Enterostomy care - Complex care at home for children

Last update: December 2016

What is it?

An enterostomy or ostomy (colostomy, ileostomy) is a surgically created opening of the bowel (intestine) to the outside which allows the body to empty stool (poop) and gas. The end of the intestine, which is brought to the surface of the skin on the abdomen, is called the stoma.
An enterostomy can be temporary or permanent.

Your child has no control over the output of stool or gas through an enterostomy.
The stool (poop, bowel movements) can be:
- liquid, semi-liquid or pasty (usually seen with an ileostomy),
- solid or semi-formed (usually seen with a colostomy).
Several factors can influence the consistency of the stool.
The location of the stoma influences the consistency of the stool. The further away from the anus (where stool usually exits the body), the more liquid the stool tends to be.
The amount and frequency of output through a stoma depends upon many factors, including your child’s diet and activity.
A healthy stoma looks like a round/oval opening with skin that resembles the inside of the mouth (moist and dark pink/red).
When your child cries, the stoma can change colour from pale to dark red or even purple; the colour should return to normal once your child is calm.
The ostomy opening may be swollen for up to 6-8 weeks after the surgery. The swelling usually decreases after this time.
From the surface of the abdomen, a stoma may appear to be:
- slightly below the level of the skin (retracted),
- at the level of the skin (“skin-deep”),
- on top of the skin (outside or external to the skin), protruding/sticking out slightly (1-2 cm) or protruding moderately (more than 2 cm).
A stoma may also stick out like a telescope; this may be called a herniation or prolapse.
The diameter and shape of a stoma may vary.

Any change in the diameter, shape or length of your child’s stoma should be discussed with your healthcare team.
The skin on the inside of the stoma is fragile; it can bleed slightly when touched but is not usually painful or sensitive.
You may notice that the stoma can vibrate or move slightly. This is the normal movement of the intestines, called peristalsis, which normally propels the stool towards the rectum and anus, the usual exit from the body. Your child has no control over the peristalsis.

What happens to the remaining portion of the intestine?

During surgery, the rest of your child’s bowel/intestine, that is, the part that comes after the stoma, may be removed or not, depending on your child’s specific problem.

If the rest of the bowel is kept, it may be:

sewn closed and left in the abdomen (Hartmann sac) or,
may be redirected outside of the body via a second stoma (called a mucous fistula).

When there is a section of remaining intestine in the body, it naturally produces some secretions (mucous).

This may be removed from the body via the mucous fistula or, if your child still has a natural rectum and anus, the mucous may come out like a bowel movement, either in the diaper or in the toilet, depending on the age of your child.

How does it work?

An enterostomy allows gas and stool (poop) to pass directly from the intestine into a collection device (called a stoma appliance or stoma pouching system) that your child wears on the abdomen.

The stoma appliance has two specific roles:
- it collects the stool,
- it protects the stoma and the skin around the stoma.
The stoma appliance has two parts:
- a collection bag/pouch to hold the stool and gas,
- a skin barrier (also called a wafer or skin protector) that sticks to the skin and around the stoma to protect this fragile skin.
These two parts of the stoma equipment may be joined together (one piece) or separated (two pieces) depending upon the model recommended by your child’s healthcare team.
If they are separate pieces, then the skin protector part has a raised portion (called a flange). The flange is used to secure the collection bag to the skin protector without putting pressure on the actual stoma. The collection bag clips onto the flange like a lid on a plastic container.

There are many different models and sizes of stoma appliances. Your child’s healthcare team will help select the type that will suit your child best. You may need to try a few different models out to find the one that works best for your child.
The collection bag may be either closed or drainable.
- The closed bags do not have an opening. They should be discarded when they are approximately one third filled; this type of bag is rarely used in children.

The drainable bags allow for the contents to be removed from an opening in the bottom and then to be resealed shut to use again. The bag should be emptied when it is one third full. The bag stays attached to the flange and the skin protector; it does not need to be removed to empty the bag. The drainable bags close at the bottom using a clasp which can be either part of the bag or a separate piece.

Either type of collection bag (closed or drainable) can be used with a internal disposable bag (called a pouch liner), which is often appealing to teenagers who have enterostomies because it is easy to empty and easily replaced with a new one. The pouch liner is removed when it is one third full and the contents can be flushed down a toilet.

The collection bags can be either transparent (clear) or opaque (can’t see through them). Some models have a filter that removes air without releasing odours.

The stoma appliance is changed every 3 to 7 days but the frequency will vary according to the specific needs of your child. Speak with your enterostomal therapy nurse or child’s healthcare team to know how often your child’s appliance should be changed.