Stoma Care

A stoma is an opening on the front of your abdomen (tummy) which is made by your surgeon with an operation. It allows poo or pee to be collected in a pouch (bag) on the outside of your body.

If you have a stoma, it may take a little while to adjust but you should then be able to lead a full and active life.

What is a Stoma?

The stoma sits on the surface of the skin on your abdomen (tummy), usually low down on one side. It will stick out a little, above the surface of your skin. A healthy stoma will be red and moist. You won’t feel pain or any other sensation from the section of bowel that sticks out. 

You may need a stoma if you have various bowel conditions including bowel cancer and inflammatory bowel disease (Crohn's disesase or ulcerative colitis). The stoma may be temporary and reversed later, or it may be permanent. You may need to have a stoma created from your urinary tract if you have surgery for bladder cancer or prostate cancer.

The main types of stoma are listed here.

• Ileostomy – an opening from your small bowel, to allow poo to leave your body without passing through your large bowel. The poo is usually quite fluid after an ileostomy.
• Colostomy – an opening from your large bowel, to allow poo to leave your body without passing through your back passage (anus). After a colostomy, poo is usually quite solid.
• Urostomy – an opening for your ureters, to allow pee to leave your body without passing through your bladder.

Managing your Stoma day by day

At first, you may be concerned about how you’ll manage your stoma. It may take you a while to learn, but you’ll have lots of help and support from a specially trained stoma care nurse. 

There are lots of different kinds of stoma bag. They’re all designed to fit discreetly under your clothing, be easy to change and not to leak or smell. Your stoma care nurse will help you decide what type of bag is best for you.

The main types of bag are described briefly here.

• Drainable bags – you can empty these through an opening at the bottom of the bag so you don’t need to change the bag so regularly.
• Closed bags – you can’t empty these, but you change them when they're full. Also available are closed bags with a disposable liner that you can flush away.
• Urostomy bags – these have a tap at the bottom, to drain the pee.

Stoma bags come in two main systems – one-piece and two-piece. 

• Two-piece system – here there is a separate base plate called a ‘flange’ that you stick to your skin over the stoma. Then you attach the bag to that. You can change the bag, leaving the flange in place for up to four days to avoid disturbing your skin.
• One-piece system – this is less bulky, but you have to pull the whole thing off every time you change the bag. 

Emptying and Changing the bag

You’ll need to empty your stoma bag to remove the waste – a stoma care nurse will show you how to do this. The way you empty the bag will depend on the type of stoma bag you have. It’s best to empty the bag when it’s between a third and a half full.

How often you need to empty or change your bag varies from person to person, and depends on the type of stoma you have. It’s a good idea to get into a routine for changing your bag. As you get used to your stoma, you’ll find out when it’s likely to be active. You can then choose the best time for you to change the bag.

When emptying your stoma bag, you can pour the poo and pee down the toilet. The best way to dispose of a stoma bag is to rinse it after emptying and wrap it in a plastic bag. You can then put the stoma bag in either a clinical waste bin or a normal dustbin. This will depend on your local authority’s policy on disposing of clinical waste products such as stoma bags. Some local auIthorities provide a home collection service for clinical waste – check with your local council for more details.

Irrigation

Instead of wearing a bag, you can empty certain types of bowel stoma with lukewarm tap water at a time to suit you. This is called irrigation. The aim is to only have bowel movements when the bowel is irrigated, not between flushings. Rather than a bag, you wear a colostomy plug or cap over the stoma instead.

There are also colostomy plugs that you can wear between bowel motions. They are called ‘continence control devices’ but are only suitable if you pass formed poo no more than two or three times a day.

You can ask your surgeon and stoma care nurse if these may be an option for you.

Looking after the skin around your Stoma

You need to look after the skin around your stoma carefully, so that it doesn’t become sore. There are two reasons this might happen: contact with the contents of the bag or as a reaction to the adhesive on the stoma bag. It’s very important to clean and dry your skin when you change your bag. There are different cleansing products, protective creams and lotions available. Your stoma therapist or nurse can advise you what to use, how to use them and what to do if your skin becomes damaged or sore.

It’s best to use recommended products to clean your skin. Strong or perfumed soaps or gels and lotions that contain alcohol can make your skin sore. You can just use warm water. Anything that is too oily may stop your bag and flange from sticking properly. Pat your skin dry after cleaning, rather than rubbing, to avoid damaging it. Sometimes, the adhesives you use to attach a stoma bag to your body can damage your skin. Using an adhesive remover may help to prevent this. You must only ever use adhesives which have been recommended or prescribed change your bag. There are different cleansing products, protective creams and lotions available. Your stoma therapist or nurse can advise you what to use, how to use them and what to do if your skin becomes damaged or sore. It’s best to use recommended products to clean your skin. Strong or perfumed soaps or gels and lotions that contain alcohol can make your skin sore. You can just use warm water. Anything that is too oily may stop your bag and flange from sticking properly. Pat your skin dry after cleaning, rather than rubbing, to avoid damaging it.

Sometimes, the adhesives you use to attach a stoma bag to your body can damage your skin. Using an adhesive remover may help to prevent this. You must only ever use adhesives which have been recommended or prescribed by your doctor or stoma care nurse. You can use a number of different products to protect your skin, including barrier creams and gels. Creating a barrier between your skin and the adhesive will also protect your skin if your stoma bag leaks.

Stomas can shrink or change shape over time. This can mean that the hole in the flange or bag no longer fits properly and some of your skin will be exposed to the contents of the stoma bag. It’s best to check the size of your stoma every few months. Your stoma nurse can show you how to do this and advise on better fitting products if it has altered.

Living with your Stoma

You should be able to return to your normal daily activities after you've fully recovered from your stoma operation. Be prepared for this to take at least three months.

You can find many more tips and hints on all aspects of living with a stoma from the organisations listed in our section ‘Other helpful websites’.

Emotional Changes

Having a stoma can make you feel a bit down and can also have a big impact on your body image. And it’s natural to worry about possible leakage or smells from the stoma. Your stoma care nurse will support you through the emotional aspects of having a stoma. You may find it useful to talk to other people with stomas and who are in a similar situation. Your nurse may be able to put you in touch with a support group in your local area.

Diet

With a bowel stoma, most people are able to eat and drink as normal shortly after their operation. Eating a healthy balanced diet will help your bowel get back to working normally. Your stoma care nurse or dietitian can advise you on your diet. It’s important to drink enough fluids and eat high-fibre foods to make sure you don’t become constipated.

If you have an ileostomy, the poo coming through the stoma will be watery. Make sure you drink enough to replace the water you’re losing or you may get dehydrated.

Over time, you’ll learn if there are foods you can’t eat. For instance, you may find that some foods, such as beans and onions, give you wind or make your poo smell bad. (Your doctor may prescribe charcoal filters or pouch deodorisers if you find that odour is a problem). Some hard foods, like nuts, can get stuck in the stoma. If you think you are having problems with particular foods, it can help to keep a food diary. You write down what you eat and when you have symptoms. After a while, you may be able to spot a pattern when you eat specific foods. You could try our food and symptoms diary. 

Medicines

If you have an ileostomy, you may have to avoid taking certain types of medicine. These include slow-release tablets and capsules and enteric-coated medicines, which have a special coating that makes them resistant to stomach acid. The products may not release enough of the active ingredient in your stomach or bowel. It’s important to tell your pharmacist about your stoma before you buy any over-the-counter medicines.

Going back to Work

You will need some time to get over your operation, but you should be able to return to your job once you’ve recovered. Your surgeon can advise you about this, depending on your particular circumstances. If your job is strenuous or involves heavy lifting, you may need to wear a support garment to protect your abdomen. And your employer may need to make some adaptations to your work.  

Sport and Physical Activity

The good news is that you can carry on with most sports and activities after your stoma operation. You’ll need to start with something gentle like walking, then build up gradually. Check with your stoma care nurse before you do anything strenuous. You may need to avoid rough contact sports and heavy lifting.

You can still go swimming, and shower after doing sports. You don’t have to cover your stoma, as water won’t go into it. But if you prefer, there are special smaller bags or you could wear a stoma cap or plug.

If you’re worried about coping with your stoma while exercising, or are concerned about what you can safely do, ask your stoma care nurse for advice.

Travelling

With a little bit of preparation, you can still enjoy travelling if you have a stoma. Here are some tips on travelling with a stoma.

• Take double the amount of stoma supplies you think you’ll need. That way, you’ll have enough to cope with anything which might affect how often you need to change your bag – for example, a different diet.
• Carry plenty of spare supplies in your hand luggage if you’re flying. Contact the airline to see if you can get an extra luggage allowance, and if any certification is needed.
• Consider taking along some medicines you may need for diarrhoea or constipation. Ask your stoma care nurse about these.
• Make sure you drink plenty of fluids (ideally bottled water) to avoid dehydration in hot countries. Take some sort of oral rehydration solution or sachets with you.
• If flying, avoid any foods and drinks that you know give you wind for a day before you travel. This is because the change in air pressure on the flight can mean you pass more wind.
• It’s best to put on a new stoma bag just before boarding a flight, and make sure you let out any air from the bag.

Problems with your Stoma

If you have a stoma, sometimes problems can happen. These include the following.

• Leaks. These can be upsetting and can irritate your skin. Your stoma care nurse can suggest ways to help prevent leaks. These include using different bags and accessories. If leakage is due to watery poo, medication or changes to your diet may help.
• Stenosis. This is where your stoma or the part of your bowel connected to the stoma becomes too narrow. As a result, your poo may be thin and you may have high-pitched wind. It may need to be corrected through surgery.
• Retraction. The opening of your stoma pulls back into your belly, instead of sticking out slightly as it should. This can make your skin sore and cause leakage. Different accessories such as a belt attached to the flange may help, but you may need surgery to correct the problem.
• Prolapse. This is where the opening of your stoma or part of your bowel sticks out too much. Your stoma care nurse will advise you what to do. You may be able to manage with special bags, but you may need further surgery.
• Parastomal hernia. When your surgeon forms your stoma, they create a hole in the muscle layer of your belly to bring part of the bowel to the surface of the skin. A parastomal hernia is where another part of the bowel bulges through the hole in the muscle. It can sometimes be managed using a special support belt, but you may need surgery at some point.

If you think there is a problem with your stoma, speak to your Doctor.