APER or APR & stoma Complications


Overall Introduction   -  My problems   -  

APER COMPLICATIONS
Urine retention    -   Neurogenic Bladder    -   Diarrhea or changes in your output   -   Retrograde ejaculation    -  Impotency & Erectyle dysfunction   -   Rectal discharge from a rectal stump

STOMA COMPLICATIONS
Bleeding   -  Granuloma's   -    Obstructions  -   Mucosal separation   -   Necrosis    -  Retracted Stoma    -   Parastomal Hernia (basic)  -  More Parastomal hernia help (With Ians 1st Hand experience & advice) NEW PAGE    -   Prolapsed Stoma   -   Cut Stoma

PERISTOMAL SKIN CONDITIONS
 Peristomal skin conditions introduction   -  Peristomal Skin Excoriation    -   Mechanical Irritation   -   Allergy & Sensitivity   -    Folliculitis   -  Monilia/Candida Albicans (Yeast Infection) 

TEXT BOOK URINE PROBLEMS & SEXUAL DYSFUNCTION
  
Two PDF's on urological complications after surgery with a new document recently added     -  An extract of Sexual dysfunction  -   Urinary and sexual dysfunction after rectal cancer treatment  -  Impotence After Anterior Resection of Rectal Carcinoma   -  Protein Could Heal Erectile Dysfunction After Surgery   

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Warning this page contains some images that some may find upsetting.


OVERALL INTRODUCTION

Ok so what can go wrong ? You don't think about these things at the time and would hope that nothing else goes wrong with your body. As having your rectum removed is bad enough without having to contend with anything else. Now this is not a list of things of complications or things that will go wrong. It's not here to frighten you, it is here to educate you. If you are paranoid then do not read any further and go and look at other pages on this site.

 

MY PROBLEMS

From the whole ordeal you can expect at least to have some complications & I would be very surprised if you didn't. Here is a basic list of my problems.


1) Burning testicle from straight after the operation for about 1 month or so, could of been due to Varicocele's = still unsure what has caused this as I never got a 100% sure answer from everyone I asked. This has now ceased but this is what they are. A varicocele is an enlarged (varicose) vein in the cord that connects to the testicle. Varicocele's are found in 15% to 20% of all men and in 25% to 40% of infertile men. When varicocele's occur in both testicles, they may contribute to hormone imbalances that cause erectile dysfunction.

2) Urine retention that I truly believe caused my parastomal hernia due to excessive perseverance to pass urine when I was told by a GP to persevere.

3) Anxiousness & depression = due to lack of proactive or conflicting advice from the NHS professionals.

4) Impotency with Erectile dysfunction and retrograde ejaculation with embarrassing amounts of urine expelled  rather than seminal fluid.= still apparent 2.5 years after the main APER . This also leads to wetting the bed if you are fortunate enough to have a wet dream. (Most of these are apparently common but I was not told any of this this before the operation & has nearly caused my suicide on more than one occasion)

5) No normal feeling of wanting to urinate, I have a lower super pubic odd feeling that I get when I need to urinate. Or I have to think how long a go it was when I last passed urine & time it for several hours.

6) When I urinate it takes longer than average to empty my bladder as my bladder holds more now since the operation ( typically over 800mils according to the video urodynamics tests I under went )

7) As I urinate I have no sense of relief or sense when the bladder is empty. I just have to watch and wait until all urine finishes dribbling out. This is very frustrating & embarrassing as inevitably you can end up urinating down your leg or in your pants if you think you have finished and you put your penis back in your pants.

8) A parastomal hernia caused by trying to persevere to urinate while under going a trial without catheter as I was incorrectly told by a senior GP at practice to "persevere to urinate as it will be difficult at first"

END OF IANS SO FAR PROBLEMS ENCOUNTERED

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APER CONDITIONS

URINE RETENTION

Where the bladder fails to pass urine due to nerve or other problems in the urethra, prostate etc (also see Neurogenic bladder below)

 

NEUROGENIC BLADDER

Apparently a very common problem in males as I found out only after the operation

The inability to urinate due to nerves not operating as they should in the bladder system , This is why you go into urine retention necessitating you to have a foley catheter for a long time which can then cause more problems like infections etc. You will be advised to carry out intermittent self catheterise which is the next usual step forward from the foley catheter. The thought of this brings tears to your eyes but so does the debilitating condition of neurogenic bladder & urine retention. You would not believe that is was so damn difficult to pass urine after doing it so naturally after 45+ years.

 

DIARRHEA OR CHANGES IN YOUR OUTPUT

Just like anyone else you can get loose stools & there are many reasons why the normal output from your stoma could change.So keep hydrated, take the recommended anti Diarrhea tablets (unless you have been told already by your stoma nurse or GP not to), and if still persistent over a no more than 2 days then go & see the GP.

HOW LONGS DOES IT TAKE FOR OUTPUT
Over several years I have only had about 2 stomach upsets where I have had to take Diarrhea tablets

Ok so my digestive system is now completely flushed through and I have probably cut down on food intake (but not changed the diet) and I have taken the 3 anti Diarrhea tablets. You ask when do I expect an output?, well for me it is was 6 and half days and another time was about 5 days before harder stools started to appear. Is this the normal ? well who knows but I generally felt well after the Diarrhea with no temperature or bloated feelings. After the Diarrhea & before any output you tend to hear rumbling noises or may get some gas passing through the system which is always a good sign. I would say I would of gone to see the GP or stoma nurse if I did not have these rumblings or felt unwell at around the 3 - 4day mark after the initial diarrhea Remember there is only so much that the digestive system can hold so after approx 2 mini & 2 midi bag changes within about 8 hours (over night) of Diarrhea / very loose stools my system is empty. You will no doubt get used to yours over time and will vary depending how active you are and what your normal output is like etc.

If the stool becomes loose or watery, this will increase the possibility of it leaking under the adhesive onto the skin and causing soreness. If you are experiencing a change in the consistency of your output, speak to your Stoma Care Nurse, who will be able to advise you. It goes without saying you need to look after the skin around your stoma a little bit more than usual as the loose output will sting & irritate your skin more than usual.This is where I ensure the skin around the stoma is clean and if need be use an adhesive remover, wash with water , then protect it with a skin protector pad ( I use the 3m ones from coloplast) Make sure its dry before applying your new pouch otherwise leaks will follow & with loose output this finds its way through the smallest of creases in the flange or skin.

POSSIBLE CAUSES OF LOOSE STOOLS
(a) Changes in medication e.g. antibiotics or chemotherapy.
(b) Changes in your diet or something that doesn't agree with you
(c) Anxiety.
(d) Gastroenteritis.
(e) other stomach bugs

To “thicken up” your output try eating marshmallows, jelly babies (in fact any sweets that contain gelatine) or bananas. Another alternative but not as much fun is to pop an“OAKMED Gel-X Capsule” directly into your bag, this will dissolve then thicken the contents of the bag. These are very useful at night time when you are sleeping. Obtained from  http://www.oakmed.co.uk/accessories.asp

 

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RETROGRADE EJACULATION

Apparently another very common problem in males as I found out only after the operation which is where the ejaculatory fluid is not passed out through the end of the penis but instead back flows and goes into the bladder. Apparently causing no harm. So I am told

 

IMPOTENCY

http://www.homeoint.org/site/ahmad/impotency.htm
Dr. Sayeed Ahmad D. I. Hom. (London)

Impotency signifies a permanent condition of inability to effect sexual intercourse successfully. It is the worst calamity one can encounter in life which takes away the pleasure and bliss of youth. It is very humiliating for a person to find himself ineffective while performing coitus, since on the other part the female partner expects the male partner to give her immense sexual pleasure and gratification during the course of sexual union. Real bliss of married life lies in the sexual harmony of the couple. The impotency of a person also brings disharmony in domestic life. Occasionally it frustrates people to commit suicide or makes them insane too.

The symptoms of impotency in normal males are as follows :

  1. Speedy discharge (premature ejaculation).
  2. Reduction in the time occupied by male in sexual acts.
  3. Imperfect or partial erection of a short duration and subsides before the sexual act is started.
  4. Erection does not take place at any time of the day or night or if it occurs, it is very flaccid.
  5. Male finishes without causing much excitement in the female and it does not make any difference whether she is satisfied or not.
  6. Strong and frequent erection followed by premature ejaculation is a signal for imminent sexual impotence.
  7. Penile erection is seldom activated. Very rarely is a few drops of semen discharged.
  8. No sexual passion, no erection, no discharge.
  9. Semen thin and odourless.
  10. Absence of morning erections.
  11. Nocturnal discharges without erections or the erections are loose and during dreams it occurs at the mere attempt of kissing, embracing or just during insertion of the penis or before it.
  12. Hanging of testicles loose.
  13. Immediate softening of erection after seminal emission.

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RECTAL DISCHARGE FROM A RECTAL STUMP

Rectal Discharge is normally a clear discharge that doesn’t smell. Some people also pass an occasional whitish bowel motion from there rectum after colostomy surgery. This is normal and is a mixture of mucus mixed with dead cells from the lining of the rectum and lower bowel.

The lining of the bowel and rectum makes a mucus lubricant. This is to keep the lining of the bowel lubricated and help the passage of stools without causing any damage to the bowel.

The rectum can make quite a lot of mucus, after colostomy surgery the rectal tissue still makes mucus even though no stools are passing through, this can leak from the rectum and cause distress / shock the first time it happens, be assured it is quite normal.

If this becomes a problem your GP can prescribe steroid suppositories that can reduce the amount of mucus made.

If the leakage is green or yellowish and smells strongly, then you should contact your GP as you may have an infection that needs treating in the lower part of the remaining bowel / rectum. If this continues you could have surgery to remove the remaining part of the rectum but is only used as a last resort. Your surgeon would advise you if this is an option.

 

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STOMA COMPLICATIONS

BLEEDING

The bowel has a very good blood supply, which is needed to absorb the goodness from the food we eat. The tiny vessels called capillaries can bleed when the stoma is cleaned; this is similar to cleaning your teeth and your gums bleeding and is quite normal. If however you take anticoagulants eg Warfarin or Aspirin to reduce blood clots this may increase the risk of bleeding. If the bleeding is heavy or persistent or comes from the inside of the stoma you should seek advice from you GP or stoma nurse.

 

GRANULOMAS

granulomas
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Your surgeon will have stitched together where the skin and your stoma meet during the operation. In some cases the area goes through a process of over-healing of the surfaces, called “Granuloma” which will appear as moist, red raised areas. Applying and removing the back plate can make this worse. “Granuloma” are harmless but can be a nuisance as they bleed easily when touched.
The moisture from this can cause the back plate to leak as, it is covering over the “Granuloma” so will irritate them causing them to bleed this in turn causes moisture which will cause the back plate to lift and break the seal.
This can be easily treated contact your stoma nurse for advice.

The can also be tender red areas which have a cauliflower appearance that occur around the edge of the stoma. They often develop where the stitches are inserted around the stoma but can occur many years after the operation. Sometimes rubbing from the flange or base plate can increase the risk of this problem. Bleeding caused by granulation can occur and may interfere with the pouch adhering. The template should be checked and if necessary the application of silver nitrate by your Stoma Care Nurse or surgical excision may be necessary.



 

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OBSTRUCTIONS

A blockage in the bowel can be caused by a collection of undigested food, a narrowing of the bowel or a twist in the bowel. When this happens it may cause the stoma to stop working and cause tummy pains. If the obstruction is caused by a collection of undigested food this may settle without surgery by rest and water only to drink until the blockage clears. If the bowel is narrowed or twisted then surgery may be required

 

MUCOSAL SEPARATION

When the stoma is formed it will be held to the skin by stitches. Occasionally following surgery this ‘join’ can separate slightly. Your stoma care nurse can advise you on the use of various powders, pastes and gels to aid healing.

 

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NECROSIS

The stoma should have a good blood supply which is indicated by the stoma being a pink healthy colour, slightly darker than the inside of the mouth. Necrosis occurs if the blood supply to the stoma is restricted (usually 24-48 hours after surgery). Initially the stoma will become dark red and may even turn black, this is an indication that the blood supply is impaired. Close observation is necessary and if no improvement is noted further surgery may be required.

 

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The following is extracted from http://www.mtsinai.on.ca/ibd/patient/ostomy/complications-stoma.htm

RETRACTED STOMA

retracted stoma
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The retracted stoma functions at or below skin level. It may develop around the stoma or the supporting structures at the fascia layer which may shrink causing the stoma to be pulled inward. It may also be due to a surgical problem in which not enough bowel is available to create a protruding stoma. A retracted stoma can prove problematic because the stool has the tendency to pass underneath the appliance resulting in stool leakage and skin soreness.
The goal is to increase the degree to which the stoma protrudes. This can be accomplished in two ways. The first method is to add convexity to the pouching system which will help to “bud” the stoma. If convexity does not resolve the problem then the second method used is to add flexibility to the pouching system which may help to conform and adhere to uneven skin surfaces.

Retraction occurs when the stoma appears to fall back into the abdomen and does not protrude above the level of the skin. There are various reasons for this:-

  • It has been difficult to pull the bowel through to the skin surface.
  • The bowel being under tension.
  • Weight gain.

Leakages can be a major problem, so appliance selection is very important. The use of seals or pouches with built in convexity (shaped flanges) will make the stoma protrude more. Your Stoma Care Nurse will be able to offer advice on suitable accessories or appliances.



 

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PARASTOMAL HERNIA

perisotmal hernia
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A Parastomal hernia is characterized by a bulging of the area around the stoma. It can result from the following :-
A blockage or obstruction,it can also occur due to weak abdominal muscles, inadequate healing or difficulties at the time of surgery. Parastomal hernias are more commonly found when the stoma is sited outside the rectums muscle. However mine was the result of persevering while trying to pass urine during a TWOC (Trial With Out Catheter) some 3 - 4 months post op. As I was told to persevere to pass urine as it will be difficult at  first during a GP appointment  Now I know how wrong this was!.

Parastomal hernias can be supported by hernia belt purchased at surgical supply stores, a wide tensor bandage or light-weight panty girdle. A flexible pouching system might adhere better to the bulging skin surface. Surgical repair may be necessary if pain or obstructive symptoms become an issue of concern.


After the operation you have a 50% chance of developing a parastomal hernia but it doesn't have to stop you living exactly the way you want to. However as I have found out the quality of life due to the appearance and stigma of a bulge under your clothes is very distressing. A hernia is a weakness in the muscle which can occur around the stoma, and is very commonly found in those with colostomies. The hernia can vary in size from a slight bulge to a large hernia. It is more prevalent in older people, overweight people or as a result of heavy lifting or strenuous exercise.(Straining to pass urine , so don't do as I did to persevere )Surgery to repair the hernia is only necessary in extreme cases and there may still be a risk of another hernia developing. An abdominal support garment can be worn which can be fitted by your Stoma Care Nurse. However some surgeons argue it easy to deal with small hernias rather than large ones, and it is about quality of life.

WHY DO THEY HAPPEN? A picture of a parastomal hernia

During surgery to create a stoma, the medical team make a cut in the muscles of the abdomen, around the tummy area.

This makes the muscles weaker around the stoma area, which means a section of the bowel can sometimes push through the muscle wall to form an uncomfortable bulge, or ‘parastomal hernia.’

How will your hernia affect you?

It might reassure you to know that, as a parastomal hernia sufferer, you're not alone. Research shows up to 50% of stoma patients develop a hernia following surgery. Again another fact I was not told about before surgery or the fact not to strain while trying to pass urine for the first time after surgery.

In the early stages, feelings of distress, discomfort and self-consciousness are common. But the fact that so many hernia patients are getting on with their lives tells you it doesn't have to be a major problem. Your Stoma Care Nurse can help you with the emotional issues of coping with your hernia.

Remember, you don't have to suffer in silence! Some ways to help prevent a parastomal hernia

Even if you haven't developed a parastomal hernia after your operation, there is still a chance of it happening in the weeks and months ahead.

The good news is: you can reduce the risk by doing some gentle tummy exercises - ask your Stoma Care Nurse for advice. Then, when you feel ready, you can start going for short walks or a swim. Remember, you should always speak to your Stoma Care Nurse before you set out on any program of exercise.If anything my stoma nurse abandoned me soon after leaving hospital and some months later I eventually confided in another professional (also an ostomate) The co-founder of the colostomy association who now lives in France (www.stomadata.com) He has lectured colorectal consultants & other professionals world wide on exercise after having a colostomy operation. I was told " I have not beaten all records but smashed them in obtaining a parastomal hernia by persevering to pass urine."

Other tips to reduce the risk of developing a hernia include:

  • Avoiding any heavy lifting for at least 3 months after your operation
  • Standing and sitting up straight at all times
  • Using a support belt or girdle if you're lifting things at work or home
  • Watching your weight and following a healthy diet
  • Supporting your stoma and abdomen with your hand when you cough for the first few months after surgery.

When any surgical procedure is performed the benefits and risks of the operation should be explained to you.When a stoma is formed this carries risks similar to those of any operation. Whilst it is not common to experience complications, it is important that you should be aware of them, so that should problems arise you will have a better understanding of them.

 

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PROLAPSED STOMA

prolapsed stoma
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A prolapsed stoma is an increase in size of the stoma, usually in the length of the stoma. The possible causes of a prolapse include obesity, too large an abdominal opening for the bowel which may prevent the mesentery from remaining secured to the abdominal wall, increased intra-abdominal pressure that may occur with coughing, sneezing, or vigorous peristalsis, multiple previous incisions, or the stoma sited outside the rectus muscle.

In the event of a prolapse, it is recommended that the patient lie down and the stoma covered with a warm damp cloth. The bowel can then be gently manipulated back in place. A patient can be taught this technique. An abdominal binder or prolapse guard can be used to prevent the prolapse from reoccurring. If the prolapse is not resolved by the above measures, surgical repair and/or relocation of the stoma site may be necessary.

A prolapse of the stoma is where the bowel extends in length similar to a telescope effect (this can be several inches). Sometimes lying down will make a prolapse smaller. Providing the stoma stays its usual colour and continues to function as normal, this is not serious. The template will need checking and a larger pouch to accommodate the stoma may be necessary. Placing baby oil inside the pouch will help reduce friction from the pouch rubbing on the stoma. Your Stoma Care Nurse can advise you on the use of a support garment or belt. Should the prolapse become too difficult to manage surgery may be offered.


 

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CUT STOMA

cut stoma
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The signs of a cut stoma would include a noticeable break in the integument of the stoma which may be accompanied by bleeding. A stoma can be traumatized due to: the movement of a flange which is not properly fixed to the peristomal skin, a sharp blow, or an inadvertent cut by scissors or nails. Bleeding may be stopped through use of a silver nitrate stick, a stitch, or use of a haemostatic dressing. Surgical intervention may be necessary if bleeding persists.
Patients need to be taught preventive measures in terms of properly sizing the opening of their appliance, and avoiding rough, contact sports without proper protection to the stoma site. Patients also need to be reminded that once a stoma is cut, scarring will occur and the mucosa will appear white.

 

 


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PERISTOMAL SKIN COMPLICATIONS

extracted from http://www.mtsinai.on.ca/ibd/patient/ostomy/complications-peristomal.htm

INTRODUCTION

Methods taught by an Enterostomal Therapy (ET) Nurse, as well as supplemental written information about ostomy care, should help to prevent the development of skin problems related to ostomy care. However, skin complications can occur and these need to be identified quickly and managed appropriately in order to avoid further problems. Ideally, assessment and management of parastomal skin problems should be done in conjunction with an Enterostomal Therapy Nurse so that correct determination of the problem can occur, and correct treatment can be initiated.

The most common problems that can occur with the peristomal skin are: peristomal skin excoriation or irritation; mechanical irritation; allergy/sensitivity; folliculitis; and monilia (yeast) . Other causes of skin irritation may be due to the construction/shape/size of the stoma, abdominal contours (dips and creases), changes in weight, or incorrect pouching systems.

Sore skin under back plate
If you have red, inflamed or weeping skin around the stoma where the back plate normally sits this may cause the back plate to loose adhesion and come away. Try using a moisture- absorbing powder “CONVATEC Orahesive protective powder” around the area, dust off the excess before applying the skin barrier and back plate.

Uneven skin around the stoma.
If you have uneven  or hollows in the skin around the stoma this can be a potential leakage area as the back plate will not get full adhesion to your abdomen, Try a small amount of “Stoma Paste” in the hollows before fitting the back plate.

 

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PERISTOMAL SKIN EXCORIATION

peristomal skin excoriation
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Stool excoriation is the most common skin complication. It can lead to redness, weepy bleeding areas, pain, itching, stinging or burning sensations. Skin excoriation is often the result of stool coming into contact with the peristomal skin. Additional factors which may lead to excoriation include chemotherapy, radiation, psoriasis, adverse reaction or side effect to certain medications such as, steroids, antibiotics, chemotherapy, or immunosuppressives. A flush or retracted stoma can lead to stool leakage and excoriation. Poor hygiene, an inappropriate pouching system as well as allergies or sensitivity can also cause skin reactions.The most common reason for stool irritation is an appliance or flange with an opening that is too large. Too much skin becomes exposed and stool comes in contact with it, causing irritation/erosion. The opening of an appliance/flange should be no more than 1/8 inch (3 to 4 mm) larger than the base of the stoma. This allows for adequate skin protection, but also ensures some "wiggle" room for peristalsis or normal movement of the stoma. The opening should not be snug against the stoma as this can cause a laceration or a cut to the stoma to occur. To ensure that the opening is correct, save the paper or plastic backing of the current appliance and place it over the stoma, ensuring that it is centered over the opening. Look in a mirror and check the gap between the base of the stoma and the edge of the opening. The stoma may need to be moved around (use a tissue and just gently move it from side to side, or up and down) to check all sides. If the opening is too large, then the pattern needs to be adjusted accordingly.

Once the cause of the stool irritation has been identified and corrected, then the actual treatment is quite simple. Using a pectin based powder (e.g. Stomahesive Powder™ or Premium Powder™), sprinkled lightly on the affected area, and then sealed with a skin sealant (e.g., No Sting™ or Skin Prep™) is usually sufficient. Using powder only may prevent the appliance from adhering to the skin, so a sealant is helpful. Usually, if all things are corrected, then healing or resolution should occur by the time the next appliance change is due. Ongoing difficulties emphasize the need for review by an Enterostomal Therapy Nurse.



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MECHANICAL IRRITATION

mechanical skin irritation
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Mechanical irritation is another common source of irritation. This tends to be related to the removal technique of ostomy appliances, or due to fragile skin. If an appliance is removed too quickly, then the first layer of skin may become damaged, leaving a patchy, red, painful area that may "weep" fluid. This tends to happen more easily under the tape border portions of flanges, and is less likely under barrier portions of appliances. Individuals who have fragile skin (e.g. people who have had long-term steroid use, or the elderly), may be more susceptible to skin loss or damage during appliance changes.

Routine removal of the appliance should be done slowly and gently by rolling or pushing the skin away from the back of the appliance. Peeling should be avoided (do not "rip" quickly, as is commonly done with bandages), particularly with tape bordered appliances.

If technique is not at issue, then perhaps other causes such as fragile skin, may be considered. Some individuals find the use of skin sealants such as No Sting™ or Skin Prep™ under appliances help provide a sufficient "shield" between the appliance and the skin to allow for protection and avoidance of damage. Some people find that they need to switch from a tape border product to a full barrier product to avoid problems. An Enterostomal Therapy Nurse can help to determine the best course of treatment.

Once the cause has been determined and corrected, actual treatment can be done simply with the use of a pectin-based powder (e.g., Stomahesive Powder™ or Premium Powder™), sprinkled on the affected area, and then sealed in with a skin sealant (e.g., No Sting™ or Skin Prep™). Healing/resolution will usually occur by the next appliance change. Ongoing problems emphasize the need for help from an Enterostomal Therapy Nurse.



Friction

This can occur from the stoma rubbing on the inside of the pouch or if the hole in the pouch is too tight. Ulceration can occur on the stoma and these look similar to mouth ulcers. Having the template checked and applying baby oil inside the pouch can prevent this.

 

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ALLERGY & SENSITIVITY

peristomal allergy or sensitivity
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Allergies or sensitivities to products can occur over time. These reactions are not always predictable and may take months or years to develop. Sometimes, the reaction can occur quite quickly, particularly if there is known previous sensitivities to tape(s). The reactions can range from persistent itchiness without actual rash or skin breakdown, to blistering, redness and skin breakdown. Allergies or sensitivities tend to happen more easily with tape bordered products than with full barrier products.

As indicated above, the range of reactions can be quite varied. For sensitivities that just involve itchiness with no rash or skin breakdown, then using a skin sealant (e.g., No Sting™ or Skin Prep™) as a "shield" between the appliance and the skin. Sometimes, using a full barrier product between the skin and appliance (e.g., Extra Thin Duoderm™ or Coloplast™ barrier), may be needed to improve the situation.

If there is actual blistering of the skin, then at an absolute minimum, the choice of appliances must be changed. Depending upon the severity of the allergy and skin blistering/breakdown, you may need to be seen by an Enterostomal Therapy Nurse to help manage the reaction. Measures such as providing an interim appliance that will allow the skin to heal by helping to cope with the "weepy" fluid from the blistered areas and by helping to select an alternate appliance may be beneficial solutions. "Patch testing" of other products on unaffected skin may be recommended to help determine the best pouching option.



 

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FOLLICULITIS

folliculitis
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Folliculitis, infected hair follicles, can cause redness and sometimes pustules at the base of the hair follicles. There is often itching, burning and pain. This can be due to damage to the hair follicles usually after the traumatic removal of an appliance or when tape is removed too quickly.

To prevent damage to the hair follicles, excess hair around the stoma should be gently removed with an electric razor, always shaving in the direction of hair growth. Scissors can also be used to remove excess hair. Protective powder can be added to the skin prior to shaving to decrease trauma. Appliances should always be removed gently by pushing the skin away from the barrier rather than pulling away from the skin.

 

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MONILIA / CANDIDA ALBICANS (Yeast Infection)

monilia/candida albicans (yeast infection)
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Yeast can occur under the appliance as a result of excessive moisture and heat (e.g. perspiration on hot, humid days; long soaks in hot tubs), after antibiotic use, or when someone is immunocompromised (e.g. chemotherapy). Patches of yeast are solid red in colour with an irregular border and will have tiny little red or white points scattered out from the main rash — called "satellite lesions". It can be itchy, and in severe cases, may weep slightly.

It is important to check for the presence of yeast in other areas such as under the arms, in the groin, under breasts, in abdominal folds or in the mouth. If yeast is found in these areas as well, they must also be treated topically, usually with a cream such as Canestan™ or a mouth rinse in the case of oral yeast. For treatment under the appliance, Mycostation™ powder is most commonly used. The powder is sprinkled lightly on the affected areas and sealed in with a skin sealant (e.g. No Sting™ or Skin Prep™). This process is repeated with each appliance change, usually for about three to four changes or until the rash is resolved. If there is no resolution, then an Enterostomal Therapy Nurse should be contacted for review.

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TEXT BOOK URINE PROBLEMS & SEXUAL DYSFUNCTION

TWO PDFS ON UROLOGICAL COMPLICATIONS AFTER SURGERY

Functional urological complications after colorectal cancer surgery PDF file downloaded from http://www.pelviperineology.org/pelvic_floor/functional_urological_complication_after_colorectal_cancer_surgery.html

Bugeja - Urological Complications of Colorectal Surgery PDF file downloaded from http://www.maltime.com/lectures/Bugeja%20-%20Urological%20Complications%20of%20Colorectal%20Surgery.pdf

 

NEW 2013

The main thing to realise is that there is a very high chance of impotency after this operation and you should of been told this prior the operation with detailed information so you could make the correct informed decision for the hospital who practices nerve sparring with a choice of hospitals (this is your right to choose this!)

Here is a DOC. ref erectile dysfunction from the BMJ after surgery ( it also refers to prostate cancer at times) but explains a study that was conducted with males who encountered erectyle dysfunction on this complication and the information they were given.

 

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An extract of Sexual dysfunction

from http://www.springerlink.com/content/d4rp70765l6170wx/Abstract

In a series of 26 male patients undergoing abdominoperineal resection of the rectum for malignant disease, a detailed history of sexual function was obtained, using a questionnaire before and 12 months after the operation. The overall incidence of sexual dysfunction was 61.5 per cent, total and partial erectile impotence being, respectively, both 27 per cent. Taking age into account, among men of the youngest age group (41–48 yrs), incidence of complete and partial erectile impotence was 14 per cent. In the middle age group (49–57 yrs), 22 per cent reported total and 33 per cent reported partial erectile impotence, whereas in patients of the oldest group (58–65 yrs), total erectile impotence was present in 40 per cent and partial in an additional 30 per cent. The extent of the disease (Dukes' stage) was found to be of no value as a prognostic index of postoperative sexual dysfunction. It is concluded that the age of the patients is the most important factor related to sexual activity after abdominoperineal resection for cancer.

 

 

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Urinary and sexual dysfunction after rectal cancer treatment

Nature Reviews Urology 8, 51-57 (January 2011) | doi:10.1038/nrurol.2010.206

http://www.nature.com/nrurol/journal/v8/n1/full/nrurol.2010.206.html

Marilyne M. Lange & Cornelis J. H. van de Velde

Abstract
In light of the improving prognosis for patients with rectal cancer, the quality of functional outcome has become increasingly important. Despite the good functional results achieved by expert surgeons, large multicenter studies show that urogenital dysfunction remains a common problem after rectal cancer treatment. More than half of patients experience a deterioration in sexual function, consisting of ejaculatory problems and impotence in men and vaginal dryness and dyspareunia in women. Urinary dysfunction occurs in one-third of patients treated for rectal cancer. Surgical nerve damage is the main cause of urinary dysfunction. Radiotherapy seems to have a role in the development of sexual dysfunction, without affecting urinary function. Pelvic autonomic nerves are especially at risk in cases of low rectal cancer and during abdominoperineal resection. Data concerning nerve damage during laparoscopic surgery for resection of rectal cancer are awaited. Structured education of surgeons with regard to pelvic neuroanatomy, and systematic registration of identified nerves, could well be the key to improving functional outcome for these patients. Meanwhile, patients should be informed of all associated risks before their operation, and their functional status should be evaluated before and after surgery.

 

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Impotence After Anterior Resection of Rectal Carcinoma?

http://www.medscape.com/viewarticle/438051

Richard A. Hodin, MD

Posted: 07/15/2002

Question

What is the incidence of impotence after anterior resection of rectal carcinoma, and what is the treatment?

Response from Richard A. Hodin, MD

Surgical resection of the rectum requires dissection close to the nerves responsible for bladder and sexual function. The inferior hypogastric plexus is responsible for erection in both men and women. These nerves exit bilaterally at approximately the level of the sacral promontory. The superior hypogastric plexus, located anterior to the lower abdominal aorta, mediates ejaculation via the sympathetic nervous system. In older surgical series, as many as two thirds of patients undergoing surgical resection for rectal cancer exhibited postoperative sexual dysfunction. In recent years there has been increasing awareness of this problem. A nerve-sparing technique that includes total resection of the mesorectum has been popularized by Heald and others, and has now become the standard approach for most patients with rectal cancer.

Numerous series have demonstrated the low incidence of bladder and sexual dysfunction that can be achieved with a meticulous, nerve-sparing technique for resection of the rectum. In fact, major bladder dysfunction has become quite rare after total mesorectal excision. On the other hand, sexual function appears to be more complex than bladder function, involving multiple physical and psychosocial factors. Sexual dysfunction exists in many patients at baseline, such that careful preoperative and postoperative questioning are required in order to assess the true impact of surgery. The rate of postoperative sexual dysfunction has been reported to be in the 25% range, even in patients who have had a meticulous nerve-sparing procedure. On the other hand, some series have documented no change in sexual function before and after nerve-sparing resection.

Sexual dysfunction following surgery for rectal cancer may improve for a period of 3-6 months, but after that time improvement is unlikely. Referral to an impotence specialist should be considered. A variety of treatment options exist including psychosexual counseling, intracavernous injection therapy, sildenafil treatment, and penile implant

 

Protein Could Heal Erectile Dysfunction After Surgery

http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2605.2003.00384.x/abstract    =  June 8, 2010 | Research

‘Sonic hedgehog’ helps regenerate critical nerve that runs along prostate

By Marla Paul

CHICAGO --- After men have surgery to remove a cancerous prostate gland, up to 80 percent of them will lose the ability to have an erection because of damage to a critical nerve that runs along the prostate.

New research from Northwestern University Feinberg School of Medicine shows the damaged nerve can be regenerated more quickly with a protein called sonic hedgehog delivered via a nanofiber gel.

The study, done with rats, showed the protein regenerated the damaged nerve twice as fast as it would have regenerated on its own. Speeding up the nerve healing is essential in order to prevent cell death in the penis and to preserve erectile function.

"This discovery about sonic hedgehog could be applicable not only to erectile dysfunction after prostate surgery but also when the cavernous nerve is damaged by diabetes, which also causes erectile dysfunction," said principal investigator Carol Podlasek, assistant professor of urology at Feinberg.

The whimsically named sonic hedgehog, with a wink to the popular video game character, is a vital building block in the body that promotes nerve regeneration and directs the activity of many other proteins in the body.

"There is a tremendous need for a therapy to treat erectile dysfunction caused by cavernous nerve damage," Podlasek said. Men's quality of life after prostate cancer surgery is of greater concern, she noted, because men are being diagnosed at a younger age and live longer due to improved cancer therapies.

"The biggest concern for many men before they undergo surgery for prostate cancer is quality of life after surgery" Podlasek said. "It not only affects the men undergoing surgery but also their partners."

A recent survey of patients undergoing prostate cancer treatment showed that 45 percent of patients were most concerned with quality of life after surgery, 29 percent with extending their life and 13 percent with delaying disease progression.

"So for patients with prostate cancer, being able to have an erection and lead a normal life after treatment is very important," she noted.

Nonsurgical treatments for erectile dysfunction are only effective in a minority of patients with cavernous nerve damage, she noted.

The new study findings may also apply to any damaged peripheral nerve, such as the sciatic nerve or facial nerve, that needs this protein to maintain its structure, Podlasek said.

Podlasek presented her study findings at the recent American Urological Association 2010 Annual Meeting.

When a man's cancerous prostate gland is removed, the fragile cavernous nerve is often damaged when it is crushed or pulled during surgery. Once the nerve is damaged, smooth muscle cells quickly begin to die in the penis. The consequent scarring prevents the smooth muscle from relaxing and allowing blood to flow into its tissue to become erect.

"Once the smooth muscle starts to die off, you don't get an erection or you get less of an erection," Podlasek said. "The muscle damage is irreversible, so it's essential to heal the damaged nerve as quickly as possible."         

Her goal is to regenerate the nerve more quickly to reduce the damage downstream in the penis. "When the nerve is functional, you get normal erectile function," she said. "It's two pieces to a puzzle."

For the current study, Podlasek combined sonic hedgehog with a nanofiber gel designed by study coauthor Samuel I. Stupp, the Board of Trustees Professor of Chemistry, Materials Science and Engineering, and Medicine at Northwestern. The gel traps the protein as it self-assembles into linear nanofibers, which resemble slender threads made out of gel. Podlasek applied the nanofibers to crushed cavernous nerves in rats. When she examined the nerves six weeks later, they had regenerated twice as fast as they would have on their own. 

In previous research, Podlasek saw a 63 percent decrease in smooth muscle cell death in the penis when sonic hedgehog was restored to injured cavernous nerves. Also in previous research, she found that decreasing sonic hedgehog in the penis caused smooth muscle cells to die.

Her research was funded by the National Institute of Diabetes and Digestive and Kidney Diseases

http://www.biolreprod.org/content/76/1/19.full ( another site regarding sonic hedgehog information to overcome erectile dysfunction )

 


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APER  or  APR referring to abdominal perineal excision of rectum or AbdominoPerineal Resection and not paper ,  or aper or apr referring to financial or other related websites.

Why is this information tucked away at the bottom out the page outof sight?  Well if you are like everyone else when you are looking for information on lower rectal cancer and what is called an APER operation to remove it.You simply type in APER into the search engine to try and find out more information. You soon realise that this rarely brings up the correct results & you get wise and try other variants like APER help , APER colostomy etc. This isn’t what you really require when confronted with any cancer of the rectum as you are desperate to find out about any words like . AP resection, APR, APER, Abdoperineal excision of rectum, abdoperineal resection, rectal cancer help, colostomy, rectal polyp.etc

So with no disrespect to the owners of  the other websites listed below but when you are need this information regarding the APER operation, you do not want to be confronted with any other meanings  & abbreviations of  terms detailing APER & APR except those dealing with your problem.

Below are the typical example of other results when you search for APER & APR.
http://fsahandbook.info/FSA/html/handbook/APER
www.fsa.gov.uk/pubs/hb-releases/rel69/rel69aper.pdf
www.thefreedictionary.com/Aper      idlastro.gsfc.nasa.gov/ftp/pro/idlphot/aper.pro     en.wikipedia.org/wiki/Lucius_Flavius_Aper
www.merriam-webster.com/thesaurus/aper
en.wiktionary.org/wiki/aper     wikileaks.org/tag/APER_0.html
Annual percentage rate - Wikipedia, the free encyclopedia
APR - Wikipedia, the free encyclopedia
APR - High Performance Development for Audi, VW and Porsche ..

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