Managing an ostomy after Crohn’s disease-related surgery may take some time, but don’t get discouraged. Request an ostomy nurse to help you address issues, such as drains in surgical sites and other skin issues. Initially, it may be difficult to get a good pouching system seal on the stoma site, though many of these issues can be remedied with the help of an ostomy nurse
Below are some of the issues that could present along with resources you can refer to for more information:
Peristomal Skin Conditions
These are usually benign and can be managed with some stoma powder or paste as recommended by your ostomy nurse.
Occasionally, Crohn’s disease-related complications may develop on or around the stoma, including, fistula, hidradenitis suppurativa or pyoderma gangrenosum (skin conditions that may be related to Crohn’s disease).
These may require more complex Crohn’s disease management with your gastroenterologist, colorectal surgeon and/or dermatologist.
Please visit www.ostomy.org/ostomy-skin-care for a skin assessment guide or read Maintaining Healthy Peristomal Skin and Top 8 Signs that Your Peristomal Skin is Irritated or Damaged for additional information.
A Bowel Obstruction, also known as an intestinal blockage, is a blockage that keeps food or liquid from passing through your small intestine or large intestine (colon).
Signs and symptoms of
intestinal obstruction include:
With Crohn’s disease, intestinal obstructions can be caused by inflammation, adhesions (scar tissue), and strictures, which can cause the intestine to narrow.
For additional details, please see How to Treat Intestinal Blockage.
A Parastomal Hernia occurs when the intestines press outward near the stoma site, creating a rip/tear in muscle tissue and causing a portion of the abdomen to bulge under the skin. This can sometimes result in pain, discomfort, or leakage on or around the ostomy site. A hernia may or may not require additional surgery, depending on how large and uncomfortable it may be. Hernia belts can be worn to protect the hernia site and prevent further damage from occurring.
Prolapse of the Stoma
A Prolapse of the Stoma can result in abnormal, visible external lengthening of the stoma after surgery. Prolapses, when severe, can result in a color change of the stoma due to diminishing blood supply, as well as constipation from bowel obstructions at the stoma site. Small prolapses are generally benign, but some require careful monitoring by your colorectal surgeon to see if it may become necessary to revise the stoma.
Medical Management With Your Gastroenterologist
Additionally, after ostomy surgery, your Crohn’s disease may continue to need medical management. This often means re-initiating Crohn’s disease medications post-surgery and ensuring that your bloodwork and nutrition improves as you heal. If your Crohn’s disease is active again after ostomy surgery, be sure to coordinate with your gastroenterologist and colorectal surgeon to review your treatment options. Please refer back to the first section of this website to understand how shared decision making works as well as what your options are medicinally and/or surgically to treat your disease.
Written by Tina Aswani Omprakash. Medically reviewed and validated by Jordan Axelrad, MD, MPH. These webpages are funded by a grant from The Leona M. and Harry B. Helmsley Charitable Trust.