What Should You Expect After a Colostomy Closure?
What Is a Colostomy?
A colostomy creates an opening on the belly (stoma) to allow stool to pass out of the body and into a stoma bag. The colostomy closure is when the surgeon closes the colostomy, or the external opening on the belly, to allow for stool to be passed through the rectum or the bottom.
Before the Surgery
- Your child may need to go to the hospital the day before surgery to have the bowel cleaned out and prepared for surgery. If your child does not go to the hospital for a clean out, the surgeon may want you to complete a clean out at home which would be given to you by your nurse prior to surgery.
- If your child does not need to go to the hospital the day before surgery, same day surgery will call you 24-48 hours (one to two days) before the surgery. They will discuss:
- Rules about eating and drinking
- Which hospital location to arrive to
- When you need to arrive at the hospital
- Talk with the doctor if your child takes any medicine. Do not give your child any medicine on the morning of surgery unless your child’s doctor tells you to.
- On the day of surgery, the health care team will make sure your child is ready for surgery.
Your child cannot have anything by mouth until the bowel starts working after surgery. The bowel will start working by either having a bowel movement or passing gas. Patients often start passing gas and stool through the rectum in 24 to 48 hours (one-two days), but sometimes it takes 72 hours (three days). By the third or fourth day after surgery, patients are often discharged from the hospital.
The closure of the stoma in the belly is done with sutures (stitches). The stitches stay under the skin and go away on their own as the incision heals. This means the doctor will not need to remove them.
When your child starts passing stool, the stool is usually liquid. You child may have many liquid stools until the colon gets used to taking in more water. These loose frequent stools can last from one to three weeks after surgery.
Since the child's skin in this area may not have been in contact with stool before, or in a long time, the skin may be very sensitive. Children who wear diapers could get a bad diaper rash.
Preventing Diaper Rash
- The best way to avoid diaper rash is to keep stool from touching the skin.
- Change the diapers/pull ups as often as you can.
- Do not rub the skin; that can make the diaper rash worse. Baby wipes can be irritating to the skin. Instead, pat the skin with soapy water and a soft cloth until clean and dry.
- Put on diaper cream as directed by your child’s colorectal doctor or nurse.
The Switch to Constipation
After one to three weeks, the number of bowel movements will start to decrease. It is vital to watch for signs of constipation. Examples of signs of constipation are: no bowel movement within 24 hours or small round, hard balls of stool, nausea, loss of appetite and / or bloating
Your child must have at least one stool each 24 hours (one day).
Your child’s nurse or dietician will give you nutrition tips that will help prevent constipation.
Many times laxative food is not enough to manage constipation and a laxative will be prescribed by your child’s doctor. They will adjust the amount of laxative so that the child is not constipated, but also does not have diarrhea.
If constipation is not managed well it can lead to problems with potty training in the future.
- The stool should be soft, but formed.
- Sticky, pasty stool or small, frequent stools can be a sign of constipation.
Many parents do not want to give laxatives because they think it will make the child always need laxatives. Due to a slow moving colon, many children need help from a laxative to keep the colon and rectum clean on a daily basis. Every child is different and requires individualized plan of care. Depending on the child, some may need some help for a short time or a long time with laxative, to help their colon to have a bowel movement. Majority of over-the-counter laxatives are natura and will not cause problems of addiction or dependency of the medication to have a bowel movement.
Your child’s doctor will talk with you about your child’s outlook for bowel control and potty training. These tips will help to promote regular bowel habits in your child. This will increase your chance for success with potty training.
- Make sure your child has at least one stool per day.
- Try to keep your child’s meals at the same time each day.
- Follow the nutrition advice given by our center.
When to Call the Doctor
Call your child’s doctor if you notice any of the following:
- Bleeding from your child’s surgery site
- No stool in diaper for more than 24 hours (one day)
- No gas passing
- Wound infection of drainage, swelling and redness
- Fever (temperature over 100.4 degrees)
Call the Colorectal Center if you notice any of these issues or if you have any questions or concerns, 513-636-3240.