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!