Colostomy patients may suffer from constipation and whenever possible should be treated by increasing fluid intake or dietary fiber. Bulk-forming drugs should be tried. If they are insufficient, as small a dose as possible of sienna should be used.
Anti-diarrhea drugs such as loperimide, codeine phosphate, or co-phenotype (dioxalate with atropine) are effective. Bulk-forming drugs may be tried but it is often difficult to adjust the dose appropriately.
Antibacterials should not be given for an episode of acute diarrhea.
Antacids have a tendency for diarrhea if made from magnesium salts. In addition, constipation from aluminum salts may be increased in these patients.
Diuretics should be used with caution in patients with ileostomies as they may become excessively dehydrated and potassium depletion may easily occur. It is usually advisable to use a potassium-sparing diuretic.
Digoxin used in patients with a stoma make them particularly susceptible to Hypokalemia, if on digoxin therapy and potassium supplements, a potassium-sparing diuretic may be advisable.
Potassium supplements in liquid formulations are preferred to modified-release formulations.
Analgesics such as opioid analgesics may cause troublesome constipation in colostomy patients. When a non-opioid analgesic is required, paracetamol is usually suitable but anti-inflammatory analgesics may cause gastric irritation and bleeding.
Iron preparations may cause loose stools and sore skin in these patients. If this is troublesome and if iron is definitely indicated, an intramuscular iron preparation should be used. Modified-release preparations should be avoided for the reasons given above.
Patients are usually given advice about the use of cleansing agents, protective creams, lotions, deodorants, or sealants while in the hospital, either by the surgeon or by an ostomy nurse. Voluntary organizations can offer help and support to patients with a stoma.
