The Ins and Outs of Ostomies: A Fun and Practical Guide for New Nurses

Written By Rhoda Sommer

How would you care for a patient with an ostomy?

What is an Ostomy?

An ostomy is when the colon is brought to the skin, an incision is made, and the intestine is brought through and sewn to the skin. This creates another way for the waste to exit the body. This could be related to a detour on the highway when under construction, when pavement needs time to harden, or tissue needs time to heal. The difference between an ostomy and a stoma is that the stoma is around the opening where the waste exits the body. 

Types of ostomies

Types of ostomies and conditions which caused the need for an ostomy:

We have three types of ostomies: colostomy, ileostomy, and urostomy. A colostomy is a diversion created with your colon, when it is brought up to and through the abdominal wall and skin with an opening made in the abdomen. It diverts the waste away from the damaged or diseased part of the colon. The waste product here is formed or semi-formed stool.  An ileostomy is created out of the small intestine, specifically the ileum. The waste product here is very much liquid and has not formed stool. Urostomy involves the tubes that go to your bladder, which are brought to the skin and through to drain urine from the body.  All three of these different ostomies are carefully placed on the abdomen to help with easy access for care after the ostomy. 

Ostomies can be temporary or permanent depending on the condition that caused the diversion. While doing the surgery, if it is determined that the rectum needs to be removed, and the ostomy will be permanent.

Patients who need an ostomy:

  • Colon or rectal cancer

  • An injury affecting the small or large intestine

  • A blockage of the bowel

  • Conditions that cause GI irritation - including ulcerative colitis and Crohn’s disease

  • Diverticulitis - characterized by the inflammation of small pouches in your colon.

  • Bladder cancer

Ostomy usage steps.

Understanding the Ostomy Bag: What’s in the Bag?

The appliance a patient uses is up to their comfort level when applying it, and the type of stoma/ostomy the patient has. Placement can affect how the appliance is placed. There are two appliances: two pieces, which include the flange and the bag that attaches to the flange, and two pieces with a belt to help hold it in place. The adhesive is already on the flange, but extra is needed around the edge of the stoma to increase the time it takes for the appliance to remain adhered and in place without leaking stool on the patient’s skin.

The appliance should be changed every 6-7 days, or when full or leaking.  Changing the appliance does take some thought:

1.) After removing the appliance, you will need paper towels or washcloths to place on the ostomy.

2.) You will need to wash the stoma and skin with water. Soap can be used on the skin as long as it has no lotion. The lotion will affect the ability of the appliance to remain stuck to the skin.

3.) Empty the bag of the appliance. If using again, wipe the end with a paper towel and replace the clip. Take the flange and bag off now and assess the skin around the stoma.

4.) Apply any stoma powder to areas that are irritated or open. Ensure it is just a light layer. Do not cake it on. Place adhesive around the stoma opening on the flange you cut - if needed. Place the bag down towards their legs. So when the patient sits down in the bathroom, it can be emptied in the toilet. If the patient is bed-bound, turn the bag so the stool can be removed to the patient's side.

Remember: Ostomy care is doing perineal care only on the abdomen. Your patient will need to care for that skin more carefully; it is not used to stool or urine coming into contact daily.

Daily Care and Troubleshooting:

Tips to keep your patient comfortable and emotionally stable with an ostomy: 

  • Let the patient learn and explore their appliance and bag. Get acquainted with how it works.

  • Let the patient look at other appliances and see if they would better fit them.

  • It's crucial to understand that the stoma will change in size and color over time. Being aware of these changes before they happen will make your patient feel prepared and knowledgeable. For instance, the stoma will shrink over the first 12 weeks, and knowing this in advance can help your patient manage their expectations.

  • Advise your patient that living with an ostomy will likely affect them emotionally, with anxiety, depression and low self-esteem.

  • Finding a support group of people with ostomies or who have been where your patient is now, can help. 

  • Getting enough sleep, eating a healthy diet, and exercising will also help your patient.

  • Advise your patient about the myths that circulate about patients with ostomies. Many of these myths incorrectly advise that a patient with an ostomy will be limited in what they can do.

There are many myths about ostomies.

Debunking Myths and Addressing Common Questions:

There are several myths surrounding ostomies that can cause unnecessary worry and fear. By debunking these myths and providing accurate information, we can reassure patients and help them understand that life with an ostomy can be fulfilling and normal.

Myth 1: The pouching system you were given at the hospital is the only one you have to use.

This is not true. We have discussed looking to see if another pouch system would work better for you, and you have the freedom to choose what works best for you.

Myth 2: The pouching systems are all the same, so there is no need to look around.

Again we have already put this myth to bed, it is not true. Patients should be encourage to explore other options to make them feel more comfotable and at ease with caring for their ostomy.

Myth 3: The stoma should not change size in the weeks and months following surgery.

Again, this is not true. We have already covered the need to know it will change over the first 12 weeks after surgery.


Myth 4: Skin irritation is normal.

No, this needs attention as soon as it is noticed. An opening in the skin is a chance for infection. Patients need to react quickly and get help from a medical professional if needed. Remind your patient, they are not alone in this journey, and seeking help is a sign of strength.


Myth 5: If you have an ostomy, your significant other will not love you the same way.

Remember, the ostomy does not change your patient’s worth. Any fears the patient or their significant other have, need to be talked about and thought through. Your patient can work this out, and many patients have found their relationships do work after getting an ostomy.

Myth 6: Odor is a part of life with an ostomy.

No, it is not! The bag holds most of the smell inside. If you do have odor, some specific bags or pouches have charcoal in them to help with it. Also, you can put drops in the pouch to help with odor.

Myth 7: You can't go swimming if you have an ostomy.

Yes, you can. The patient can get in the shower with the appliance on and go swimming with the appliance on.

*** Do you have questions I did not answer? Then let me know in the comments below.

More information from ConvaTec:

Here are some esources for more information and learning if you need or want it.  Click through to the links below, and let’s keep learning!

Articles:

  1. American Society of Colon and Rectal Surgeons: Ostomy Overview
    This article provides a comprehensive overview of the different types of ostomies, their indications, and care tips.

  2. Wound, Ostomy, and Continence Nurses Society (WOCN) Resource Library
    WOCN offers articles and guidelines related to ostomy care, focusing on evidence-based practices.

  3. Cleveland Clinic: Ostomy Care Guidelines
    This guide covers everything from basic ostomy care to handling common complications and patient education.

  4. Johns Hopkins Medicine: Stoma and Ostomy Care
    An informative article offering practical tips for managing stomas and ostomies.

  5. MedlinePlus: Ostomy Care
    A resourceful page with links to various articles about ostomy management, post-op care, and related procedures.

Videos:

  1. https://youtu.be/gdJv2MwaDy How to change an ostomy by a nurse with an ostomy  Shows care of an ostomy with skin irritation and treatment needed to clear this up

  2. Colostomy and Ileostomy Care and Bag Change | Nurse Skill Demo Shows care of ostomy and ileostomy

Patient and Professional Resources:

  • UOAA Support Groups and Resources
    The United Ostomy Association of America offers support groups, articles, and forums where both nurses and patients can find valuable resources.

  • WOCN Society: Educational Resources
    In addition to articles and guidelines, the WOCN Society offers courses and webinars on ostomy care.

Sources:

Let’s Keep the Conversation Going!  

We’d love to hear from you! Feel free to leave your comments or questions below—let’s make this a conversation!

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Comment below!

I invite my readers to join a discussion in the blog comment section to share tips and support each other in developing this essential skill.

Share your thoughts and experiences in the comments:

  1. Put yourself in the shoes of a nurse caring for a patient with an ostomy. What would you do to educate them or put them at ease?

  2. Why myth about ostomies suprised you?

  3. What resources would you give your patient who is experiencing a decline in metal health due to their ostomy?

  4. Would you like to see more case studies like this?

  5. Any tips or stories you'd like to share with your fellow new nurses?

Ready to embark on this learning journey? Let's make this learning experience interactive and fun!

Share your answers in the blog comments to learn from each other.

Don’t forget to follow me on my Instagram account @nclex_one_on_one_tutoring and share it with your colleagues!

Rhoda Sommer https://oneononetips.com
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