Stoma care

What is a stoma?

A stoma is an artificial opening made by a surgeon to bring part of the intestinal tract out through the abdominal wall. Stomas are usually created when a part of the bowel needs to be bypassed, either because it is not working properly or because the patient has undergone surgery to remove diseased sections of the bowel.

Reasons for having a stoma include inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis, bowel cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body., trauma and complications arising from other abdominal operations.

Stomas are named after the section of the intestineThe section of gut, or gastrointestinal tract, from the stomach to the anus. that is used to form them. They can be temporary or permanent.

  • An ileostomySurgery that involves bringing part of the small intestine, the ileum, through the abdominal wall. The intestinal contents are collected by a bag worn over the hole, or stoma. is an opening from part of the small intestineThe section of gut, or gastrointestinal tract, from the stomach to the anus. called the ileumThe last part of the small intestine.. It allows faeces to leave the body without having to go through the large bowel
  • In a colostomySurgery that involves bringing part of the large intestine through the abdominal wall, through an opening called a stoma. Faeces are collected by a bag worn over the hole., the opening is formed from the colonThe large intestine., farther along the intestinal tract. It allows faeces to leave the body without going through the anusThe external opening of the back passage, the rectum..

A bag is attached to the stoma opening to collect the waste material. This needs emptying regularly or, with one-use bags, changing to a new bag.

Practical concerns you may have if you are facing the prospect of having a stoma include:

How do I adapt to life after a colostomy or ileostomy?

The most important thing to remember after ostomy surgery is that it takes time to get used to managing an ostomy bag. It requires a complete change of your daily routine and, understandably, it may take several months or more before you feel completely comfortable and confident. That said, there is no reason why you cannot do everything in life that you did before the surgery. In fact, you will probably find that you are more active after surgery as your pain and symptoms subside.

Thousands of people with stomas return to full-time work within a few months and resume their normal lives. Having a positive mindset helps greatly. Before your surgery, you will be assigned a stoma nurse or other specialist experienced in helping stoma patients prepare for surgery and adjust to life afterwards.

You may have many questions about the surgery you need. Some common questions are:

Q. Will I be able to go swimming?
A. Yes, although it may take some time and practice in attaching and using your stoma bag before you are confident to do so.

Q. Will the bag smell? 

A. The output (the name often used for the waste material) from the ileumThe last part of the small intestine. is less pungent than a normal stool, because the bacteriaA group of organisms too small to be seen with the naked eye, which are usually made up of just a single cell. that cause odour in the colonThe large intestine. (and break down food) are not present in the small intestineThe section of gut, or gastrointestinal tract, from the stomach to the anus.. For output from the colonThe large intestine., colostomySurgery that involves bringing part of the large intestine through the abdominal wall, through an opening called a stoma. Faeces are collected by a bag worn over the hole. bags are available that use modern smell-proof technology.

Q. Should I tell my work colleagues?

A. Although it may feel awkward at first, most people are likely to be supportive, and this may make your work life easier than trying to keep your stoma a secret. If you are worried about telling colleagues, confide in a friend, relative or medical professional, who can support you with sharing the news.

Your stoma nurse will also be able to put you in touch with your local support group for people with stomas, and you may find joining the sixpartswater IBDAn abbreviation for inflammatory bowel disease, a group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis. community or bowel cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. community helpful, too.

Have a look at the list of organisations around the world for people with bowel cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body., Crohn’s disease and ulcerative colitis. Many of these groups have resources for people living with a stoma.

What happens after surgery?

Immediately after surgery your stoma is likely to be raw and swollen. Its appearance may be a shock and it may take time to adjust to your new routine of changing your bag and not going to open your bowels in the ‘normal’ way.

Your stoma nurse will be there to help you through the initial few weeks after surgery and will show you how to change your bag. Your doctor and stoma nurse will also give you advice for when you return home to make sure you can care for your stoma with confidence.

How do I manage my stoma?

Every person with a stoma is different. You will gradually develop your own routine for managing your stoma, emptying your bag and keeping the skin around the stoma clean and in good condition.

There is now a wide range of specialist products and accessories available for people with a stoma. Several companies manufacture their own brand of stoma bags and skin barriers and they each have different design features and variations in size, shape and materials used.

It is common for people with a new stoma to experiment with different products over the first few months to find a combination that works best for them. Your stoma nurse, specialist or support group can be of real help here. They will have detailed knowledge about the products available and can offer advice.

A special seal that sticks to the skin around the stoma, protecting it from the output, is put on the skin first. The bag is then fitted over the stoma to collect the waste material. You can choose from the many bags now available that are lightweight, discreet, odour-proof and thin enough not to be seen under your clothes.

Bags come in two main types:

  • all-in-one bags that incorporate a protective skin barrier
  • two-piece bags with a separate skin barrier that stays on the skin between bag changes and is changed only every few days.

Bags are either drainable or closed. Ileostomy bags tend to be drainable, as the output is more fluid, whereas colostomySurgery that involves bringing part of the large intestine through the abdominal wall, through an opening called a stoma. Faeces are collected by a bag worn over the hole. bags are usually closed, one-use, disposable bags.

Protective skin barriers, skin wipes and creams will help prevent skin rashes. Newer bags have extra features such as smell-proof technology and gas filters. A special stopper cap that temporarily blocks the stoma is available for sports activities.

How do I stop my skin getting sore?

Many stoma patients experience skin irritation and soreness around their stoma. Most rashes are caused by a leaky or ill-fitting pouch, or by problems with the skin barrier. There are many ways that you can try to reduce skin flare-upsTerm to describe episodes when the symptoms of a condition worsen. and ease irritation. A different seal around the stoma or a different style of bag, for example, could stop leakages, and creams could help to reduce inflammationThe body’s response to injury..

Because moisture can collect on the skin, the area around your stoma will be susceptible to yeast infections. Prevention is the best way to manage such potential complications and it is important to follow the daily skin care and hygiene advice given by your nurse or medical professional.

These are a few important points to remember about cleaning the skin around a stoma (called the peristomal skin):

  • The skin surrounding the stoma must be treated gently and kept scrupulously clean. Because it will be exposed to both faeces and digestive enzymes, it is particularly vulnerable to infectionInvasion by organisms that may be harmful, for example bacteria or parasites.
  • The pouch attachment puts increased pressure on the skin and may cause scratches or small wounds that can become infected
  • It is advisable to clean a stoma and the peristomal skin when the digestive tract is at its least active. For most people, before breakfast is the ideal time
  • A stoma contains mucus-producing internal tissue: this means that it cleans itself, so there is no need to use soap on the actual stoma. It is best to use clean, warm water to rinse the stoma, then gently press or pat it dry. Remember never to scrub a stoma
  • You can use a very mild, preferably non-perfumed, soap to clean the peristomal skin. Use clean, warm water and wash it gently, then press or pat it dry
  • Some people with a stoma use a barrier or sealant on their skin. If any of the sealant or barrier remains after washing, do not attempt to rub it away. It is very important that the skin remains intact and is not broken through vigorous cleaning. As long as the skin appears healthy, leave the residue until your next clean
  • If your have any body hair in the area of the stoma or peristomal skin, ensure that you carefully trim the hair regularly. Removal of your pouch can otherwise pull the hair and possibly open the skin, leaving it open to infectionInvasion by organisms that may be harmful, for example bacteria or parasites.
  • Remember that healthy peristomal skin should be the same in appearance as the skin anywhere else on your abdomenThe part of the body that contains the stomach, intestines, liver, gallbladder and other organs.. If you notice any changes, such as redness, swelling or chapping, speak to a stoma nurse or medical professional immediately.

Tip: If you do have problems, it is essential that you seek advice straight away. Don’t be embarrassed or worried about bothering your nurse or doctor – they are there to help you. Suffering in silence could actually lead to more serious complications such as prolapseDisplacement of an organ below its normal site. or infectionInvasion by organisms that may be harmful, for example bacteria or parasites.. There are now plenty of accessories and medications that can help ease irritation so most problems can be solved.

Will my stoma mean I have digestive problems?

Different foods cause digestive problems for different people with or without a stoma.  However, now that you have a stoma, certain foods may cause you problems such as excess gas or incomplete digestion.

There are no hard and fast rules about what to eat, and your diet needs to be adapted to your own responses. It is a good idea to try foods you are unsure about individually at home before eating them with friends. That way you can build up a picture of which foods are best to avoid.

There is no way of knowing when your stoma is going to ‘go’ or pass gas but, over time, you will grow familiar with the behaviour of your stoma and develop your own strategies for managing the flow.

  • The main output from an ileostomySurgery that involves bringing part of the small intestine, the ileum, through the abdominal wall. The intestinal contents are collected by a bag worn over the hole, or stoma. tends to be in the evenings, usually a few hours after a main meal
  • Patients with a colostomySurgery that involves bringing part of the large intestine through the abdominal wall, through an opening called a stoma. Faeces are collected by a bag worn over the hole., however, often find the biggest output to be in the morning, during the hour or so after waking.

Patients with an ileostomySurgery that involves bringing part of the small intestine, the ileum, through the abdominal wall. The intestinal contents are collected by a bag worn over the hole, or stoma. need to ensure that they consume plenty of water and salts, as the large intestineThe section of gut, or gastrointestinal tract, from the stomach to the anus., where these are usually absorbed, is now bypassed. Doctors recommend drinking an extra litre (2 pints) of water a day, and increasing water and salt intake during warm weather to prevent dehydrationWater deficiency in the body..

Tip: Stoma bags with a gas filter can help to manage excess intestinal gas and are recommended when flying, as changes in cabin pressure on board a plane can increase the amount of gas passed.

Will I still need to take medication?

One of the benefits of surgery for people with ulcerative colitis is that because removing the colonThe large intestine. cures the condition, they no longer need to take drugs such as steroids, and so avoid the possible side effects associated with them.

On occasion, however, patients with a stoma may need medication to slow the movement of food through the gastrointestinal tractThe gut, which begins at the mouth and ends at the anus. or to control the consistency of the waste, either by easing diarrhoeaWhen bowel evacuation happens more often than usual, or where the faeces are abnormally liquid. or by helping with constipation. 
Some patients with Crohn’s disease can avoid medication after surgery. Depending on the type of operation, it may still be needed, though. In addition, even after successful surgery to remove part of the intestineThe section of gut, or gastrointestinal tract, from the stomach to the anus., Crohn’s disease may come back elsewhere in the gastrointestinal tractThe gut, which begins at the mouth and ends at the anus..

What should I do if I get a blockage?

On rare occasions, people with stomas can suffer from a blockage, when food gets stuck in the small intestineThe section of gut, or gastrointestinal tract, from the stomach to the anus. and stops the usual passage of digested food into the bag.

Signs that you may have a blockage are:

  • Fever or nausea
  • Stomach cramps
  • Watery output
  • No output at all.

Blockages can become serious if left untreated, so if you have any symptoms of a blockage, contact your doctor straight away.

Tip: If you are prone to constipation and slow bowel movements, regular warm baths or showers can help relax the intestinal muscles and keep the contents of your gastrointestinal tractThe gut, which begins at the mouth and ends at the anus. moving. Gentle stomach massages can also help, as can some basic yoga positions.