When disease or injury prevents the normal passage of stool through the digestive tract, surgical solutions like colostomy or ileostomy can restore bowel function. Both procedures create a stoma—an artificial opening on the abdominal wall—allowing waste to exit the body into an external pouch.
These surgeries can be temporary or permanent and have significant physical, nutritional, and psychological implications. For nurses, understanding the differences, care protocols, and patient education strategies is essential—both for optimal recovery and for NCLEX/HESI exam success.
What Are Colostomy and Ileostomy?
Surgical Overview
A stoma is created by surgically bringing a portion of the intestine to the abdominal surface. This bypasses diseased or damaged sections of the bowel.
- Colostomy: Opening is made in the colon (large intestine).
- Ileostomy: Opening is made in the ileum (last part of the small intestine), typically in the right lower quadrant (RLQ).
Purpose:
- Divert stool flow to protect healing tissues
- Remove or bypass a blockage
- Manage chronic bowel disease (e.g., Crohn’s, ulcerative colitis, cancer)
Key Differences: Colostomy vs. Ileostomy
| Feature | Colostomy | Ileostomy |
|---|---|---|
| Location | Colon (large intestine) | Ileum (small intestine) |
| Stool consistency | More formed | Liquid to semi-liquid |
| Output color | Brown (“Down” → mnemonic) | Green/yellow (“Ileo” → mnemonic) |
| Output frequency | 1–3 times/day | Continuous or frequent |
| Fluid loss | Lower | Higher risk of dehydration |
Memory Trick:
- Green/Yellow → Ileostomy
- Brown “Down” → Colostomy
Indications for Surgery
Colostomy
- Colorectal cancer
- Diverticulitis
- Traumatic bowel injury
- Obstruction
Ileostomy
- Inflammatory bowel disease (Crohn’s, ulcerative colitis)
- Familial polyposis
- Bowel obstruction at ileum level
Stoma Assessment and Care
Normal Findings:
- Post-surgery: Red, “beefy,” moist
- Long-term: Pink, moist, shiny
Abnormal (Report to HCP):
- Pale, grey, dusky, or purple (indicates poor blood flow)
- Cold to touch
- Excessive bleeding
NCLEX Tip: Immediate action is required if a stoma turns purple—this may indicate ischemia.
Daily Stoma Care Steps
- Cleanse peristomal skin with mild soap and water.
- Dry completely to prevent skin breakdown.
- Apply barrier cream or wafer.
- Fit pouch snugly to prevent leakage.
- Empty pouch when one-third to half full.
Dietary Guidelines After Ostomy Surgery
First 4–6 Weeks (Low-Fiber Diet):
Avoid high-fiber, gas-producing foods:
- Broccoli, Brussels sprouts
- Beans, nuts, seeds, popcorn
- Whole grains
- Dairy if poorly tolerated
Safe Early Options:
- White bread, pasta, rice
- Lean meats
- Cooked vegetables
- Bananas, applesauce
NCLEX Tip: For a new colostomy, low-fiber diet is recommended for the first 4–6 weeks to allow healing.
Fluid and Electrolyte Considerations
Especially in ileostomies, output is more liquid—risking dehydration and electrolyte imbalances like:
- Hyponatremia (low sodium)
- Hypokalemia (low potassium)
- Hypomagnesemia (low magnesium)
- Hypocalcemia (low calcium)
Prevention:
- At least 3 liters/day fluid intake
- Monitor electrolyte labs
- Oral rehydration solutions if needed
Irrigation (Colostomy-Specific)
- Use 500–1000 mL warm tap water (never cold)
- Place bag above stoma (shoulder height)
- Stop if cramping occurs
- Goal: regulate bowel emptying
Post-Operative Nursing Care
Priority Actions:
- Monitor stoma viability
- Measure output
- Maintain fluid balance
- Provide pain management
- Teach self-care and appliance use
- Address body image concerns
NCLEX Sample Question
A patient with a new colostomy should be taught:
Low-fiber diet for the first 4–6 weeks post-op
Complications
| Complication | Cause | Nursing Response |
|---|---|---|
| Skin irritation | Leakage, poor fitting | Refit pouch, protect skin |
| Stoma necrosis | Poor blood supply | Notify HCP immediately |
| Retraction/prolapse | Surgical technique, increased abdominal pressure | Support appliance fit, HCP referral |
| Dehydration (ileostomy) | High fluid loss | Encourage oral fluids, monitor labs |
| Psychological distress | Body image issues | Offer counseling, support groups |
Saunders NCLEX Note
Question: Which finding requires immediate notification for a client with a recent transverse colostomy?
Purple discoloration of the stoma → Indicates compromised blood flow.
Psychological and Social Impact
Patients may struggle with:
- Body image concerns
- Fear of odor or leakage
- Dietary restrictions
- Returning to work or intimacy
Nursing Role:
- Provide emotional support
- Connect with ostomy support groups
- Encourage gradual return to normal activities
Summary Table: Nursing Priorities for Colostomy/Ileostomy
| Priority | Actions |
|---|---|
| Stoma health | Assess color, moisture, temperature |
| Fluid balance | Monitor intake/output, labs |
| Diet education | Avoid high-fiber initially |
| Skin care | Clean, dry, protect peristomal skin |
| Patient teaching | Appliance management, irrigation, complication signs |
Frequently Asked Questions (FAQ)
1. How long after surgery can patients eat normally?
Gradually reintroduce foods after 4–6 weeks, monitoring tolerance.
2. Is irrigation for both colostomy and ileostomy?
Only for certain colostomies; ileostomies are not irrigated.
3. How often should pouches be changed?
Every 3–7 days, or sooner if leaking.
4. Can patients swim with a stoma?
Yes—waterproof pouching systems are available.
5. What if the stoma changes color?
Report pale, dusky, or purple discoloration immediately to a healthcare provider.
