STOMAS

 Opening in front of abdomen  Surgically created  Bowel or bladder  Enables elimination of contents

Some diseases predispose patients: - Inflammatory bowel diseases (IBD) - Diverticular disease -Cancer of the Large Intestine  Volvulus (twisted bowel)  Perforation of colon  Toxic Megacolon (inflammation>bowel wall thins>colon bloated with gas>fever/GI pain)  Colonic Polyps

-Colostomy -Ileostomy - Urostomy

 Most common  Large intestine used  End colostomy -Descending = firmer stool -Ascending or Transverse = more fluid stool - Permanent or temporary

 End of small intestine becomes the stoma  Large intestine removed  Right-hand side  Generally more fluid contents

 Formed following bladder removal  Output is urine  Ileal Conduit Urinary Diversion -Small piece of bowel connected to the ureters -Acts as a channel for urine  Not reversible  Continuous flow  **Urostomy Association

 Generally closed bag (Disposable) -Change once – twice a day  Opaque/beige more discrete  Normally use one- or two-piece system  Two Piece -Base plate (change every 3-7 days) -Pouch

 Generally drainable bags (Reusable) -Change every 3-5 days  Also one- or two-piece systems  Integrated clip, or no closure system  Integrated tends to be preferred

 Many different types available -Also one- or two-piece systems  Tap outlet bag needs changing every 1-3 days  Specialist stoma nurse involvement  Night drainage bags can be used at home

 Adhesives  Adhesive Removers  Deodorants  Skin Fillers and Protectives  Stoma Caps

 Diet: (Fluids, Fibre-rich food, Dispelling gas, Reducing odour)  Clothes: (Discrete, Special designs)  Travel: (Forward planning, Plenty of supplies, ORS and anti-diarrhoea medicines)  Personal life: ( Most resume normal sex life, Smaller bag or stoma cap)  Swimming/Sport: (Stoma caps can be helpful, perfect for stable patients who need to use a smaller capacity bag for a short time)

• Gas Producing: Alcohol, Banana, Beef, Cucumber • Odour Producing: B-Vits, Fish, Garlic, Onions, Turnips • Increase/Loosen stool: Apples, Figs, Spicy foods, WG-Cereal, Prunes • Cause Blockage: Beef, Broccoli, Celery, Grapes, Coleslaw, Nuts, Corn, Mushrooms • Red stool: Beetroot, Strawberries, Tomato sauce

• DIARRHOEA: Antibiotics, Furosemide, NSAIDS, Laxatives, Mg ions, Misoprostol, Theophylline • CONSTIPATION: Anticholinergics, Diuretics, Fe2+, Opioids, Verapamil, Aluminium ions • INTESTINAL DYSMOTILITY: TCA, CCB, Opiates, Loperamide • GI SIDE EFFECTS: Aspirin, NSAIDS, CCB, Atenolol, Nitrates, Prednisolone, Ferrous Sulphate

Constipation  Diet and medicines review  Increase fluid and fibre  Consider use of Ispaghula Husk -NOT ileostomy patients -Increases water and salt loss -Refer to Ileostomy nurse

Diarrhoea  Diet and medicines review  ORS use  Loperamide (liquid or disp tab) - Caps may pass too quickly to be absorbed (check stoma output to check)