November/December 2000


Perineal Wound

One of the neglected areas in the care and management of patients with permanent end colostomies and proctocolectomy with ileostomy is the perineal wound. Prior to and following surgery most of the concern of persons caring for the ostomy patient is related to the stoma.

Many ostomates have stated that the perineal wound was not anticipated by them. Doctors and nurses explained the ostomy and the need to remove the rectum but did not mention the abdominoperineal approach.

Automatically, the wound is bounded by the pelvic bones. The space left by organ removal does not collapse but has to be filled with granulation tissue which takes a varying length of time. The wound heals from the inside outward, contrary to other wounds that are cut and simply grow together. Many peculiar symptoms occur in the perineal wound area because the properties of scar tissue differ from those of the tissue it replaces.

A frequent concern of ostomates is the time factor in perineal wound healing. Determinants include the size of the wound, local problems, the shape of the pelvis, the extent of the operation, the presence of pre-existing scar tissue, and the physical condition of the patient. Many physicians feel the patients who have been on long-term cortisone therapy may experience delayed perineal wound healing.

Many ostomates have phantom rectal sensations. They experience the feeling of the need to evacuate the rectum although it has been removed. Some ostomates have phantom rectal sensations at the time of irrigation. Explanation of phantom rectal sensation helps the ostomate to understand that it is a normal mechanism related to the spinal nerve control.

Simply stated, the nerves that innervated the rectum and were responsible for rectal continence continue to function even though the rectum has been removed.

There are a variety of methods of dealing with the feeling of pressure. Sometimes knowledge of the nature of the situation alleviates the ostomate's concern. Changing the position and even sitting on the toilet for a short period may relieve the symptom temporarily. Pain in the perineal wound area during the first year after surgery may be significant. It could indicate an infection of the wound. There may be healing at the skin level with underlying abscess formation. As a rule of thumb, ostomates who have persistent perineal pain or sensations should consult their physicians to rule out any medical problem.

Sensations are common in any wound. Old wounds have a tendency to itch and may cause sharp pains in the surrounding skin. All sorts of sensations occur in the perineal wound for many months following surgery. They are especially noticeable after prolonged sitting or standing. Many are apparently a part of the normal healing process.

By Nursing Clinics of North America; via Los Ileos and Stillwater-Ponca City (OK) Ostomy Outlook July 2000, via Inside Out On-line Nov/Dec 2000.

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