Ostomies, J-pouches, and COVID-19

If you have a new ostomy—or if you've had one for quite some time—you may have concerns about your risk of getting COVID-19, and what special precautions you may need to take. It's important to understand that having an ostomy, or not having a colon or rectum, does not negatively affect your immune system, nor does it increase your risk for getting COVID-19. 

Explore our resources below to find guidance and helpful tips regarding ostomies and COVID-19.

 

Video Length 00:27:13

Ostomy & j-pouch surgery: What IBD patients should know during COVID-19 In this video chat, Erin Testerman-Mitra, a wound, ostomy, and continence nurse at New York-Presbyterian/Columbia Medical Center in New York, provides general information about ostomies, ileostomy and j-pouch surgery, and maintenance. Additional guidance about surgery is provided in the content below.

 

Ostomy care tips

Handwashing is one of the best ways to protect you and your family from getting sick. Before cleaning your stoma or changing your appliance, always be sure that you first wash your hands carefully with soap and water for at least 20 seconds. If you have general questions regarding cleaning your stoma or changing your appliance, check with your healthcare provider to see if you can meet with an ostomy nurse through a telehealth or virtual appointment rather than making an in-person visit. If you are experiencing unusual color, size, shape, or bleeding near the stoma, always be sure to reach out to your healthcare provider. You can take a picture of the problem and ask if there is a way to share it with your nurse or doctor prior to a telehealth visit.

If you have a new stoma or a leaky appliance, you may need to have a nurse assist you in person. Check with your healthcare provider if you should be going directly to your healthcare center or if you should arrange for an in-home visit. For either option, inquire about screening procedures and safety precautions (such as wearing a mask and gloves) for both staff and patients to ensure that everyone is protected and safe.

IPAA (J-pouch)

Patients who undergo ileal pouch anal anastomosis (IPAA, or construction of a J-pouch), may have the pouch constructed in one, two, or three stages. If you were previously scheduled for an IPAA during this period, it is important to talk to your doctor about your options and what may be the safest way to approach your surgery. Hospitals and institutions are required to follow state and local laws; therefore, many surgical procedures that are considered elective are being postponed or canceled. 

Temporary ostomies

If you currently have a temporary ostomy and are awaiting to complete the next stage of the IPAA surgery, talk to your doctor about the appropriate time to continue the process. The risks to your health due to the progression of IBD are important to consider with your surgeon and healthcare team. IPAA surgery is elective and there is no harm in postponing it for several months if you have already had your colon out.

Disposing Waste: Suspected or Positive COVID-19

People who have fecal diversions and J-pouches may have questions about how to safely dispose of waste and/or their ostomy pouch if suspected of having or positive for COVID-19 . 

As of April, 23rd 2020, the CDC has released the statement that “the virus that causes COVID-19 has been found in the feces of some patients diagnosed with COVID-19. However, it is unclear whether the virus found in feces may be capable of causing COVID-19. There has not been any confirmed report of the virus spreading from feces to a person."

The World Health Organization (WHO) released guidance on water, sanitation, hygiene and waste management for the Covid virus and recommends that persons with suspected or confirmed COVID-19 disease “should be provided with their own toilet… and when possible, the toilet should be flushed with the lid down to prevent droplet splatter and aerosol clouds.”  

  • If a separate bathroom is not available, the CDC recommends the bathroom be cleaned and disinfected after each use by an ill person. 
  • If this is not possible, other residents in the home “should wait as long as practical after use by an ill person to clean and disinfect the high-touch surfaces.” High-touch surfaces include the handle, lid and seat of the toilet, sink and faucets.

The WHO states that “frequent and proper hand hygiene is one of the most important measures that can be used to prevent infection with the COVID-19 virus.” Follow proper hand hygiene after contact with fecal matter. 

  • Use soap and water for at least 20 seconds. See healthy hygiene practices for more details. 
  • Use disposable paper towels to dry hands. If paper towels aren’t available, use clean cloth towels and replace them frequently.
  • If soap and water are not available to you, use hand sanitizer that contains at least 60% alcohol.  

The WHO recommends any surfaces that become soiled with respiratory secretions (droplets from nose and mouth) or other body fluids should be cleaned with soap or detergent, and then disinfected with a regular household product containing a 0.5% diluted bleach solution. Wear personal protective equipment (PPE) such as a mask, gloves and a plastic apron to disinfect the bathroom. Again, after removing the mask, gloves and other protective equipment, wash hands as described above.  

For those providing self-care with ostomy pouch or appliance removal (no assistance from family or roommates):

  • No gloves are needed for self-care of ostomy pouch and appliance changes or when handling own body waste. 
  • When removing an ostomy pouch, place into a small plastic bag, tie off the end, and place within a bagged garbage can with a lid. 
  • Perform proper hand hygiene.

If a caregiver assists with ostomy pouch or appliance removal:

  • The person with symptoms should wear a medical mask to contain respiratory secretions. The mask should be worn as long as possible and changed daily. 
  • Caregivers should also wear a medical mask that covers their mouth and nose when in the same room as the one they are providing care for. Masks should not be touched or handled during use. 
  • Use disposable gloves when handling stool, urine, and other waste. 
  • Follow proper hand hygiene before and after removing gloves and the mask.
  • When the caregiver removes the trash containing waste, they should wear gloves and tie off the trash bag before disposing. 
    • After disposal of trash, remove gloves and perform hand hygiene. 
    • Any surfaces that become soiled with respiratory secretions or other body fluids should be cleaned with soap or detergent and then disinfected with a regular household product containing a 0.5% diluted bleach solution. 
Ostomy supplies

Many people in the ostomy community may be concerned that the virus will affect access to ostomy supplies. United Ostomy Association of America (UOAA) has noted that at this time, there have been no reports of issues concerning delays in production of delivery of ostomy supplies. It is not recommended to stockpile supplies as this will stress the supply chain. For more information and updates on the status of ostomy supplies, visit the UOAA’s website

Importance of staying hydrated

A recently published study indicates that digestive symptoms, such as a lack of appetite and diarrhea, are common in patients diagnosed with COVID-191. These symptoms are also common in IBD patients. Therefore, it is extremely important for all IBD and ostomy patients, but especially for patients with ileostomies, to stay hydrated. Ostomy patients may at times experience vomiting and diarrhea which can quickly lead to dehydration. 

Some symptoms of dehydration may include:

  • dry mouth
  • dark colored urine
  • weakness / fatigue
  • dizziness

If you are experiencing minor symptoms of dehydration, be sure to hydrate with oral rehydration solutions (4 cups of water, ½ tsp salt, 6 teaspoons of honey, sugar, or maple syrup; you can also add a squeeze of lemon, lime, or orange), broth, or specially formulated rehydration packets. It's important to have liquids that can replenish your electrolytes (sodium, calcium, potassium, chloride, phosphate, and magnesium). If you are experiencing severe vomiting, are dizzy to the point that you're unable to stand, or are very weak and fatigued, be sure to contact your healthcare provider to determine if you are in need of a saline infusion. UOAA has more information on hydration and related issues in their Eating with an Ostomy Guide.

Finding support and resources

Finding support and resources

There are many options for patients with ostomies and their caregivers to connect and find support virtually while practicing social distancing. The Crohn’s & Colitis Foundation offers support through:

UOAA also offers support groups for patients and their caregivers. Visit their website for more information. Many ostomy support groups are now also meeting virtually during this time.

Questions to ask your healthcare team

  • If I have questions or concerns about my ostomy, are you offering telehealth appointments?
  • If I have a leaky appliance or notice something unusual with my stoma, am I able to come to the office in person or should I make arrangements for an in-home visit?
  • Are ostomy nurses (WOC nurses) also offering an option for virtual visits?
  • If my nurse needs to visit me during this time, what precautions will be followed to ensure limited exposure?
  • If I am experiencing dehydration or other GI symptoms, how can I tell if it’s related to COVID-19?
References
  1. Lei Pan, Mi Mu, Pengcheng Yang, et al. Clinical Characteristics of COVID-19 Patients With Digestive Symptoms in Hubei, China: A Descriptive, Cross-Sectional, Multicenter Study. American Journal of Gastroenterology. y: April 14, 2020 - Volume Publish Ahead of Print - Issue -doi: 10.14309/ajg.0000000000000620

 

United Ostomy Association of America, Inc. logo

United Ostomy Associations of America, Inc. offers helpful ostomy guidance and an update on COVID-19 related resources. Please visit https://www.ostomy.org for more information on how ostomy patients can stay safe and healthy.


The information provided above is for educational purposes only. It should not replace any advice you receive from your healthcare provider. If you have questions about your specific care, please reach out to your healthcare provider.

This content was developed in partnership with United Ostomy Associations of America, Inc. Review was also provided by the Crohn’s & Colitis Foundation’s National Scientific Advisory Committee

Last updated 5/9/20