What To Expect After Your Stoma Surgery
Straight after surgery
What will my stoma look like?
Don’t be alarmed by the size of your stoma for the first few weeks after surgery. Your abdomen and your stoma will both be quite swollen and your stoma may also ooze blood for the first few days. This is all quite normal and nothing to be worried about. You will also have stitches around the outside of your stoma, these may be dissolvable or you may need these to be removed by your stoma nurse a couple of weeks after your surgery. Your stoma will go down in size quite considerably over the next 2-3 months.
Straight after surgery you will most likely have a large, clear bag over your stoma. This is so that your surgeon and your specialist nurses can monitor the size, shape and output from the stoma.
Managing any pain
Hopefully you had the chance to discuss your postoperative pain relief options with your surgeon or anaesthetist during your pre-op assessment. Most people will be offered a PCA (patient-controlled analgesia), which will have a pump with a button attached that allows you to deliver pain relief such a morphine or fentanyl. These buttons are pre-set so that it is impossible for you to overdose should you keep pressing the button. It is a very effective form of postoperative pain relief. You may also be offered an epidural to the spine as an alternative or your pain may be managed with oral pain relief such as oramorph or tramadol. Making sure that you are comfortable will be a priority to your hospital team.
During your hospital stay
How long will I be in hospital for?
This depends on what type of surgery you had but it will most likely vary anywhere between three and 10 days as long as there aren’t any additional complications. You will not be able to leave hospital until your stoma has started working and they are happy with it.
Learning to change your pouch
Around your second or third day, your stoma nurse or CNS (Colorectal Nurse Specialist) will train you how to clean your stoma and change your pouch. They will show you a variety of different pouch types and explain which is best suited for you. They will also take you through any additional products you may need such as adhesive remover sprays, barrier sprays, strips and pastes. You may not need all of these products. Everyone will have their own individual routine. It is a good idea to write down any questions you may have about your stoma so you can ask your stoma nurse during your training.
Eating and drinking
Straight after surgery you will only be able to have fluids as your bowel will have most likely gone to sleep following the surgery. You may have a tube that goes down your nose and into your stomach to prevent vomiting. Once your bowel starts to ‘wake up’ you will be able to progress onto soft foods and foods that are easily digestible. You should be back to a fairly normal diet after a few days. You may hear that there are foods that you cannot eat with an ostomy including foods with a tough outer skin such as sweetcorn, popcorn, peppers, jacket potato skins etc. These foods can be tougher to digest and are more prone to causing blockages but these foods are all trial and error. As with everyone, food choices are individual and you may not necessarily experience any problems with any of the foods on the ‘ostomy bad list’ It is best to try a little bit of everything and see how you react.
Getting up and about
It is important to get as mobile as possible, as soon as possible after your surgery. It will help to aid your recovery by getting your lungs working fully again, prevent chest infections and get your bowel working quicker. You will be encouraged to at least sit out in your chair either the same day or the day after your surgery and start walking soon after. You may feel tired and a bit wobbly on your legs to begin with but regular walking will soon increase your strength.
When will my stoma start working?
It can take a few days for your stoma to start producing any output. Your bowel will have gone into a shock like state following surgery. You can aid this process by being mobile and eating small regular amounts of food. You will most likely experience colic/gas pains – painful bloating to begin with before your stoma starts working. This can be quite uncomfortable but will pass. Pain relief can be given for these and some people find that peppermint tea can help with these pains. Once your stoma does start working, the output may be a little erratic. You may experience either loose stools or constipation. This is all completely normal and your bowel should settle into a normal pattern over the next few weeks.
Back at home
How will I feel?
You may feel quite tired and weak following your bowel surgery and your abdomen may still feel quite tender. It is important that you rest following your surgery. You do not need to remain in bed though and it is also important to remain mobile to aid your recovery. Just take it slow and don’t expect to be able to go straight back into your normal routine. It takes around 8 weeks to feel fully recovered from stoma surgery. You may also feel quite emotional and maybe a little bit overwhelmed. Having stoma surgery is a big change physically and emotionally. It is perfectly natural to feel like this after surgery and it can be helpful to talk to others in your situation. The Bladder and Bowel Community forum can help you connect with those people and gives you an opportunity to ask others with a similar condition any questions you may have.
Getting out and about
Short, regular walks will help you to increase your strength and give you the confidence to get back out and about again. You can resume driving once you feel that you can perform an emergency stop safely, a rough guide would be around 6-8 weeks. It is best to check with your colorectal team and with your insurance company on what they advise. If you are feeling well enough you should be able to go back to work around this time too. If your job involves heavy lifting or manual labour you may be advised to wait longer.
No heavy lifting
It is important that for the first 8 weeks after surgery that you do not lift anything more than the equivalent of a kettle full of water. This is in order to prevent a hernia from forming behind the stoma or behind the incision and causing future issues.
It is perfectly fine for you to have a bath or shower with your stoma bag on or off. Showering is recommended whilst your stoma and any other abdominal wounds are healing as the water is cleaner. You need to be careful not to use any bath products, lotions, shower gels that leave a residue on your skin as this could prevent your ostomy wafer from sticking to your skin. If you’re going to bathe or shower with your stoma bag on, pop a sticker over the filter to prevent it from getting clogged (these will normally be provided in the box alongside your stoma bags).
You should hopefully feel confident to perform a bag change by yourself once you’re at home. It is important to regularly measure the size of your stoma over the next few weeks as it will be shrinking as it’s healing. Having a good seal around the stoma will prevent your bag from leaking and prevent any sore patches from forming on your skin. You can use the guides provided in the box with your bags to measure your stoma.