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Stoma care


Expert reviewer Dr Stephen Pollard, Consultant General Surgeon
Next review due January 2021

A stoma is an opening on the front of your abdomen (tummy) which is made using surgery. It allows faeces or urine to be collected in a pouch (bag) on the outside of your body. There are several reasons why you might need a stoma.


An image showing a diagram of the colostomy

What is a stoma?

The bud-like structure sits on the surface of the skin on your abdomen. It can be either temporary, and reversed later, or permanent. It collects faeces from your bowel or urine from your urinary tract, which have been diverted from their normal route through the body.

Once you have a stoma formed, you should be able to carry on with life as normal. You will need to learn how to keep it clean and change the collection bag.

Why do some people need a stoma?

  • You may need to have a permanent stoma created from your bowel if you have bowel cancer or inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
  • Sometimes surgeons create a temporary stoma to allow your bowel to heal after surgery, or to rest part of your bowel.
  • You may need to have a stoma created from your urinary tract if you have surgery for bladder cancer or prostate cancer. This may also be done if you have severe urinary incontinence or damage to your pelvis.

Types of stoma

The type of stoma you have will depend on why you need it. Your surgical team will carefully plan where to place your stoma, to make sure you can look after it as easily as possible.

If your surgery is planned in advance, a stoma care nurse will usually see you beforehand. They’ll show you some stoma bags and how to change them. They’ll also decide with you where the best location for your stoma is. This will take into account factors such as your natural skin folds and where you wear your belt if you use one.

A stoma is usually placed to one side of the lower part of your abdomen (tummy). A healthy stoma will be red and moist and may bleed if you touch it, although this should stop quite quickly. It will stick out a little, above the surface of your skin. You won’t feel pain or any other sensation from the section of bowel that sticks out.

There are several different types of stomas.

  • Stomas that collect faeces are formed by bringing the end of your bowel through your abdominal wall.
  • Stomas that collect urine are created by attaching the tubes that carry urine from your kidneys to your bladder (your ureters) to a part of your bowel. This part of your bowel is then brought out through your abdominal wall to form the stoma. It will have been disconnected from the rest of your bowel so that no faeces will be running through it.

The main types of stoma are listed below.

Ileostomy

An opening from your small bowel, to allow faeces to leave your body without passing through your large bowel. Bowel movements after an ileostomy are usually quite fluid.

Colostomy

An opening from your large bowel, to allow faeces to leave your body without passing through your back passage (anus). Bowel movements after a colostomy are usually quite solid.

Urostomy

An opening from your ureters, to allow urine to leave your body without passing through your bladder.

What are the alternatives?

Your surgeon may be able to create a pouch for bowel waste inside your body instead of forming a stoma. The pouch is made from your remaining bowel and then attached internally to your anus (the end of your large intestine). This is known as pouch surgery. It means you don’t have to wear a bag. These complex operations aren't suitable for everyone. They are generally done for ulcerative colitis. Ask your surgeon if this is an option for you.

Your surgeon may be able to use a small part of your bowel to reconstruct a bladder instead of performing a urostomy. Another operation uses part of the bowel to create an internal pouch to collect your urine, which you drain with a catheter you put into a stoma. Both these operations mean you won’t have to wear a bag, but they aren’t suitable for everyone. Ask your surgeon for more information.

Managing your stoma

There are several different types of bags available to fit around your stoma. These are all designed to fit discretely under your clothing, be easy to change and not to leak or smell. Your stoma care nurse can help you choose one to suit your needs. For example, certain stoma bags will be more suitable if you're very active, have poor eyesight or have any allergies.

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 exact type of stoma bag you have. The different types of bags are listed below.

  • 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.
  • Disposable bags – you can flush this type down the toilet or they may have a disposable liner that you flush away with the contents. They are more suitable for formed bowel motions.
  • Urostomy bags – these have a tap at the bottom, to drain the urine.

Stoma bags come in two main systems – one piece and two piece. In the two-piece system 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. This system may help to reduce skin soreness.

The one piece system is less bulky, but you have to pull the whole thing off every time you change the bag. The advantage is that some people may find it sticks more securely in place than the two-piece system.

When emptying your stoma bag, you can pour the faeces and urine 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 authorities provide a home collection service for clinical waste – check with your local council for more details.

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 it.

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 wear 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 motions no more than two or three times a day.

Both continence devices and irrigation are only suitable for some types of stoma. You must talk to your stoma nurse or surgeon before trying them, and you will need to learn the techniques before managing on your own.

Living with your stoma

You should be able to return to your normal daily activities after you've fully recovered from your stoma operation, which will take at least three months. Because your abdominal muscles will have been weakened by the surgery, at first you will need to avoid heavy lifting and support your abdomen when you cough or sneeze. Later, you may need to wear an abdominal girdle or belt if your work is strenuous or puts a strain on your abdominal muscles. If your stoma is created through keyhole surgery rather than open surgery, you may recover sooner.

If you have a stoma, you should be able to wear normal clothes. Depending on the position of your stoma, high-waisted underwear and trousers may be more comfortable.

Having a stoma can make you feel a bit down, especially if you find it difficult to change your stoma bags at first. It can also have a big impact on your body image. 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

If you have had a urostomy, your diet will not be affected. With a bowel stoma, most people are able to eat and drink as normal shortly after their operation. Eating normally will help your bowel get back to working normally.

You may find that some foods give you wind or make your faeces smell bad. These include beans, cauliflower, cabbage, beer, fish, eggs and fizzy drinks. Cranberry juice or yogurt may help to reduce any odour. Peppermint tea or charcoal tablets may help with wind. Your doctor may prescribe charcoal filters or pouch deodorisers if you find that odour is a problem.

It’s important to drink enough fluids and eat high-fibre foods to make sure you don’t become constipated. High-fibre foods include wholegrain cereals, fruit and vegetables. Some foods, such as beetroot, spicy foods, alcohol and fruit juice, may give you diarrhoea. Over time, you’ll learn whether there are foods you can’t eat, while you work with your dietitian or stoma care nurse. Some people find that eating nuts can block their stoma.

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. It’s important to drink enough or you may get dehydrated. Some foods, such as white rice and stewed apple, can make your faeces thicker if you’re losing too much fluid. If you have an ileostomy, you may need to avoid foods that can cause a blockage, such as mushrooms, nuts and dried fruits.

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. Click on the image below to download the food and symptoms diary (PDF 1MB).

 A food and symptoms diary from Bupa UK

Finally, do remember that there are other reasons for bowel symptoms. If you have diarrhoea, you may have a bug. And wind can be caused by eating in a hurry, irregular eating patterns, talking while eating or drinking through a straw.

Skin care

Your skin may become irritated around your stoma, so you need to look after it carefully. Skin can become sore because of the adhesive used to stick on the bag or base plate (flange) or because the bag contents have come into contact with your skin. Your skin may become red, sore and itchy. If not treated, it can weep or break down. Sore skin may also be caused by allergy to the adhesive or by a fungal skin infection. Speak to your stoma nurse if you think you might have an adhesive allergy or a skin infection.

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, show you how to use them and advise what to do if your skin becomes damaged or sore.

It’s best to use the products that are recommended 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 can use a number of different products to protect your skin, including barrier creams and gels. You need to rub barrier cream in well and wipe off any excess as it may stop your bag or flange from sticking. Creating a barrier between your skin and the adhesive will also protect your skin if your stoma bag leaks.

Another way of protecting your skin is to use a flexible protective skin wafer. Skin wafers come in a range of shapes and sizes and can sometimes be cut to fit your stoma. If your skin is damaged, a wafer can help to protect it while it heals. If your doctor or nurse has recommended any creams or lotions to treat your skin, you can use them under the wafer.

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.

Problems with your stoma

Leaks

It can be very upsetting if your stoma bag leaks. It can also irritate your skin – see our section on Skin care for more information.

Ask your stoma care nurse or doctor about the best ways to avoid leaks. This could include using seals and adhesive paste to help secure the bag. It may be possible to attach a special belt to the flange to tighten it, or for the flange to be extended. If you have an ileostomy or a colostomy, leaks are more likely if you have very liquid faeces. In this case, your nurse may suggest changes to your diet, or using medication to help thicken your faeces.

Your stoma care nurse can also arrange psychological support if you feel upset by leaks, or about having a stoma in general.

Stenosis

Stenosis is where your stoma, or the part of your bowel connected to the stoma, becomes too narrow. As a result, your faeces may be thin and you may have high-pitched wind.

Stenosis can happen some time after your stoma is formed. Your doctor or stoma nurse will talk with you about the options for dealing with stoma stenosis. It may need to be corrected through surgery.

Retraction

Retraction is where the opening of your stoma pulls back into your belly, instead of sticking out slightly as it should. This can happen either straight after surgery, or some time later; for example, if you have gained weight. Stoma retraction can make your skin sore and increase the chances that your stoma bag will leak, as it will be flush against your skin.

There may be ways to manage this problem that don’t require surgery if the stoma is only slightly retracted. For example, a belt attached to the flange may help to tighten it and prevent leaks. But otherwise, you may need surgery to correct the problem.

Prolapse

Prolapse is where the opening of your stoma or part of your bowel sticks out too much. This can cause problems with attaching your stoma bag, and it may lead to difficulty passing faeces. Stoma prolapse may happen if you have long-term coughing, if you strain a lot when you need the toilet, or if you are pregnant.

You may need surgery to correct the prolapse. A newer treatment that may be available involves using a surgical stapler to make this correction, which avoids the need for a more major operation. In some cases when stoma prolapse occurs, it damages the blood supply of the bowel and needs to be operated on urgently.

Parastomal hernia

When doctors first form a stoma, they create a hole in the muscle layer of your belly. This allows them to bring part of the bowel to the surface of the skin. A parastomal hernia is where a second part of the bowel also passes through the hole in the muscle, and bulges under the skin next to your stoma.

You may not need surgery to correct a parastomal hernia. It can sometimes be managed using a special support belt. If you do have surgery, it may involve using a surgical mesh to reposition the bowel or moving the stoma to a different area of the belly. Because parastomal hernias are a common problem, surgeons sometimes implant a mesh as part of the first operation where the stoma is formed, to prevent hernias in the future.

Medicines

If you have an ileostomy, you may have to avoid taking certain types of medicines. 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.

Sport and physical activity

There’s no reason why you can’t carry on with most sports and activities after your stoma operation. Walking is a good form of gentle activity to start off with. Check with your stoma care nurse before you do anything more strenuous. You should be able to return to doing a wide range of sports, although you may need to avoid rough contact sports and heavy lifting. There is no reason why someone with a stoma shouldn’t go swimming. 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. Stoma adhesive is waterproof, so you don’t have to worry about that.

If you are worried about your bag rustling or leaking when you are exercising, you can get a body belt on prescription. This holds the bag more securely against your body.

Travelling

There is no reason why having a stoma should stop you from travelling. When you are away from home, make sure you have more stoma supplies with you than you think you’ll need. Double what you usually use should be enough. Remember to take double the wipes, disposal bags and anything else you use to care for your stoma. This may seem excessive, but your diet may be different, and if you’re going anywhere hot you’ll be perspiring and this may mean you need to change your bag more often.

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. It’s also a good idea to take any medicines you may need for diarrhoea or constipation. Make sure you take precautions against catching a stomach bug, particularly if you have an ileostomy. Drink bottled water, avoid ice in drinks and take salt replacement sachets (Dioralyte or similar) in case you do get diarrhoea.

If you’re flying, you may find that the change in aircraft cabin pressure gives you wind. This can be made worse if you drink fizzy drinks or beer on the flight. It’s best to change your stoma bag just before boarding the flight, to make sure there’s no air in the new stoma bag.

Frequently asked questions

  • You should still be able to have a baby if you have a stoma. It’s important to talk to your surgeon before you get pregnant.

    Pregnancy and childbirth are considered to be safe in women who have a stoma. You should be able to change your stoma bags as normal during pregnancy. If you find it difficult to see your stoma as your baby grows, try using a mirror to help you change your bag.

    Sometimes your stoma can get bigger during pregnancy. As your skin and muscles stretch with your growing baby, some of your bowel may stick out into your stoma bag. This is called prolapse. It isn’t dangerous at all, but if it happens, ask your stoma care nurse for advice. Stoma prolapse can also happen when you’re not pregnant – see the section above about Problems with your stoma.

    Most women with a stoma are able to have a vaginal delivery, but there are a few factors that can affect how you give birth. If you have an internal pouch, for example, your doctor may recommend that you have a caesarean section to prevent incontinence from the pouch during delivery.

    If you have any concerns about pregnancy and a stoma, talk to your doctor, stoma care nurse or midwife.

  • If you have a permanent stoma, it can’t be reversed. If you have a temporary stoma, you may be able to have it reversed.

    You may have a temporary stoma fitted if your bowel needs time to heal or rest. This may be because you have bowel cancer, inflammatory bowel disease, diverticulitis or an injury to your bowel.

    Your stoma won’t be reversed until your bowel has fully recovered from the effects of your initial surgery. It will probably be at least two or three months before you have this done. The risk of complications after the reversal is higher if it is done sooner than that.

    How a stoma reversal operation is done depends on how your stoma was created in the first place. If your stoma has been formed from a loop of bowel, the operation is more straightforward. It will also depend on how much of your bowel was removed and which part. After having your stoma reversed, it will take time for your bowel to settle down. You may have looser or more frequent bowel movements at first. You may also find you need to go to the toilet more urgently. In some people, the lower bowel becomes inflamed because it hasn’t been used for a while. If this happens, you may pass some mucus and blood. Do tell your surgeon, but it usually settles down without further treatment.

    Sometimes the bowel stops working temporarily after a stoma has been reversed. This is called ileus and is caused by the bowel being handled during the operation. If this happens, you will have to stop eating to rest your bowel until it starts to work again. You will have fluids through a drip and a tube down your nose and into your stomach.

    Ask your doctor if stoma reversal is an option for you and what you can expect after the operation.

  • It’s very important to maintain a positive attitude about your child’s stoma. Your child will need a lot of support at first. As time goes by, it’s worth encouraging him or her to take on more responsibility for looking after their stoma.

    Most stomas in children are temporary, which means they can be reversed. How much practical support you need to give your child will vary depending on their age and on whether their stoma is likely to be permanent.

    With a baby or young child, you will need to learn how to manage the stoma and teach your child as they get older. Your child can start by learning how to empty the pouch. As they get older, your child can gradually learn to take more responsibility for looking after their stoma. Once they are confident about emptying the bag, you could begin to encourage them to gather everything together for a bag change. Then, gradually get them to do more of the steps themselves until they are able to manage on their own. The type of stoma bag that’s best for your child will depend on their age and may change as they get older. Ask your child’s stoma care nurse for advice.

    Your child should be able to take part in all the activities that they enjoy, despite their stoma. Some doctors advise against contact sports because of the risk of injury to the stoma, but apart from that, there is nothing that they can’t do. However, having a stoma fitted is bound to affect them, whatever their age because it will make them feel different from their friends. Your child’s stoma care nurse can give them reassurance and support and help them fit their stoma management around their school and social lives.

    It’s important to encourage a positive attitude to the stoma from a young age. As your child gets older, they will become more aware of their stoma. Having a stoma can make your child or teenager feel self-conscious and embarrassed.

    There are a number of support groups, books and activity camps specially designed for children with stomas. Find out more in our section on Other helpful websites.


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  • Reviewed by Graham Pembrey, Lead Health Editor, Bupa Health Content Team, January 2018
    Expert reviewer Dr Stephen Pollard, Consultant General Surgeon
    Next review due January 2021



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