte supplementation, as recommended, to help prevent dehydration and electrolyte imbalance from developing.
2. Leakage of stool and skin irritation: Poorly measured stomas, improperly cut wafers, and loosely attached colostomy bags can all lead to stool leakage and accidents. This can invite embarrassing situations, when in public. Leakage of stool, frequent exposure of the skin surrounding stoma to moisture, and tightly adherent adhesive used to fix the colostomy bag can result in irritation of skin and over a period of time can lead to severe inflammation and injury. Measures such as, appropriately measured stomas, properly cut wafers, caution exercised with attaching the colostomy bags, using barrier rings, emptying the bag periodically, and use of adhesive remover can all help prevent leakage of stool and risk for skin irritation.
3. Abdominal discomfort and pain: Eating multiple smaller meals, especially during the first 6-8 weeks of initiating on colostomy can be helpful versus having three bigger meals. Larger portions in one sitting can lead to abdominal discomfort and pain. Multiple meals with smaller portions could be better tolerated. Individuals can slowly graduate to eating regular three big meals, over a period of time, as tolerated.
4. Blockage of stoma: Poorly chewed food with bigger chunks in swallowed portion can increase the risk for blockage of stoma in individuals with colostomy. Individuals with stoma blockage could present with nausea, vomiting, swelling of stoma with discoloration, and swollen abdomen, thus precipitating an emergency. Chewing the food thoroughly to almost liquid consistency helps prevent risk for blockage of stoma. As chewing thoroughly involves some time, individuals with colostomy must plan enough time on their schedule for meal and not rush through it.
5. Poor processing of fiber-rich foods: Individuals on colostomy poorly process foods rich in fiber. Fiber rich foods can clog up the colostomy resulting in severe abdominal pain. Fiber rich foods can also produce lot of gas, leading to symptoms of abdominal fullness and discomfort and necessitating the individual to frequently burp their bags. So, avoid or exercise caution with foods such as, brown rice, brown bread, green leafy vegetables, raw fruits with skin, raw vegetables with skin, and most of foods on the salad menu.
6. Increased gas production: Individuals on colostomy must avoid or minimize consumption of foods that are increasingly gas-forming. Increased gas production can result in bloating, diarrhea, and severe abdominal discomfort. High fiber foods in general are also increasingly gas-forming. So, these individuals must avoid or minimize consumption of vegetables, such as, beans, artichoke, turnip greens, lentils, green peas, broccoli, brussels sprouts, cabbage, and onions. Exercise control on consumption of whole grains, such as brown rice, oatmeal, and whole wheat. Avoid or exercise caution with fiber rich fruits, such as, apples, banana, mango, pineapple, and strawberries. The golden rule for these individuals regarding any fruit in general is peel the skin off. Foods rich in starch/carbs, such as, potatoes and pasta can also be excessively gas-forming and so, must be limited on consumption. Skin peeled potatoes can be a healthier option for these individuals. Left undigested, the milk sugar lactose can also lead to the increased production of gas and contribute to bloating, abdominal pain, and discomfort. Individuals on colostomy must avoid or exercise caution with whole milk and other products of whole milk, such as, cheese and yogurt. Picking milk and dairy products that are lactose-free can be a healthier option for individuals on colostomy. Using an air freshener, especially when emptying or burping the bag in a public toilet, can help avoid/minimize this uncomfortable situation to oneself, caregivers, and others in the restroom. Using a mask or menthol vapor rub on the nose can be of additional help. Placing some deodorizing drops into the bag every time you empty the bag or into a fresh bag at the time of bag change can help reduce impact of the odorous states. This can help promote personal comfort and avoid embarrassing situations while in group. Having an Osto-ez-vent device attached to the bag also helps easy burping.
7. Stoma retraction: Occasionally the stoma can move inward and become smaller. This usually happens with individual gaining weight and deposition of some abdominal fat. Growth and contraction of scar tissue, as part of healing process, at the surgical (stoma) site can also lead to shrinkage and retraction of stoma. Retraction of stoma can make attachment of the bag difficult, resulting in leakage, skin irritation, and need for frequent bag change.  Use of convex wafers, paste or seals to level out the point of retraction, with proper use of colostomy belt can help address stoma retraction and reduce risk for stool leakage. Severe cases of stoma retraction might necessitate a revision surgery.
8. Parastomal hernia: Often the intestines can bulge outward under the skin, near the stoma. This bulge is called a parastomal hernia, which can make attachment of the bag difficult, resulting in leakage, skin irritation, and need for frequent bag change.  Development of parastomal hernia is quite common and they can be self-limited. Severe cases of parastomal hernia might necessitate a laparoscopic repair.
9. Necrosis: Occasionally blood supply to the bowel at the site of stoma can get compromised, resulting in tissue infection, tissue death and necrosis. The tissue infection can spill into the blood stream and spread to distant sites, resulting in sepsis and shock. Individuals in sepsis and shock can present with low blood pressure, reduced urine output, fatigue, and confusion. Individuals with necrosis of bowel can present with symptoms, such as, fever, nausea, vomiting, severe abdominal pain, distension, black discoloration of the involved bowel segment, and bleeding at the stoma site. Severe cases of necrosis might necessitate an emergency excision of involved bowel segment and a revision surgery for colostomy. Report any of these above findings to your physician at the earliest notice for further investigation and employing appropriate relief measures.