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Stoma care

A stoma is a bud-like structure that is formed when a surgeon stitches the opening of your bowel or ureter (the tube that carries urine from your kidneys to your bladder) to the skin on your abdomen (tummy).

About stomas

A stoma is an artificial opening of your bowel on the front your abdomen, created during an operation, to collect either faeces or urine.

Stomas that collect faeces are formed by bringing the end of your bowel through your abdominal wall. This can either be your large bowel (a colostomy) or your small bowel (an ileostomy).

Stomas that collect urine are also created from your bowel but from an isolated section. Your surgeon will connect your ureters to the stoma so urine from your kidneys passes through the stoma, effectively replacing your bladder – this is called a urostomy or ileal conduit.

If you have a stoma, waste products will pass through the stoma (which just means opening) and are collected in a reservoir bag, which you place over the stoma on the outside of your body.

A stoma can be either temporary (and reversed later) or permanent, depending on what type of operation you have had and which part of your bowel or urinary tract has been removed. The location of your stoma will also depend on the type of operation you have but it’s usually put in the lower part of your abdomen to one side.

A stoma will always be moist and may bleed if you touch it. It may protrude a few centimetres from the surface of your abdomen.

Illustration showing the location of the large and small bowel

Types of stoma

The main types of stoma are:

  • ileostomy – an opening from your small bowel, to allow faeces to leave your body without passing through your large bowel
  • colostomy – an opening from your large bowel, to allow faeces to leave your body without passing through your anus
  • urostomy – an opening from your ureters, to allow urine to leave your body without passing through your bladder

Illustration showing the position of a stoma

What are the alternatives?

It may be possible for your surgeon to create an internal pouch for bowel waste, which he or she will attach internally to your anus. Your surgeon can create this out of your remaining bowel and it will mean you don't have to wear a bag. This is known as pouch surgery. There are several different types, such as 'J' pouch, 'S' and 'W' pouch. They are complex operations and may not be suitable for everyone. Ask your surgeon if it’s an option for you.

Rather than have a urostomy, it might be possible to reconstruct your bladder. However, this type of surgery isn't suitable for everyone – ask your surgeon for more information.

Managing your stoma

There are several different types of appliance available to fit over your stoma. They are all designed to fit discretely under your clothing, be easy to change, and not to leak or smell.

You will need to empty your bag to remove the waste – a stoma nurse (a nurse who specialises in caring for patients with a stoma) will show you how to do this. The way you empty it will depend on the exact type of stoma you have.

It's a good idea to get into a routine for changing the bag. If you have an ileostomy or colostomy, you may find that at certain times of the day the bag is more active than at others, such as shortly after a meal. Rather than change it then, choose a time when it's relatively inactive, such as first thing in the morning. You won't be able to control when you have bowel movements but you will usually need to change the bag twice per day (but this can depend on the type of bag you use).

As an alternative to wearing a bag, certain types of stoma can be emptied with lukewarm tap water at a time to suit you. This is called irrigation and the aim is to only have bowel movements when the bowel is irrigated, not between flushings. Rather than wear a bag, you wear a colostomy 'plug' or 'bung' over the stoma instead.

Living with your stoma

You can expect to return to your normal daily activities after you have fully recovered from your stoma operation. You should be able to return to the same job. However, if your work is strenuous and involves heavy lifting or puts a strain on your abdominal muscles, seek advice from your doctor or stoma nurse about wearing appropriate support. You can return to doing sports – even swimming, as there are special smaller bags you can wear and waterproof shields to protect the stoma.

Many people become much more active once they have a stoma, as their symptoms are relieved.

Occasionally, some of your bowel may stick out of the stoma (prolapse), or become narrowed. This can block the passage of faeces into the bag. If this happens, see your stoma nurse or surgeon. Both of these problems can be corrected with surgery.

If you have a stoma of your bowel (a colostomy or ileostomy), you may notice that it sometimes moves, or 'wiggles' on its own. This is normal, and happens because your stoma is attached to your bowel, which squeezes and relaxes to allow digested food to move through.

Diet

In the first few months after your operation, your body will need to adapt to your shortened bowel and stoma. Your stoma nurse will give you information on what's best to eat as you recover.

After you have recovered fully and the stoma is functioning normally, you should be able to eat a normal healthy diet.

If you have had a colostomy, your nurse or surgeon may advise you not to eat foods that may give you wind, such as beans, cauliflower and cabbage or fizzy drinks.

Having a daily portion of cranberry juice, yogurt or buttermilk may help reduce any odour. Your doctor may prescribe you charcoal filters if odour is a problem.

It's important to drink enough fluids and eat foods that are rich in fibre to make sure you don't become constipated. Your large bowel normally absorbs water. If you have an ileostomy and your large bowel has been removed, the faeces coming through the stoma will be watery so it’s important to drink enough fluids or you may get dehydrated.

Skin care

Your stoma therapist or nurse will show you how to care for your stoma and the skin around it. A number of different protective pastes, membranes and powders are available. Your stoma therapist or nurse will show you how to use these, and what to do if your skin becomes damaged or sore.

Travelling

It's best to carry spare bags in your hand luggage when you travel. You may need to carry a special certificate for carrying these. If you're planning a long journey, it's best to irrigate your bag just before you leave, and again when you arrive. If you're travelling to a country where the tap water isn't drinkable, use bottled water for your irrigation.

Help and support

Having a stoma can have a big impact on your body image. Specialist nurses and stoma therapists can help you at each step of the process. They may assist you with the practical aspects for example, such as helping you to choose the most suitable appliance system, empty the bag and look after the skin around your stoma. Just as importantly, your stoma nurse will support you through the emotional aspects of having a stoma.

There are also patient support groups, which can give you advice and support.

 

Produced by Rachael Mayfield-Blake, Bupa Heath Information Team, August 2012.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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