Colostomy Care
Key Points
- Approximately 500,000 individuals in the United States have an ostomy; it can be permanent or temporary.
- Healthy stoma: moist, beefy pink or red; dusky/purple/black indicates compromised blood supply — report immediately.
- Pouch emptied when one-third to one-half full; pouch and wafer changed every 3–5 days.
- Output consistency depends on location: ascending colon (watery) → descending/sigmoid (more formed).
- Psychosocial impact is significant — nurses must not display disgust; referral to wound/ostomy nurse specialist is key.
Pathophysiology
An ostomy diverts stool through a surgically created opening (stoma) in the abdominal wall, bypassing diseased, damaged, or removed sections of the bowel. Indications include colorectal cancer, inflammatory bowel disease, trauma, and bowel perforation. Patients have no sensation or voluntary control over stoma output.
Output by Ostomy Location
| Ostomy Type/Location | Output Characteristics |
|---|---|
| Ileostomy | Liquid/watery; high output; risk for fluid/electrolyte loss |
| Ascending colostomy | Watery (minimal water absorbed) |
| Transverse colostomy | Semi-liquid to semi-formed |
| Descending/sigmoid colostomy | More formed/solid (most water absorbed) |
Nursing Assessment
NCLEX Focus
Stoma color assessment is a high-priority skill. A beefy red stoma is normal. Report bluish, purple, or black discoloration immediately (vascular compromise). Assess peristomal skin at every pouch change.
Stoma Assessment
| Finding | Interpretation |
|---|---|
| Pink/red, moist | Normal — adequate blood supply |
| Swollen (first few days post-op) | Normal — edema subsides over weeks |
| Bluish, purple, or black | Compromised blood supply → report immediately |
| Pale or dry | Possible dehydration or vascular compromise |
| Malodorous discharge | Possible infection or necrosis |
- Stoma should begin producing output within 2–3 days postoperatively
- Frequent assessment and bowel sound auscultation is critical in the first 2–4 days
Complications to Monitor
- Stomal gangrene or retraction
- Colostomy prolapse
- Peristomal hernia
- Surgical site infection
- Atelectasis and pneumonia (post-abdominal surgery)
Nursing Interventions
Pouching System Management
- One-piece system: skin barrier and pouch are combined
- Two-piece system: skin barrier (wafer) snaps onto the pouch separately; preferred for easier appliance changes
- Measure stoma at each appliance change (stoma shrinks over weeks after surgery); cut wafer opening to fit snugly without constricting the stoma
- Empty when one-third to one-half full to prevent leakage and skin breakdown
- Change wafer/pouch every 3–5 days, or immediately if leaking, odor, itching, or burning
Peristomal Skin Care
- Clean stoma and surrounding skin with warm water and mild soap (no alcohol-based products)
- Apply skin barrier products (creams, powders, protective sheets) to prevent stool irritation
- Ensure complete seal of pouching system
- Report any peristomal skin breakdown to the provider
Patient Education
- Adequate fluid intake is essential (especially with ileostomy — higher fluid losses)
- Foods to reduce gas: avoid cabbage, broccoli, beans, carbonated beverages
- Foods to reduce odor: avoid fish, eggs, onions
- Patients can shower and swim with the pouching system on
- Notify provider if: stoma changes color, swells, retracts, or develops malodorous discharge
- Colostomy irrigation (descending/sigmoid only): once daily or every other day, same time each day; allows fewer pouch changes
Body Image and Psychosocial Support
- Recognize that ostomy profoundly affects body image, self-esteem, and intimacy
- Do not display disgust (verbal or nonverbal) at stoma appearance or odor during care
- Encourage patient and family involvement in care demonstrations before discharge
- Refer to wound, ostomy, and continence (WOC) nurse specialist, social worker, and support groups
- Patient must demonstrate independent pouch emptying before discharge
Discharge Readiness
Patient must demonstrate independent pouch emptying before discharge. Provide 2–3 days of supplies. Ensure follow-up with WOC nurse is scheduled.
Related Concepts
- digestive-system — Anatomy of the colon and mechanisms of water absorption.
- inflammatory-bowel-disease — Leading indication for permanent colostomy.
- postoperative-pacu-priorities-and-complication-surveillance — PACU priorities after bowel surgery.
- pressure-injury-staging-and-risk-assessment — Peristomal skin breakdown shares risk factors with pressure injuries.
- fecal-incontinence-and-bowel-retraining — Altered bowel elimination patterns requiring nursing intervention.
Self-Check
- A patient’s stoma appears purple and dusky 2 days after colostomy surgery. What is the nursing action?
- When should the nurse empty an ostomy pouch, and how often should the pouch and wafer be changed?
- What should the nurse teach a patient about diet after a colostomy?