What are the best management strategies for a patient with an ostomy experiencing gas?

Management of Gas in Ostomy Patients

Gas management in ostomy patients centers on dietary modification, proper pouching techniques with gas-release filters, and judicious use of simethicone for symptomatic relief, while addressing any underlying complications that may worsen gas production.

Dietary Modifications

• Avoid gas-producing foods including beans, carbonated beverages, beer, cruciferous vegetables (broccoli, cabbage, cauliflower), onions, and dairy products if lactose intolerant 1
• Limit air swallowing by eating slowly, avoiding chewing gum, not drinking through straws, and minimizing talking while eating 1
• Consider timing of meals as eating smaller, more frequent meals rather than large meals can reduce gas production 1

Pouching System Optimization

• Use pouches with integrated gas-release filters that allow gas to escape while containing odor through charcoal filtration 1
• Ensure proper appliance fit with the opening cut one-eighth inch larger than the stoma to prevent leakage that can worsen with gas accumulation 1
• "Burp" the pouch regularly by releasing the seal at the top of the pouch to let gas escape in a controlled manner 1
• Check for leakage issues as gas buildup can indicate poor seal, which requires addressing with convex appliances, ostomy belts, paste, or barrier rings 1

Pharmacologic Management

• Simethicone (antigas medication) can be used for relief of pressure and bloating, with dosing of 1-2 softgels as needed after meals and at bedtime, not exceeding 2 softgels in 24 hours 2
• Avoid extended-release medications in ileostomy patients as absorption is impaired; use immediate-release formulations instead 3

Evaluation for Underlying Complications

• Rule out high ostomy output (>1.5 L/day) which can be associated with increased gas production and may indicate infection (C. difficile), ileus, or medication effects 1, 4
• Assess for partial obstruction which can present with increased gas, cramping, and changes in output consistency 1
• Evaluate for stomal complications including parastomal hernia (occurs in up to 50% within 5 years) or prolapse (5-10% incidence), both of which can alter bowel function and gas passage 1, 5
• Check for recurrent Crohn's disease in IBD patients, as inflammation can increase gas production 1

Patient Education and Support

• Provide wound ostomy continence (WOC) nurse consultation for ongoing education about gas management techniques and troubleshooting 1, 5
• Reassure patients that some gas production is normal, with ileostomies typically producing more gas than colostomies due to the liquid effluent and lack of colonic gas absorption 1
• Address psychological concerns about odor and social situations, emphasizing that modern pouching systems with filters effectively manage odor 1

Common Pitfalls to Avoid

• Do not recommend abdominal binders as they increase side torsion at the gastrostomy site and can worsen complications 1
• Avoid prokinetic agents in ostomy patients as they can worsen output and gas production 3
• Do not ignore persistent excessive gas as it may signal complications requiring intervention, including infection, obstruction, or stomal dysfunction 1