Stoma and Dementia: How Stomal Dilators Can Help with Stoma Care
Caring for a loved one with dementia can be a challenge. Dealing with a stoma can add another layer of complication to the situation.
Stoma and dementia isn't a topic that most elder-care resources cover, so you may be feeling a little lost about how to manage your dementia patient's stoma. Learning more about stomas and how to prevent and address complications can provide the confidence that you need.
Stoma Care in Early Dementia
Early in the progression of dementia, patients may still be able to take care of their own stomal needs. This may be especially true if the person has been living with an ostomy for a long time.
Even still, you may need to provide support and reminders. Consider posting step-by-step guides in the spot where bag changes usually take place. Depending on your loved one's current ability level, you may choose to provide a written list of instructions or illustrated diagrams.
It may help to have all of the supplies laid out ahead of time for your loved one. You can even pre-cut the flange to the right size. Making pouch changes as easy as possible can help a person with dementia retain independence.
When assembling stoma-care kits, consider including disposable gloves. Thorough hygiene can be hard for many dementia patients. Wearing gloves during bag changes can reduce the risk of skin or fingernails harboring fecal bacteria.
Stoma Care in Later Dementia
As the disease progresses, your loved one may no longer be able to handle stoma care on her own. You'll need to learn how to empty or swap out the pouch.
It's easiest to perform bag changes when the person is standing up. For patients who are unable to stand for that long, lying in bed can be a good alternative.
In this video, you can watch a caregiver change the bag of a person who's lying down:
Some dementia patients find bag changes distressing, so you may need to offer distractions. For example, if your loved one is brushing his hair or teeth, he may be less likely to fixate on your activities.
Fiddling with the bag is a common problem among stoma and dementia patients. Some pick at the seal, and others yank the pouch off.
Reducing access to the bag may help solve this problem. You can tuck shirts into underwear or dress your loved one in one-piece garments without snaps or buttons in front. A heavy bag can uncomfortable, so emptying or changing it frequently may help. It's also smart to place a disposable plastic bag around the ostomy pouch to catch any leaks from a loosened seal.
Skin irritation may provoke your loved one to mess with the ostomy bag more frequently. To reduce irritation, make sure that the flange is cut to just the right size. You may also need to use two-piece bags so the flange doesn't need to be peeled from the skin as frequently.
The stoma itself can become irritated as well. Each time that you change the bag, you should inspect the site for signs of a problem. Even if your loved one is still able to take care of daily bag changes, you or a nurse may need to take a good look at the stoma on a regular basis.
Signs of a problem may include:
If you notice any of these symptoms, it's a good idea to consult a medical provider. Some changes aren't critical, and you can learn to work around them. Other problems may require medical interventions or surgery.
Benefits of Stomal Dilation
Stenosis is one concerning development that sometimes occurs in patients with ostomies. This is when the stomal opening becomes tighter and narrower. This condition can cause pain, nausea and the inability to pass waste.
Stenosis sometimes begins with a retraction. The stoma pulls back so that it is no longer raised above skin level but instead sits lower than the surrounding skin. It might happen just on one side, or the whole stoma may retract.
This is one reason why regularly checking the stoma of a loved one with dementia is important. An unnoticed and untreated retraction can lead to stenosis. A serious case of stenosis may require surgery.
If retraction or stenosis is caught early, though, you may be able to avoid the need for surgery. Stomal dilation is an at-home procedure that you can perform to gradually widen the opening.
Your loved one's colorectal specialist may recommend that you use a reusable Dilastom stomal dilator for this process. Dilastom instruments come in two sizes. You'll probably be instructed to start with the smaller one and advance to the larger size in time.
The process is simple. After applying lubricating gel, you'll gently insert the stomal dilator into the stoma and hold it in place for 10 to 15 minutes. The process should be repeated twice a day.
As with bag changes, a person with dementia may resist stomal dilation at first, but you can learn to perform this procedure in a way that's comfortable for both you and the patient. Regular stomal dilation may reduce the need for more invasive treatments that could be especially hard for a person with dementia.
Stoma and dementia can be a tricky combination to handle, but you can learn to provide the care that your loved one needs. This may include performing bag changes and keeping an eye on stomal health. If a doctor recommends dilation for treating retraction or stenosis, ask about using reusable Dilastom stomal dilators.
As with all medical issues, your physician is the ultimate source as to what procedure best fits your needs. Discuss all options and get a second opinion if you have any doubts. These articles are intended to be a source of general information only.