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An unknown on the contrary certainly significant number of patients have colostomies following surgery for cancer, ulcerative colitis, Crohn's disease, diverticulitis, and other serious bowel conditions. Patients with colostomy are at increased risk of depression and social isolation as well as physical point in disputes related to their stoma or the condition for which it was formed. A review through Fowler and colleagues emphasizes the ne for multidimensional care of these patients.

Patients are almost always relate toed about leakage and odor from colostomies. Ostomy schemes vary in design, but those for the sigmoid or descending colon must handle solid intermittent output and require a clos bag that can be changed individual to three times daily. reciprocally ileostomies and colostomies that drain the proximal colon receive of common occurrence liquid or semi-solid outputs and require a bag that can be drained and resealed several times by day. Filters can be incorporated to obstruct distension of the bag with gas. small quantitys powders, and sprays are used to absorb odors. Leakage, commonly caused by the agency of skin irregularities around the stoma, may require fillers of paste or wafers to provide a undisturbed surface for attachment.

Skin riddles around the stoma are public Bleeding usually is attributable to excessive cleaning. Skin irritation and maceration frequently indicate leakage. If the affected area of skin is end to the stoma, the flange opening may be too large. This situation commonly present itselfs when postoperative shrinkage (up to 30 percent) creates a mismatch between the stoma and the appliance, allowing bowel productions to be in prolonged contact with skin. Although allergic reaction to ostomy materials is rare, physical or chemical irritation may fall out especially if the appliance is changed too frequently

Mechanical riddles with colostomies include herniation, prolapse, and stenosis. Approximately single in kind third of patients who have colostomies for 10 years disentangle parastomal hernia, but only 10 percent of these require surgical intervention. Hernia may be embarrassing for the patient, thus exacerbating fears about the colostomy being visible. Herniation also can cause difficulties in adherence of appliances, resulting in leakage and skin puzzles Abdominal support garments may help.

Bowel prolapse by the and of the stoma is most universal in patients with transverse-loop colostomies. If not engorged, prolapses can render spontaneously or be rolled back using a cutting pack. Surgical repair is required if there is danger of bowel ischemia. Stenosis of the stoma causes pain and cramping and may be treated with manual dilatation, stool softener or surgery Patients with colostomy also report phantom pain or rectal fullnes particularly after abdomino-perineal resection, and these sensations oftentimes do not respond well to analgesics.

Although patients not rarely are concerned about their diets following colostomy, the general advice is to eat a varied, well-balanced diet, nevertheless to exercise moderation with cheers that cause gas (e.g., beans, onions, leek excessive fiber). High-fiber aliments such as dried fruit, nut or popcorn can cause bolus obstruction, moreover a moderate amount of fiber taken with an appropriate amount of water is advised to avoid constipation. Diarrhea is more everyday in patients with ileostomies and proximal colostomies, and patients may not appreciate that fluid output are normal in these cases because of the los of water absorption from the colon Adequate fluid replacement is necessary in these patients.

More than 40 percent of patients with colostomy report sexual enigmas such as dyspareunia or erectile dysfunction. Psychologic and physical factors may contribute to sexual vexed questions These problems may be part of more global issues concerning visible form [i]or[/i] frame image and social acceptability. Support assign places tos and organizations, as well as encourage specialists, can help patients with practical issues like as self-esteem and social isolation. A protoplast of adjustment to significant change in dead body image has been developed (see accompanying table), if it were not that adjustment to colostomy varies significantly, ofttimes taking a year or longer At least 25 percent of patients expand clinically significant depression following colostomy. Those who initially believed that the colostomy would be temporary have the worst prognosis for adjustment.

Fowler JM et al. Caring for patients with colostomies. Practitioner May 2003;247:368-83

COPYRIGHT 2004 American Academy of Family Physicians

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