QUESTION: Are than any contraindications to allowing a patient with a colostomy bag in the pool? We have an order form one of our doctors to include the pool along with land PT.
ANSWER: We would say there is a precaution but not a contraindication. In other words, it is a concern, but not always a prohibited behavior. Many people with colostomies swim and exercise in water.
Below is an excerpt of text from our Aquatic Therapy Boot Camp training.
You can also read an article on aquatic therapy and stomas, ostomies and appliances from the Aquatic Therapy Journal. Finally, here are some discussions from the ATRI listserv on waterproof bandages.
A colostomy, urostomy, or ileostomy bag
Patients with any –ostomy bag (bags which collect waste from the intestinal tract) present a special risk with immersion, especially if their bags do not seal properly or the skin around the bag is macerated. Because these bags collect waste, a punctured or leaky bag can result in fecal matter being deposited into the pool. Equally troubling perhaps, is the potential for additional contaminants from poorly disinfected pool water from entering the system of a patient who is already at high risk due to the underlying medical condition which required the bag.
Patients with long-standing and well-managed –ostomies are not typically barred from swimming or therapy pools. One method of preparation for aquatic activities is for the patient to empty his collection bag, place a clean gauze dressing over the bag, place a bio-occlusive dressing (such as Tegaderm) over the entire bag, and then place a pair of compression or “bikers” shorts over the site. Some patients will take the additional step of wrapping a compression bandage like an Ace wrap around their abdomen prior to pulling on the shorts.
An area of open, macerated or non-intact skin, especially non- or poorly healing wounds
Open wounds and macerated, unhealthy skin present a risk during immersion — both to the public and to the patient. Any significant area of non-intact skin presents an open port for infection in poorly disinfected water. And immersion in water can further degrade the integrity of macerated, unhealthy skin, especially that present around wound beds or open -otomies. Even immersion in properly disinfected water can cause additional skin irritation in patients with chlorine or other halogen sensitivities. And while clean surgical wounds (such as those present after a knee surgery) present little risk to the public, persistent open sores or wounds can be colonized with infections such as MRSA which theoretically can be spread to others.
You can watch a 10 minute clip of the Aquatic Therapy Boot Camp DVD online; just tab down to bottom of page. It's not on precautions, but it gives you the flavor of the class. The ATBC series does have a whole section devoted to precautions and contraindications and the 4 hour DVD is an amazing way to train your entire staff on aquatic therapy.
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