Thinking about ostomy whump, so I have one question. How would a character care for their ostomy? How would they receive the ostomy surgically? What does the recovery look like? How long is recovery? How would they be treated before discharge?
Thinking more like the permanent ostomy, but I also know they have it for more temporary purposes.
If you can, I also want to see actual websites that talk and actually support people with ostomies. It's okay if you cannot answer, this is terribly obscure for a whump topic.
Thank you!
You're in luck! Ostomy care is one of the topics that gets drilled in nursing school and I've had to study it three times for different exams!
There are several types of intestinal ostomies. Ileostomies lead out from the ileum and colostomies lead out from some part of the colon (large intestine), including the ascending, transverse, descending, or sigmoid portions. The diagram below shows these locations.
Temporary ostomies can be created to allow a portion of bowel to heal or until two portions of bowel can be connected. A permanent ostomy is created when a large portion of bowel has to be removed, such as for cancer, diverticulitis, inflammatory bowel disease, or severe trauma.
Bowel resection and ostomy creation is done under general anesthesia. The surgery removes the diseased or dead portion of bowel and creates a hole in the abdominal wall, which the healthy end of the bowel in pulled through and folded back on itself. The ostomy should be roughly donut-shaped and red or pink. The postop recovery will be the same as for any abdominal surgery (described in this post), but the patient will be taught to care for their ostomy before they are discharged. If the surgery was open, the patient may be in the hospital for up to a week and be fully recovered in about 6 weeks. If the surgery was laparoscopic, the patient will likely be discharged after 1 or 2 days and will be fully recovered in about 2 weeks. The ostomy will start to function 2 to 3 days after the surgery.
As soon as possible, the patient will be encouraged to learn how to change their own ostomy bag. A nurse will perform the first change while teaching that patient and, if they are comfortable, the patient will perform subsequent changes. This may take some time, since many patients struggle with the change in body image and are reluctant to touch or even look at the ostomy at first. The patient will not be forced to change the bag if they are uncomfortable. This is a washable and reusable ostomy bag:
The adhesive wafer should be cut to 1/8-1/16th centimeter larger than the ostomy. When the bag is applied, the wafer is applied to the peristomal skin. Any hair should be clipped and the skin should be washed with soap and water before application. The bag is then attached to the wafer. The clip at the bottom can be removed to empty the bag. Some bags have deodorizing filters that release collected gas.
The patient should assess their stoma weekly for narrowing, protrusion, or retraction. Dull, blue, or black coloring of the stoma or new onset swelling may indicate complications and should be reported to the patient's doctor or nurse. Reddened or broken peristomal skin should also be reported.
The character of the stoma output depends on the location of the ostomy. Ileostomy output will be liquid, while sigmoid colostomy output will resemble typical fecal matter, and so on. The bag should be changed when it is 1/3 to 1/2 full. Intestinal gas will also flow into the bag, which is often a concern for patients due to odor and inflation of the bag. Deodorizing filters are available, or the patient can place a breath mint in the bag to eliminate odor. For lower colostomies, irrigation may be required to regulate bowel movements. This is performed in a similar manner to an enema, by hanging a bag of tap water and directing the tube into the ostomy.
Diet does not require much adjustment after an ostomy, but patients may want to limit fiber to reduce gas. However, the patient should still eat fiber and drink plenty of fluids to prevent constipation. Stool softeners may also be taken. No foods are forbidden, but foods with lots of insoluble fiber like popcorn may cause discomfort.
Many times, people with new ostomies are connected with a trained volunteer who also has an ostomy ("ostomate"). Patients can be referred to the United Ostomy Associations of America or the Wound, Ostomy, and Continence Nurses Society (which provides educational resources and connects patients with nurses that specialize in ostomies).
Happy whumping!
