Stoma Surgery

What is a stoma?

A stoma is an opening on the abdomen that can be connected to either your digestive or urinary system to allow waste (urine or faeces) to be diverted out of your body. It looks like a small, pinkish, circular piece of flesh that is sewn to your body. It may lie fairly flat to your body or protrude out more like a spout. Over the top of your stoma you will wear a pouch, which can either be closed or have an opening at the bottom. Your stoma has no nerve endings so you should feel no pain from it.

There are many reasons why you may need a stoma with common reasons being as a result of bowel cancer, bladder cancer, inflammatory bowel disease (Crohn’s Disease or Ulcerative Colitis), diverticulitis or an obstruction to the bladder or bowel. A stoma can be temporary or permanent depending on the cause.

There are three main types of ostomy:

• Colostomy – a colostomy is when a part of your large bowel or colon is pulled through from an incision made on your abdomen to form a stoma. There are two types of colostomy that can be formed:
  1. End Colostomy – where one end of the colon is pulled through and sewn to your abdomen. This can be permanent or temporary. The other part of the diseased bowel is usually either removed or allowed to heal before being joined back up together
  2. Loop Colostomy – this is when a looped portion of your colon is pulled through to your abdomen. An incision is made in the loop and then sewn to your stomach with a rod to keep it above surface level. A loop colostomy is usually a temporary measure performed in emergency operation and will be reversed a few weeks/months down the line
• Ileostomy – an ileostomy is when part of your small bowel (the ileum) is pulled through an incision made on your abdomen to form a stoma. There are two types of ileostomy that can be formed
  1. End Ileostomy – where one end of the ileum is pulled through and sewn to your abdomen. This can be permanent or temporary. The other part of the diseased bowel is usually either removed or allowed to heal before being joined back up together
  2. Loop Ileostomy – this is when a looped portion of your ileum is pulled through to your abdomen. An incision is made in the loop and then sewn to your stomach with a rod to keep it above surface level. A loop ileostomy is usually a temporary measure performed in emergency operation and will be reversed a few weeks/months down the line
• Urostomy – a urostomy is formed when your bladder is removed due to disease such as bladder cancer. A small piece of your bowel will be pulled through an incision made through your abdomen and sewn to your stomach to form a stoma. The ureters will then be detached from the bladder and attached to the piece of bowel to form the urostomy

Stoma surgery – what to expect

Stoma surgery can be daunting and it can be very hard getting used to the idea of living with an ostomy bag. The important thing to remember is that once you have recovered from your operation you should be able to go back to normal life with very few adjustments.

You may have some concerns about how your ostomy looks/feels/smells but rest assured that ostomy pouches have been designed to be very discreet. In fact, in can be very difficult to tell if someone has an ostomy bag. Most people are able to go back to wearing the same clothes as before, even clothing that fits closely to the body like skinny jeans!

Before surgery

Before your operation you will meet with either a stoma nurse or a colorectal nurse who will take some bloods, check your weight and take you through the details of your operation. You may also be given a bowel prep such as laxative to take prior to your operation to cleanse the bowel. The nurse will also mark the place on your stomach where your stoma will go. This should be in a location where there are no creases or folds. A colostomy is usually sited on the left-hand side and an ileostomy and urostomy are usually sited on the right-hand side. The length of surgery time will depend on the type of surgery you are having but an end colostomy performed via key-hole takes around an hour and a half.

After surgery

You will be taken to a colorectal ward for monitoring. Your first pouch will likely be a clear pouch so that they can monitor what the stoma looks like. You may eat and drink only liquids for a day or two to allow your bowel to rest before starting on solid food. Once your stoma ‘wakes up’ and become active and you are passing faeces then you will be able to continue your recovery at home. On average most people are in hospital between three and five days but this will depend on how well your stoma is functioning. A stoma nurse will visit you whilst in hospital to show you how to change your pouch and care for your stoma.

Living With An Ostomy

Choosing the right pouch and accessories

There are many different pouches for you to choose from. Your stoma nurse will probably help you choose one in the beginning. You may like to try some different pouches to see which type you find the most comfortable and most secure. Bags can be closed, open/drainable, have a flat wafer or a convex wafer, be a one-piece system of two-piece with a separate bag and wafer. There are also a range of accessories to help protect the skin or improve your bag security. Below are some of the common pouch types and accessories that you might use. The Bladder and Bowel Home Delivery Service can offer you expert, impartial advice on all ostomy bags and accessories.

Closed bag

As the name suggests, these bags are sewn at the bottom without an opening and are usually used by those who have a colostomy and produce solid stools. This bag will then be changed when needed between one and three times a day.

Open/drainable bag

These bags are usually used by those with an ileostomy as the output tends to be more of a liquid state. These bags can be emptied from the bottom as and when it’s needed and can be changed every three or four days. Some people who have colostomies may prefer to use a drainable if they have a high output stoma.

Urostomy bag

These bags have a little tap on the bottom, which can be opened and the urine drained when needed. Again these bags will normally need to be changed every three or four days.

One-piece bags

Both the wafer and the pouch are joined together and will need to be completely changed each time. These tend to lay quite flat to the body.

Two-piece bags

The wafer and the pouch are separate. The baseplate/ wafer attaches around the stoma and then then the pouch clicks on top of the wafer. This means that you can leave your wafer on and just change your bag. This can be good for avoiding skin irritation. This pouches may be slightly more bulky though.

Convex wafers/bags

A convex wafer is domed to help push out a stoma that is inverted and sits within the folds of the skin. This can help to prevent leaks around the stoma.

Adhesive remover sprays/wipes

These can be used to help remove the bag quickly and without damaging your skin. There are various brands and types, some that are scented or unscented depending on what you like.

Barrier rings and paste

Barrier rings or paste can be used to fill in any gaps, cracks or creases around your stoma and prevent any output from seeping under your bag and creating a leak or irritating your skin. Again, there are many types out there for you to try. You should be able to order these via your ostomy supplier.

Ostomy powders and barrier spray

Once you have cleaned and dried your skin some people like to apply a powder or spray to the skin to avoid any adhesive irritation from the wafer or to avoid any further damage to broken skin. They can also help your pouch stick better if your skin is wet and broken. You should be able to order these via your ostomy supplier.

Fragranced drops and sprays

The filters in the bags should prevent any smell from escaping from the bag whilst you are wearing it. The only time you should notice a smell is when you remove the pouch. For extra confidence some people like to add scented ostomy drops or a spray inside the bag to neutralise or cover any smell inside the pouch. There are a variety of scents and brands available for you to try. You should be able to order these via your ostomy supplier.

Wafer Extenders

These are thin sticky patches that come in a variety of shapes and sizes and overlap around the outside of your bag to create a larger wafer area and create extra bag security. These can be useful if you are going swimming or temporarily extend wear time if you’re out and about. You should be able to order these via your ostomy supplier.

Skincare

Looking after your peristomal skin (the ring of your skin that sits under your bag) is a vital part of your stoma care routine. It is important to avoid faeces or urine from coming into contact with your skin otherwise this can cause sore and inflamed patches around your stoma. Not only is this painful and uncomfortable, it can also affect how your pouch sticks to your skin, which can lead to leaks from your pouch. It is important to know how to prevent and treat these skin problems. Below are some tips for looking after your skin:

• Make sure your pouches are cut to the correct size – your pouch should be cut to fit exactly around your stoma. Your stoma nurse will be able to show you how to accurately measure your stoma. If you wafer is cut too big it can lead to leaks and sore skin. If your wafer is too small, these can dig into and cut your stoma and restrict your output, also leading to leaks.
• Use a barrier ring or paste to fill in any uneven cracks or edges around your stoma – this can help prevent output from leaking under your bag or getting onto your skin
• A convex pouch may help if you have an inverted stoma – if your stoma sits below skin level, a convex pouch can help push it forward allowing the output to fall into the bag rather than seep under, which can happen with a flat wafer. You must speak to your stoma nurse before using a convex pouch. A convex pouch can cause damage to a stoma if it’s not needed
• Make sure your skin is dry before applying your pouch – to make sure your pouch sticks effectively, clean the peristomal area with clean, warm water and dry thoroughly before applying the pouch
• Use an adhesive remover to take off your pouch – avoid any damage to your skin by using an adhesive remover when changing your pouch. Your GP should be able to prescribe this alongside your ostomy bags and can be delivered by your ostomy company or pharmacy
• If you do have sore skin – ask your stoma nurse for advice or contact the Bladder and Bowel Home Delivery Service where our specialist trained nurse can help you with any skincare questions. Having ‘bag off’ time can help and allow the skin to breathe (remember to have some paper towels or tissues hand in case of any unexpected output). For any sore or itchy patches calamine lotion can help or a barrier cream/spray such as Cavilon. Make sure that these are fully dry before trying to reapply your pouch. Be careful of which creams you apply as some may affect your pouches ability to stick

Diet and your stoma

What you can eat and drink with a stoma can often be very confusing. Immediately after surgery, you may be advised to stick to a low residue diet to allow the bowel to recover. After that time you can start to introduce your normal foods back into your diet. Some people may be advised to avoid eating very fibrous foods or foods with tough outer skins such as sweetcorn, popcorn, peas and potato skins to avoid causing a blockage in the bowel and avoid fizzy drinks if you produce a lot of gas. Different foods affect people differently, it is completely individual, whether you have an ostomy or not. It is worth trying a small amount of any food to see how you react. Try not to restrict your range of food. For many having an ostomy has helped relieve painful bowel symptoms and allows you to go back to eating a normal, healthy diet.

Exercise and your stoma

You may hear some people tell you that you shouldn’t exercise whilst you have a stoma but this isn’t true at all. It is best to avoid any heavy lifting or exercise for the first 12 weeks after surgery or until your colorectal specialist tells you that it is safe to do so, however after that time being an ‘active ostomate’ can have a positive impact on your overall health as it does for everybody. It is important to start off slowly, try 30 minutes of walking a day and build from there. Pilates and Yoga are also good forms of exercise and they can help to build core strength (build up the abdominal muscles). Make sure that you wear a support band or belt around your stoma to avoid developing a hernia. Your stoma nurse should be able to help you get fitted with one. The Colostomy Association offers some good advice on being active with an ostomy.

Travelling with a stoma

Having a stoma shouldn’t limit your ability to travel in the UK or abroad. It may just take a little more forward planning. The Colostomy Association have developed a useful guide on travelling with a stoma. Here are our top tips.

• Make sure you have enough supplies – this sound obvious but you will also need to take into consideration that a change of climate can cause your pouches to be needed to be changed more regularly than normal. Heat can cause pouches to become unstuck and a change of diet can cause constipation or an upset stomach. It is probably worth taking at least double the amount you would normally use. Remember that your ostomy supplier may need a couple of weeks to deliver your supplies so order them in plenty of time
• Pack your ostomy supplies in hand luggage – if the worst happens and your suitcase goes missing at least you will have your ostomy supplies. It can be very difficult and expensive to get hold of additional supplies in a foreign country. It can be useful to ask your airline is you can have extra hand luggage, which they can give in certain medical situations. Adhesive remover wipes may be better to take than sprays and remember any liquid sprays need to be 100ml or less for hand luggage and contained in a clear plastic bag. It is worth having worth bags pre-cut as you cannot take scissors in hand luggage
• RADAR key and Just Can’t Wait Card – if you’re travelling in the UK a RADAR key can give you access to accessible toilet facilities so that you can feel confident changing your ostomy bag out and about. You can obtain a RADAR key free by joining up to the Bladder and Bowel Home Delivery Service. We all know that embarrassing leaks can happen from time to time and our ‘Just Can’t Wait’ card can help you access a toilet quickly and explain to someone discreetly that you need to use a toilet urgently. Our ‘Just Can’t Wait’ card is available as an app on the iPhone and comes with a handy interactive map showing you where the nearest toilet is
• Take travel insurance and your EHIC card – make sure that you take appropriate travel insurance and your EHIC card if travelling abroad in case you need any urgent medical care abroad. It is important to declare any health conditions and your stoma to your travel insurance company
• Use bottled water – to avoid stomach upsets it is best to drink bottled water and irrigate with bottled water. It may be worth taking a travel kettle so that you can warm up the bottled water

Irrigation

Irrigation is a system of bowel management for a colostomy in which you ‘wash’ the bowel to encourage a bowel movement. Over time your bowel will adopt this regular habit, and you should not produce any output in between irrigation sessions. Some people have been known to go up to 72 hours without output after regular irrigation. The norm is between 24 and 48 hours. This can leave those with a colostomy feeling freer and more in control of their stoma. You may also choose these to wear a smaller colostomy bag or a cap instead of a standard bag. This technique can only be performed after consultation and being taught by your Stoma Nurse. It’s not suitable for everyone including those who produce loose output, those with a large hernia, those with active Crohn’s or colitis and those with heart or kidney disease.

Bladder and Bowel Home Delivery Service

The Bladder and Bowel Home Delivery Service can offer you expert, friendly advice on all your ostomy needs. It is run in partnership with Bullen Healthcare as an independent service, which means we can supply all products and all brands and offer you completely impartial advice. This way you know you can be confident that our recommendations are completely about you. The Bladder and Bowel Home Delivery Service not only manage all your ostomy and continence supplies but can also liaise with your GP to deliver all your medication prescriptions providing you with an easy, friendly, straight-to-your-door service.
Find out more about the Bladder and Bowel Home Delivery Service or call us FREE on 0800 031 5406.

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