What Are the Most Common Ostomy Problems?

Ostomy A container used to store human waste, such as urine or feces.

Ostomy

definition:

For people:

Divided according to the drain of the pouch

Ostomy products are generally divided into three categories:

1) Closed pocket: suitable for changing the bag no more than once a day.

2) Open bag: suitable for semi-formed or liquid feces. The bag can be emptied frequently as needed.

3) Urinary ostomy bag: it can discharge urine, liquid drainage, has anti-backflow device, and can be connected with drainage bag.

There are generally two types of classifications by product use:

1) One-sided ostomy bag

2) Bilateral Ostomy

In fact, after the intestinal stoma operation, only the defecation site and habits are changed. The original digestion and absorption function of the intestinal stoma is not lost. You only need to cooperate in daily life to enjoy the food like normal people. After the intestinal stoma operation, , The initial diet should be gradually from liquid semi-liquid general food, food should be clean, hygienic, fresh, eat less fried, irritating food; diet in the rehabilitation period should be eaten quantitatively, chewing slowly to prevent

1. Stoma bleeding

the reason:

(1) Stoma mucous membrane erosion

(2) The stoma scrub is too rough and the intensity is too rough

(3) Trauma to the stoma

(4) Rupture of capillaries in the intestine (severe intestinal flora imbalance, diarrhea, radiotherapy, chemotherapy, etc.)

Inspection: glass test tube, flashlight

Treatment: Lighter early bleeding usually occurs in the first 72 hours after surgery. A slight stoma mucous membrane can be seen, and there are few bleeding points. Gently compress with a wet paper towel to stop bleeding. Severe local bleeding can be stopped with hemostatic agents, Yunnan Baiyao or local laser electrocautery. If necessary, surgery to stop bleeding.

2. Skin and mucous membrane separation

Causes: Partial necrosis of the intestinal mucosa at the stoma opening, shedding of mucosal sutures, high abdominal pressure, wound infection, malnutrition, diabetes, long-term use of steroid drugs.

deal with:

1. Cleaning and debridement Rinse and dry with sterile saline, if there is necrotic tissue, use debridement gel.

2. Fill the cavity. The cavity is shallow. You can only use Kanghuier ulcer powder or paste. If the cavity is deep, you can use seaweed filling strips or paste.

3. Protect and separate wounds with ulcer stickers or transparent stickers.

4. Stick the ostomy bag to avoid fecal contamination and promote wound healing.

3.Narrow stoma

Stricture is a narrow and tight stoma. The skin opening of the stoma is small. It is difficult to see the mucous membrane or the stoma skin opening is normal. However, it is difficult for fingers to enter and the tissue around the intestine is tight during digital diagnosis. Finger check: hoop finger.

Causes: Poor healing around the stoma; poor blood flow; infection of the stoma mucosal skin sutures; contraction of fascia or skin scar tissue; skin openings are too small during surgery; muscle openings in the abdominal wall are too small during surgery; crons disease relapses, tumors Compress the intestine (there is a tumor around the stoma or the edge of the stoma); secondary healing forms scar tissue contraction.

Treatment: If it is not serious, you can open the stoma with your fingers or an anal expander, but be careful not to damage the stoma. (After slowly improving from the tail finger, apply the index finger, apply lubricant to enter the stoma gently, and stay 2-- 5 minutes, once a day, need to be performed for a long time. Urinary stoma requires intermittent catheterization.

4. Stoma retraction:

Retraction is that the stoma is indented below the surface of the skin, which easily causes leakage, causing skin damage around the stoma and emotional disturbance of the patient

Causes: Insufficient dissociation, resulting in pulling; Mesentery is too short; Insufficient suture around the stoma or premature shedding of the stoma; Poor healing around the stoma leads to scar tissue formation; Premature stent removal of the ring stoma; Weight Dramatic increase;

Handling: In general, it is recommended to use a gently convex chassis, or use a leak-proof strip with a normal ostomy bag; those with skin damage can apply skin protection powder or painless protective film; sigmoid colostomy and continuous skin damage, consider using Colonic lavage method; weight loss; severe cases may require surgery.

5. Stoma prolapse:

Definition: The intestinal canal is turned out from inside the stoma. It can range from several cm to 10-20 cm. It usually occurs in circular stoma. It may cause edema, hemorrhage, ulcer, intestinal torsion, obstruction or ischemia and necrosis. Extreme embarrassment and psychological problems.

Reasons: Intestinal tube is not fixed firmly to the abdominal wall; the opening of the base layer of the abdominal wall is too large; abdominal pressure increases; abdominal muscles are weak;

Treatment: choose one-piece ostomy bag; choose soft skin care glue; size should be appropriate, guide the patient to measure the stoma and sticking steps correctly, reduce the number of bag changes; guide the patient's intestinal obstruction symptoms and signs (defined); guide the patient Symptoms of bowel necrosis (look for it by definition); the prolapsed part is pushed back into the abdomen from the stoma (if it is pushed back by hand, it may still prolapse, such as the prolapse of the distal stoma, and then put back with a pacifier Hold the intestine and fix the pacifier on the bottom ring of the stoma. The stool can still be removed at the proximal end, but this method cannot be used for single-chamber stoma. It must be surgery.); Psychological support; Severe cases require surgery. .

6. Parastomy hernia (protruding stoma)

Cause: Part of the intestinal canal is perforated to the subcutaneous tissue through the fascia notch, and it is difficult to stick the ostomy bag due to unevenness.

Reasons: The stoma is located outside the rectus abdominis; the fascia opening is too large; the abdominal muscles are weak; after multiple surgeries; continuous abdominal pressure increases;

Handling: Avoid lifting heavy objects 6-8 weeks after surgery; re-select a suitable ostomy bag, such as a softer chassis; re-instruct the patient's bag-changing techniques, such as using a mirror; guide the patient's symptoms of intestinal obstruction; prohibit stoma Lavage; weight loss; reduce abdominal pressure; hand pressure on the stoma site when coughing to reduce abdominal pressure; explain the reasons, psychological counseling; can wear a suitable stoma abdominal belt to relieve local discomfort, severe cases require surgical repair.

7. Fecal dermatitis (most asked by users)

Reasons: Poor stoma position; ileal stoma does not form proper protruding nipples; improper stoma care (leakage due to incorrect operation); leakage caused by skin folds;

deal with:

(1) Treatment of skin problems; light: skin care powder + protective film; severe: ulcer stickers or transparent stickers;

Especially serious: Chaoji + Stelli pocket

(2) Re-instruct patients to choose ostomy supplies; skin folds: choose leak-proof cream; severe skin depression: leak-proof strips (preferred), leak-proof cream, gently convex chassis; skin inflammation: Tera transparent chassis, 5900 Ostomy

(3) Instruct the patient on the correct installation method.

9. Allergic dermatitis

Reason: Place the ostomy bag or the adhesive base on the skin behind the ear and observe for 24 hours. Local skin redness, itching, pain and other discomfort symptoms are positive.

Treatment: If the allergy history is serious and the cause is unknown, you may need to do an allergy test; replace another type of ostomy supplies; topical steroid drugs. After 10 minutes of application, wash with water and dry the bag; if the condition does not improve, you may need a dermatology consultation

10.Granuloma of the mucosa

For benign tissue, it usually occurs where the mucous membrane comes in contact with the skin. It can be one or two capsules or around the edge of the stoma.

Cause: Mostly caused by irritation of sutures, but also by irritation of hard, stoma items

Handling: Check whether there are sutures around the stoma that have not fallen off; Instruct the patient to measure the size of the stoma correctly to avoid the chassis frequently rubbing the edge of the stoma, which will cause granulation.

11. Folliculitis around the stoma

Observation: Red rash, seemingly fungal infection

Cause: Caused by shaving or improper film changing

Handling; correct shaving and changing the film, it is recommended to use scissors to remove sweat and pustules with Staphylococcus aureus infection: first apply anti-inflammatory powder with a wipe, and then apply the film.

12.Uric acid crystal

Cause: Common urinary stoma

Treatment: use local white vinegar solution diluted twice with water for local wet compressing and cleaning; instruct urinary ostomy patients to drink more water daily, more than 3000 ml per day; daily vitamin C supplementation (daily vitamin C greater than 4g).