It is important that you, as an ostomate, know you should be handled differently as a hospitalized patient than non-ostomates. It is up to you to communicate with the medical personnel who take care of you (including every physician that treats you) that you have an ostomy and what type. Here are some “rules” to help you cover the details:

Rule I: - The cardinal Rule - If you feel something is being done, or is going to be done that might be harmful, refuse the procedure. Then explain to the personnel, and especially your physician.

Rule 2: - Supplies - Take your own supplies to the hospital. Never assume the hospital will have the exact pouches or irrigation system you use.

Rule 3: - Laxatives and Irrigations - Follow the points below concerning laxatives or irrigation practices, according to the type of ostomy you have. (Medical personnel often assume that all stomas are colostomies...) A transverse colostomy cannot be managed by daily irrigation. The only colostomy that can be managed by irrigation is the descending or sigmoid colostomy. But sigmoid or low colostomies do not have to be irrigated in order for them to function; many sigmoid colostomates prefer letting the stoma work as nature dictates. If you do not irrigate your colostomy, let the fact be known to caregivers. - If your physician orders your bowel cleared, irrigate your own colostomy; do not rely on others. There is a strong possibility that those caring for you will not know how to perform the irrigation. Take your own irrigation set to the hospital. - If you have an ileostomy or urinary diversion, never allow a stomal irrigation as a surgical or x-ray preparation. Remember that laxatives or cathartic by mouth can be troublesome for colostomates. For ileostomates they can be disastrous; ileostomates should always refuse them. An ileostomate will have diarrhea, may become dehydrated and go into electrolytic imbalance. The only preparation an ileostomate needs is to stop eating and drinking by midnight the night before surgery. An IV should be started the night before surgery to prevent dehydration.

Rule 4: - X-rays - X-rays present special problems for ostomates and must be managed according to ostomy type. Colostomates: Never allow radiology technicians to introduce barium into your stoma with a rectal tube. Take your irrigation set with you to x-ray and explain to the technicians that a soft rubber or plastic catheter F#26 or 28 should be used to enter the stoma. Put a transparent bag on before you go to x-ray. Have the technician or yourself place the plastic catheter into your stoma through the clear plastic bag. When enough barium is in your large bowel for the xray, the rubber or plastic catheter can be withdrawn and the open end of the bag be closed. The bag will then collect the barium as it is expelled and can be emptied neatly after the procedure. Once the x-rays are complete, irrigate normally to clean the remaining barium from your colon. This will prevent having to take laxatives by mouth after the procedure. Heostomates may drink barium for an x-ray procedure, but never allow anyone to put barium into you ostomy. Urostomates can have normal 01 x-rays without problems. Never allow anyone to put barium into your stoma. At times, dye may be injected through the soft plastic catheter into a urostomy for retrograde ureter and renal studies, often called ileo-loop study. - The same study may be performed on a urostomate patient with a Koch pouch. - The dye will be injected via a large syringe; this can be a very painful procedure if the dye is not injected very slowly. Even 50cc injected rapidly will create a great deal of pressure in the ureters and kidneys if done rapidly. Remember to request the injection be done slowly.

If you wear a two-piece appliance, you can remove the pouch just prior to the insertion of the catheter and replace the pouch after the procedure is completed. If you wear a one-piece appliance, take another with you to the xray to replace the one removed for the procedure. In the event you are incapacitated from using both hands to replace the appliance, have an ostomy nurse paged - or a nurse from the floor - ~o assist in replacing the appliance before you leave the x-ray department.

Rule 5: - Instructions - Take to the hospital two copies of instructions for changing and irrigating your appliance. Give one to your nurse for your chart and keep one with your supplies at bedside. if you take supplies that are not disposable, mark them “do not dispose”; otherwise you will lose them.

Rule 6: - Communicate! - Again, let me stress that you must communicate with the hospital personnel who take care of you. You will have better hospitalization and they will have an easier time treating you.