• Bookmark and Share

Stoma care

A stoma is an artificial opening on your abdomen 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 bladder to your kidneys). The waste products are collected in a reservoir bag, or pouch, on the outside of your body.

  • About stomas
  • Types of stoma
  • What are the alternatives?
  • Managing your stoma
  • Living with a stoma
  • Help and support
  • Further information
  • Sources
  • Related topics

About stomas

A stoma is a bud-like structure that is formed when your surgeon stitches the opening of your bowel or ureter to the skin on your abdomen. A bag or pouch can then be connected to your stoma to collect waste (faeces or urine) outside your body.

Any operation that creates a stoma ends with '-ostomy'. For example, a colostomy involves the large bowel (colon), an ileostomy involves the small bowel (ileum) and a urostomy involves the urinary tract.

A stoma can be either temporary or permanent, depending on the type of operation you have 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.

You may need to have a stoma if your treatment involves an operation to remove all or part of your bowel or urinary tract. Conditions that need this type of treatment can include:

  • inflammatory bowel diseases such as ulcerative colitis or Crohn's disease
  • certain types of bowel or bladder cancer
  • an injury to your bowel
  • a problem with your kidneys, where the urine can't leave your body (this is rare)

Types of stoma

The main types of stoma are:

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

What are the alternatives?

It's sometimes possible for your surgeon to create an internal pouch for the waste, which means you don't have to wear an external pouch. This is known as pouch surgery. There are several different types of pouch surgery - they are all complex operations that are usually only available in specialist hospitals.

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 to be leak-proof and odour-tight.

You will need to empty your pouch, and your stoma nurse will show you how to do this - the procedure will vary depending on the exact type of stoma you have. With an ileostomy and colostomy, the faeces collected into the pouch may be watery at first, and you may find that you need to go to the toilet more often and more urgently than before. However, as you get used to having the stoma and adapt your diet (see Diet), you will get into a routine. Sometimes, it may be possible to flush out your stoma with lukewarm tap water so that your bowel movements can be timed to suit you. This is called routine irrigation.

Living with a stoma

You can expect to return to your normal daily activities after you have fully recovered from your stoma operation. Many people become much more active once they have a stoma, as their symptoms have been relieved. However, you should have an occasional medical check-up with your doctor to make sure that your stoma stays in good condition.

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 by 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 be adapting to your shortened bowel or urinary tract and your stoma. To help this process, you may be advised to:

  • drink plenty of fluids, especially water and fruit juices
  • eat regular meals, to help you get into a routine
  • eat a healthy, balanced diet; for the first couple of months only eat small amounts of fibre

In the first few days after you get your stoma, or if you have diarrhoea, you may need to have drinks and foods that are high in salt and/or potassium. Even though this is against usual medical advice, it's important to follow your surgeon's instructions.

You should check with your stoma therapist or nurse whether your daily diet is giving you the right balance of nutrients.

After a few months, you should:

  • carry on eating a healthy balanced diet with plenty of fluids
  • slowly increase the amount of fibre in your diet - this includes fruit and vegetables, wheat cereals, and wholemeal pasta and rice
  • check with your stoma nurse or surgeon if you still need to eat extra salt and/or potassium

With any type of stoma, you may need to eat carefully. If you have had an ilesotomy, it's important that you chew properly, eat high-fibre foods in small mouthfuls, and don't eat foods that can cause blockages. These foods include celery, nuts, coconut, mushrooms and sweetcorn. You can carry on eating these foods if they don't cause you any problems, but you should only have small amounts at first and make sure you chew them well. This is because your ileum is narrow, and could become blocked temporarily. Your stoma therapist or surgeon will give detailed advice.

If you have had a colostomy, your nurse or surgeon may advise you not to eat wind-producing foods such as beans, broccoli and cabbage. 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.

With all types of stoma, it's important 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 your pouch spares in your hand luggage when you travel by plane as gases within your bowel will expand during the flight because of the reduced atmospheric pressure. You may need to carry a special certificate for carrying your pouch spares. If you are planning a long journey, it's best to irrigate your pouch just before your leave, and then again when you arrive. If you are 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 include 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 nurse or stoma therapist will provide support for the emotional aspects of having a stoma. This help will start before the operation, with your stoma therapist working with your surgeon to decide on the best place for your stoma so that it suits your body shape and is in an area you can reach easily. At some hospitals, former patients who have experience of living with a stoma are on hand to provide information and advice. There are also patient support groups, which can give you advice and support (please see Further information).

Further information

The Colostomy Association

The Ileostomy and Internal Pouch Support Group

Sources

  • Breckman B. Stoma care and rehabilitation. London: Elsevier, 2005
  • Doughty D. Principles of ostomy management in the oncology patient. Supportive Oncology 2005; (1): 59-69

Related topics

  • Bladder cancer
  • Bowel cancer
  • Crohn's disease
  • Ulcerative colitis