Sometimes treating diseases of the digestive or urinary systems involves removing all or part of your small intestine, colon, rectum or bladder. In these cases, there must be a new way for wastes to leave the body. The surgery to create the new opening in the abdomen is called OSTOMY. The opening is called a STOMA.
Stoma care - types of stoma and problems that might occur
The name of the stoma comes from the intestine that forms the opening. Here are some different stoma:
- Colostomy, an opening from the large bowel, to allow feces to bypass the anus.
- Ileostomy, an opening from the small bowel, to allow feces to leave the body without passing through the large bowel.
- Urostomy, an artificial connection between the urinary tract (the kidneys, bladder and tubes that connect them) and the abdominal wall.
- Jejunostomy, an opening from the first part of the small bowel, also used for feeding.
- Gastrostomy, an opening from the skin directly into the stomach, to allow feeding.
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.
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.
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.
What products can you put on the skin around the stoma to look after it?
There are a number of different products you can use on the skin around your stoma to protect it, including barrier creams, wafers and gels.
It's very important to protect the skin around your stoma and to repair any damage that may occur from the adhesives used to attach the stoma pouches.
To protect your skin, you will need to create a barrier between it and the adhesive used to attach your pouch. This will also help to protect your skin if the stoma pouch leaks. If your skin is damaged, it's important to help it heal. There are various products available to do this, including a skin wafer (sometimes called a peristomal skin wafer).
Skin wafers are a protective layer, often made from fabric. They come in a range of shapes and sizes, and can sometimes be cut to fit your stoma. They can be used to both protect and heal the skin around the stoma, which can be very delicate.
Protective powders are often made from similar ingredients to wafers and rings, and can also be used on broken skin.
Barrier creams, such as zinc cream or a branded cream (eg Vasogen), form a film over the skin to help protect it. However, they aren't recommended for broken skin as they don't help the skin heal. If you use a barrier cream, it should be massaged into the skin and any excess wiped away before attaching your stoma pouch.
Skin gels and lotions should only be used on unbroken skin, unless they are alcohol-free. Make sure you allow the gel or lotion to dry before fitting your stoma pouch.
Your stoma nurse can give you more information on protecting the skin around your stoma.
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 nurst will support you through the emotional aspects of having a stoma. There are patient support groups, which can give you advice and support.
Sedem Pharmacy Stoma Care Products
All Sedem Pharmacies stock a wide range of Stoma Care products.
If you would like advice in Stoma Care, please call in to any of our Pharmacies and our Qualified Pharmacist will be able to help you.