Live With Stoma ? What Would it be ?

Live With Stoma ? What Would it be ?

Live with stoma – In Europe, approximately 700,000 people are living with a stoma, and in the USA, more than 1 million people have a stoma. In the United Kingdom (UK), a national audit shows that just under 11,500 patients diagnosed with rectal cancer each year have a stoma formed and a UK charity website indicates that each year, around 2000 people with inflammatory bowel disease (IBD) have a stoma formed.

It’s never been easy living your life with something hanging in your tummy, right? Even before you get that stoma, preparing the surgery itself was challenging for you both mentally or even physically. You might feel anxiety, fear or even loss of confidence. That’s okay, that’s normal for us who doesn’t know nothing about stoma.

Live with stoma pouch ? What would it be ? Some of you might feel depressed only by seeing your tummy, or maybe you are having problems with how to deal with that stoma thing. Stoma affect the patients’ quality of life although they help them to continue their lives

Both physically or mentally reasons, someone with stoma needs support to continuing their lives. As a person who have the stoma, or as a caregiver, or a family members who took care of it you must be understand and known many things that usually happen after you get the stoma.

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Here below the most common problems that effect of daily living activity on patients with stoma.

Daily Living Activities n%
Social LifeDifficulty in performing their religious duties2953.7
 Restricted their exercises2750.0
FoodingFeeding Time Arrangements2851.9
 Food/Beverage restriction1527.8
HygieneDifficulties in bathing3055.6
 Changed their clothing style2953.7
Problems of Stoma CarePlacement of stoma adapter in the skin627.3
 Skin Cleaning522.7
 Change of Stoma Bag418.2
 Apply Stoma Powder318.2
Stoma ProblemsDiarrhea2037.0
 Leakage1425.9
 Redness1425.9
 Odor1324.1
 Gas1222.2
Psychological problemsFear937.5
 Low self-esteem625.0
 Getting away from friends/family414.8

*This descriptive study was carried out in the general surgery clinic of an university hospital in İzmir between the 1 January 2016 and 1 June 2016. The sample of the study consisted of 54 patients who were in the general surgery clinic at the time of the study, who were over 18 years of age, who had a stoma duration of at least one month.

Beside all the problems above there are still many questions that commonly the stoma’s patient asked based on what they really concern about. I would love to share this information to you, and I hope it will help you.

1. My Skin is Itchy and Irritated, what can cause and what should I do then

This can be a problem for many people that live with stoma. Redness on the skin around the stoma can be from several sources. Some of the more common reasons can include irritation from stool, sensitivity/allergy to the products you are using, or yeast.

Most commonly with an ileostomy , redness to the skin around the stoma, accompanied by burning and itching, is the result of stool having direct contact with the skin. Stool from an ileostomy is corrosive and can cause damage to the skin within a short period of time. Damaged skin will often result in itchiness and burning, particularly when the stoma is functioning. You may also notice small amounts of bleeding from the skin if the irritation has been for a prolonged period of time.

There are several possible reasons why the skin may be exposed to the stool. The opening of the flange may be too large for the size of the stoma. You should ensure that the opening of the flange is the correct size. Most ostomy suppliers have measuring devices that can help you to determine the correct size of flange opening. You can also reserve the release paper from the back of your flange (usually paper or plastic), and place it over your stoma, making sure your stoma is centered in the middle of the opening. Look in a mirror and measure the gap between the base of your stoma and the inner edge of the release paper. If you are having difficulty measuring the gap or determining the correct size, contact your nurse to help you.

Skin exposure may also be the result of an inappropriate appliance. Different characteristics of the stoma, and different characteristics of the skin around the stoma may prevent you from obtaining a “good seal” with your appliance. If you don’t have a good seal, this can allow stool to leak under your flange and to come in contact with your skin. You may require an alternative type of appliance (e.g. perhaps switching from a flat flange to one with convexity) or the addition of another product (such as a barrier ring) to help prevent leakage and skin exposure. Sometimes, a light dusting of stoma powder can dry the skin enough to provide an adequate pouching surface. Many patients also report success with something as simple as a light coating of calamine lotion, another well-known drying agent. The most important course of action is to determine if the pouch in use is the best for that stoma and for that patient’s contours.

The redness and itchiness may also be the result of a yeast infection to the skin.  Yeast infections tend to be bright red (in the initial stages; the color will change as the infection resolves), have irregular borders or edges, and will likely have several smaller pink dots on the skin away from the main part of the redness /infection. These are called satellite lesions and are new areas of yeast growth. Yeast likes to grow in moist, dark, warm places, like under an ostomy appliance. Yeast will sometimes start after someone has been on antibiotics. It can also result from frequent soaks in hot-tubs or baths, or with excessive perspiration, like in warm weather or with exercise. Yeast is easily treated with a silver based powder. The powder is applied directly onto the skin, and must be “sealed” with a skin barrier wipe. If you don’t seal the powder, the flange will not adhere to your skin. Equally, you should not use a cream based anti-fungal preparation as this will also prevent the flange from adhering. You will need to apply the powder for about a two week period. Usually, you do not need to change your flange more often than normal while using the powder. You should also check other common body sites for signs of yeast, such as under breasts, in the groin, or axillae (underarms). If you notice yeast in these areas, you will need to treat as well (though here, a cream based preparation is okay) to prevent re-infection under your flange.

If all those problems persist, make sure contact your doctor.

2. I’m Having Leakage. What can I do now?

To help solve the issue, we would ask several questions including the current pouching system being used, and the frequency of it being changed. Other questions that would assist us in problem solving might be—How are you preparing your skin before putting on your pouch? If the products are not being properly applied, it could cause adherence issues. Are you cleaning out your pouch or do you put anything in it? Most important, where is the leakage occurring? If it’s always in the same area, evaluate the area for any creases or uneven surfaces such as scar tissue, incisions, or your belly button that may cause an uneven surface under the barrier. If this is the cause, you might try a barrier ring as a filler to even out the surface area. However, make sure that the stoma size is correct in the barrier. You’ll know it’s a correct fit when the barrier fits where the skin and the stoma meet. There should be no skin exposed between the stoma and the opening of the barrier.

3. I’m not sure with My Food. What I should and What I shouldn’t Eat?

You are still having the possibility to taste your normal food or your favorite food even after you got a stoma. Although, you may get some advice from your doctor or your stoma nurse for maintaining your proper diet after your surgery.

Follow the guidelines below for the first few weeks after your surgery. This will help prevent discomfort while your colon heals. https://www.mskcc.org/cancer-care/patient-education/diet-guidelines-people-colostomy

  • Eat small, frequent meals. Try to have 6 small meals throughout the day instead of 3 large ones.
  • Eat slowly and chew your food well.
  • Drink 8 to 10 (8-ounce) glasses of liquids every day.
  • Eat mostly bland, low-fiber foods. Read the “Recommended foods” section for more information.
  • When you add foods back to your diet, introduce them one at a time.

It’s best to eat mostly bland, low-fiber foods for the first few weeks after your surgery. Bland foods are cooked, easy-to-digest foods that aren’t spicy, heavy, or fried. Eating bland foods will help you avoid uncomfortable symptoms such as diarrhea (loose or watery bowel movements), bloating, and gas.

Milk and Dairy
Foods to include in your dietFoods to limit
Non-fat (skim) or low-fat (1% or 2%)*Powdered milk*Non-dairy milks (such as soy milk and almond milk)Lactose-free dairy products (such as Lactaid products)Yogurt*Cheese*Low-fat ice cream or sherbetEggs*High-fat milk and dairy products, such as: Whole milkRegular Ice Cream or sherbetMilk and dairy products with lactose (if you have diarrhea after having them)

*If you have diarrhea after having these products, try non-dairy milks or lactose-free cheese or yogurt instead.

**When trying eggs, start with a small amount (such as 1 egg). Eggs may cause a bad odor (smell) when you open your pouch.

Meats and proteins
Foods to include in your dietFoods to limit
Lean animal proteins, such as:Meat without visible fatSkinless poultryFish*Nuts and nut butter (such as peanut)High-fat foods, such as fried meat, poultry, or fishHigh-fiber foods, such as dried or canned legumes (beans)

*When trying fish, nuts, and nut butter, start with small amounts. These foods may cuase odor when you open your pouch.

Grains
Foods to include in your dietFoods to limit
Low fiber food, such as: White bread, pasta, and riceBagels, rolls, and crackers made from white or refined flourCereals made from white or refined flour, such as Cream of Wheat, Rice Chex, and Rice KrispiesWhole grains, such as whole wheat bread, brown rice, bran cereal, quinoa, and buckwheat
Vegetables
Foods to include in your dietFoods to limit
Low-fiber foods, such as: Well-cooked vegetables without skins or seeds, such as peeled potatoes, peeled zucchini with the seeds removed, and peeled tomatoes with the seeds removedLettuceStrained vegetable juiceHigh-fiber foods, such as raw vegetables (except lettuce)
Fruits
Foods to include in your dietFoods to limit
Pulp-free fruit juice (except prune juice and grape juice)Peeled fruit (such as a peeled apple)Canned fruit (except pineapple)Fruits with thick skins. Examples include:Soft melons, such as watermelon and honeydewOrange without the membrane (the thin clear or white part around each orange section)Ripe bananaRaw fruits with the skin. Examples include:ApplesStrawberriesBlueberriesGrapesPrune juiceGrape juice

That’s it about live with stoma, hope this article will help you.

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REFERENCES

  1. Gill Hubbard, Claire Taylor, Angus J.M.Watson, Julie Munro.2020.A Physical Activity Intervention to Improve the Quality of Life of Patients with a Stoma: a Feasibility Study. Hubbard et al.Pilot and Feasibility Studies.6:12.
  2. Esma Özşaker, Tuğçe Yeşilyaprak.2018.The Problems of Patients with Stoma and its Effects on Daily Living Activities.Medical Science and Discovery.5(12):393-8. http://www.medscidiscovery.com
  3. Skin Irritation. Canadian Society ofIntestinal Research. https://badgut.org/information-centre/ostomies/skin-irritation/
  4. Peristomal Skin. Hollister. https://www.hollister.com/en/ostomycare/importanceofhealthyskin
  5. https://www.mskcc.org/cancer-care/patient-education/diet-guidelines-people-colostomy
  6. https://www.mskcc.org/cancer-care/patient-education/how-care-irritated-skin-around-your-stoma

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