Ostomy questions

[grams6167]

I joined the board a short while ago and can't find my first question. Someone asked me to put in details so I could get answers to my questions. But I can't find that now.

So I guess I'll start fresh. I had a surprise ostomy surgery the end of April this year. It was supposed to fix a rectal vaginal fistula and bowl resection due to diverticulosis. The problem with the diverticulosis was so great that a permanent colostomy had to be performed. So I woke up with an ostomy bag that I will have forever.

It was a great shock. But I was 74 and knew I had to accept it. Wasn't easy but there I was. The ostomy bag is just under my rib cage on the left. I think that it was considered ascending. Have had a lot of trouble with leakage, skin irritation and stool problems.

Currently I am having problems with constipation and I don't know what to do. My doctor is not real familiar with colostomies and my surgeon is done with her part. My nearest support group is one hour away and meets at night. So I can't get in there for support as I am usually in bed by then.

I guess my current question is what is safe to take for the constipation. I probably have a lot more questions but that is where I need to start at the moment. Can you offer any advice? Thank you in advance.

[ot dave]

Hey Grams,

Yes, if you could give us details about how you apply your appliance, we could probably help you resolve your leaking issues. What kind of pouching system are you using? Are you using a one piece or two piece system? Which manufacturer are you using? Are you using a flat flange or a convex flange? Is your stoma protruding, or is it recessed? Are you using a barrier spray or wipe? How are you cleaning the area around your stoma before applying your appliance? Etc.etc. The more details you provide, the better we can help.
As far as constipation, that's not something I personally experience. But, a normal go to is Miralax. Also, since you have a colostomy,, you might investigate irrigation. There is a separate discussion board for irrigation. I irrigate every day just to have some control over my bowels. Others use it for constipation. It works for some, but not always. Might want to give that a look see....

Hope that helps.

David

[Mara]

viewtopic.php?f=2&t=26064&p=221104#p221104

Here's your other post....just click on your name and all your posts show up.

[Luv2Sew]

Seven years ago I was gifted a colostomy after my colon ruptured. I was diagnosed with diverticulitis but had suffered severe constipation for years. My surgeon prescribed two senna pills morning and night for constipation, but now I only take two senna pills once in a while if I don't have output in a 24 hour period. Usually this prompts output in six hours. If not, then I resort to a dose of milk of magnesia which has always worked a little too well. I wish I knew about senna before my colostomy.

[Nora116]

Hello

I had a ruptured Colon last year due to constipation (fecal impaction) and I have an end colostomy that was to be reversed. I also have diverticulitis and an intestinal ulcer which probably played a part in my rupture as in my medical records my surgeon uses different causes for the rupture which is so confussing. But he is a general surgeon and isn't very knowledgable in colon surgery. For example, I waited in the ER for 6 hours before I was even examined for a perferated viscous.

Because I have continued to have occasional impaction and because my overall health is poor because of the surgery I can't find a surgeon who will do the reversal.

Has anyone else had problems finding a surgeon to do their reversal operation? I just started to irrigate everyday and it is going well. I take 5 stools softeners gel tabs a day just to be safe as when I have an impaction it is very severe.

I think that surgeons are turning me away because they want to make sure my problems with constipation are completely solved but I don't know how to make this happen. My family Dr. isn't knowledgeable in dealing with ostomy problems and my GI doctor told me I only needed to see a nutritionist to solve my constipation problems but this was a waste of time.

I want reversal surgery but I have to prove that my constipation issues are solved. Has anyone else had problems finding a surgeon to do their reversal operation? Any suggestions as to resolving constipation issues once and for all? I tried Linzess which worked well but made me very depressed. Laxatives are usually too strong. I am staying away from all foods that can cause constipation.

I am sorry I have brought up so many issues in one post but if you have suggestions on any of my issues I would appreciate it. Thank you! You guys are the best as I never would have known about irrigation if I hadn't found this site as none of my doctors ever told me about it.

[grams6167]

Okay David. Thanks for telling me what else I should say. I am using a one piece flat flange Coloplast gray bag. And a have just started using a moldable skin barrier ring with adhesive wipes and half circle barrier rings on the outside of that. Hope I'm making sense here. All the terminology is strange to me yet. My stoma protrudes a little bit.

I ended up going to the ER fearing the possibility of impacted bowel. The xray just showed some hard stool. So they had me drink a tablespoon of something called Lactulose followed by 12 ozs of warm water. Yuk! Anyhow after several hours at home with no results, I took a dulcolax and slept for an hour. Don't ever do this. I woke up with diarrehia all over the bedding and me. Now I am back to being afraid of all of it. So far today about 1pm there has been no action at all.

Thanks to all of you for your help.

[steiconi]

We've all woken up in a puddle at least once, welcome to the club!

Apparently, Dulcolax works for you. Miralax works for me. Taking fiber regularly can help.

You might consider irrigation, which keeps you kind of cleaned out so your bag stays empty (no puddles!)
learn more on the irrigation board: viewforum.php?f=12

[lp1964]

Dear Friend,
Sorry to hear about your troubles.
Sounds like the pouch you are wearing is the Coloplast Mio. That pouch has a great design, a great filter but terrible adhesion in my opinion. I had several leakage with it and stopped using it. Now I use Coloplast SenSura which I love.
It may take you a while to figure out what will work for you as far as regular output and no accidents.
You can also turn your constipation into blessing by using irrigation every morning to clean out the lower portion of your colon.
I use another method: once a week I take 6 tablespoon of Milk of Magnesia in the afternoon and a huge glass of water after I put on a new bag. Nothing happens for 4 hours then I have diarrhea for an hour where I have to empty and rinse my bag about 5 times. After this I go to bed and have no output at all for 4 days(could be longer for you). I repeat this every week and just wear a tiny Coloplast stoma cap.
Either way you decide please consult your physician.
All the best for you.

[grams6167]

Thanks for you giving me such great answers. Apparently I need to talk to someone local about irrigation. I just don't understand it. Have had no output since the puddle. Blast it anyway. I am really at a loss. It is so discouraging. Sorry don't mean to whine so much.

[steiconi]

Seems like many doctors and even WOCNs know nothing about irrigation. I learned the basics from a youtube video; there's a good discussion of "beginning irrigation" at viewtopic.php?f=12&t=26055

[ot dave]

Grams,
Is the moldable flange working better for you? Have you tried using nothing but the flange. For me, less is more. Sometimes, all those wipes and pastes and rings tend to cause problems of their own. I only use a skin barrier spray when I have an open spot on my skin....the spray acts like a scab over the surface of the spot, preventing it from causing a leak or getting infected.

As for irrigation, I'm a daily irrigater. It's part of my routine in the mornings to get ready for the day. I never had constipation, my output tends to lean towards the other direction! Irrigation may just be what you need to relieve your constipation. Check out the irrigation board. Lots of information at the top over there.

Miralax tends to be pretty effective with alleviating constipation, but you should always check with your doctor about adding something to your system.

Hope that helped.

David

[Maryrice4]

I use benefiber everyday (twice a day); actually, I use the CVS brand right next to the Benefiber. It keeps things softer. I found that my gastroenterologist dealt with constipation issues better than my surgeon did. You have to find one with a lot of experience with ostomies. I have also been told to irrigate morning and night but haven't got good at it yet. Mary

[grams6167]

Still working on the constipation issue. Seems to be leveling out now. How long does anyone go before changing the bag. Before this I changed it every 3 or 4 days. But now emptying the bag is working well. So I don't know how long to wait before changing. Thanks ot Dave for your responses. Do you have any advice on this matter. Or does anyone have any suggestions. Is a week too long or what? Thanks all for your help.

[ot dave]

Historically, I would change every week on Wednesday nights. That was a good evening for me to do it during my normal routine. Recently, I've been able to go as long as 9 days, and probably could stretch it further as I haven't been having any issues. That said, I have always felt it to be a good idea to check the skin under the flange at least once a week as I'm prone to getting abscesses under the flange around hair follicles. Keep in mind however, that I irrigate, so I rarely have any output in the flange through the day/night, so my flange doesn't take the "abuse" that others might inflict on their flange. And, when I do have output, usually caused by asian food or pizza, I rinse the pouch out with warm water to clean it out and help keep it and the filter in good shape until my next pouch change.
I think if you did a poll, you would find that most folks do change their appliance every 3-4 days.
Like everything else ostomy, it will depend on the individual. If you are feeling comfortable going longer, then by all means do it. If you feel like the flange is getting weak, change it. It almost becomes a "gut feeling" thing. For me, I like to go a week...on average. Others will do less. It will be a trial and error thing that you do to find out what works best for you.
Hope that helps.

David

[Mara]

I change once a week most of the time but because of schedule/travel issues sometimes less....