Food Blockage & Hernias

 

Articles Included:

·        Adhesions and Other Pains

·        Ileus—The Other Blockage

·        The Secrets of Preventing Blockages and Hernias

·        Secrets of Preventing Food Blockages

·        Know About Blockage

·        Blockage, My Hospital Experience

·        Peristomal Hernias

·        Peristomal Hernias Two

·        Hernias

·        More About Peristomal Hernias

·        What is a Revision?

 

Adhesions and Other Pains

Forward By ReRoute, Evansville, IN Chapter

 

     Adhesions are tough, string-like fibrous bands, often in the small intestine.  They may form spontaneously but are more common after surgery, where disturbances caused by tissue manipulation may lead to healing in the form of fibrous tissue ...  hence adhesions.

     Some people form them more easily than others. Adhesions may grow to interfere with the normal motion of the intestine causing a blockage or obstruction with food, liquid or even air unable to pass the blocked area.  Severe bloating, abdominal pain, vomiting and constipation are symptoms of blockage and present a serious situation requiring medical attention and possible immediate surgery to cut the obstructive adhesive bands.

     Abdominal pain, though, doesn’t always mean adhesions are blocking the intestines.  A frequent cause for such pain is a spasm of muscles responsible for peristalsis—the rhythmic muscular contractions that propel the bolus through the intestines.  Muscle spasms in the calf are referred to as a “charley horse”; spasms in the intestines are essentially the same thing but assume the name “irritable intestine” or “irritable bowel”.

     Even ostomates who function without colons are not immune from painful intestinal spasms—in the small intestine. An ileostomate may sometimes suffer from pain that can’t be traced to blockage and may be told that adhesions are responsible; the actual cause may instead be a spasm.

 

Ileus—The Other Blockage

Forwarded By ReRoute, Evansville, IN

 

     Bowel obstructions come in two varieties, mechanical and non-mechanical.  Most ileostomates have encountered the mechanical variety, usually when we eat something fibrous and do not chew it well enough.

     Ileus, also called paralytic ileus, is the non-mechanical variety.  It happens when peristalsis stops.  Peristalsis is the natural wave-like contractions of the intestines that move material through the bowel.  The symptoms can be very similar to those of mechanical bowel obstruction, and includes pain, vomiting, constipation and diarrhea.  Several causes are cited for ileus: infection of the peritoneum (the lining of the abdomen and pelvic cavities), or disruption for lowering of the abdominal blood supply.  

     Heart disease or kidney disease, when coupled with low potassium levels, can trigger the condition. Certain orthopedic surgeries, such as joint replacements or back surgeries and some chemotherapy drugs such as vinblastine (Velban, Velsar) and vincristine (Oncovin, Vincasar PES, Vincrex) also can cause ileus.

     So how do you know if your bowel obstruction is due to ileus?  First, see a physician.  Ileus is characterized by a few or no bowel sounds, which your physician can easily check with a stethoscope. Diagnosis can be confirmed by x-rays and CT scans.  Blood tests can also be useful in diagnosis.  If you do go for x-rays, note that barium swallows are definitely contra-indicated as they can complicate the situation.  

     Barium enemas can be used to visualize blockages but administration can be a problem in persons with ostomies. A soft catheter should always be used in the case of ileostomies.  Colostomates who irrigate should bring their irrigation catheter or ask for something similar.

     Hospitalization is indicated.  Treatment involves rest and intravenous administration of necessary salts, water and glucose.  The stomach intestinal contents may be removed via a nasogastric tube.  Peristalsis usually restarts spontaneously after two to three days of resting the bowel.  In cases where a partial mechanical blockage triggered the condition, surgery may be performed.  Fortunately, ileus is a relatively rare condition.  Very few people will ever have this happen to them.  But, this is good to know about if you happen to be that one in a thousand.

 

The Secrets of Preventing Blockages and Hernias

By  Ellice Feiveson

 

Blockages may occur when one is an ostomate.  That's a fact of life. But certain steps can be taken to minimize the risk.  Here are some ideas:

 

·        When eating, always concentrate on chewing the food.  Make sure it is chewed well

before swallowing.  For instance, if a piece of meat appears too tough and grisly, it might be better to leave it.  Don't take the chance of swallowing it and then

 having it cause a partial or full blockage.

 

·        Try new foods in moderation.  Do not eat a huge helping of something you have not tried before.  This is a good rule to follow whenever you eat anything.  As an ostomate it is better to eat small quantities of food at more times during the day than to eat one big meal.  Always follow this rule for better health.

 

·        If a particular food has given you problems in the past, try to avoid it until you feel you can do so without a problem.  Most of us try very small amounts of problem  foods from time to time, and if we chew it well and drink water with it are able to tolerate most anything.

 

·        Drink plenty of water or other fluids throughout the day.  We should drink at least 64 ounces, about two liters, of water a day.  Some fluids may be substituted for water.  These include fruit juices and non-caffeine herbal teas.  Caffeine drinks,  alcohol in any form, soft drinks and beverages don't count.  In fact, these items actually require you to drink additional water.  These drinks are all dehydrating.

 

 

Hernias prevention is not under our control all the time.  But there are certain proactive steps that we should do routinely.

 

·        Never lift anything heavy.  For some people even 10 pounds may be too much.      Picking up children and tumbling around with them could cause a hernia.  Anytime      you stain yourself, there is potential for a hernia.

                                                                                                                                              

·        Slow down your actions and be more deliberate.

 

·        Try to exercise three or four times a week.  This means about an hour each time. You should discuss a plan with your doctor.  He/she will help advise you what is best for your exact health situation.  But this warning stated, healthy people only benefit from exercise.  You will build up your abdominal muscles which will prevent hernias.  It is curious to note that every time a muscle is exercised it tears a bit.  When it repairs it builds the muscle.  A big tear is a hernia.

 

·        Do not push boxes on the floor with your feet. This can definitely put a strain on your back and cause a hernia.

 

Above all, use common sense. "God gave it to you as a tool, not an ornament.  Rather be safe than sorry!"

 

Secrets of Preventing Food Blockages

--The Swiss Ostomy website, Schweizer Stoma Suite

Due to "malnutrition" a stoma blockage may occur.  That means stringy and badly chewed food block the stoma.  A blockage is noticed by a lack of output; cramping pains which may be severe; and/or a flatulent or distended stomach.

     

In case of a blockage, go to the emergency room of a nearby hospital or see your doctor or ET nurse immediately!   If there is no possibility to visit a doctor, try the following: 

 

·        Put on a barrier with a larger stoma opening.   The stoma will swell when the stool flows.  In fact take off the pouch entirely.    This will allow the stoma to swell without obstruction and may let your body pass the blockage.

 

·        If possible use a transparent pouch to observe the stoma.  If the cramping stops, drink a lot of liquid that usually causes you diarrhea, such as grape or apple juice.   This will help clean out any of the remaining food causing a problem.

 

·        Walk around!  The action may get your body to shift the blockage and allow it to pass.

 

·        Massage your abdomen!  This will also help move around the blockage giving it a better opportunity to blast through.

 

·        For the more advanced, lubricate your little finger very well with something like white petroleum jelly. Obviously, make sure your nail is cut with no sharp edges.   Then put your finger very gently into your stoma.  The blockage is probably right at the skin level. You will be able to move it and distend your skin at the same time.   Very often, this will allow the blockage to pass.  This is sometimes called dilating.

 

After a blockage has passed, you may feel pain around the stoma for a few days. The blockage overextended the delicate tissue surrounding the stoma on the inside of your body as well as the outside.  You should feel better as each day passes.  Make sure you use a larger than normal cut out for your stoma, filling in any gap with paste.  This will allow your stoma to swell as needed.  It should be back to its usual size in a few days.  You may need to change your barrier daily for a while to check your skin and to make sure the barrier always covers your peristomal skin.

 

It is a good idea to discuss a potential blockage issue with your ET nurse before it actually becomes an issue.  He/she will review a good strategy to follow.  Every ostomate should do this.

 

If you are successful with these measures you will have diarrhea.  Drink enough to compensate for the liquid loss.  Prefer an  isotonic drink such as Gatorade.  Constipating food may help to stop the diarrhea, e.g. bananas and crackers.  After a food blockage, you should allow your digestive system a few days rest and keep a slightly liquid diet.

 

Know About Blockage

By Henly C. Finch, MD

 

The small and large intestines are as different in function as are the arm and leg.  The primary function of the small intestine is to take nutrition from digested foods; the function of the large intestine is to absorb water out of the food residue. 

 

Consequently, there is a difference in the discharge from an ileostomy, a colostomy or a rectum.  The discharge from the small intestine, which functions on liquid material and moves contents forward quickly, is liquid and soft.

 

In the large intestine, the contents are changed from liquid to solid—through the process of absorbing water.  The movement is much less rapid, and the discharge is solid or even hard.

 

Movement of the food mass through the small intestine is never more than a few hours.  Movement through the large intestine frequently takes from 36 to 84 hours.  Thus, when anything blocks the forward motion of the stream of the small intestine, an immediate chain-of-events is set up. 

 

There is pain, then gripping and cramping.  Later, if there is no forward motion, a backward motion of fluid occurs, involving vomiting.  The most frequent cause of the onset of this chain-of-events is blockage at the ileostomy stoma.

 

Usually, this is precipitated by undigested food; i.e., a bean, pea, peanut, popcorn, corn kernel, pulpy-type foods, meat casings, stringy vegetables, shrimp, lobster, coconut, raw vegetables or something similar to these.

 

The best way to handle a blockage is not to allow it to occur in the first place.  This is done by chewing foods well.  However, if symptoms of blockage occur, notify your doctor and follow his/her advice.  As blockages may arise from other causes than undigested food particles, observe the following two cautions:

 

·        Do not take any kind of laxative without your doctor's specific order.  Any Laxative may cause additional complications and pain.

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·        Do not take any medication for pain without your doctor' specific order.  Pain medication may mask a symptom that the doctor needs to know about.

 

Urostomates must be sure to take particular precautions in order to prevent blockage.  Where the ileum or colon rejoined, after a segment is removed for the conduit, a stricture can occur which is not as extendible as the normal intestines. 

 

Keep some grape juice and mineral oil around your home…just in case.  Some symptoms of a blockage can be relieved with a glass of grape juice or a tablespoon of mineral oil.  Also, it can work wonders sometimes, even to the extent of loosening the blockage enough to pass.

 

      Blockage, My Hospital Experience

            Carol Ganje, The Optimist, Greater Seattle Chapter

 

I have an ileostomy.  This means that if I get a blockage, I can start loosing fluids quickly … thereby dehydrating rapidly.  This is exactly what happened to me on a recent Friday evening when I ate something that didn't digest well, probably beans.  I had too many of them while not chewing them well and at the same time not mixing them with other food.  But, what surprised me was the treatment I received at two different hospitals over the next two days.

 

Early Saturday morning I knew I was in trouble.  I was vomiting all night, and nothing but fluids were coming through my ostomy.  After first calling my doctor and leaving a message with his service, my husband, Barry, took me to the ER at a nearby hospital at 11 a.m.  I discovered that the ER personnel there were not very well trained in the management of ostomy care.  The ER nurse assigned to me said she wished she had been given ostomy training.  But, she was a caring professional, and she did ask how I normally would handle a situation like this. 

 

I told her I was dehydrated and to begin re-hydrating me with a saline IV.  By noon, I was hooked to an IV and was given medication to relieve the pain and help calm me.  I had not yet seen a doctor.  I have had other blockages, and in the past this technique has proven to relax my gut allowing the blocked food to pass through my ostomy.  By 4:00 p.m. I no longer had cramps, apparently no blockage I thought, and was released from the ER.

 

Sunday morning, the cramps started again, but not nearly as intense as the day before.  I was still rather sore and weak from my ordeal.  By evening, I was again in so much pain that my husband was preparing to take me to the hospital.  We were able to call the backup for my gastroenterologist, and he told us to go to a certain hospital that was different from the one we had just left a few hours before. 

 

We arrived at about 11:00 p.m.  The ER was already alerted by the doctor that we were coming.  I thought everything would be carefully prepared, and that I would start receiving treatment immediately.  Unfortunately, this was not the case.  At 11:15, I was lying in an ER bed.  At 11:25, the nurse came in and took my blood pressure.  I asked about being hooked up to a saline IV, and the nurse said that they couldn't give do this until the ER doctor personally saw me.  It wasn't until 1:40 a.m. that the ER doctor saw me.  An IV along with pain medication was finally administrated at 2:00 a.m. 

 

X-rays were taken at 2:45 a.m., and I was admitted  to the hospital at 5:00 a.m., six long hours after arriving at the ER.  It wasn't until two days later that I found out the ER doctor had prescribed medication for me that slows down secretions or liquid output.  A mistake in the case of an ileostomate.  I was released from the hospital after being there four days.  The blockage finally cleared by itself with no other complications.

 

 I learned that all hospital ER rooms do not operate the same.  Nor do all the staffs have training regarding ostomy issues.  In fact, some barely know even the basics of ostomy care.  Please, make sure you have an emergency plan in place.  Know how to reach your primary care physician; your specialist (a gastroenterologist in my case); your surgeon.  Talk to your ET nurse about the actions you should take in the event of an emergency.  It is easier to research these issues beforehand in the rare chance you will ever need them than to be in an urgent situation leaving your care to chance. 

 

Peristomal Hernias

By The British Hernia Centre

Translated by Chicago's North Suburban Chapter of UOA

 

A hernia is a weakness or split in the muscle wall of the abdomen which allows the abdominal  contents, usually some part of the intestine, to bulge out.  The bulge is particularly noticeable upon tensing the abdominal wall muscles – such as occurs when coughing, sneezing, straining or simply standing.

 

Stomas pose an additional problem.  When a stoma is brought out to the surface of the abdomen, it must pass through the muscles of the abdominal wall, thus a potential site  of weakness is immediately created.  In the ideal situation, the abdominal wall muscles form a snug fit around the stoma opening.  However, sometimes the muscles come away from the edges of the stoma thus creating a hernia--in this case, an area of the abdominal wall adjacent to the stoma where there is no muscle.

 

Factors that may contribute to causing a stoma hernia to occur include coughing, being overweight or having developed an infection in the wound at the time the stoma was made.  The development of a stoma hernia is often a gradual phenomenon, with the area next to the stoma stretching and becoming weaker with the passage of time. 

 

This weakness, or gap, means that every time one strains, coughs, sneezes or stands up, the area of the abdomen next to the stoma bulges, or the whole stoma itself protrudes as it is pushed forwards by the rest of the abdominal contents behind it.

 

 As with all hernias, the size will increase as time goes by.  Stoma hernias are rarely painful, but are usually uncomfortable and cam become extremely inconvenient.  They may make it difficult to attach an appliance properly, and sometimes their sheer size is an embarrassment as they can be seen beneath clothes.  Although a rare complication, the intestine can sometimes become trapped or kinked within the hernia and become obstructed.

 

 Even more seriously, the intestine may then lose its blood supply, know as strangulation.  This is very painful and requires emergency surgery to untwist the intestine and prevent the strangulated part of the bowel from being irreversibly damaged.  Regardless of inconvenience or pain, hernias are defects in the abdominal wall and should not be ignored simply because they might not hurt.

 

There are surgeons who advocate that small stoma hernias that are not causing any symptoms do not need any treatment.  Furthermore, if they do need treatment, it should not be by operation in the first instance but by wearing a wide, firm ostomy belt.  This is probably true with small hernias, in people who are every elderly and infirm or people for whom an anesthetic would be dangerous, e.g. serious heart or breathing problems.

 

Nowadays operative repair of the stoma hernia should be given more serious consideration to improve the quality of life, prevent progressive enlargement of the hernia with time and make it easier to manage the stoma.

 

Repair of Stomal Hernias – The Traditional Approach

 

If symptoms are severe enough, the hernia is repaired.  The repair of a stoma hernia requires that the abdominal wall tissue is made to fit back snugly around the stoma, leaving no weakness.  Over the years many different surgical approaches to this problem have been tried.

 

There are two options.  One can move the stoma to a new site on the abdomen.  This would create a new opening elsewhere and repair the hernia at the old site as one would any other hernia.  Or, one can try to repair the hernia around the stoma, leaving the stoma where it is.

 

Repair of the hernia without moving the stoma involves opening the abdominal wall over the hernia adjacent to the stoma and re-suturing muscle and supporting tissues in the area.  Although this may appear to be the most straight forward way of doing it, this is not always a successful method.

 

If the original stoma site is unsatisfactory for other reasons, or if the hernia is very large, it may be necessary to re-site the stoma, making a new stoma through fresh, healthy tissue.  The area of the hernia, together with the site of the original stoma is then repaired, usually by stitches.  This can be a more successful procedure regarding repair of the hernia, but is a more major operation because of the many technical, surgical difficulties in dismantling the existing stoma and transferring it from one side of the abdomen to the other.

 

The British Hernia Centre Approach

 

Whether one chooses to leave the stoma at its original site or to move it, we feel that the hernia itself should be repaired with mesh over and beyond the weakened area to reinforce the whole weakened muscle structure.  This is an improvement over the original stitching method and our technique usually enables us to avoid the more major procedure of re-siting the stoma. 

 

Once inserted, the mesh rapidly becomes incorporated within the muscle and surrounding tissue, and forms the core of a much stronger area within the abdominal wall.  This is very similar to the way builders put a steel mesh inside reinforced concrete.  Although the mesh we use is wafer-thin, lightweight yet extremely strong, the principle is the same, in that the mechanical load becomes spread over the whole area rather than pulling on any individual stitches through the muscles.

 

This use of mesh, rather than stitches, serves to avoid future recurrences, which happen when the stitches used with other methods are pulled away from the tissue.  Once the bowel is seen to function normally, our kind of mesh repair generally requires one or two days in the hospital following which a rapid recovery with a more reliable repair can be expected.  Because the reinforcing effect of the mesh gives strength to the repair without the tissue distortion and tension of other methods, most patients are able to be completely mobile and engage in normal levels of exercise within a very few days.

 

While there can be no guarantee of the permanence of any stoma hernia repair, it is felt that this technique offers the least risk of recurrence.  As this is a highly specialized area of surgery, one should take care to seek surgeons with the appropriate level of experience with hernias, and specifically stoma hernias and this technique of repair.

 

(Editors note:  This article comes off as bit of a sales pitch.  It may just be the cultural difference.  Only you and your doctor should ever decide on the best course of action for any condition.  There may be unfavorable complications with the mesh approach.  e.g. The mesh may crinkle when you move, and you may even be able to feel it.  This being said, it is always in your best interest to know about alternative medical treatments in order to make informed decisions.)

 

Peristomal Hernia

Dr. Leroy Levin

 

When one has surgery that results in an ostomy, a space is made in the muscles of the abdominal wall, and a piece of intestine is brought through the opening.

 

Many people are fine from that point on.  But as we grow older, there is a tendency for muscles to lose strength.  In areas where a weakness already exist, such as the site of an old hernia or that of a colostomy, the muscle tone tends to decrease and the muscles spread.

 

The opening where the intestine comes through will also spread, allowing the intestine passing through to curl and fold in the extra space, rendering irrigation difficult.

 

If the hole grows larger or if a section of the regular intestine gets caught in the opening, an obstruction may occur which may require surgery.  Normally, however people who have a peristomal hernia don't have to do anything, unless it enlarges and causes pain.  When in doubt, see you physician or ET nurse.

 

(Editors note:  Isometric exercises tighten up muscle strands.  If your health permits, walking, swimming, stretching and bending are excellent, low impact methods of strengthening abdominal muscles for ostomates.  Exercises like sit-ups are muscle building but also create separations in muscle strands.  These exercises should not be used alone.  If you use them, make sure they are supplemented with a vigorous isometric routine.)

 

Hernias

--The Beacon, Coos Bay, OR

 

It was surprising to find that about a third of our group had developed hernias on one side of the stoma.  The discussion started when a new ostomate was asked if she had any problems.  She answered, "Yes, I'm having trouble with those snap-on type pouches popping off the flange because of the side pressure of a hernia."

 

She was using a four-inch wide elasticized hernia belt from New Hope.  Another member had experienced the same trouble, and he stated that when using a snap-on ostomy system, the barrier stays on better if one does not use a hernia belt.

 

A senior member with a colostomy stated that his experience was that it was much better to use a one-piece drainable system with a New Hope type of hernia belt.  The barrier life for him was about four days even with a hernia, depending on the amount of physical activity he had.  When he bent over all the time—like when he played golf—it lessened the life of the barrier.

 

Q         What is a hernia?

 

A         It is a tear or break in a muscle which allows another bodily organ to enter.  As the other organ enters—it is usually an intestine—it produces a bulge next to the stoma.  It may be painful or not, be as large as half a grapefruit, require surgery or not, and it may develop into an emergency situation if left untreated.

 

Q         Why do colostomates have hernias more often than ileostomates or urostomates?

 

A         Because the hernia opening is through the rectus muscle for the stoma, it must be considerably larger to accommodate the diameter of the colon—about 1 ¼" for a colostomy versus ½" for an ileostomy.  The opening through the abdomen is less that the diameter of what is on the outside because the intestine is turned over on itself to form a stoma.

 

Q         How can hernias in colostomates be prevented or reduced?

 

A         Lifting heavy weights is the number one reason for hernias.  Stress is placed on the inside of the abdomen pushing and tearing these tender muscles.  If muscles are weak, or are largely just fat tissue, a tear may easily be created.

 

Isometric exercises will help.  These type of  exercises not only help strengthen muscles, but they help close spaces between them.  Walking is an excellent low-impact, isometric exercise that gently builds stomach muscles.  Doing sit-ups is not recommended for any except the most physically fit.  Sit-ups build muscles but do not close the spaces between them.  Hernias may form in these spaces.

 

One member developed a serious hernia five years after her colostomy surgery took place for no apparent reason.  Another member developed a hernia six months after surgery as a result of carrying heavy travel-bags.  Warnings about hernias are given to ostomy patients before they leave the hospital.

 

Q         Can hernias around stomas be repaired?

 

A         Yes, with surgery.  If the stoma is left in the same location, the operation is relatively minor, but the hernia will return again in most cases.  However, one member had success when his doctor used a reinforcing mesh to do the repair.  He experienced no pain with the mesh in place even during bending movements.

 

Another member reported a hernia being satisfactorily repaired with a mesh made of his own body fibers, but within a year the hernia had returned to the same size it was before.

 

One member has experienced great success, after living with a hernia for 12 years, having it completely repaired by having the site of the stoma relocated at the navel.  This is a major operation.  The navel is the strongest part of the rectus muscles.  Even thought the skin surface is very uneven at the navel, she was able to have no problem using a barrier immediately after the operation.  Now, she irrigates with great success, and an ostomy system is not necessary.

 

Q         Do hernias interfere with irrigation?

 

A         Yes.  It is more difficult to get a catheter or cone in place with a hernia.  It also takes longer to admit the irrigating water and longer for the bowel to evacuate itself. 

 

One experienced member with a hernia for 10 years took over an hour to irrigate, and even then, it was done with difficulty.  Now, after having the hernia removed, she finds it much easier to irrigate, and it now takes only about 45 minutes. 

 

More About Peristomal Hernias

By Dr. Leroy Levin

 

When someone has surgery that results in an ostomy, an opening is made in the muscles of the abdominal wall and a piece of intestine is brought through that opening.  This becomes your stoma.

 

Many people are fine from that point on.  But as we get older, there is a tendency for our muscles—including the abdominal wall muscles—to lose strength.  Where there is a weakness, our muscle tone tends to decrease and the muscles spread a little.

 

Around a colostomy the muscles will spread more; as a result, the piece of intestine coming out of your body, instead of coming out straight, will start to curl in the extra space.  Someone who could irrigate very easily before, now has trouble because the intestine is folded.  If the hernia—peristomal hernia—becomes very large, or if another piece of the intestine gets caught in the space, major problems could arise.  The piece of intestine caught in the abdominal space may kink causing an obstruction.  Emergency surgery may be required.

 

Most people who have a peristomal hernia do not have to do anything unless the hernia enlarges to a point where it causes pain.  It may also mean that some who have irrigated in the past may not be able to irrigate at all, or that the irrigation may take longer.

 

Colostomy hernias may be repaired.  But, while it appears that the surgeon should just sew up the opening in the abdomen causing the hernia, it cannot be merely pulled together.  One cannot just tighten the muscle if the muscle is very weak. 

 

The colostomy must be taken out of its present location and moved to another spot.  Such an operation is not as big as the original surgery, but it is significant.  The doctor will weigh the need for such operation against the severity of the problem.

 

What can one do to avoid a hernia?  Don’t put on weight.  When you do, you stretch the abdominal muscle; and if you have a colostomy in a weakened area, it will get weaker.  If you are round and full,  lose the extra weight.  Take the pressure off that muscle.  In addition, tightening up the abdominal muscles with isometric exercises will help.  Isometric exercise tightens the muscles versus sit-ups which builds muscle but increases the separation, something you don’t want.  Walking is a light abdominal isometric exercise you may want to try.   You still may get a hernia, but this will reduce its probability to occur.

    

What is a Revision?

--Coos Bay, Oregon

 

We often hear people asking, “What is a revision?”  The term applies to a surgical correction of the stoma.  This may be a small procedure done in out-patient surgery, or it may be a procedure requiring hospitalization.  Four common reasons for revisions are listed below. But, before we begin, please bear in mind that these conditions may be present without causing much trouble—in which case a revision is not needed.  Revisions are most frequently done to correct:

 

·        A tight stoma;

·        A prolapse—when the stoma becomes very long and large;

·        A retraction—when the stoma becomes so short that it is below the skin level;

·        A hernia that is so near the ostomy that it interferes with management.

 

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