Oncological rehabilitation of patients with colon cancer. Features of the formation of colostomies in various intestinal pathologies Excretion of the intestine to the anterior abdominal wall

So, colostomy: what is it? This artificial anal opening, which doctors call Anus Preter Naturalis, is an opening formed during a colostomy in the abdomen, usually on the left, into which the end or loop of the colon or sigmoid colon is brought out and sutured. A colostomy is necessary to drain the contents of the large intestine, bypassing the natural path of the rectum, if there is damage or an insurmountable obstacle to the outlet section.

According to its anatomical location, the large intestine is almost closely adjacent to the wall of the peritoneum. When planning the location of the colostomy, the surgeon focuses on the nearest area, under which the lesion is located.

A colostomy is formed slightly above the pathological area to prevent stool from entering there. Colostomy can be a temporary palliative or permanent preventive measure, depending on the pathology and the nature of the operation preceding its placement.

How to live with a colostomy?

To a person far from medicine, normal life with a colostomy may seem like hell. For some patients, the diagnosis of “Cancer” is not as terrible as the prospect of “living with a fecal bag.” In fact, this is not so; even with a permanent colostomy, you can lead a full, active life. In the article about we present the results of a survey of ostomy patients about how they assess the quality of their life? The survey showed that life with a colostomy is just as wonderful as without it, it all depends on the person!

How many years can you live with a colostomy?

Long, very long! I have a patient who has lived with a colostomy for over 35 years. By the way, not only cancer is an indication for ostomy surgery.

Types of colostomies and indications for colostomy

Note that the intestine is removed not only for cancer! Many other illnesses lead to colostomy surgery. The need for such treatment—removal of a colostomy—always arises for two main reasons:

1. If it is necessary to give the rectum or lower parts of the large intestine time to rest and recover, for example, after severe inflammation or surgery. Then a temporary outlet is installed, which will be removed by closing the colostomy at the end of the recovery period and complete healing of the tissue.
2. If part of the large intestine (rectum, sigmoid or colon) was removed during the main operation, then a colostomy is performed with a permanent colostomy.

The types of colostomies are classified according to where the artificial outlet is planned to be formed.

Transverse colostomy

It is formed in the upper left part of the abdominal wall, since this part of the colon is less innervated. A transverse stoma is performed for such pathologies as:

• Diverticulitis,
• Colon cancer.
• Abdominal injuries with intestinal damage,
• Congenital pathologies of the large intestine.

In the vast majority of cases, a transverse colostomy is formed for a short time to eliminate the risk of complications after surgery. Further treatment is reduced to reconstructive surgery - stoma removal

Double-barreled colostomy (loop)

This type of colostomy is performed when it is necessary to temporarily disconnect the lower intestines from the digestive process, but leave access to the affected area. A loop of the colon is brought into the hole, cut across and two holes are formed. One of them is used to remove feces, and the second is used to administer medications. The closure of a temporary colostomy is carried out after complete healing of the “offended sections of the intestine”.

A double-barreled colostomy is formed in diseases such as:

• Crohn's disease,
• Nonspecific ulcerative colitis,
• Total polyposis,
• Severe infection of the lower intestine.

Single-barrel colostomy (end)

In most cases, this is a permanent colostomy, in which the completely cut end of the intestine is sutured to the abdominal wall. The technique of setting up a single-barrel stoma is carried out after complete removal of the lower intestines due to cancer.

Rectal cancer, sigmoid colon cancer and other forms of colorectal cancer may be an indication for end colostomy, and occasionally familial forms.

Advantages and disadvantages

The most important and significant advantage, which covers the many minor disadvantages of “anus preter naturalis”, is the possibility of a normal life for patients after radical surgery for cancer of the rectum or sigmoid colon.

Modern comfortable colostomy bags, bandages and other devices allow you to experience virtually no inconvenience even if you have a permanent colostomy.

Psychological factor

Depression? No place for depression! Life goes on!

Some patients with an ostomy even manage to make a business out of their situation. As they say, “you can’t forbid living beautifully!” became a celebrity thanks to his positive attitude towards ostomy!

To avoid depression, before discharge, doctors tell you how to properly care for a colostomy; what a person can feel; and what nuances he needs to take into account.

Smell

Not so long ago, the biggest problem was preventing odor. The uncomfortable rubber pads constantly slipped, rubbed the skin, and let discharge through. Life with a colostomy really turned into sheer agony.

But today, when colostomy bags with a magnetic lid, with odor filters, and special deodorants are available for free sale, not only the problem of unpleasant odor has disappeared, but also the problem of frequent changes of colostomy bag and skin irritation.

Involuntary factors

People with a colostomy should be aware and always remember that the stoma does not have sphincters, and therefore involuntary bowel movements or the release of gas may occur. To avoid this, you need to adjust your diet and try to control your bowel movements. You should also wear an elastic bandage when leaving home, which will help avoid unexpected sound effects and support the colostomy bag.

Constipation and colostomy

A common concern for colostomy patients is the possibility of the constipation they suffered before surgery or constipation after surgery. There is no need to be afraid of this factor. Since the output sections of the large intestine are excluded from the work, complete absorption of liquid from the chyme will not occur, so the feces entering the colostomy bag will always have a liquid consistency. As a rule, there is no constipation. But if constipation does occur during a colostomy, then an enema is given. How to do an enema during a colostomy is described and shown (video) in the article about.

A hernia during an ostomy is another unpleasant moment. A hernia can also occur after reconstructive surgery to close a stoma. To prevent the formation of a hernia, you should not lift more than 5 kg and it is recommended to wear an elastic bandage for at least 6 months after surgery.

Types of colostomy bags and accessories for them

Today, colostomy bags are presented in two main types, one-component and two-component.

A one-component colostomy bag is attached with an adhesive layer to the skin around the stoma opening; after filling it is removed, as it is disposable.

The two-component type of colostomy bag, in addition to the adhesive plate, has ostomy bags connected by a flange. The advantage of this device is that you can change only the bags without peeling off the plates for several days. According to the instructions, the adhesive plate should be changed only when a feeling of discomfort appears or when there is significant contamination.

Both types of colostomy bags have filters that prevent odors and air coming out of the intestines.

On average, changing colostomy bags occurs in the following mode:

• One-component – ​​after 8 hours;
• Two-component - once, twice a week.

And for fashionistas and fashionistas, designer colostomy bags have been developed. Some bags are simply a work of art! And fashionable bandages.

Colostomy care

While the patient is in the hospital, colostomy care is performed by a specially trained nurse. She changes filled ostomy bags, treats the skin with ointments and creams, and attaches clean bags. At the same time, she teaches the patient to perform all the manipulations, since after discharge he will have to do it on his own.

Immediately after the colostomy, fecal formations are removed from the outlet, the adjacent areas of the skin are thoroughly washed and dried with napkins. Then the colostomy is closed with a sterile bandage for 4 hours. Only after the colostomy has been completely reconstructed and the tissue has completely healed is the colostomy bag attached.

The main treatment of the colostomy should be done in the morning. The bags are removed carefully, without creating tension on the skin. Then traces of feces are removed, the colostomy is washed with warm water and treated with a special cleaning solution called Klinser, which foams and cleanses the skin well. Klinser does not need to be washed off. No need to treat with alcohol-containing antiseptics! After the skin has completely dried, an adhesive ointment with nutritional properties is applied for better adhesion of the colostomy bag, and after that the colostomy bag itself is attached.

For high-quality colostomy treatment, in addition to a colostomy bag, you must have:

• Support bandage
• Emollient, nourishing ointments,
• Talc,
• Detergent solution,
• Deodorant,
• Sterile wipes.

Features of nutrition during colostomy

During the first weeks after a colostomy, a low-fiber diet is prescribed. This is necessary to prevent the formation of large volumes of feces, which can lead to constipation, since large fecal formations will not be able to exit through the colostomy opening. Details in the article about.

In the future, it is necessary to adhere to a healthy, balanced diet consisting of fresh vegetables and fruits, semi-liquid cereals, lean varieties of dietary meat, lean fish and soft-boiled eggs.

Be sure to include dried apricots, raisins and prunes in your daily diet. Eliminate white bread and baked goods, replacing them with baked goods made from wholemeal flour, preferably with the addition of bran.

Treatment of various intestinal diseases may require special diets, taking into account the stoma. Features of the diet for intestinal cancer and chemotherapy are determined by the oncologist. Western scientists are inclined to exclude or limit meat (animal protein) in the treatment and nutrition of patients with colorectal cancer.

Physiotherapy

An obligatory component of treatment is specially selected exercises performed under the guidance of an experienced trainer, which help restore intestinal function and rapid healing of postoperative wounds. In addition, exercise in the pool is useful. Since all colostomy bags are waterproof, swimming is not prohibited.

Job

After complete tissue healing, you can return to your normal life and work. If your professional activity requires physical stress, you must wear a bandage. In any case, “anus preter naturalis” will not affect your professional qualities in any way, and there is no reason to give up your favorite job.

Dr. Svetlana Srivastava

Dear friends! Medical information on our website is for informational purposes only! Please note that self-medication is dangerous to your health! Sincerely, Site Editor

Not everyone knows what a colostomy is and how to live with it. These questions are quite relevant for patients who are concerned about the consequences of pathological processes associated with colon emptying.

Simply put, a colostomy is an artificial anus formed on the abdomen to remove feces. They resort to this in a situation where there is damage to the large intestine or there is an obstacle to emptying it.

A colostomy is an opening in the anterior abdominal wall created through surgery. It takes on the function of anal exit when defecation is impossible naturally.

During the operation, a round incision is made above the damaged area of ​​the organ, through which the colon or sigmoid colon is removed. It is sewn to the edges of the resulting hole.

The elevation above the skin resulting from the operation smooths out as the swelling decreases. The hole narrows.

Feces from the removed intestine are released into a colostomy bag - a special bag that is installed directly in the area where the intestine is removed.

The operation to form a colostomy makes it possible to remove feces without affecting the digestive process.

In what cases is the operation performed?

The indication for the formation of an artificial anus is the presence of intestinal diseases, when its natural emptying becomes impossible. Often such an operation is the only way to save the patient’s life.

The reasons requiring surgical intervention are as follows:

1. Weakening of the anal muscles, accompanied by.
2. Neoplasms in the anus, resulting in blockage and obstruction.
3. Injuries to the walls of the colon.
4. Intestinal diseases - perforation of walls due to abscesses, ischemic or ulcerative colitis, peritonitis.
5. The need for a colostomy is mandatory after surgery on the intestines or rectal cancer.
6. Fistulas on the internal walls of the organ.
7. Intestinal operations.
8. Congenital anomalies leading to intestinal obstruction in newborns.

Often, a colostomy is performed for prophylactic purposes before major operations, in order to prevent complications such as the appearance of pus on postoperative sutures.

Classification

Depending on the reason that caused the need to remove the rectum, surgeons distinguish two situations:

1. The indication for a permanent colostomy is the inability to restore the functions of the lower part of the large intestine. This is explained by disruption of the sphincter activity due to various diseases of the colon, especially if there are malignant tumor processes in it (that is, with oncology).
2. A temporary colostomy must be closed after 6-12 months. This is again done through surgery, resulting in natural bowel movements being restored.

Temporary installation is most often performed in newborns.

Varieties by type of localization

Based on the location where the operation is performed, there are three types of colostomy.

Transverse

This conclusion is performed in the upper zone of the peritoneum. In this case, a transverse section of the colon is brought out into the opening.

Indications for this type of surgery: congenital pathologies of the large intestine, trauma to this organ, its obstruction or cancer.

There are two types of transverse colostomies:

1. Single-barreled. They are performed in the form of a longitudinal dissection on the intestine. In this case, one end is brought out and hemmed.
2. Double-barreled. The cross-section of the intestinal loop is performed so that two outlets are fixed on the abdomen. This makes it possible to remove feces through one of them, the second is used to administer the necessary medications.

In the presence of a formed double-barreled colostomy, mucus from the lower intestine can be released both from the established mouth and through the natural anus. Deductions of this type are made for temporary use.

Rising

It is performed on the right side of the abdomen in the upper part of the colon. The excreted feces will be insufficiently formed, liquid with a large number of incompletely digested food fragments.

This causes frequent treatment of the tank to accumulate waste products.

Descending

Such an outlet of the intestine (usually the colon) is formed in the lower left region of the peritoneum.

The peculiarity of this operation is the preservation of the nerve endings of the intestine. This makes it possible to control the process of defecation.

Such colostomies are formed as permanent ones.

Types of surgical intervention

Operations to remove the colon from the outside are carried out in exceptional cases. Before this, the most optimal option for the type, type and location of the stoma is clarified.

Taking into account the individual characteristics of the individual patient, various surgical methods are used. Among them:

1. Overlay. This operation is performed using general anesthesia. First, in the area where the colostomy will be located, a round section of skin and the same amount of subcutaneous adipose tissue are cut out. Then the intestine, extended outward in the form of a loop, is cut and sewn to the abdominal muscles, the edges are connected to the skin.
2. Closing the colostomy. In order to close the artificial anal outlet after a certain time, another operation is required - a colostomy. It is carried out no earlier than 2 months and no later than six months after its application. In addition, such an important factor as the favorable condition of the lower zone of the large intestine and the natural anus is taken into account. To close the colostomy, the sutures are separated, the ends of the intestine are sutured and set into the peritoneum. After this, sutures are placed on the hole. The main complication after closure of the orifice is recurrence of intestinal obstruction.
3. Colostomy reconstruction. Surgery to change the opening is performed in the presence of a temporary colostomy.

This procedure does not provide a 100% guarantee that closing the stoma will lead to the full formation of the natural functioning of bowel movements. This is explained by the fact that reconstructive surgery does not replace the removed section of intestine. This affects the activity of the entire large intestine.

A similar operation is performed from 2 months to a year after the establishment of a colostomy. Most often, permanent anal shaping is recommended.

Pros and cons of the operation

We must not forget that intestinal obstruction is associated with a high risk of death for patients. The operation gives a chance to continue life.

An indisputable fact included in the positive aspects of artificial exit is ensuring a complete process of formation and removal of feces from the intestines.

Flaws

The biggest disadvantage should be recognized as the psychological state of patients who become depressed. The depressed state is eliminated during conversations with patients after surgery.

While still in the hospital, they are taught the rules of caring for the hole, warned about possible sensations and ways to eliminate discomfort.

What frightens patients most is the possibility of a bad odor. But this can be easily avoided by using special devices equipped with reliable devices with filters that do not allow odors to pass through, as well as deodorants.

Possible complications

There is a possibility of negative consequences with any operation. Among the most common such manifestations are:

1. Discharge of mucus in the mouth, resembling the consistency of egg white. Its formation in the intestines promotes the movement of feces through it. The appearance of pus and blood in it indicates the presence of infection or damage to the tissues of the colon.
2. Blocking the formed anus. This situation occurs with insufficiently formed stools and frequent bowel movements with poorly digested food fragments. This provokes swelling of the colostomy, increased gas formation, nausea and vomiting.
3. Paracolostomy hernia. In this case, the intestine extends beyond the opening, and a convex formation is felt under the skin in this area.
4. Stricture, stenosis (narrowing) of the stoma mouth. A pronounced narrowing is accompanied by pain, makes it difficult to empty the bowel and, in some cases, completely eliminates its possibility. If constipation occurs that is not eliminated with laxative food, they resort to the irrigation method - the use of an enema.
5. A rare manifestation of complications is the patient losing weight after surgery. This may be a consequence of psychological experiences due to which the patient loses his appetite. A more complex reason for this phenomenon is recurrence of a removed tumor in the intestine or metastases.

In addition to the complications listed above, you should know that excessive physical stress, as well as weight gain, can lead to the stoma becoming overgrown, blackened, and enlarged.

In such situations, it is necessary to see a doctor who will give appropriate recommendations to eliminate the complication that has arisen.

How to avoid bad consequences

To prevent the formation of a hernia, the following preventive measures are taken:

• use of a bandage;
• exclusion of physical activity;
• prevention of weight gain.

Such preventive measures do not always succeed in eliminating the hernia. In this case, it is surgically removed, which does not exclude relapse.

To prevent narrowing of the lumen of the colostomy, its bougienage (expansion) is recommended. In most cases, it is carried out by the patient independently. But before using this method, you must complete a training course.

Do you need a diet?

There are no strict nutritional requirements after surgery. But you should follow some rules:

• It is advisable to exclude from the menu (especially at first) foods that cause diarrhea or constipation - freshly baked white bread, rice dishes, strong tea, black coffee, fruits and vegetables containing a lot of coarse fiber;
• limit the consumption of eggs, cabbage, beans, peas, onions and garlic to prevent the appearance of a heavy odor;
• Spicy seasonings and alcoholic drinks are prohibited.

About quality of life

The ability to properly maintain the normal state of a colostomy makes it possible not to change the usual way of life, to be active and experience the joy of communicating in society.

The main thing is not to become isolated, which often happens when patients are granted disability. Gloomy thoughts about one’s own inferiority and inadequacy not only spoil one’s mood, but also make one think about suicide.

All problems after surgery can be solved quite simply.

This is facilitated by the presence of special devices that facilitate the care of the colostomy, which are perfectly attached to the skin.

They prevent the penetration of odors, are not visible under clothing, and do not interfere with movements. With their help, life with a colostomy does not present any difficulties.

Types of fecal storage devices

Colostomy bags are available in several types:

• one-component - with a plastic bag;
• two-component - with bags attached to a self-adhesive plate with special flanges;
• closed and open tanks (closed ones have filters that neutralize odors, open ones are equipped with a clamp and a hole for removing feces);
• special - for patients with a retracted orifice.

The advantages of a two-component colostomy bag are that the plate is glued for 2-3 days with daily replacement of bags. Whereas single-component ones must be replaced at intervals of 6-9 hours.

Rules of care

Immediately after surgery, the patient is taught how to care for the colostomy.

The first step in this procedure is to treat the orifice. It provides:

• removal of feces;
• thorough rinsing of the hole and skin;
• drying with sterile wipes;
• applying Lassara paste (or Stomagesiv ointment) to the skin near the mouth and placing gauze soaked in Vaseline on it;
• placing a sterile napkin over the hole and applying a bandage.

The dressing is changed regularly after four hours.

Second phase

Mastering the methods of applying a colostomy bag. This procedure is performed after the stoma has completely healed. The home care algorithm consists of replacing the device daily in the following sequence:

1. Rinse the colostomy as described above.
2. Measure its size and increase the diameter of the hole on the colostomy bag to the same size.
3. Place a colostomy bag, aligning its hole with the mouth, and secure the device with a slight movement, preventing the formation of wrinkles.

The tank replacement procedure is carried out in the morning or evening.

How to avoid skin irritation

The use of Coloplast paste, which soothes the irritated dermis and facilitates the fixation of the device, will help prevent the likelihood of inflammation.

To cleanse the surface of the skin, it is treated with Klinzer paste, which helps remove feces, mucus, and glue. Being an excellent antiseptic, it does not lead to dry skin.

The use of a special protective film prevents inflammatory processes on the skin.

It should be remembered that life continues after the colostomy is removed. But in order to prevent complications, it is necessary to strictly follow the recommendations of specialists.

Proper nutrition, careful care of the hole and compliance with the rules for using tanks ensure a comfortable life for many years.

The patient stays in the clinic for several days. Several different devices can be attached to it; they are removed after the patient has recovered:

1. A dropper that provides fluid into the body.
2. Catheter for urine excretion.
3. An oxygen mask or nasal oxygen cannulas to make breathing easier.

A colostomy bag, a special sealed bag, is attached to the stoma. It is usually larger than standard ones. It is later replaced with smaller ones before discharge.

During hospitalization, a nurse at the Assuta clinic will teach you how to care for your stoma, how to keep your skin clean and avoid irritation, and advise you on the emptying process and changing bags. The colostomy bags are waterproof, so you can swim with them.

3-10 days after colostomy surgery, the patient will be able to leave the hospital.

During this period, it is important to avoid tiring activities that will put stress on the abdominal cavity. The medical staff of the Assuta Clinic will inform you how to return to such activities.

In the first few weeks after colostomy surgery, you may experience excessive bloating and unpredictable discharge. However, the condition will improve as the intestines recover from surgery.

To get a consultation

Closing the colostomy

If the stoma is temporary, surgery will be needed to close it. It is performed only when the patient’s health has been restored, he has recovered from the consequences of the formation of a colostomy. It is usually performed 12 weeks after the initial intervention.

However, the recovery process may take longer if further treatment, such as chemotherapy, is required. There is no exact limit in this case; some people can live with a colostomy for several years before it is closed.

Sometimes surgery to close a colostomy is not recommended. For example, if the muscles that control the anus (sphincter muscles) have been damaged. Then the elimination of the stoma will cause intestinal incontinence.

The operation to close a loop colostomy is relatively simple. The surgeon makes an incision around the stoma. The upper part of the large intestine is connected to the rest of the colon.

Surgery to close an end colostomy is a more invasive surgery because the doctor will need more access to the abdomen. Therefore, the risk of complications will be higher and the recovery period will be longer.

Most patients feel well enough to leave the clinic 3-10 days after such surgery. It will take some time for normal bowel function to be restored. Some people experience diarrhea, but it goes away over time. There is pain in the anal area. The use of protective creams such as Sudocrem is suggested.

The operation to close a colostomy is less extensive than to create one. However, it will take several weeks to recover and return to normal life.

Potential Complications of a Colostomy

After creating a stoma, there is a possibility that some complications may arise. Let's look at some of them.

Discharge

After a colostomy operation that did not involve the rectum and anus, mucus may be discharged from the rectum. It is produced by the intestinal lining and acts as a lubricant, helping the passage of stool. Its consistency ranges from pure "egg white" to sticky and sticky. If blood or pus is noted, this is a sign of infection or tissue damage.

One option for managing this symptom is the use of glycerin suppositories. The capsules dissolve, making the mucus watery, which makes it easier to get rid of.

Sometimes mucus causes irritation around the anus, which is where barrier creams can help.

Paracolostomy hernia

A hernia is a condition in which an organ protrudes from the cavity it normally occupies, such as muscle or surrounding tissue, due to weakness. In this particular case, the intestine protrudes through the muscle tissue of the abdominal cavity, near the site of the colostomy, forming a noticeable bulge under the skin. People with an ostomy have an increased risk of this complication because the abdominal muscles have weakened during surgery.

The following are considered effective ways to prevent hernia:

1. Wearing a support belt or underwear.
2. Maintaining a healthy weight, as being overweight or obese puts extra strain on your abdominal muscles.
3. Avoid heavy lifting.

Most hernias are treated conservatively, but sometimes surgery is required after colostomy surgery. However, there is a possibility that the hernia will reappear later.

Blocking the colostomy

This complication occurs due to food sticking. Possible signs of blockage:

1. Decreased stool volume or watery stools.
2. Flatulence.
3. Swollen stoma.
4. Nausea and/or vomiting.

If you suspect this complication after colostomy surgery, you should:

1. Avoid solid foods for the time being.
2. Drink plenty of fluids.
3. Massage the abdomen and the area around the stoma.
4. Lie on your back, tuck your knees to your chest and roll from side to side for a few minutes.
5. Take a hot bath (15 - 20 minutes), which will help relax the abdominal muscles.

However, if there is no improvement, you should contact your doctor immediately, as there is a risk of colon rupture.

You can reduce the likelihood of this colostomy complication by chewing food slowly and thoroughly, without eating large amounts at one time.

Avoid blocking foods such as corn, celery, popcorn, nuts, cabbage, coconut macaroons, grapefruit, raisins, dried fruit, and apple peels.

Other complications of colostomy after surgery

There are a number of other complications that can occur after a colostomy is formed:

1. Skin problems when inflammation and irritation occurs on the skin around the stoma. Doctors at Assuta will give recommendations on how to solve it.
2. Fistula (fistula) – a fistula, a pathological small channel, develops next to the colostomy.
3. Stoma retraction - the colostomy is retracted into the abdominal wall. The cause may be either sudden weight loss or weight gain. As a result, intestinal contents can leak and cause skin irritation. Various types of colostomy bags can alleviate this problem, although in some cases further surgery is required.
4. Stoma prolapse is prolapse of the intestinal mucosa due to a wide stoma. Other contributing factors may be intestinal flatulence, increased intra-abdominal pressure, and wearing waist colostomy bags. If the prolapse is small, using a different colostomy bag may improve the situation, although surgery may be required in the future. It is also recommended not to lift weights and use a bandage.
5. Leakage of digestive waste from the colon onto the skin or into the abdominal cavity. For external problems, the use of various colostomy bags and techniques can help; for internal problems, further surgery will be required.
6. Ischemia of the stoma due to decreased blood flow to it. There will be a need for additional surgery.
7. Stenosis or narrowing of the stoma. In most cases, it appears six to eight weeks after colostomy surgery. An operative approach that widens the orifice may be used. The procedure of “finger bougienage” and a special massage will bring benefits.

The high level of professionalism of doctors at the Assuta clinic and modern medical capabilities will ensure the best treatment result with minimal complications.

Sign up for treatment

Digestion is one of the most important processes performed by such a system of the human body as the gastrointestinal tract.

A disruption in the functioning of one of its components affects the functioning of the entire organism.

In some cases, getting rid of intestinal diseases requires radical measures, especially if the negative changes are irreversible.

One of these procedures is the creation of a colostomy (artificial anus), which is used when the normal functioning of the lower intestine is impossible, either temporarily or permanently.

Colostomy - what is it and how to live for people who have gone through this surgical method? And also, colostomy - what is it, and what types of operations are there?

Colostomy concept

What is an intestinal stoma? The surgical term “stoma” implies an artificially created opening or exit opening connecting the surface of the skin with one or another hollow organ, to allow direct interaction with it.

What is a colostomy? A variation of such a formation connecting the colon and the surface of the abdomen is called a colostomy.

A hole is surgically made in the abdomen into which a section of intestine (most often the colon) is sutured.

Colostomy is a type of surgical intervention, during which a formation such as a stoma is obtained.

Subsequently, a special bag called a colostomy bag is placed at the exit, into which fecal matter enters, reaching this artificially created outlet.

Its creation is necessary in case of pathological formations (for example, tumors, intense inflammation) that impede the passage of feces, for subsequent natural exit.

In some cases, a colostomy is a necessary temporary measure to allow for surgical procedures in the lower abdomen or for normal recovery from them.

The colon is closely adjacent to the inner wall of the abdominal cavity, so the choice of location for the surgical formation depends on the location of the affected area.

The outlet must always be above the segment that poses a hazard.

The type of pathology or other circumstances that caused the use of this technique also influence the following choice: whether the changes made will be temporary or permanent. For example, if it is impossible to restore the lower intestines, the effect of surgery will be a permanent measure.

And it's not scary. Over time, a person learns to control the activity of the “updated” digestive system, independently regulating the processes of emptying.

A colostomy is a way to freely remove feces from the intestines without disrupting its activity, when the digestive system is unable to do this on its own.

Indications for use

What are the indications for forming a colostomy:

1. Anorectal incontinence.
2. Malignant neoplasms in the lower intestine, which by their growth close the intestinal lumen (for example, rectal cancer).
3. Injuries to the walls of the lower part of the gastrointestinal tract resulting from gunshot wounds or other mechanical impacts.
4. Complicated cases of diseases such as ischemic or peritonitis or malignant degeneration of inflammatory cells, ulcerative colitis of a nonspecific type, polyposis, abscess of the intestinal walls, complicated by their perforation.
5. Recurrence of oncological pathologies in the tissues of the bladder, uterus, canal connecting the uterus to the vagina (cervical), or rectum.
6. Complicated consequences of radiation therapy after treatment of uterine or cervical cancer.
7. Formation of fistulas leading from the rectal walls to the bladder or vagina.
8. Elimination of postoperative complications such as broken sutures or their inflammation, that is, as a preventive measure during the recovery period.
9. Congenital pathologies of the lower intestine that complicate or eliminate the process of normal bowel movements. For example, Hirschsprung's disease, anal atresia, meconianal obstruction (most often diagnosed in newborns).
10. Resection of part of the rectum or sigmoid colon, in which it is not possible to suture the remaining areas.

Classification

Depending on the location of the new “anus,” the following types of colostomies can be distinguished:

• transverse (transversostomy);
• ascending (ascendostomy);
• descending (descendostomy and sigmostoma);
• parietal.

Transverse

This intestinal stoma is located in the upper abdomen, opposite the transverse colon. To avoid damage to the nerve endings of this area, a transversostomy is formed closer to the spleen, namely to its left side.

The main indications for this type of surgery are:

• intestinal blockage;
• oncological pathologies;
• damage to the intestinal walls caused by mechanical injuries;
• abnormalities of the large intestine that are of genetic origin (congenital).

Most often, this type of stoma is temporary. They are removed after the necessary treatment.

The permanent placement of such a formation is determined by resection of the following parts of the gastrointestinal tract.

Transversostomy has two types of design: single-barrel colostomy (end) and double-barrel:

1. In the first case, an incision on the intestine itself is made in the longitudinal plane and a single hole remains on the surface. Most often, this type of exposure involves a permanent colostomy. The reason is to remove the rest of the colon.
2. In the second case, the intestine is dissected transversely and two openings are brought out at once, performing different functions: higher in the intestine - removal of feces, lower - for the administration of medications. Moreover, mucus produced by the intestinal walls can come out through the “lower” stoma, but this is part of the norm. A double-barreled colostomy is temporary, used for the duration of treatment of other parts of the intestine or manipulation of the organs of the lower abdominal cavity.

Rising

With this operation, a colostomy is installed on the ascending portion of the colon, located on the right side of the peritoneum. This section of the intestine belongs to the initial sections of its thick part, which is reflected in the excreted masses.

It is distinguished by its liquid consistency, alkaline composition and the presence of a large amount of residual digestive fermentation.

Taking this into account, a patient with an ascendostomy should more carefully monitor hygienic care around the surgical formation - the colostomy bag requires more frequent cleaning.

The intestines do not have time to absorb the required amount of liquid. Therefore, you should strictly monitor your water balance to avoid dehydration.

An ascendostomy, in most cases, is installed temporarily.

Descending

This surgical method is divided into two subtypes: descending colon stoma (descendostomy) and sigmoid technique (sigmostoma).

Both of these varieties are localized on the lower left side of the abdomen, that is, on the terminal portion of the sigmoid colon. They are characterized by the fact that the fecal masses coming out through it practically do not differ from ordinary feces either in consistency or composition.

It is this type of stoma that is distinguished by the ability to regulate and control bowel movements. This is possible due to the nerve endings located in this part of the intestine, which normally perform the same functions.

Therefore, if the patient’s condition allows, they try to install a permanent stoma in this particular area of ​​the large intestine.

Parietal

This type of surgical intervention is rarely used. Parietal colostomy is characterized by the formation of a stoma that drains the intestinal contents not in full, but partially. It is used to reduce pressure in the intestines, that is, for its decompression.

Advantages and disadvantages

The main thing can be said about the advantages of such operations: most often they are due to vital necessity.

Statistically, the largest percentage of colostomies are performed on patients with malignant tumors in the lumen of the rectum or sigmoid colon.

The advantages include the ability to ensure the normal healing process of the underlying parts of the intestine after surgical treatment or during operations on the organs of the genitourinary system.

Bandages and colostomy bags produced today use all the latest advances in technology, which is reflected in their comfort and functionality. Therefore, today you can live with a permanent colostomy and enjoy all the delights of life.

If we talk about the disadvantages, the first of them relates to the psychological component of the issue. Natural shyness and other factors (difficulty in processing and maintenance) can lead the patient into a state of deep depression. Life with a colostomy seems unbearable to them.

Accurate recommendations from attending physicians and the help of a psychologist, which is available in any modern medical institution, help to cope with this problem.

Often the main disadvantage is the presence of a corresponding unpleasant odor. But this problem has long ceased to be such.

All colostomy bags produced today have air filters that do not allow the “aroma” to pass through, and magnetic lids that tightly close the container. In addition, you can buy special deodorants designed just for these cases.

Colastomy treatment

Any stoma requires careful special care from the first days of installation.

And for the first few days, this is done by the medical staff, until the moment when the person leaves the hospital.

In the future, the patient performs all the manipulations that are necessarily taught to him independently. And the likelihood of complications will depend on the degree to which you follow the recommendations when caring for a colostomy.

The principle of operation when processing a fresh colostomy result is as follows:

1. Remove accumulated feces (it is still prohibited to use a colostomy bag during this period).
2. Wash the edges of the hole and the skin around it with boiled water at room temperature, then remove the remaining moisture by blotting it with gauze.
3. Treat clean skin with the recommended product (Stomagesiv ointment, Lassara paste). Next, cover the skin with a bandage or gauze, pre-soaked in Vaseline, then cover the hole and adjacent areas of the skin with cotton wool and a bandage (exclusively sterile). The last step is to apply a gauze bandage - it needs to be changed at least 6 times a day. Colostomy after surgery requires strict adherence to these hygiene rules.

The use of a colostomy bag is possible only after the healing process is completed and the stoma is finally formed. Signs of this will be the appearance of the mouth, rising above the surrounding skin and the complete absence of ichor.

At pharmacy counters you can purchase a specialized film that is applied before installing a colostomy bag and allows you to avoid the appearance of an inflammatory process or irritation on the skin.

Fecal bags used to collect fecal matter are usually changed in the morning or evening, depending on the type of device used.

The procedure for treating the skin after removing the colostomy bag is simple:

1. Remove the stool receptacle.
2. Remove any remaining feces and wash the stoma.
3. Treat the mouth and adjacent skin with the chosen product (ointment, paste).
4. Reinstall the device.

Is it possible to use an enema during a colostomy? This procedure, called irrigation, is advisable to use when constipation occurs, when the use of laxative products does not bring the intended effect.

Colostomy and care for it are inseparable concepts.

Possible complications

Considering the location of the stoma and the complexity of the procedure for its formation, if the operation is performed poorly or the postoperative recommendations of the attending physician are not followed, the likelihood of complications increases.

Complications with colostomy:

1. Specific secretions. Normally, intestinal secretions, which are a lubricant to facilitate the passage of mass and produced by intestinal tissues, have the consistency of egg white. If there are fragments of blood or pus in them, we can talk about the development of inflammatory processes against the background of infectious infection or mechanical damage to the intestinal walls.
2. Blocking the mouth. This condition is characterized by swelling of the tissues surrounding the mouth, increased gas formation, nausea, sometimes with vomiting, and loose stools. The main reason is food fragments adhering to the inside of the colostomy. To avoid the progression of negative phenomena, it is necessary to completely limit the consumption of solid food, increase the volume of daily fluid intake, and massage the abdominal area, especially closer to the mouth.
3. Paracolostomy hernia. The main symptom is the appearance of a bulge under the skin next to the stoma, which is a segment of intestine pushing against the abdominal muscles. To avoid such a situation, you need to use special bandages, eliminate heavy lifting, and control your body weight. Most often, this formation can be treated with conservative methods of treatment; otherwise, surgical intervention is necessary.

There are other complications, including the development of fistulas, purulent processes, the entry of fecal fragments into the abdominal cavity, necrosis, and others.

Principles of nutrition

The operation does not affect important organs of the digestive system, so there will be no special changes in the patient’s diet. Nutrition has a preventive function.

You need to know how each product affects digestion and calculate the possible consequences. For example, there are products that increase gas formation in the intestines (beer, carbonated drinks, legumes, chocolate, eggs and others). It is advisable to reduce their consumption to a minimum.

The proportion of foods in the diet that enhance the smell of gases should be limited. These include garlic, onions and green onions, spices, cheeses and fish. And such as lettuce, spinach, parsley, yogurt and lingonberries, on the contrary, help reduce the intensity of the odor.

Nutritionists advise carefully choosing foods for your daily diet. It will be useful to switch to fractional meals.

If you have an intestinal stoma, you should avoid foods that cause diarrhea or constipation.

Bottom line

Colostomy, in some cases, is the only way to allow the patient to live a normal life, with some reservations. This is especially true when cancer tumors are detected in the lower intestines in the final stages of their course.

In others, it is an opportunity to operate on other organs of the abdominal cavity or genitourinary system without interference or serious consequences, and also to allow them to recover after this.

The effectiveness of the colostomy procedure depends not only on the qualifications of the operating surgeon, but also on the patient’s consciousness. Only compliance with all hygiene rules and the recommendations of the attending physician can guarantee the absence of complications.

An intestinal stoma is the removal of a section of intestine that serves as an artificial place to remove waste products from the body. That is, the stoma performs the function of the anus. After such an operation, the patient needs to learn how to properly care for the problem area.

1 Indication for surgery

Intestinal ostomy is performed quite often in medical practice. It can be either permanent or temporary. Everything will depend on the degree of pathology. For example, if a complete removal of the intestines is performed, then the stoma is installed on a permanent basis, since there is no other way to ensure the normal functionality of the body. A temporary ostomy is performed during treatment of a disease, such as a hernia. Its surgical removal is planned for the period when the functionality of the body is restored. Patients who have had an external artificial opening made for the purpose of draining feces are not entitled to disability, since the presence of a stoma is not related to illness or serious pathology. Unlike the stoma itself, it is the indications for this procedure that may cause the patient to be assigned a certain disability group.

Do you have gastritis?

The removal of an artificial opening for the discharge of feces may be necessary in the presence of the following pathologies:

bowel cancer; serious organ injury; ischemic or nonspecific colitis; fecal incontinence; chemical or radiation damage to the intestines.

There are many other diseases of this organ, the treatment of which may require an ostomy.

2 Types of stomas and care for them

During surgery performed on the intestines, the patient may have an ileostomy or colostomy.

If the installation of an excretory tube is carried out in the wall of the large intestine, then the patient is indicated for a colostomy. When a diversion is necessary from the thin - ileostomy. After the operation is completed, the patient will have a hole in the abdominal wall (fistula). A container for collecting feces is attached to it. To avoid complications in the postoperative period, the patient must independently learn to care for the stoma. Regular care will also prevent the appearance of unpleasant odors.

According to statistics, a large percentage of postoperative complications are due to the fact that people incorrectly handle the device (tube) artificially removed from the body.

In order not to damage the stoma and prevent irritation in the area of ​​the outlet, the colostomy bag must be changed according to established standards.

It is recommended to change colostomy bags of a one-component system only after the contents of the receiver bag are half filled or when it causes some discomfort to the patient. Using two-component receivers, the adhesive part is changed after 3 days.

The container itself for collecting feces must be attached precisely at the time of defecation. Immediately after emptying, the bag is removed and processing begins. The intestinal stoma is treated with a soap solution. After cleaning it needs to be dried. To do this, use a clean napkin. You can't rub it, you need to blot it. After washing, it is necessary to treat the fistula with a special product called Stomagesiv, or its equivalent. The intestinal mucosa should also not dry out, as cracks may appear, so it is treated with Vaseline. The final step is to apply a clean napkin, which is fixed with a bandage.

3 Risk of complications

Despite following all medical instructions, complications may develop in the postoperative period. Most often, skin irritation (or periostomal dermatitis) appears. A rash may appear near the excretory tube, accompanied by itching or burning. As a rule, such complications are observed in patients who did not immediately learn how to properly cope with the task at hand - processing an artificial hole. An allergic reaction to the drugs used during treatment should not be ruled out.

Other postoperative pathologies include:

Injury to the mucous membrane by a catheter or tube. As a result, the patient may begin to bleed. Even if there is a small amount of blood released, it is recommended to see a doctor. In most cases, injury is not serious, but it can be different. Pulling the stoma inward (retraction). Treating the ostomy site and using a colostomy bag becomes problematic. A doctor's consultation is required. Narrowing of the outlet (stenosis). As a rule, the narrowing process is observed during the inflammatory process. In severe cases of stenosis, defecation may be difficult or even impossible. The solution to the problem is surgery. Prolapse of intestinal stoma. The pathology is typical for people who subject their body to severe physical stress, but prolapse can also occur during a coughing attack. As a rule, significant prolapse of the intestine is rarely observed, but in medical practice cases of its complete prolapse are recorded. It is not recommended to reduce the stoma on your own, despite the fact that if it goes slightly beyond the existing boundaries, the patient’s condition does not worsen, nor does the functionality of the stoma become impaired.

If an ostomy was performed during treatment, you should not be upset, as life does not end there. As soon as the patient begins to properly treat the operated area and use a stool collection bag, he will be able to fully return to his normal lifestyle.

And a little about secrets...

Are you tired of stomach pain, nausea and vomiting...

And this constant heartburn... Not to mention bowel disorders, alternating with constipation... It’s sickening to remember the good mood from all this...

Therefore, if you are suffering from an ULCER or GASTRITIS, we recommend that you read Galina Savina’s blog about how she coped with gastrointestinal problems. Read article »

With a number of intestinal diseases, the passage of stool and its release through natural means is impossible. Then doctors resort to colostomy.

Colostomy - what is it and how to live with it?

A colostomy is a kind of artificial anus that doctors make in the abdominal wall. A hole is made in the peritoneum, and the end of the intestine (usually the colon) is sewn into it. Feces, passing through the intestines, reach the opening and fall into the bag attached to it.

Typically, such an operation is performed when there is a need to bypass the rectal part in the postoperative period, in case of traumatic injuries or tumors, inflammation, etc.

Photo of rectal colostomy

If the lower intestinal tract cannot be restored, a permanent colostomy is performed. Healthy people can easily control bowel movements. This is ensured by the uninterrupted activity of the sphincters.

In patients with colostomy, feces exit through the artificially formed anus in the form of semi-formed or formed masses, without disturbing intestinal activity.

Indications for colostomy

A colostomy can be temporary or permanent. Children most often undergo a temporary stoma.

In general, the indications for colostomy are as follows:

Anorectal incontinence; Blockage of the intestinal lumen by tumor formation; Traumatic damage to the colonic walls such as gunshot or mechanical wounds; Severe cases of colonic pathologies such as diverticulitis or ischemic colitis, cancer or peritonitis, polyposis and ulcerative colitis, abscesses of the intestinal walls with perforation, etc.; Recurrent cases of cancer in the bladder tissue and uterus, cervical canal or rectum; The presence of severe forms of post-radiation proctitis, this is especially common after radiation therapy for cervical cancer; In the presence of internal fistulas from the rectum to the vagina or bladder; As a preoperative preparation for the prevention of suture dehiscence and suppuration; For congenital anomalies such as Hirschsprung's pathology, meconium ileus in newborns or atresia of the anal canal, etc. (if radical intervention is not possible); With rectosigmoid resection, if after the operation the sutures are ineffective.

Types of stoma

Depending on the location, colostomies are classified into several types: transverse, ascending and descending.

Transverse colostomy.

A transversostomy is formed in the upper abdomen, in the transverse colon.

To avoid nerve damage, the transverse stoma is placed closer to the left splenic flexure.

A transverse colostomy is indicated for intestinal blockage or oncopathologies, traumatic injuries and diverticulitis, and congenital colon anomalies.

Typically, such colostomies are installed temporarily for the duration of treatment. On a permanent basis, transverse stomas are necessary when removing an underlying section of intestine.

Transverse stomas are divided into two types: single-barrel and double-barrel.

Single-barrel or the end stoma is a longitudinal incision of the large intestine, so only one opening is brought to the surface. This technique is usually permanent and is used in radical ectomy of the descending colon. Double-barreled A colostomy involves removing a loop of intestine and making a transverse incision on it in such a way that 2 intestinal openings are exposed to the peritoneum. Through one passage, feces are excreted, and through the other, medications are usually administered.

The lower intestine may continue to produce mucus, which will be released through the hole created by the cut or the anus, which is normal. Such transversostomies are usually made for a certain period of time.

Ascending colostomy or ascendostomy.

A similar stoma is located on the ascending colon, so it is localized on the right side of the peritoneum. This area is located in the early intestinal part, therefore the excreted contents will be alkaline, liquid and rich in residual digestive enzymes.

Therefore, the colostomy bag needs to be cleaned as often as possible, and the patient is advised to drink more to avoid dehydration, since an ascendostomy is characterized by thirst. An ascending colostomy is usually a temporary therapeutic measure.

Descending and sigmoid colostomy method (descendostomy and sigmostoma).

These types of colostomies are installed on the left side of the peritoneum in its lower part, actually at the end of the colon. Therefore, it produces masses with physical and chemical properties similar to ordinary feces.

A distinctive feature of such colostomies is the patient’s ability to regulate bowel movements. This is explained by the fact that in these parts of the intestine there are nerve endings that allow you to control the process of excretion of feces. Such localization of colostomies allows them to be installed for a long time and even permanently.

Advantages and disadvantages

The procedure is often vital in nature, providing the patient with a normal life after radical surgical intervention for cancer of the sigmoid or rectum.

This fact is the main indisputable advantage of the artificially created anus.

In addition, modern bandages, colostomy bags and other devices allow you to live comfortably even with a permanent colostomy.

The method certainly has its drawbacks. Perhaps the main one is the psychological factor, which is often the cause of deep depression in the patient. But doctors have learned to deal with this too - they carry out explanatory work with patients, talk about proper stoma care, clarify important nuances, talk about sensations, etc.

For many, smell may seem like another drawback. But the problem is completely solvable, because modern colostomy bags are equipped with magnetic covers, anti-odor filters, and there are also specialized deodorants on sale. Therefore, today such accessories allow us to solve the problem of skin irritation and frequent replacement of the colostomy bag.

Types of colostomy bags

Colostomy bags come in one- and two-component types. Two-component ones are equipped with ostomy bags and a self-adhesive plate, connected by a special flange. But such colostomy bags are inconvenient because they can cause skin irritation. Therefore, when using them, it is allowed to replace the plate every 2-4 days, and the bag - daily.

If there is a feeling of itching and discomfort, it is recommended to immediately peel off the plate. An undoubted advantage is that the colostomy bag is equipped with a special filter that eliminates gases and odors.

Unlike a two-component one, a one-component colostomy bag must be changed every 7-8 hours. Two-component ones involve replacing only the bag, and the plate is changed only once every 3-4 days.

The drainage bag must be emptied when it is 1/3 full; to do this, bend over the toilet a little and open the drainage hole, after which the feces bag must be washed and dried. Before reusing the bag, check the drainage hole to ensure it is closed.

How to care for your stoma at home?

A colostomy requires very careful care, which begins from the first day after surgery. First, the patient is taught by a nurse who changes colostomy bags and cleanses the stoma. In the future, the patient independently changes fecal bags and treats the stoma opening.

The whole process takes place in several algorithms:

First, the feces are removed; Then the outlet hole is washed with boiled warm water, the skin around it is thoroughly washed, and then dried with gauze napkins; Treat the skin surface with Lassara paste or Stomagesiv ointment, after which gauze soaked in Vaseline is applied around the stoma and covered with a sterile bandage and cotton wool. Cover the treatment area with a gauze bandage, which is changed every 4 hours. When the stoma heals and is completely formed, you can use colostomy bags. The final formation and healing is indicated by the mouth not protruding above the skin and the absence of inflammatory infiltrate. Only with such a clinical picture is the use of a colostomy bag allowed. It is recommended to change fecal bags in the evenings or in the morning. First, carefully remove the used feces receptacle, then remove any remaining feces and wash the stoma. Then the mouth and the skin around it are treated with ointment or paste, and then the colostomy bag is fixed again.

Typically, Coloplast paste containing a small amount of alcohol is used to glue the receiver. The product does not cause irritation even to skin damaged by trauma and inflammation, and also improves the fixation of the device.

Some patients, before gluing the colostomy bag, treat the skin with a special protective film, which protects the skin from inflammation and irritation.

Nutrition

There is no special specialized diet for colostomy patients, so after surgery, significant changes in the patient’s diet are not expected.

With a colostomy, the only thing that needs to be taken into account is the effect of each product on the digestive processes.

It is recommended to limit foods that contribute to gas formation, which include eggs and beer, carbonated drinks and cabbage, mushrooms and legumes, onions and chocolate, for obvious reasons. Foods such as garlic and eggs, spices and fish, onions and cheese significantly enhance the smell of intestinal gases. Lettuce and yogurt, lingonberries and spinach, parsley, etc. have the opposite effect.

With the right combination of products, many unpleasant situations can be avoided. In addition, it is recommended to chew food with special care, eat more often and little by little.

To prevent unwanted gas escape, you can lightly press on the stoma. Colostomy patients should also monitor the consumption of laxatives and constipation foods to avoid problems such as diarrhea or constipation.

Types of operations

The location of the colostomy is determined by the doctor, taking into account the specific clinical picture of each patient.

The presence of hems or scars can significantly complicate the installation of a stoma on the intestine, since it is necessary to take into account the condition of the fatty tissue and muscle layer, which, when folds form, can displace the colostomy over time.

Patients may require surgery to create or close a colostomy, as well as surgical intervention for reconstructive purposes. Each intervention has its own individual characteristics, requiring a different approach to the patient.

Overlay

The colostomy procedure is performed under general anesthesia in a sterile operating room.

First, the surgeon cuts off a rounded area of ​​subcutaneous tissue and skin at the site of the intended location of the stoma. In the second stage of the operation, the muscles are separated in the direction of the fibers. To avoid compression on the intestine, the hole is made large enough. In addition, the likelihood that the patient will gain excess weight is taken into account in advance if the stoma is applied for a long time. Then the intestine is brought out through a loop and the necessary incision is made on it. The intestine is sutured to the muscle tissue of the peritoneum, and its edges are attached to the skin.

Unfortunately, it has not yet been possible to invent drainage means into the stomal mouth, since the immune system includes protective functions and actively resists foreign materials, provoking tissue degeneration and inflammation.

Only surgical suturing of the intestinal edge to the skin heals favorably, although it would be much easier to use special tubes coming from the intestinal lumen and brought out.

Closing

Surgery to close a stoma in the intestine is called a colostomy.

A temporary colostomy is usually closed 2-6 months after placement. This operation is the elimination of an artificially created anus.

A prerequisite for closing the operation is the absence of obstructions in the lower parts of the intestine to the anus.

About a centimeter from the edge of the stoma, the surgeon makes a tissue dissection, slowly separating the adhesive elements. Then the intestine is brought out and the edge with the hole is excised. Then both ends of the intestine are sutured and returned back to the peritoneum. Then, using contrast, the seam is checked for leaks, after which the wound is sutured layer-by-layer.

Reconstructive surgery

Typically, such interventions are prescribed to patients with temporary colostomies imposed while the underlying sections of the intestine are being treated. Many patients believe that after stomal closure, intestinal functions are completely restored, which is not entirely true.

Even if the restorative surgical intervention is completely successful, the absence of a certain area in the intestine cannot but affect its further functionality.

The most optimal period for stromal closure is the first 3-12 months after surgery. This is the only way to count on successful healing of intestinal tissues without consequences for the body. In fact, reconstructive surgery is the closure of a stoma or colostomy, the description of which is presented above.

Diet after surgery

After reconstructive surgery or closure of the stoma, you must follow a strict diet so that the digestive processes quickly recover.

The diet comes down to excluding foods like:

Hot seasonings or spices like curry, chili pepper, etc.; Excessive amounts of soda, kvass or beer; Gas-forming products such as beans, garlic or cabbage, etc.; Fatty foods; Foods that cause irritation of intestinal tissues, such as currants or raspberries, grapes or citrus fruits.

If necessary, the doctor prescribes individual restrictive dietary instructions for the patient.

Complications

Colostomy is a serious surgical procedure that can cause many complications.

Specific secretions. This mucus is produced by intestinal tissues as a lubricant to facilitate the passage of stool. Normally, the consistency of the discharge may be sticky or similar to egg white. If there are purulent or bloody impurities in the mucus, this may indicate the development of an infectious process or damage to the intestinal tissue. Blocking the stoma orifice. Typically, this phenomenon is the result of the adhesion of food particles and is accompanied by watery stools, swelling of the stoma, flatulence or nausea and vomiting symptoms. If you suspect the development of such a complication, it is recommended to exclude solid foods, periodically massage the abdominal area near the mouth of the stoma, increase the volume of fluid consumed, and take hot baths more often, which helps to relax the abdominal muscles. Paracolostomy hernia. This complication involves protrusion of the intestine through the muscles of the peritoneum, and a clear subcutaneous bulge is observed near the mouth of the stoma. Special support bandages, weight control, and avoidance of lifting and dragging heavy objects will help you avoid a hernia. Usually hernias are eliminated using conservative methods, but sometimes surgical intervention is unavoidable. Unfortunately, there is always a possibility of re-formation of the hernia process.

Also, with a colostomy, other complications may develop such as fistulas, prolapse or retraction of the stoma, stenosis or ischemia of the colostomy, leakage of digestive waste into the abdominal cavity or onto the skin surface, stricture or evagination,

intestinal obstruction

and necrosis, purulent processes, etc.

You can avoid such troubles, the main thing is to strictly follow medical recommendations, especially the diet and hygienic requirements for caring for a colostomy.

Videos about how to care for a colostomy:

Modern medicine has a variety of means to save a patient’s life. But there are still methods in medical practice that were known to ancient doctors. One of them is a surgical intervention called an “ostomy”. What it is, what indications it has, how it is carried out - you will learn about all this by reading the material. We also paid special attention to the care of different types of ostomies, since such manipulations are often carried out at home, and the quality of their implementation affects the healing process.

The concept of ostomy in medicine

Stoma - what is it in surgery? This is a special hole that is surgically made for a patient for medical reasons. Most often, a stoma is performed on the intestine, bladder, and less often on the trachea. What is an ostomy? This is an opening that connects a hollow, damaged organ with an external catheter or tube in order to normalize the patient’s condition after surgery or other manipulations. The most common operation is to create an opening in the abdominal cavity. In this case, the indication for ostomy is removal of the intestine (or part of it).

Is an ostomy temporary or lifelong? Is this condition considered a disability? An artificial hole is not considered a disease and in itself is not a reason for disability, since it does not exclude the possibility of a full life. Having learned to properly use a colostomy bag or other devices for stoma care, a person can fully work, study, play sports, and build a family. But often the indications for ostomy are a serious pathology that leads to disability and limited capabilities of the patient.

An ostomy can be temporary; for example, such an operation is performed to rehabilitate a patient after an operation or a severe infection that disrupts the functioning of the excretory system. After restoration of impaired functions, the stoma can be removed surgically. But in some situations, for example, after removal of the intestine, an ostomy is a necessary condition for ensuring the patient’s normal functioning.

Indications for ostomy

Indications for ostomy surgery include congenital pathologies, injuries, and operations that led to complete or partial removal of the excretory organs. Accordingly, the normal operation of damaged systems is disrupted. An ostomy helps restore the natural functions of the body. In what cases does it become necessary to completely or partially remove the intestines, bladder or trachea, after which an artificial opening is required:

The first place is occupied by cancer of these organs, which leads to surgical intervention to remove damaged tissue. Trauma. Nonspecific and ischemic colitis. Incontinence. Radiation and chemical injuries. Other diseases that impair the functioning of organs.

There are different types, shapes and sizes of stomas. What it is? The photo below shows an intestinal artificial fistula.

Types of stomas

Ostomies are differentiated depending on the area of ​​surgical intervention:

gastrostomy; intestinal: ileostomy, colostomy; tracheostomy; epicystostomy.

The shape is convex and retracted. There are single-barreled and double-barreled. Depending on the duration of use: temporary and permanent.

According to statistics, intestinal stoma is more common than other types.

Each type differs in its setting principle, method of action and requires specific care and a rehabilitation period.

Tracheostomy: indications, features

A tracheostomy is an artificially created hole in the neck with a tube removed, which is installed with the aim of recreating damaged human respiratory functions. If there are disturbances in the functioning of the respiratory system and the impossibility of performing an independent act of inhalation and exhalation, the patient often undergoes an emergency tracheal ostomy.

This type of stoma is quite difficult to care for. It causes a lot of discomfort to a person. Especially if it is installed forever. Open airways facilitate the easy penetration of viruses and bacteria, which leads to various diseases and weakens the overall human immune system. In addition, the artificial “trachea” does not humidify or warm the inhaled air, which also contributes to the penetration of infections and the risk of developing various diseases. Therefore, it is necessary to control the quality of inhaled air from the outside - carefully monitor the air temperature in the room in which the patient is located. For moistening, special devices are used or a damp cloth is placed on the surface of the tracheostomy tube, changing the fabric as it dries.

The patient should not engage in active sports or swim (much less dive under water). Any, even slight, ingress of water into the tube can lead to respiratory arrest.

Is a tracheal stoma forever? Most often not. It can only be permanent if the trachea is removed (which is extremely rare) or a person is completely unable to breathe independently, when such a condition cannot be treated or restored.

A temporary tracheostomy is installed during surgery to provide anesthesia if it is impossible to provide anesthesia by other means.

Tracheostomy care

A tracheostomy requires regular proper care:

Every few hours, the outer tube should be washed with a solution of sodium bicarbonate (4%) to remove residual mucus from the cavity. To prevent the formation of skin inflammation and diseases, it is necessary to treat the area around the tracheosome. To do this, moisten cotton balls in a bowl with a solution of furatsilin. Then, using tweezers, they blot the area of ​​skin around the tracheostomy. After which zinc ointment or Lassara paste is applied. The treatment is completed by applying sterile wipes. The bandage is secured with a plaster. It is periodically recommended to suction out the contents of the trachea, since often patients with a tracheostomy cannot fully cough, which leads to stagnation of mucus and, as a result, difficulty breathing. To carry out this manipulation, you need to sit the patient on the bed and perform a manual chest massage. Pour 1 ml of sodium bicarbonate (2%) into the trachea through the tube to thin the mucus. Then you need to insert a tracheobronchial catheter into the tube. By attaching a special suction, remove the mucus from the trachea.

Proper care of the stoma is extremely important, since disruption of its functions can lead to respiratory arrest.

Gastrostomy

A gastrostomy is removed from the abdominal area to provide a person with nutrition in cases where the patient cannot eat food on his own. Thus, liquid or semi-liquid nutrition is introduced directly into the stomach. Most often, this condition is temporary, for example, with serious injuries and in the postoperative period. Therefore, gastrostomy in rare cases is permanent. When the function of independent food intake is restored, the gastrostomy tube is closed surgically.

How to properly care for a gastrostomy tube?

Gastric stoma - what is it, in what cases is it established? When a gastrostomy is applied, a rubber tube is brought out, intended directly for transporting food into the stomach. During feeding, insert a funnel for convenience, and in between meals, clamp the tube with a thread or clothespin.

With a gastrostomy, the main goal of care is to treat the skin around the hole in order to prevent skin inflammation, diaper rash, and rash. The area of ​​skin around the stoma is treated first with furatsilin solution using cotton balls and tweezers, and then with alcohol. After which it is lubricated with aseptic ointment. The procedure is completed by applying a bandage.

Epicystostomy: indications, care

The epicystoma is removed from the bladder to the surface of the abdominal wall using a special catheter. The indications for such manipulation are the patient’s inability to urinate naturally for various reasons. There are temporary and permanent epicystostomies.

This type of stoma requires special monitoring. What does it mean? Caring for an epicystostomy is quite complex: you need to be able to not only clean the catheter and care for the skin around it, but also rinse the bladder and replace the urine bag. Therefore, it is better if such procedures are carried out by a qualified nurse or caregiver.

Epicystoma imposes certain restrictions on the patient’s life. Thus, the patient is not recommended to swim, play sports, or stay at low air temperatures for a long time.

You need to carefully monitor the cleanliness of the catheter and the skin around it. Twice a day you should wash your skin with soap and water, and wash the outer tube and urine bag as they become clogged.

It is important to monitor the quantity and quality of discharge. There should be no pus or blood - if such symptoms occur, you should urgently seek medical help. Consultation with a specialist is also required if the patient’s body temperature increases, the volume of urine decreases, its color changes, the catheter is damaged or its position is disturbed, or there is pain in the lower abdomen.

Intestinal stomas: types

Intestinal stomas - what are they, what types exist? This type of opening is also called an “artificial intestine.” They are installed in case of disturbances in the functioning of the corresponding organ after various surgical operations. For example, when removing the intestine or part of it. In this case, a permanent stoma is placed. And, for example, after an operation to remove a hernia, which has led to the body’s inability to cope with the elimination of feces naturally, surgeons perform a temporary ostomy.

Extraction to the abdominal wall of the colon is called a colostomy. And thin - ileostomy. From the outside, both types represent a section of intestine brought to the anterior wall of the abdominal cavity. Such a stoma is a fistula in the form of a rose, onto which a colostomy bag is installed externally.

In order to prevent postoperative complications and the spread of unpleasant odor, the intestinal stoma needs regular care.

How to care for intestinal stomas?

With intestinal stomas, more often than with other types, complications associated with improper care are observed. Contrary to popular belief, colostomy bags should be changed only when necessary, since frequent changes lead to irritation and damage to the stoma and the area around the hole. Depending on the type of colostomy bag, it should be changed with the following regularity:

when the contents of the one-component system have reached half or the patient has discomfort from the receiver bag; with a two-component system, the adhesive strip is left for 3 days.

The bag for receiving feces is put on directly at the time of defecation. After which they are immediately removed, the intestinal stoma is cleaned with a soap solution, and blotted dry with napkins. Then they are lubricated with the drug “Stomagesiv”, and the intestinal mucosa is lubricated with Vaseline to prevent cracks. A napkin folded in several layers is applied, the bandage is fixed with a plaster, and then the underwear is put on. Ostomy care is an important component of a patient's recovery.

Complications

Complications after ostomy surgery are a fairly common situation. An ostomy after surgery requires careful medical supervision and proper care. What problems may arise, how to deal with and prevent them, let’s consider in more detail:

Periostomal dermatitis (skin irritation). Irritation can occur due to improper care, inappropriate products and medications, and improper strengthening of the catheter. Burning, itching, and rashes appear. Bleeding from the area of ​​the artificial opening can be caused by injury to the mucous membrane with a catheter or tube. Typically, such injuries do not cause concern to doctors and go away on their own. But if the bleeding is heavy and does not stop for several hours, urgent medical help is needed. Retraction (the stoma is pulled inward). This condition makes it difficult to use colostomy bags, external parts of tubes and a catheter. Skin care is also complicated. Consultation with a specialist is necessary. Stenosis (narrowing of the opening). If the stoma narrows to such an extent that its functions are impaired (stool does not pass through with an intestinal stoma or breathing becomes difficult with a tracheostomy), then surgical intervention is necessary. The narrowing of the opening occurs due to inflammatory processes. The prolapse of the intestinal stoma by a few centimeters does not disrupt its functions and does not in any way affect the patient’s condition. But there are cases of complete loss. This often happens during intense physical activity or coughing. Depending on the situation, a prolapsed stoma can be adjusted independently. If you experience frequent loss, you should consult a doctor.

A stoma is not a disease, but, nevertheless, a person in such a condition needs careful treatment and care. Both temporary and permanent ostomies require compliance with medical instructions. Choose the type, form and brand of care products recommended by the specialist, since only the surgeon can determine which type of receiver and catheter, paste and ointment will be most effective and comfortable for the patient in a particular medical case. When choosing, the size and type of hole, its purpose, skin type, the patient’s tendency to allergies and many other related factors are taken into account. Do not self-medicate - strictly follow the specialist’s instructions.

Visit your healthcare provider regularly. Control examinations are recommended after a month, 3 months, 6 months, for the first 2 years – once every 6 months, then – once a year. Shared toilet: it is recommended to share a shower (bath, bathhouse to be avoided) Wash the stoma (reduced intestine) with soap and water, then do not wipe it, but blot it with a soft napkin or gauze (do not use cotton wool) After using the toilet, treat the stoma (reduced intestine) with baby cream. If the skin around the stoma (reduced intestine) is irritated, treat with Lassara paste (salicylic-zinc paste), baby powder or company products Coloplast,Convatec(information by phone 324-10-55 ) If there is bleeding from the stoma (reduced intestine), apply a dry cloth and press firmly for 10-15 minutes. After the “reduction” operation, it is recommended to carry out high cleansing enemas every 2-3 days for the purpose of mechanical cleansing of the intestines. In case of cramping pain in the abdomen, retention of stool and gas, nausea, vomiting, bloating, use: 2-3 tablets of No-Spa, immediately stop eating, do not drink water, cold on the stomach (any product from the freezer compartment of the refrigerator) if relief does not occur After 2-3 hours, consult your doctor, if impossible, call “03”

What is a stoma?

In order to understand what changes and problems await ostomy patients after having a stoma, let's start with a brief description of the gastrointestinal tract.

From the stomach, food enters the small intestine (about 7-10 m long), consisting of the duodenum, jejunum and ileum. The latter is called ileum in Latin. In the small intestine, the process of chemical processing of food under the influence of digestive juices and enzymes and the absorption of nutrients into the blood are completed. The contents of the small intestine are liquid. Next, products that the body does not need enter the large intestine, where, as they pass through it, they acquire the consistency of dense feces. The large intestine (length about 1.5 m, diameter about 5 cm) consists of the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum.

Thus, the large intestine plays a small role in digesting food, therefore, if surgical intervention is necessary (disease, intestinal injury), the surgeon can form an artificial anus on the abdominal wall, i.e. to impose a stoma (from the Greek stoma means mouth).

Depending on the section of intestine that is removed, the operation is called a colostomy or ileostomy. In a number of diseases of the genitourinary system (bladder cancer, bladder stenosis, trauma), the surgeon places a urostomy.

An ileostomy is placed on the right side of the abdominal wall, at the border of the small and large intestines. The colostomy is located on the left side of the abdominal wall. The stoma may have a different location depending on what part of the intestine needs to be removed. There are three types of stoma depending on the surgical intervention: double-barrel (loop), single-barrel (end) and parietal. The stoma can have a convex, flat or retracted shape.

The colostomy is bright red in color. Its color is the same as the color of the oral mucosa. Most often, the stoma lags behind the edges of the abdominal skin. After surgery, the stoma may be swollen, but the swelling will subside over time. Its normal size is about 2-5 cm in diameter. Depending on the type of operation, the resulting stoma may have one or two openings that expand during stool passage. Due to the lack of innervation of the mucous membrane, touching the stoma during care is painless. A little bleeding during stoma care is also normal and should not cause you any fear. If the bleeding is prolonged and profuse, you should consult a doctor.

Stoma is not a disease

Thanks to modern stoma care products, a person is able to lead a normal active lifestyle, work, and love. Coloplast products have been used in the Oncoproctology Department of the Russian Cancer Research Center for the past few years. The main components that were popular were colostomy bags and various stoma care products (ointments, pastes, powders, plugs, cleansing wipes, etc.).

Despite the tendency in the clinic to perform sphincter- and organ-preserving operations, the percentage of operations ending in colostomy is about 25%. Of all the types of colostomy bags, our patients are most satisfied with two-component colostomy bags with open ostomy bags. This is primarily due to economic considerations - the ability to use ostomy bags several times. After all, the cost of colostomy bags does not allow their regular use by all patients. The most common sizes of colostomy bags are 45, 55, 60, 72 mm in diameter.

Ostomy bags are rarely needed for ileostomies. In our clinic we try to avoid their formation.

An important point is the presence of flavorings that eliminate unpleasant odors, which contributes to better adaptation of patients in society.

The most popular among patients are various creams and lotions for treating the skin around the colostomy. Colostomy plugs and “second skin” protective film are also interesting.

I would like to note that Coloplast products, despite their higher cost compared to some analogues, are distinguished by their simplicity and ease of use, aesthetics and durability of use, which allows patients to neutralize the painful sensations associated with the presence of a colostomy.

After surgical placement of a stoma, it is impossible to control the emptying of intestinal contents, since there are no adductor muscles, such as in the anus. The contents of the intestines, as they form, are released through the stoma, regardless of your will: through the ileostomy - continuously 4-5 hours after eating, and its amount reaches 800-1500 ml; through a colostomy - the stool is usually semi-solid and formed. Normalization of the discharged contents from the stoma occurs in most cases after 6 months or earlier, after a few weeks. Therefore, it is necessary to constantly use stoma care products.

They are one- and two-component systems. The one-component system is self-adhesive ostomy bags. The two-component system consists of ostomy bags with an adhesive plate. Ostomy bags can be closed or open, with the contents discharged; transparent and opaque. The adhesive plate is equipped with a flange connection in the form of a ring. The ostomy bag is also equipped with a ring that seals with the flange connection of the adhesive plate. Open bags have clips. Ostomy bags are equipped with an odor-absorbing filter containing activated carbon. There is also a special powder to absorb odor Ostobon.

Stoma care is simple:

The skin around the stoma is cleaned with either warm water and soap or cleansers. Comfeel(hair is also removed). Then dry the skin with a soft towel using blotting movements.

The adhesive layer of the plate is protected by a paper layer. Remove the protective paper from the plate and warm it with your hands for easy adhesion.

Place the plate so that the hole in the plate fits exactly against the stoma, i.e. intestinal mouth. Starting at the bottom edge of the wafer, adhere the wafer to the skin, being careful not to create wrinkles in the adhesive wafer, which could cause the seal to fail.

The plate hole is also equipped with a paper stencil. Cut a hole along the marked contour in accordance with the diameter of the stoma. In this case, the size of the cut hole should be 3-4 mm larger than the size of the stoma. We recommend using scissors with curved ends.

The ostomy bag is then precisely pushed onto the ring of the plate until it “slams shut”. You will hear a click. The ring of the ostomy bag is equipped with lugs to which a belt can be attached for greater security.

A used bag emptied in the toilet should be thrown away. Closed bags are usually for one-time use, but open ones can be washed and used several times.

Ostomy patients change bags 1 or 2 times a day. To avoid rupture of the ostomy bag, do not allow it to overfill. The plate is changed when it begins to separate from the skin and does not fit tightly. This condition is determined by the whitish color of the adhesive plate.

To avoid skin injury, do not remove the ostomy bag by jerking or using mechanical means or chemical solvents. Removal occurs in the reverse order, starting from the top edge.

If there are uneven areas around the stoma, they can be filled with special pastes produced by the company « Coloplast».

There are also special adhesive rings and wipes that protect the skin around the stoma from irritation and contact with intestinal discharge.

So-called anal tampons Conseal are used to close the stoma during bowel movements using lavage (irrigation), during water procedures, visiting a pool or bathhouse, and during sex.

Rehabilitation of ostomy patients

Immediately after surgery, ostomy patients find it difficult to come to terms with the idea of ​​leading a normal daily life in a new environment with a formed stoma. Over time, habituation and adaptation gradually follows. To lead a normal life, you need to learn how to quickly and correctly care for your stoma and overcome the psychological barrier, which your loved ones will undoubtedly help you with. After some time, when you get used to daily emptying and changing bags, you will not think about it so much, and after rehabilitation and returning to work, you will even forget.

Who can you tell about your stoma? You should not talk about this unless absolutely necessary to your relatives and friends. Your close family members with whom you live should know about this.

You can wear normal clothes and the ostomy bag is not visible. You can dress the same as you did before your ostomy. You need to know that you can swim, take a shower, and the ostomy bags will not come off. If the stoma is in the waist area, it is recommended to wear suspenders instead of a belt.

After complete rehabilitation, you can and even should return to your job. However, this work should not be physically strenuous.

Sexual life is not subject to restrictions. Difficulties in this matter are usually psychological in nature. Over time, you will find that your sex life gives you as much joy and satisfaction as it did before the operation. Women also retain their reproductive function: they can become pregnant and give birth.

There is no special diet for ostomy patients. Most patients can eat and drink the same things they did before surgery. But some foods and drinks can cause gas accumulation. It is necessary to limit the consumption of eggs, cabbage, onions, asparagus, chocolate, beer and lemonade. The approach to nutrition is very individual: you decide what is possible and what should be avoided.

Your diet should be varied and rich in vitamins. You need to eat slowly and chew your food thoroughly. It is necessary to eat three times a day, with large meals in the morning. Dishes should not be very fatty and not very sweet; it is necessary to remember about large losses of water and electrolytes. Therefore, you should take 2 liters of fluid per day. Alcohol in small quantities is not contraindicated, with the exception of beer, which should be crossed off the menu. Bran, buttermilk, yogurt, lingonberry juice are recommended, which reduce the amount of gases and their unpleasant odor.

Having a stoma, you can engage in many sports without much physical exertion. You can travel without restrictions. Before your trip, take enough ostomy care products. You can swim in natural ponds and in the pool.

Visit theaters, cinema, exhibitions.

Helpful tips for stoma care

Ostomy bags « Coloplast» do not allow gases to pass through. They are reliable and contain an activated carbon filter, which eliminates unpleasant odors.

The skin in the stoma area requires constant attention. Skin irritation can be caused by intestinal discharge, sweat, or insufficient care. Its manifestations vary in degree: redness, blisters, cracks, abscesses. The skin needs to be cleaned regularly. After washing, irritated skin should be covered with a special healing cream. Comfeel. The bags need to be changed if the intestinal contents get slightly under the adhesive layer, which indicates a leak. In cases of skin irritation, it is better to use two-component systems. In these systems, only the ostomy bags are changed, while the adhesive plate remains on the skin for several days. Coloplast's adhesive material not only sticks to the skin, but also has healing properties.

Diarrhea most often occurs due to a gastrointestinal infection or poor diet. In such cases, you should avoid spicy foods, vegetables and juices. Be sure to take more liquid.

Constipation can cause discomfort. Foods such as oranges, nuts, asparagus, and mushrooms take a very long time to digest and can lead to constipation. During this time, it is recommended to eat more fruits and vegetables, move more and do exercise. If constipation recurs, you should consult a doctor.

Irrigation is the controlled emptying of the bowel using lavage. In practice, intestinal lavage consists of introducing very slowly warm water into the stoma in an amount of 0.5 liters once a day or once every two days. You can only rinse the large intestine. After rinsing, the patient remains without stool for 24-48 hours. He can use anal tampons instead of ostomy bags Conseal or MiniCap.

Sometimes ostomy patients have to deal with various complications, in addition to skin irritation, diarrhea, constipation: narrowing of the stoma, prolapse of the stoma, hernia in the area of ​​the stoma. In all such cases, you must consult a doctor.

During your hospital stay after surgery, the staff will help you choose the company's ostomy care products. "Coloplast" and will teach you how to use them.

There are societies for ostomy patients, whose activities are aimed at exchanging experiences, mutual advice, information about new devices, and solving family and employment problems. Ostomy patients in these societies do not feel so much loneliness and can talk openly and without false modesty about their problems.

Recommended: beef, veal, lean pork, poultry, rabbit, lean ham, soft smoked meats, offal - liver, brains; language. The meat can be boiled, stewed, fried or sometimes fried.

Taking milk as an independent dish is completely individual. It creates considerable waste and, therefore, in many cases causes bloating and other difficulties. Must try. To maintain the correct composition of the intestinal environment, it is recommended to regularly take kefir and yogurt several times a week.

Cheeses and dairy products

Bakery products

Recommended: peeled tomatoes or tomato juice, carrots. Vegetables, on the one hand, are suitable due to the large amount of indigestible cellulose, and on the other hand, they are of great importance as a source of minerals and vitamins.

Recommended: boiled, puree, compotes from peeled fruits (without peel), jams, juices (orange, lemon, raspberry). From fruits: bananas, peeled peaches, apricots, peeled grated apples, stewed fruits, jelly.