A Guide To Living With A Stoma

What is a stoma? 

A stoma is an opening between the bowel and the skin on the abdomen so that the bowel contents empty into a bag on the abdomen, rather than the usual transit through the body. Patients will be given special attention by their nurse during their hospital stay so that they are taught how to care for their stoma. This leaflet is designed to assist you after discharge at home.

Diet 

You will be referred to a dietitian before discharge for an individualized diet plan. 

Common intestinal reactions to certain foods: 

 
Gas Asparagus, beans, beer, broccoli, brussels sprouts, cabbage, carbonated beverages, cauliflower, onions, peas
Incomplete digestion Apple peels, cabbage, celery, coconut, corn, dried fruit, mushrooms, nuts, pineapple, popcorn, seeds, skins from fruits, skins from vegetables
Thickened stool  Applesauce, bananas, cheese, pasta, rice, peanut butter (creamy), potato (without skin), tapioca
Thinned stool Fried foods, grape juice, high-sugar foods, prune juice, spicy foods
Increased odor Alcohol, asparagus, broccoli, dried beans, eggs, fish, garlic, onions, peas
Reduced odor Buttermilk, cranberry juice, parsley, yogurt
Source: Academy of Nutrition and Dietetics, United Ostomy Associations of America (https://www.mayoclinic.org/diseases-conditions/colon-cancer/in-depth/ostomy/art-20045825) 

Skin Care

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

Preparing to Change your Stoma Bag 

The ideal setting for changing your appliance is the bathroom. Before starting to change your appliance, make sure you have the following at hand:
  • Bowl of lukewarm water
  • Gauze wipes or soft cotton towel (not tissues) 
  • Disposal bags  
  • Medical adhesive remover (optional) 
  • Barrier wipes 
  • Prepared appliance (clip/tie if necessary) 
  • Deodorant spray if required 
  • Pair of scissors to cut the appliance to the required size
  The next step after preparation is the actual changing of your stoma bag. This stage of the process also involves emptying and disposing of your old bag. 

Types Of Stoma Bags

Stoma bags can come as a one-piece pouch or a two-piece pouch. 

Two-piece stoma bags have a separate adhesive (flange) with a raised collar, over which the pouch is fitted. The flange can be kept on for two to three days and the new pouches can be changed when necessary.

Changing A Stoma Bag 

  1. Wash hands 
  2. Gently peel back the flange, applying adhesive remover if supplied and required
  3. Remove excess soiling on the stoma and surrounding skin with a dry wipe 
  4. Wash the stoma and surrounding area with water, and dry thoroughly
  5. Check the stoma site and skin around for any skin excoriations. If present, seek advice for further management, i.e. protective powder or cream may need to be prescribed by your doctor  
  6. If necessary, check the size of your stoma, using the measuring card supplied

Changing A One-Piece Stoma Bag

  1. If your pouch needs adjusting, cut a hole to the required size using a pair of scissors.
  2. Clean the skin with a wipe around the stoma and leave for a few seconds until dry. 
  3. Remove the protective cover from the adhesive flange.
  4. Fit the pouch and smooth over the adhesive from the stoma to the edge, ensuring that there are no creases that might cause leakage. 
  5. Hold in place with your hand for 30 to 50 seconds as the warmth increases the adhesion to your skin. 

Changing A Two-Piece Stoma Bag

  1. If your pouch needs adjusting, cut a hole to the required size using a pair of scissors.
  2. Clean the skin with a wipe around the stoma and leave for a few seconds until dry. 
  3. Remove the protective cover from the adhesive flange. 
  4. Fit the flange and smooth over from the stoma to the edge, ensuring that there are no creases in the adhesive (the flange can be kept for two to three days, change the stoma bag when necessary). 
  5. Hold in place with your hand for 30 to 50 seconds as the warmth increases the adhesion to your skin.
  6. Attach the stoma bag to the flange from the bottom, ensuring that the bag and the flange are aligned.

Emptying And Disposing Of Drainable Stoma Bags

You can empty the contents into the toilet before disposal or you can put the pouch with contents and the gauze wipes into a disposal bag. Seal the bag and put it into a domestic refuse bin, and then wash your hands.

FAQ’s 

Should I bathe or shower with or without my pouch?

You may bathe with or without your pouching system in place. If you wish to take a shower or bath with your pouch off, you can do so. Normal exposure to air or contact with soap and water will not harm the stoma, and water does not enter the opening. Choose a time for bathing when the bowel is less active. You can also leave your pouch on while bathing. 

Is travel possible?

All modes of travel are possible. Many people with ostomies travel extensively. Ensure you pack enough supplies to last the entire trip. It would be wise to take double what you think you may need. Checked luggage sometimes gets lost so carry an extra pouching system and other supplies in your hand luggage if you are traveling by plane. When traveling by car, keep your supplies in the coolest area.

What about Medications? Can I take Vitamins?

 Absorption may vary from person to person or depending on the type of medication. Certain drug problems may arise depending on the type of ostomy you have, and the medications you are taking. Make sure all of your health care providers know the type of ostomy you have and the location of the stoma.

When Should I Seek Medical Assistance?

 You should call the doctor or nurse when you have: 
  • severe cramps lasting more than two or three hours
  • a deep cut in the stoma 
  • excessive bleeding from the stoma opening (or a moderate amount in the pouch during emptying on several occasions) 
  • continuous bleeding at the junction between the stoma and skin 
  • severe skin irritation or deep ulcers
  • unusual change in stoma size and appearance 
  • severe watery discharge lasting more than five or six hours 
  • continuous nausea and vomiting; or 
  • the ostomy does not have any output for four to six hours and is accompanied by cramping and nausea
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