SIDE EFFECTS OF CHEMOTHERAPY:
Bone marrow suppression - commonly referred to as neutropenia, this can be a major problem to the ostomy patient. There is a decreased white blood cell count with a resulting risk for infectious diseases. This could be a simple viral infection, a local infection in the peristomal area, or gastroenteritis, resulting in diarrhea. Patients may also be prone to ulceration in or around the stoma.
Steps need to be taken to decrease trauma to the peristomal skin to minimize the risk of an infection. Patients need to be reminded to cleanse the peristomal area with soap and water, avoiding overzealous cleansing or changing the pouch too frequently. Special care should be directed to preventing stool or urine from coming into contact with the skin by creating a properly fitted pouch opening with a tight-fitting seal. If there is a fungal infection, an anti-fungal powder followed by a light coating of a skin preparation may be applied to the peristomal skin before applying the pouch. In all cases, see your ET if a skin problem arises.
There is also a risk during treatment that the platelet count will drop with a risk of increased bleeding. This is commonly called thrombocytopenia and is detected by bruising of the skin or possibly unusual bleeding from the stoma or mucous membranes. Should bleeding from the stoma be noticed, pressure should be applied directly to the site. If this is unsuccessful, other measures - such as a silver nitrate stick applied to the bleeding area, cauterization or suturing - may be used after consulting with your doctor.
Ensuring that the pouch opening is the correct size is important to avoid any trauma to the stoma. Don't place anything in your pouch, such as aspirin, which might damage the stoma. At one time it was thought that aspirin was efficient at controlling odour in the pouch but it can be a danger to ostomy patients with thrombocytopenia.
Anemia is less common during treatment but it deserves mention as it may change the colour of the stoma from a reddish pink to a pale pink. Anemic patients frequently experience fatigue and should be encouraged to rest, conserving as much energy as possible.
GASTROINTESTINAL EFFECTS:
Diarrhea:
As many as 75% of ostomy patients receiving chemotherapy have reported experiencing diarrhea. It may be caused by a bacterial or viral infection or it may simply be a function of the irritating effects of the chemotherapeutic drugs on the intestine.
Diarrhea may necessitate changes in the schedule, equipment or technique for pouch changing and peristomal skin care. If you are using a closed-end pouch, you may have to switch to an open-ended variety to aid in the emptying of stool and to prevent overfilling and leakage. Peristomal skin care should include gentle cleansing with tepid water and if needed, mild soap. Look for signs of dehydration and electrolyte imbalances and look for foods that aid in the formation of firm, less frequent stools such as rice, bananas, yogurt and applesauce.
Constipation:
This is another complication of some chemotherapeutic drugs. You will experience abdominal pain and pass infrequent, hard, dry stool through the stoma. Other causes of constipation include changes in dietary intake related to nausea, anorexia, or stomatitis, or to fatigue, which decreases activity levels. Constipation can also be caused by pain-killing drugs, such as morphine. To alleviate this condition, try to be more active, increase your daily fluid intake and eat a diet high in fiber.
Mucositis:
This is a generalized inflammation of the mucous membranes, ranging from the oral cavity to the rectal mucosa. Problems with mucositis may be minimized by cleansing the stoma gently with mild soap and water and observing the peristomal area for irritation. This area will heal after treatment is completed.
Skin changes:
Skin reactions may be intensified during chemotherapy. Possible effects include rashes, folliculitis, or dry skin conditions. For optimal skin protection, a 1/16 to 1/8 inch opening around the stoma allows optimal protection. In addition, a skin barrier or wipe may be used. Try to change the pouch a day before you expect a leakage might occur.
Fatigue:
Fatigue is a normal occurrence during chemotherapy. This not only interferes with concentration but may leave you in a weakened state and unable to perform basic activities of daily living. Fatigue usually begins during or shortly after treatment week, peaks after another 7 to 10 days and then declines slowly, allowing you to resume normal activities.
Potential effects of radiation:
Tissues most sensitive to radiation therapy are those undergoing a rapid rate of cellular division, such as the interior lining of the gastrointestinal and urinary tracts. Acute effects are primarily a result of the depletion of actively proliferating cells. Side effects vary widely by individual and may be mild in some or absent in others.
Radiation changes in the small intestine may cause alterations in absorption of fats, carbohydrates and proteins. Nausea, vomiting and diarrhea may be symptoms, sometimes leading to dehydration. This can be a particular problem for ileostomates, who are already at high risk for electrolyte imbalances. Stomas that lie directly in the treatment field may show acute reactions and may develop ulcers or show a watery discharge. Since radiation effects are cumulative, the greatest reactions are seen toward the end of therapy. Side effects are temporary and usually subside 1 to 3 months after therapy has ended. (It is best to mention any side effects you are experiencing to the radiation oncologist at the time you notice them.)
Fatigue is one of the most common side effects associated with radiotherapy. Common sense suggestions for dealing with tiredness include pacing activities, rest during the day, get plenty of sleep, accept help with household duties, and use moderate exercise regularly.
Skin reactions:
Skin care is essential during radiation. Avoid irritation to the treated area by avoiding temperature extremes, sunlight, unapproved skin care products, scratching or rubbing the area, or coarse, restrictive clothing. Men who shave their peristomal skin may be asked to refrain from shaving. Gentle skin cleansing, gentle adhesives, and gentle adhesive-removal technique are imperative to prevent additional trauma to the skin. It may also be advisable to avoid soaps, solvents, cements, sealants, pastes, and powders unless approved by the radiation oncologist or nurse. You might try using pouch covers to absorb moisture trapped between the skin and the pouch.
Gastrointestinal effects:
Nausea, vomiting and anorexia may occur with radiation therapy. Not everyone will experience these symptoms. The best control of nausea and vomiting is relaxation exercises and dietary modifications. It is best to avoid "heavy," high fat, overly spicy, or sweet meals. Small, frequent meals at cool or room temperatures are suggested. Mild exercise, like a walk, before eating and making mealtime relaxed and pleasant are also recommended.
Diarrhea is probably the most common radiation-related side effect and is usually reported by the third week of treatment. Patients report that medication, particularly Lomotil, is most helpful in controlling diarrhea. Some also reported a low reside diet to be beneficial. It has also been reported that adding bulk to the stool with medication such as psyllium (Metamucil) will help to minimize diarrhea.
