PATIENT EDUCATION GUIDELINES

STOMA MANAGEMENT IN THE HOME

Stoma is a Greek word that means mouth. A stoma is an opening in the abdominal area
that is surgically made to change the usual pathway for stool or urine elimination. The
stoma is normally red, moist and produces mucus.

Your stoma is part of your intestinal tract. It has the same type of mucous membrane as
the inside of your mouth. Your stomas may slightly enlarge or become smaller with
digestion and movement of stool through the intestine. Your stoma may bleed slightly
when rubbed because of the rich blood supply to the area. This is no cause for alarm.

EMPTYING AND CHANGING THE POUCH

1. Change the pouch as soon as it leaks. Do not tape a leaking pouch to the skin as
this may cause skin irritation where moisture and stool are trapped under the
pouch.

2. Burning or itching around the stoma may mean that the skin is irritated. In this
case the pouch needs to be changed immediately.

3. Empty the pouch when it is 1/3 full to prevent the weight from breaking the seal
and causing leakage.

WASHING

1. Wash the skin around the stoma (peristomal skin) with a mild soap to cleanse
the area. The peristomal skin should then be rinsed well to avoid any soap
residue that could also cause irritation.

2. Ivory and Dial are mild soaps. Do not use soaps that contain lotion, creams or
oils.

3. Pat the skin dry, as moisture will keep the pouch from sticking. Gently wipe, do
not rub the stoma.

4. A bath or shower may be taken with or without the pouch.

HAIR

Remove hair on the peristomal skin as needed with a blunt-type scissors or an electric
razor. Never use a straight or safety razor or razor blades because they could cut
delicate tissue and cause bleeding.

Formulated 07/96
CLOTHING

1. Avoid a tight belt because this may cause skin irritation. Pad the belt tabs for a
comfortable fit.

2. Wear belts above or below the ostomy pouch to prevent rubbing.

GAS

1. Gas and stool cannot be controlled when you have a stoma because a muscle
sphincter is not part of the stoma. The sound of passing gas may possibly be
muffled by pressing a hand against the stoma.

2. Release gas in your pouch either by opening the end of the pouch or through the
pouch gas-relief valve.

3. Excessive gas can be caused by air swallowing, eating too rapidly, talking while
eating, chewing gum, drinking through a straw, drinking carbonated beverages,
eating gas-forming foods, and smoking.

FOODS

1. Add foods to your diet gradually, adding one different food at a time to determine
how the food affects you.

2. If a food causes problems, stop it and try again later. If it still causes problems,
avoid eating that food. You will usually be able to eat the same kinds of food that
you ate before your surgery.

3. During the summer and with vigorous exercise, you sweat more, so you may
need more liquids and salt. Be sure to ask your physician about recommended
liquid intake. Gatorade and chicken bouillon are helpful to replace liquid and salt
losses.

ODOR CONTROL

1. A liquid deodorizer can be dropped on a piece of tissue and placed into your
pouch. There are deodorizers in pill form.

2. Check with your physician before taking any medications by mouth for odor
control.

Formulated 07/96
MEASURING FOR POUCH FIT AND SUPPLIES

1. Remeasure your stoma before ordering a new supply of pouches in case the
stoma has become smaller after surgery.

2. The pouch opening should be 1/8-inch larger than the stoma.

3. Skin barriers, if used, should be 1/8-inch larger than the stoma.

4. Always take ostomy supplies with you when you travel. Carry supplies on you
and do not check them through with the luggage. Carry an emergency pouch at
all times.

IRRIGATION

Ostomy irrigation may vary because of individual differences and types of surgery. Ask
your physician and home health nurse for information about ostomy irrigation.

CARE FOR SOR SKIN

When the skin is red and weepy do the following:

1. Wash the skin and pat dry. Do not use alcohol or hydrogen peroxide to clean
around the stoma because this can damage the tissue.

2. Paint sore skin very thinly with a liquid antacid, such as Maalox. Allow the liquid
antacid to dry until it is chalky. You can use a hair dryer on a low setting to dry
the skin. Do not use antacid on healthy skin to prevent skin problems.

3. Dust with Karaya or Stomadhesive powder; rub in the powder, and brush off the
excess.

4. Use a skin barrier past, such as Stomadhesive or Hollihesive.

5. Put on the pouch as usual.

6. Consider more frequent pouch changes if the skin is red and irritated.

7. If the skin is red from an improper fit of the pouch, you may need to add
convexity. (See Convexity.)

8. Do not use Benzoin on skin around your stoma. Skin preparations should not be
used under wafer type barriers because this can result in redness and itching
and can actually interfere with the integrity of the barrier.

Formulated 07/96
 9. If itching and redness surround the stoma, this can be the sign of a yeast
infection. Talk to your physician, as you may need an antifungal powder. Brush
off the excess powder before applying the pouch.

CONVEXITY

1. Convexity pouches are used when the stoma is retracted or is flush with the
abdomen and has leakage problems. Convexity helps improve the seal.

2. Some pouching systems have built-in convexity; others use a separate,

disposable plastic convex insert ring. These are pressed into the flange skin
barrier until they are seated under the flange.

WHEN TO CALL YOUR PHYSICIAN

Notify your physician if the following occurs:

1. Your stoma becomes swollen or bleeds constantly (a small amount of blood is

normal.)

2. Your stoma changes color or becomes dark purple or black.

3. You do not have a bowel movement for 48 hours.

4. You experience forceful vomiting.

OSTOMY CLUB

You may with to join your local ostomy club. Meetings are held once a month. For
information about your local club contact the following organization:

United Ostomy Association

1111 Wilshire Boulevard
Los Angeles, CA 90017

SPECIAL TIPS FOR ILEOSTOMIES

1. Expect frequent drainage from ileostomies, especially 30 minutes to 1 hour after

a meal. The consistency of the drainage may be somewhat like oatmeal.

2. It is best to change the appliance when the stoma is not draining, such as in
early morning before breakfast, or 3 to 4 hours after eating.

Formulated 07/96
 3. If the stool is thinner and more watery than usual for 48 hours, notify your
physician for an antidiarrheal medicine. Eat bland foods, such as applesauce,
rice, bananas, and cereals to thicken the stool.

4. Laxatives should never be taken. If you are taking medicines, check the pouch
for pills that have not been digested. Time-release capsules do not work with an
ileostomy. Ask your physician to prescribe a liquid form of the medicine.

5. Undigested foods may cause your ileostomy to stop draining. Limit food high in
cellulose fiber such as corn, popcorn, nuts, mushrooms, fruit skins and pulp,
celery, olives, and Chinese vegetables. If these types of food are eaten, drink
extra amounts of liquids.

6. Signs of food blockage include swelling of the stoma, cramping, vomiting, and
drainage changes from semisolid to liquid or to no drainage. If you have these
symptoms and have eaten fibrous foods in the last 24 hours, suspect food
blockage. Drink 2 to 3 cups of hot tea or 8 ounces of grape juice. Lie down and
relax for 30 minutes. Check your pouch for stool drainage. If there is no
drainage, notify your physician or go to the emergency room. Do not irrigate the
stoma or take a laxative.

SPECIAL TIPS FOR UROSTOMIES

1. The normal color of urine is yellow. The amount of liquids that you drink can
often change the lightness or darkness of the urine. A dark urine means that you
should drink more liquids.

2. Medicines may also change the color urine.

3. Mucus may cause the urine to look cloudy. If there is a lot of mucus, the urinary
pouch can become clogged. Drinking increased amounts of water will help thin
the mucus.

4. The stoma continuously drains urine. When changing the pouch, a wick may be
placed on the stoma to soak up urine. Make the wick out of a rolled piece of
gauze, paper towel or tampon.

5. A reusable pouch may be washed and reused approximately 3 or 4 times. Clean

the reusable pouches with a mild soap and tepid water, followed by a vinegar
rinse. Air dry the pouch, using a folded towel stuffed inside the pouch to keep the
sides from sticking together. Permanent faceplates may be scrubbed with a
brush and soaked in 1:1 vinegar and tap water solution.

6. During the night connect the pouch to a drainage container. Clean this container
as you would the pouch. When hooking the pouch to the night drainage tubing,

Formulated 07/96
 leave a little urine in the pouch to start drainage and to keep a vacuum from
forming. Place night drainage bags toward the foot of your bed.

7. Urine should be normally acidic. Alkaline urine that constantly bathes the skin
and stoma can cause white, gritty skin deposits or a gray, warty look to your skin
and stoma. If your physician agrees, taking vitamin C, 500mg 4 times a day,
drinking at least 2 quarts of liquid a day, and applying a vinegar solution soak to
the stoma will maintain urine acidity and help prevent urinary infection and skin
irritation.

8. Vinegar solution is made with white, distilled vinegar and is mixed with equal
parts of tap water. A vinegar soak to the stoma is done by placing a small
washcloth, wet with the vinegar solution, on the stoma for 20-30 minutes during a
pouch change.

9. Report signs of a skin rash, a foul odor of urine, elevated temperature, bloody
urine, and side or back pain to your physician.

Formulated 07/96