Principles of ostomy management in the oncology patient.

Fecal and urinary diversions are fairly common among patients diagnosed with abdominal and pelvic malignancies who have undergone removal of the bladder or rectum or who have suffered from obstruction caused by tumor invasion or radiation damage. Effective ostomy management is important in palliative care and involves establishment of an effective pouching system, attention to diversion-specific alterations in dietary and fluid intake, and management of peristomal and stomal complications. Management of colostomy must include measures to prevent or manage constipation, management of ileostomy must include strategies for maintenance of fluid-electrolyte balance and prevention of food blockage, and management of urinary diversion must include options to be used at night and a focus on consistent adequate fluid intake. Common peristomal and stomal complications may necessitate use of barrier products, convex pouching systems to compensate for retraction, and/or binders. Surgery may be needed if incarcerated hernias, persistent prolapse, or stenosis severe enough to interfere with function occur.