Stoma care

Published by Bupa's Health Information Team, October 2010.

This factsheet is for people who have a stoma, or who would like information about it.

A stoma is a bud-like structure that is formed when a surgeon stitches the opening of the bowel or ureter to the skin on the abdomen (tummy).

About stomas

A stoma is an artificial opening in your abdomen (tummy) to collect waste (either faeces or urine). Stomas to collect faeces connect to your bowel (intestine); stomas to collect urine connect to your ureter (the tube that carries urine from your kidneys to your bladder). This means you will no longer use a toilet when you open your bowels or urinate, as any waste products will pass into and be collected in a reservoir bag or pouch, on the outside of your body.

A stoma can be either temporary (and reversed later) or permanent, depending on the type of operation that has been done and how much of your bowel or urinary tract has been removed. The size and shape of your stoma will also depend on the type of operation you have had. A stoma will always be moist and may bleed if you touch it. It may protrude a few centimetres from your abdomen.

Types of stoma

The main types of stoma are:

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

What are the alternatives?

It's sometimes possible for your surgeon to create an internal pouch for the bowel waste out of bowel that has not been removed; this means you don't have to wear an artificial external pouch. 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.

Rather than have a urostomy, it might be possible to reconstruct your bladder. However, this type of surgery isn't suitable for everybody - ask your doctor for information.

Managing your stoma

There are several different types of pouch 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 pouch - a stoma nurse (a nurse who is qualified and specially trained to care 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 pouch. If you have an ileostomy or colostomy, you may find that at certain times of the day the pouch 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 the pouch usually has to be changed twice per day (but this can depend on the type of pouch you use).

Rather than use pouches, you may find that it's possible to flush out your stoma with lukewarm tap water so bowel movements can be timed to suit you. This is called routine irrigation and the aim is to only have bowel movements when the bowel is irrigated - not between flushings. Rather than wear a pouch 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. If your work is strenuous and involves heavy lifting or puts a strain on your abdominal muscles, you should first seek advice about wearing proper 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 the bowel may stick out of the stoma (prolapse), or become narrowed. This can block the passage of faeces into the pouch. If this happens, you should see your stoma nurse or surgeon. Both of these problems can be corrected with surgery.

If you have a stoma of the 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 your 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, broccoli and cabbage or fizzy drinks. He or she may also advise you to eat slowly and not to talk and eat at the same time, to prevent you swallowing too much air, which could cause wind.

Having a daily portion of apple sauce, cranberry juice, yogurt or buttermilk may help reduce any odour. Charcoal filters may be prescribed by your doctor if odour is problematic.

It's important to keep up your intake of fluids and eat foods that are rich in fibre to make sure you don't become constipated.

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 pouch spares in your hand luggage when you travel. You may need to carry a special certificate for carrying your pouch spares. If you're planning a long journey, it's best to irrigate your pouch just before you leave, and again when you arrive. If you're travelling to a country where the tap water isn't drinkable, you should 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 should be available to help you at each step of the process. This help may include assistance with the practical aspects, such as choosing the most suitable pouch system, emptying the pouch and looking 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 patient support groups, which can give you advice and support.

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

For sources and links to further information, see Resources.