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Colostomy Care in Paediatric Patients

Article  in  International Journal of Science and Research (IJSR) · January 2013

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Jahanara Rahman
Jamia Hamdard University
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 International Journal of Science and Research (IJSR)
ISSN (Online): 2319-7064
Index Copernicus Value (2013): 6.14 | Impact Factor (2014): 5.611

Colostomy Care in Paediatric Patients

Jahanara Rahman
Tutor, Rufaida College of Nursing , Jamia Hamdard University, New Delhi, India

Abstract: A colostomy is a surgical opening (stoma) made from the colon that passes through the abdominal wall. It allows stool to
bypass a diseased or damaged part of the colon. It can be constructed through any point along the length of the colon and it can be
temporary or permanent. Unlike in adults, colostomy in children is usually made as a temporary measure which is reversed after the
primary pathology is taken care of.

Keywords: colostomy, stoma care, Hurschprung’s disease, colostomy bag, stoma effluent

1. Indications  Accessories such as skin friendly adhesive cream,

powder, gel, measuring guide, scissor, gloves are
Colostomies in children are frequently performed to relieve important tool for stoma care (fig.8)
obstruction resulting from congenital anomalies such as
Hurschprung’s disease, anorectal malformation, and Important points to note in the post-operative period in a
occasionally for pelvic and perineal tumours, Crohn’s child with colostomy4
disease and rectal perforation1. Although it is mostly  Bleeding from the stoma site.
temporary in nature colostomy care in children requires  Fever
skilled care and intimate involvement of physician, parent,  Redness, swelling and discharge from the wound
nurses and stoma therapist. (features of SSI)
 Colour of stoma
2. Basic Facts About Colostomy  Signs of dehydration
 Watery stool
Before we discuss about the colostomy care, it is prudent to  Very hard stool
briefly know about the problems and complications of  No gas or effluent from the stoma
colostomy. Ideally, the colostomy and its site should be  Nausea, vomiting, cramping or bloating
planned beforehand and plan of care discussed with the These conditions warrant vigilance and should be reported to
parents except in the condition of colorectal perforation or the treating surgical and gastroenterologist team.
toxic colon. The stoma may be a loop colostomy (fig.1)
where a loop of colon is exteriorised, an end colostomy Applying and changing the colostomy bag
(fig.2) where the cut end of colon is taken out or along with A transparent one-piece colostomy bag is preferred in the
the end colostomy distal non-functional bowel end is post-operative period to enable a clear look of the stoma and
brought out as mucous fistula. The complications of its effluent.
colostomy are usually due to improper stoma site,  It is important to measure the stoma using the measuring
compromised vascularity, and skin erosion and infection due grid supplied with the stoma kit. Using scissors, an
to imperfect effluent management2. There may be bleeding opening is cut in the skin barrier following the traced
from the stoma or obstruction due to tight skin or sheath shape avoiding cutting through the front of the pouch.
through which the bowel is exteriorised. Later on, there may  The skin around the stoma is cleaned with water and
be stricture (fig.3) or prolapse (fig.4) of the stoma and dried. The stoma should be covered with gauge piece to
parastomal herniation (fig.5). While judicious placement of avoid spillage of the effluent on the skin.
colostomy avoids many complications, meticulous care of  A thin layer of barrier paste is applied on the skin around
stoma and skin with appliances and colostomy bags prevent the stoma. The customised and trimmed skin barrier is
nagging skin complications3. placed over the stoma which should not be too big to
allow effluent over the peristomal skin nor too tight to
3. Appliances for Colostomy Care cause irritation of the stoma.
 Any ulcerated or eroded skin should be covered with
 Pouching system consisting of collection pouch or barrier powder or gel. Any leak from the bag should
plastic bag which may one-piece system (fig.6) or a prompt for early change to prevent the skin from getting
two-piece system (fig.7) comprised of a base plate and a eroded.
separate collecting pouch fitted on the base plate in an
airtight seal mechanically or with adhesive. When to change the colostomy bag?
 The pouch or bag can be open ended (drainable) and The wear time of the bag or pouch typically ranges from 1-2
closed end (disposable). days in infant and up to 3 days for child depending on stoma
 A charcoal filter is fitted in the bag to absorb bowel effluent output, activity and other factors. The following
gases to control the odour. conditions warrant change of the bag:
 Two piece bags are sometimes fitted with a belt to  The loose or leaking bag to prevent skin damage.
secure the appliance,

Volume 4 Issue 10, October 2015

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Paper ID: SUB159241 2067
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 International Journal of Science and Research (IJSR)
ISSN (Online): 2319-7064
Index Copernicus Value (2013): 6.14 | Impact Factor (2014): 5.611
 The child complains of itching or burning over the stoma should be dried and integrity of the skin barrier
peristomal skin. checked.
 Swimming: An ostomy belt or waterproof tape can help
Emptying the bag securing the bag while swimming.
The bag requires emptying several times a day.  Sleeping: The pouch should be emptied before nap and
 It should be emptied when it is 1/3-1/2 full of gas or bedtime. Sleeping on abdomen does not hurt stoma but
stool. An overfilled bag will get loose leading to leak infants should sleep on their back.
and skin damage.  Clothing: Tight garments or the one with waistband
 The bag should be emptied before naptime, bedtime or might hurt the stoma and should be avoided.
going outdoor.
Useful recommendations
Food and stoma effluent  The colostomy bag should be changed when the stoma
Usually the colostomy output will be semisolid or formed is less active such as in the morning or two hours after
stool with characteristic odour. meals.
 Cabbage, cauliflower, egg, fish, onions and some spices  It should be done when the child is quite and co-
will increase the odour of the stool. operative with the appliances and all the accessories
 Colostomy bags have inbuilt odour-barrier film to ready beforehand.
control the smell. Moreover, the bags are fitted with  Stoma therapist is of help until the parents or guardian
filters which let the gas escape but not the odour are trained and comfortable doing it on their own.
preventing ballooning of the pouch.
 Certain foods such as beans, sprouts, garlic, onions etc. 4. Conclusion
and drinking through straw may increase gas.
 There may be diarrhoea in children with colostomy. Colostomy in infants and children requires passionate care,
Certain food such as yoghurt, banana, white rice, cheese requisite skill and substantial endurance. Fortunately,
or noodles may be tried to thicken the stool. colostomy in most of these patients is temporary,
nevertheless requires the utmost care of the stoma and skin
Guidelines for activity around it along with the maintenance of the nutritional and
 Bathing: Water does not harm the stoma and can be social needs of the child for a healthy outcome.
done with the pouch on or off. The skin around the

Volume 4 Issue 10, October 2015

www.ijsr.net
Paper ID: SUB159241 2068
Licensed Under Creative Commons Attribution CC BY
 International Journal of Science and Research (IJSR)
ISSN (Online): 2319-7064
Index Copernicus Value (2013): 6.14 | Impact Factor (2014): 5.611

References
[1] Pena A, Migotto-Krieger M, Levitt MA. Colostomy in
anorectal malformation: a procedure with serious but
preventable complications. J Pediatr Surg. 2006; 41:
748–756.
[2] Nour S, Beck J, Stringer MD. Colostomy complications
in infants and children. Ann R Coll Surg Engl. 1996
Nov; 78(6): 526–530.
[3] Kwiatt M, Kawata M. Avoidance and management of
stomal complications. Clin Colon Rectal Surg. 2013
Jun;26(2):112-121.
[4] Sheikh MA, Akhtar j, Ahmed S. Complications /
problems of colostomy in infants and children. J Coll
Physicians Surg Pak. 2006;16 (8): 509-513.
[5] Anyanwu LJ, Mohammad A, Oyebanji T. A descriptive
study of commonly used postoperative approaches to
pediatric stoma care in a developing country. Ostomy
Wound Manage. 2013 Dec;59(12):32-37.

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