ComplicationsColostomy
There are a number of possible problems you may experience after having a colostomy.
Rectal discharge
If you've had a colostomy but your rectum and anus are intact, you may have some mucus discharge from your bottom. Mucus is produced by the lining of the bowel to help the passage of stools.
The lining of the bowel continues producing mucus, even though it no longer serves any purpose. The longer the remaining section of your bowel, the more likely you are to have rectal discharge.
The mucus can vary, from a clear "egg white" to a sticky, glue-like consistency. It can either leak out of your bottom or build up into a ball, which can become uncomfortable.
Some people have rectal discharge every few weeks, while others have several episodes a day.
Contact your GP if there's blood or pus in the discharge – it may be a sign of infection or tissue damage.
Managing the discharge
You may find it helps if you sit on the toilet every day and push down as if passing a stool. This should remove any mucus and stop it building into a ball.
But some people find this difficult because surgery can reduce the sensation in the rectum. Contact your GP if this is the case, as you may need further treatment.
Glycerine suppositories that you insert into your bottom can often help. When the capsules dissolve, they make the mucus more watery, so it's easier to get rid of.
The mucus can sometimes irritate the skin around your bottom. Using a barrier skin cream should help. You may need to try a few before you find one that works for you. Ask your pharmacist for advice.
Some people find that eating certain foods increases mucus production. While there's no scientific evidence to support this, you may want to try keeping a food diary for a few weeks to see whether certain foods could be linked to an increase in mucus production.
Parastomal hernia
A parastomal hernia is where the intestines push through the muscles around the stoma, resulting in a noticeable bulge under the skin.
To reduce your risk of getting a parastomal hernia:
- wear a support garment (belt or underwear)
- avoid heavy lifting and straining
- maintain a healthy weight – being overweight can place additional strain on your abdominal muscles
A parastomal hernia isn't usually painful, but it may be more difficult to hold the colostomy appliance in place and change it.
Most hernias can be managed with the help and support of your stoma nurse. In some cases, surgery may be needed to repair the hernia. But the hernia can come back, even after surgery.
Stoma blockage
Some people develop a blockage in their stoma as the result of a build-up of food.
Signs of a blockage include:
- not passing many stools, or passing watery stools
- bloating and swelling in your tummy
- tummy cramps
- a swollen stoma
- nausea or vomiting, or both
If you think your stoma is blocked, you should:
- avoid eating solid food for the time being
- drink plenty of fluids
- massage your tummy and the area around your stoma
- lie on your back, pull your knees up to your chest, and roll from side to side for a few minutes
- take a warm bath for 15 to 20 minutes to help relax your tummy muscles
When to get medical help
After trying these steps, if there's no improvement within two hours, you should contact your GP or stoma nurse immediately as there's a risk your colon could burst.
Preventing a blockage
To reduce your risk of developing a stoma blockage:
- chew your food slowly and thoroughly
- drink plenty of fluids
- avoid eating large amounts of food at one time
Also, avoid eating foods known to cause blockages, such as corn, celery, popcorn, nuts, coleslaw, coconut macaroons, grapefruit, dried fruit, potato skins, apple skins, orange pith, and Chinese vegetables like bamboo shoots and water chestnuts.
Other complications
Other problems you can have after a colostomy include:
- skin problems – where the skin around the stoma becomes irritated and sore; your stoma care team will explain how to manage this
- stomal fistula – where a small channel or hole develops in the skin alongside the stoma; depending on the position of the fistula, appropriate bags and good skin management may be all that's needed to treat this problem
- stoma retraction – where the stoma sinks below the level of the skin after the initial swelling goes down, which can lead to leakages because the colostomy bag doesn't form a good seal; different types of pouches and appliances can help, although further surgery may sometimes be needed
- stoma prolapse – where the stoma comes out too far above the level of the skin; using a different type of colostomy bag can sometimes help if the prolapse is small, although further surgery may be required
- stomal stricture – where the stoma becomes scarred and narrowed; further surgery may be needed to correct it if there's a risk of blockage
- leakage – where digestive waste leaks from the colon on to the surrounding skin or within the abdomen; trying different bags and appliances may help an external leak, but further surgery may be needed if the leak is internal
- stomal ischaemia – where the blood supply to the stoma is reduced after surgery; further surgery may be needed