Healing from Ostomy Surgery

Understanding the phases of recovery from the hospital to home

By Anita Prinz, RN, MSN, CWOCN

Over 120,000 people of all ages undergo ostomy surgery every year in the United States. Ulcerative colitis, Crohn’s disease and colorectal cancer are the most common reasons. Many ostomies are temporary while others are permanent. Either way, having an ostomy is a life-altering experience that affects individuals physically and psychologically. Healing from an ostomy takes time and patience. Living life with an ostomy is a personal journey.

Physical Healing

What happens when the surgeon creates a stoma? You are probably aware that the surgeon cut your intestines and brought the end through an opening in your abdomen. A simple description is that the plumbing in your body has been reworked. Where digested food was once excreted through your anus, it is now diverted through a stoma on your abdomen. Think of the gastrointestinal tract as a long tube where food goes in one end, the mouth, then nutrients are absorbed and finally your body excretes the remains of your digested food. It’s amazing that food goes in one end smelling and tasting so wonderful and then comes out not so wonderful.

Stomas can be created by several different surgical techniques; the most common is the Brooke technique where the end of the intestine is brought through a surgically created hole in the rectus abdomens muscle and then through the skin on your abdomen, inverted like a turtleneck sweater and sewn into place. The procedure takes place through a large midline incision or laparoscopic ally. The incision is stapled closed and an ostomy pouch is applied to the stoma.

The next day, you wake up to a very sore belly, with dressings and tubes poking into your abdomen and down your nose and a pouch on your belly covering your new stoma. At this stage, you just need to rest and let your body recover from the trauma of surgery and anesthesia. Your intestinal function has been traumatized by the surgery and effects of anesthesia and takes approximately 24-72 hours to wake up and start functioning again. The first sign of awakening intestines is flatus or gas. There might be stool in your pouch already. The doctors and nurses will be examining your stoma and checking to see if you have passed gas. You may hear sounds from the stoma area or notice that the pouch is blowing up like a balloon and you didn’t think you were full of hot air! After flatus returns, soon comes the stool – usually liquid with a vengeance.

Now the fun begins!

First Challenges

Getting acquainted with your stomais one of your very first challenges. A “text-book” stoma is red, moist and protrudes about one inch with the opening pointing straight out. Stomas come in all and shapes, just like belly buttons. Some are round, some oval, some innies and some outies. Looking at a stoma, touching it or seeing it expel stool are very private matters, but it seems that everyone in the hospital is now doing just that. The WOC nurse may comment on what a beautiful stoma you have and even suggest you name it, maybe Charlie or Rosy.

Anatomically, there are no nerve endings in the stoma, so when you dare to touch it for the first time you might be surprised that you don’t have any sensation. Control over when and where to pass stool is lost also. The stool comes when it wants to, without any notice or control, but typically after eating. You will get to know your own patterns. Learn to love your stoma as it most likely saved your life!

Learning how to change the ostomy appliance is the next challenge. The purpose of an ostomy appliance or pouch is to keep you clean, dry and smelling pretty. Everyone learns differently, but ostomy management is definitely a “hands-on” experience. Some doctors seem to think ostomy management is a no-brainer, just peel the back off the pouch and stick it on. A technically simple process, but not always so easy. A WOC nurse will teach you the basics of emptying and changing the appliance in the hospital. The less leakage problems you have in the hospital, the easier the transition to home will be.

Colostomy New Patient Guide

Once you come home, you may be experiencing post-traumatic shock about what has really happened to your body and what other treatments you may be needing. Despite your hospital education, you may be bewildered by your new ostomy and its activities. Many people balk at the first change, claiming they can’t see the stoma. Spouses, family members and home care nurses often help out for the first few weeks while you recover physically and emotionally and notice some mucous. This is quite normal as the tissue of the rectum and colon don’t know that it’s not being used anymore and still continue to produce mucous. Diarrhea and constipation can still occur, but ileostomates are more prone to food blockages. All ostomates will need to relearn their bowel habits as both gas and stool pass through their stomas and they won’t be using toilet paper the same way again! Eventually, it’s time to be brave and overcome your fears or become dependent on someone else to do the “dirty work.”

Generally, people learn to change their ostomy appliance standing or sitting in front of the bathroom mirror. Practice, humor and a dash of patience are essential, but no gloves are required! Bathroom habits are just not socially acceptable topics. Some patients feel dirty all the time. Individuals who are fanatical with being clean have a very difficult appliance standing or sitting in front of the bathroom mirror. Practice, humor and a dash of patience are essential, but no gloves are required!

Once your stoma has assumed its rightful size and shape, about six to eight weeks after surgery, you might decide to order precut pouches to end the “arts and crafts” ritual of cutting a hole in the wafer. Shopping for an ostomy appliance is another daunting task. There are so many different manufacturers and systems to choose from that it can be overwhelming. The language of ostomy care is almost foreign and confusing. Some mail order catalogues have 80 plus pages of ostomy products.

The hospital gives you a transparent, “one-size-fits- most” ostomy pouch. When you have mastered the technique of changing the ostomy appliance, you may switch to an opaque pouch so you don’t have to see the stool. Let’s be honest, who really likes to look at poop? Other options for colostomates are to use closed- end pouches which are removed and discarded rather than emptied. Your WOC nurse can help you find an appliance that’s right for your body and lifestyle.

Stool patterns usually return to pre-surgery patterns, perhaps once or twice daily for colostomates. Ileostomates will have a more liquid or mushy stool consistency (the colon is no longer absorbing water from your diet) and will empty their pouch an average of four to eight times per day. If your anus is still intact, you will experience the urge to defecate on occasion and notice some mucous time adjusting to life with an ostomy. While ostomy pouches are designed to be odor proof and waterproof, they are not self-cleaning. Some ostomates choose to rinse out their pouches after emptying, others empty and go on their way. Manufacturers do not encourage rinsing as the pouchs are designed to be odor proof. Accepting the fact that you will have stool in the front and not inside is another emotional hurdle to overcome. Pouch covers, specially designed underwear, binders and opaque pouches are helpful here.

Psychological Adaptation

Much of your emotional healing will depend on If your surgery was planned or due to an emergency. Other factors that impact your psychological well- being are your age, relationship status, social support, the reason for your ostomy and how you view yourself. If your surgery was planned, your surgeon or Wound Ostomy Continence (WOC) nurse may have explained the surgical procedure and what an ostomy is. If your surgery was done emergently, you had no preparation and may be quite shocked when you awoke from surgery. Individuals who are physically and emotionally prepared for life with an ostomy adapt much easier to their stomas than those who are not.

Accepting and adapting to life with a stoma is an enormous task. So much has changed – the way your body looks, how you use the bathroom, maybe your clothing, diet and your self-image. You may be concerned that people look at you differently. You may experience frequent ostomy leaks which make you very anxious about going out in public. You might feel that your body is not normal and that you don’t fit in. You might also have fears that others are aware of your pouch or that you might be pooping in public!

Altered Image

Having a stoma requires a great deal of psychological adaptation and adjustment. Grieving the loss of your body image as it once was is a normal process. You might also be grieving the loss of a smooth abdomen, body parts, maybe even having a belly button. C.M. Parkes describes1 five stages individuals go through with an altered body image:

• Realization – avoiding or denying the loss followed by experiences of unreality or blunting.

• Alarm – characterized by anxiety, restlessness, fear and insecurity.

• Searching – acute episodic feelings of anxiety and panic and a preoccupation with loss.

• Grief – feelings of internal loss and mutilation.

• Resolution – efforts to construct a new social identity.

It takes time to heal from ostomy surgery both physically and emotionally. Talking to other ostomates, your WOC nurse, attending support groups and social networking on the internet can provide the support you need to successfully adjust and adapt to life with an ostomy. Professional counseling may be helpful and antidepressants are sometimes necessary.

Once you have gone through these stages of healing and education, you should be able to resume an active, rewarding and full life. Thousands of ostomates have returned to work, dating, playing sports, sexual intimacy, having babies and enjoying life to the fullest. Your ostomy will hold you back only as much as you let it.