1. Essential Stoma Care
Catherine Murray, Lead Stoma Care Nurse, GHT

2. What is a Stoma? Derived from Greek word meaning mouth or opening.
Diversion of bowel or bladder contents onto the abdomen.
First performed in 18th Century on wounded battle casualties.
Red/pink in colour and moist.

3. Types of Stoma Colostomy - Loop or end Ileostomy - Loop or end
Urostomy - Ileal conduit

4. Colostomy- Diversion of Large Bowel
Colon
Left iliac region
Temporary or permanent
End / loop
Formed stool
Flush to skin
Closed pouch

5. Conditions Necessitating Colostomy
Diverticular Perforation
Bowel Cancer
Obstruction
Irradiation damage
Bowel ischaemia
Incontinence
Trauma
Volvulus
Congenital abnormalities
Hirschsprungs disease
Imperforate anus
Spinal injury
Colovaginal / colovesical fistula

6. Ileostomy - Diversion of Small Bowel
Ileum
Right iliac region
Temporary or permanent
End/loop
Semi formed stool
Spout
Drainable pouch

7. Conditions Necessitating Ileostomy
Anastomosis protection
Crohns disease
Ulcerative colitis
Familial polyposis
Obstruction
Irradiation damage
Trauma

8. Urostomy/Ileal Conduit
Bladder cancer
Interstitial cystitis
Congenital Abnormality
Ileum used as channel
Spout
Usually permanent
Appliance with tap

9. Urostomy/Ileo Conduit
Reason for:
Bladder Cancer
Interstitial Cystitis
Incontinence.

10. Choice of Appliance Colostomy formed stool closed pouch
Ileostomy semi formed stool
drainable pouch
Urostomy urine
pouch with tap

11. Choice of Appliance One Piece Flexible Low Profile Discreet
Convex Appliance
Two piece
Robust
Frequent
pouch change
Less skin
disturbance

12. Changing an Appliance Gather supplies Bowl warm water
Wipes / kitchen roll
New appliance
Scissors
Measuring guide / pen
Disposal bag

13. Changing Appliance Ensure privacy at all times
Be aware of body language
Empty pouch
Gently remove soiled pouch
Fold in two - disposal bag
Wash around stoma and surrounding skin
Inspect skin and stoma
Pat skin dry
Measure stoma and cut appliance - snug fit
Remove plastic backing
Apply from bottom up
Check closure secure
Secure disposal bag
Wash hands

14. Diet and the Ostomist

15. Diet and the Ostomist No hard and fast rules
Promote healthy balanced diet
Trial and error
Introduce new foods slowly
Post op -
Regular grazing
Transit of food erratic through operated bowel
4 - 6 weeks lower fibre diet
Do not diet!

16. Diet and the Ostomist Colostomy Ileostomy
Can tolerate most foods
Avoid constipation
Fibre and fluids
Medication
Eat regularly
Ileostomy
Initially some foods difficult to digest
May need long term Loperamide
Care taken with
Fruit and veg skins
Green leafy veg
Spicy foods
Fizzy drinks
Onions
May need to avoid
Nuts,seeds,dried fruit
Sweetcorn,oranges

17. Urostomist and Diet Plenty of fluids Cranberry juice to reduce mucus
Asparagus / fish - odour
Some medication can colour urine
Avoid constipation

18. Who we are and where to find us
Gloucester Royal Hospital
Level 5, Tower Block
Tel:
24hr answermachine

19. Who we are. Where to find us
Cheltenham General Hospital
West Block – opposite vascular lab
Tel:
24hr answermachine