Possible Complications of Ostomy Surgery

What to Expect from Your Hospital Visit

On the day of the operation, you will be fitted with an intravenous line (IV) to allow administration of fluids, anesthetic, and medications. You will also receive a catheter to drain urine. Both will remain in place for several days. The operation itself usually takes two to four hours. The surgeon will make an incision in the abdomen, examine the intestines, remove the diseased or injured area as needed, and construct the stoma.

Post-surgery, you will need to keep a close watch for complications. Colostomy complications, ileostomy complications, and urostomy complications share many of the same signs. If you observe any of the following, contact your physician immediately: bulging skin around the stoma, severe cramps, unusual odor, continuous or excessive bleeding between the stoma and the skin, severe injury to the stoma, unusual changes in the stoma’s size or color.

Possible Colostomy Complications

Possible colostomy complications include:

• Hernia: A hernia is a separation of the muscles in the abdominal wall. It may be indicated by a bulge in the skin around the stoma and/or partial obstruction of the stoma. For prevention of hernias, an ostomy nurse should mark the location of the stoma prior to surgery. After surgery, you will need to avoid heavy lifting.

• Phantom rectum: A “phantom rectal” sensation is when the body feels as if it needs to evacuate—even though the rectum is no longer connected to the bowel. This is a normal, if disconcerting, occurrence similar to the “phantom limb” sensation reported by amputees. Some patients are able to relieve the sensation by sitting on a toilet and going through the motions of evacuation.

• Blockage: Lack of output from the stoma, distended abdomen, or severe cramping can indicate a blockage in the intestines or stoma area. Severe cramping, nausea, vomiting, and/or a lack of discharge from the stoma for more than 4 hours should be reported immediately to your physician. Untreated, a blockage could result in small intestine perforation.

• Bleeding: Although a little bleeding is normal after surgery, you should tell your physician if you have excessive or continuous bleeding around the stoma. Moderate amounts of blood in the pouch can also indicate a problem and should be reported to your doctor.

• Infection: Infection is a risk with any surgery. Signs to watch for including fever, unusual odor, and changes in the size or appearance of the stoma.

• Stoma injury: Report any severe injury or cut in the stoma to your physician. Also watch for unusual changes in the stoma size or appearance.

• Severe skin irritation: Skin irritations can be caused when bowel contents—often highly acidic—leak onto the skin surrounding the stoma. To avoid serious skin irritations, keep the area surrounding the stoma clean and treat chronic irritation, ulcers, and sores as early as possible. Severe skin irritation can prevent a good seal around the stoma.

Ileostomy Complications

Many complications that occur with colostomy surgery (described above) are also seen with ileostomy surgery. As for colostomy, ileostomy patients need to watch for signs of blockages, excessive bleeding, infection, stoma injury, and skin irritation. Ileostomy patients may also experience “phantom rectal” sensations.
Other possible complications are unique to ileostomy surgery:

• Difficulty with absorption of nutrition and/or short bowel syndrome: Since ileostomy surgery removes part of the small intestine, there is less small intestine available to perform its essential nutrient-absorbing function. You have to take great care to get adequate nutrition. Short bowel syndrome is the extreme example of this problem.

• Dehydration and electrolyte imbalance: Since ileostomy removes the entire colon and a portion of the small intestine, the bowel’s ability to absorb electrolytes and fluids is compromised as well as its ability to absorb nutrients. You need to watch for signs of dehydration and electrolyte imbalance such as dry mouth, extreme thirst, nausea and even vomiting. Diarrhea poses a special risk for ileostomy patients, because it causes the digestive contents to move through the bowel too quickly for fluid and electrolytes to be absorbed. If you experience diarrhea or signs of dehydration, replace electrolytes quickly with a sports drink or electrolyte solution.

Urostomy Complications

Urostomies can result in many of the same complications as seen with colostomy and ileostomy surgery (described above): blockage, excessive bleeding, infection, stoma injury, and severe skin irritation.

Urostomy patients also need to watch for:

• Urinary crystals: These occur when the urine is too alkaline. They can cause stomal irritation and/or bleeding. Urinary crystals can be prevented by keeping the stoma clean and maintaining acidic urine. If urinary crystals form, you can apply a compress dampened with equal parts white vinegar and water for a few minutes when changing the pouch.

Any ostomy surgery is a major surgery with the potential for major complications. Educating yourself about possible complications enables you to detect problems early, deal with them quickly, and, whenever possible, avoid them altogether!