colostomy

hello,

I am the RN student, and I have a question about colostomy :"can you control evacuation of the bowel with a colostomy." I think there is no way to control it (I am not talking about clean the bag) if you have whatever colostomy. however, my classmate thought it depends on where the colostomy is located. I checked books and really cannot find a answer for this question. Can anyone please help me? thanks ahead.

no you can't, because there's no sphincter.

i'd be shocked to learn otherwise.

great question, btw.

leslie

If the bag were completely sealed from outside air, you might be able to control it with positive/negative pressure, but that's a long shot and not something that is actually done to my knowledge. Probably not a good idea to try and back up stool in the bowel for the sake of convenience anyway.

The consistency of the stool can be different depending on the location of the colostomy in relation to the section of the bowel, however. Is that maybe what your classmate was talking about?

I'm not sure if this is what you're looking for, but there are medication (imodium) that we give to patients to control the quantity of their output and slow it down. Also depending on its location in the colon (ileostomy vs. colostomy), that also impacts the consistency and quantity of the output. A low residue diet can also impact the output.

oh...re consistency...

it's going to be liquid stool the closer to the ileum, with stool being more formed as you near the splenic flexure and downward.

is that what you're asking?

leslie

I have had patients who were able to time bowel movements, to some degree by timing when/what they ate, but they were the rare exception rather than the rule.

I think its also true that the lower along the bowel the stoma is, the more predicatable it is?

Also the BM gets firmer, there is more sensation of a full bowel wanting to empty.

I also recall something about having to eat corn, its the one food that does not breakdown, so its highly visible when it appears in the stoma bag. It give patients the chance to figure out the timing of their colostomy a bit more acurately, they can see the corn and work out how long ago it was they ate it, and then calculate /predict with reasonable accuracy when the bag will fill again.

Different foods also go thru at difference rates, spicy sauce-based foods such as Chinese or Indian food goes thru a whole lot quicker than bread and cheese!

But like an earlier poster said, there is no sphincter and therefore no true control, only varying degrees of prediction.

If the bag were completely sealed from outside air, you might be able to control it with positive/negative pressure, but that's a long shot and not something that is actually done to my knowledge. Probably not a good idea to try and back up stool in the bowel for the sake of convenience anyway.

There are plugs available for patients that want to go swimming, they remove the bag and plug the stoma temporarily. THe benefit of exercise outweighs the problem of potentially 'backing up' the bowel, if its only for a short time.

There is a way to control the timing of colostomy output, and thousands of ostomates do this daily. It is called irrigation. After the abdomen has had plenty of time to heal, irrigation teaching can begin. The stoma must come from no farther up the bowel than the descending colon. Unfortunately, this technique is unknown to patients unless someone tells them about it, and this person is you! You can google "colostomy irrigation", and you can contact your major vendors...Hollister, Convatec, Coloplast, and others and they would be very happy to discuss the particulars and the equipment needed to perform the task. My patients that irrigate wear only a small patch over their stomas, no wafer, no pouch. It's a very freeing thing for ostomates and should be taught when applicable.

There are plugs available for patients that want to go swimming, they remove the bag and plug the stoma temporarily. THe benefit of exercise outweighs the problem of potentially 'backing up' the bowel, if its only for a short time.

Interesting...

In the colostomy teaching I've witnessed in acute care settings, it has always been recommended that the patient always leave the bag in place while swimming and apply a water proof seal over the skin barrier with tape...

The short answers is NO. The control of when a person evacuates the bowels is driven by the colon muscles and sphincters inside the rectum, therefore there is no contraction control over muscle movement in the areas where the stoma is located. The first person to post a response had the correct answer, and the following responses were great too. There is a lot to be learned just in those posts.

Interesting...

In the colostomy teaching I've witnessed in acute care settings, it has always been recommended that the patient always leave the bag in place while swimming and apply a water proof seal over the skin barrier with tape...

Plugs have been available in Europe since the mid 1980s, but now that you mention it, I dont recall seeing them in the US, it was just the more clumsy bag and tape combo that you describe.

In school we have learned about bowel training. It's similar to when a person with dementia is bowl trained. You sit them on the toilet at specific times and so their body kind gets used to the timing. But no, they can't literally hold it in if they want. But what you friend said is prtially correct as it really depends on the area. For instance if a pt had an ileostomy it would just continuously leak and there would be no control at all.