Stoma Care After Surgery

When you wake up after the operation you’ll be wearing your first pouch. This will probably be a clear one so that your nurses can check on your new stoma easily. You may also have drips and drains attached to your body. This is perfectly normal and they will be removed with very little discomfort when appropriate.

Your stoma
Your stoma will be moist and pinkish-red in colour and should protrude from your abdomen. It may be quite swollen to begin with but will reduce in size over time – usually 6 to 8 weeks after surgery. A stoma is red in colour.  This is because it is a mucous membrane, just like the mucous membrane inside your mouth. There is no sensation in the stoma, so it is not at all painful to touch.  The stoma can bleed a little when being cleaned, especially in the beginning, but this is quite normal, and should stop shortly afterwards.

Your stoma will begin to work shortly after your operation, usually within a few days. At first the output will be a watery liquid and may be strong-smelling as your bowel hasn’t been working for a while. Don’t worry, though, the consistency will thicken slightly and the smell will diminish as you resume a more balanced diet. Your doctor will advise you when you will be able to eat and drink as usual.

Initially, it’s also likely that a certain amount of noisy wind will come from the stoma – again this is perfectly normal. It is not uncommon to feel the need to go to the toilet as you did before. This is normal and should reduce with time. If your anus is still present there may be some mucus discharge from it.

Urostomy
If you have a urostomy, the stoma will begin to work immediately after your operation. The tubes placed in the urostomy will be left in place for seven to ten days. At first, your urine may be tinged red, but it will soon return to its usual colour.

After your operation, your stoma care nurse will focus on helping you become confident in taking care of your stoma. It will help to have a close relative or spouse with you for this training.

Your nurse will help you with:

• Learning how to care for your stoma, including what to watch out for
• Re-ordering stoma pouches and accessories
• Your rights regarding reimbursement and other economic support relating to your stoma
• Other practical aspects of living with a stoma, e.g. foods and drink, your social life, travelling and your intimate relationships
• Who to contact when you have questions
• Ostomy associations in your area

Ask questions
There will be a lot of new information to take in at once; it may even feel a bit overwhelming. Take your time and ask all the questions you need, as many times as you need to. The more you ask and try things out, the better prepared you will be once you are back at home.

Before you leave hospital, your stoma care nurse will make arrangements for a follow-up consultation to make sure you feel confident caring for your stoma.

Overcoming challenges
Once you are home, you may experience some challenges caring for your stoma. But remember that your stoma care nurse, as well as Coloplast Customer Care will be more than happy to help you with any issues.

Coloplast also has a support programme called Coloplast Care that you may find useful. Coloplast Care was created to help make living with a stoma easier. (NB to be replaced with exact aim phrasing for Coloplast Care)

Thinking ahead
After surgery, it’s entirely possible for most people to go back to work. But when and how you do this really depends on how you feel, the type of work you do, and the stoma operation you had.

Talk to your employer and discuss your options as soon as possible. It may be possible to return to work part-time; this could be particularly helpful when you first go back as you may still feel tired and need time to get used to new routines.

Try it out
A few weeks before you go back, do a few trial runs where you dress and plan your day as if you were going to work. Think about your diet and when and how many times a day you may need to change or empty your pouch. This will help you to establish routines and plan your day accordingly. Most importantly, it will make you feel prepared.

Tips

• Speak to your employer as soon as you can
• If possible, build up your working hours gradually
• Check the available changing facilities at work
• Pack a small changing bag that you can take discreetly to the bathroom
• Do trial runs before you start work, thinking about diet and clothing etc.

Whatever you decide to do, the most important thing is that you are comfortable with your decision. You may want to explain that you had major surgery because of a serious illness and now wear a stoma pouch. This often leaves few other questions to be asked and people will see that you have a straightforward attitude towards your condition.

Family and friends
Being open and honest with the people close to you can help you get back to the life you had before your stoma surgery. In the beginning, it’s important for the people closest to you to understand that although you are back home, recovery from major surgery will take time.

Children
If you have young children or grandchildren you may feel that they are too young to understand. However, children tend to cope well if they are given the information in a simple way. Children will often pick up on secrets and hiding the truth from them can sometimes make them think a situation is more serious than it really is.

At work
Many people are concerned about telling work colleagues. And just like with family and friends, who you tell and what you tell them is entirely up to you. However it’s usually advisable to ensure that at least one person knows you have a stoma. Then, in case there are any problems or issues, you will have someone to talk to. 

Sports
Exercise is good for everyone. What you can do now really just depends on what you did before. Swimming and walking are both great low-impact ways to keep fit and keep your energy levels up. Just remember that taking up sport again should be a gradual process. Talk to your stoma care nurse for advice on how to reduce the risk of getting a hernia.

Swimwear tips:

• Try before you buy. There is specialist swimwear available, but it should not be necessary

For women

• A one-piece costume with detail or patterns can help disguise the stoma pouch
• Swimwear with a panel across the stomach can provide extra support.
• Sarongs are great for covering up on the beach

For men

• Layering a pair of lycra or stretch material swimming trunks underneath shorts will help hold your stoma pouch in place.
  Sunbathing tip:

• Apply suntan lotion only after you’ve put your bag on, as the creams may affect the adhesive.

Diet

You don’t need to follow a special diet, but just like anyone else, some foods may cause wind or just not suit you.

If you think a particular food is causing problems, try cutting it out for a while – then reintroduce it into your diet later. If you do this three times with any suspect food, you’ll know if it’s really causing an issue.

Chewing your food really well before swallowing aids digestion. In addition, charcoal tablets from the pharmacy can help avoid wind, as can peppermint and fennel tea. Yoghurt and yoghurt drinks can help some people too.

Foods that can cause wind include broccoli, cauliflower, cabbage, spinach, beans (green and baked), onions, garlic, Brussels sprouts, cucumbers, sweetcorn and peas.

Drinks
As before your surgery, how much fluid you drink will affect the consistency of your output. It’s very individual, but many people find fizzy drinks and beer tend to cause wind. Water, squash and fruit juice are better than tea and coffee, which can be dehydrating. As for alcohol, you can still have a drink as long as it doesn’t interfere with any medication.

Have a chat with your doctor or specialist stoma nurse if you have any concerns. 

Constipation
If you are suffering from constipation, adapting your diet will help. Everyone’s is different so you know what is normal for you. If you are passing wind, your stoma is working. Increasing your fluid intake will help with constipation, but if you have any discomfort or concerns please contact your specialist stoma nurse or pharmacist. If you haven’t been for 3-4 days, they may recommend a laxative.

Diarrhoea
Occasionally, just like everyone else, you may suffer from a bout of diarrhoea or loose stools. Don’t be too alarmed about this. A one-off episode of diarrhoea may be caused by something you ate and will often resolve itself. However, three or more consecutive loose stools are a cause for concern as you risk becoming dehydrated. At this point, you should consult your stoma care nurse.

Dining out
Once you have a better idea of the types of foods that suit you, there’s no reason not to enjoy eating out again.

Start with a familiar restaurant and keep it simple – something like a pizza. When ordering, you don’t have to be too over cautious, just sensible. Order what you want but be aware that rich foods and sauces may cause a problem.

If you’re concerned about particular types of food, try them out at home first so you know how you’re going to react, and then add them to your diet gradually.

If you normally have a drink at home, start with a smaller version of your usual, e.g. a small beer rather than a large one. This will help your body build up your tolerance to alcohol again.

Socialising
Whether it’s a quiet drink in your local bar, a meal out with your partner or going out with friends, nothing should stop you from enjoying all the social events that you were doing before your operation.

It may be helpful to set yourself small targets to start with. It could be something as simple as using a public toilet for the first time, visiting a restaurant or relative or planning a day away. Before long, you will be thinking about booking a holiday or even going out dancing.

When you meet new people, you don’t have to tell them about your condition, unless you are comfortable doing that. It’s entirely up to you.

Intimate relationships
Having any type of operation can affect how you look and feel about your body. Try and accept that it will take time to adjust. It’s not just about your stoma but your whole body.

Sexual activity doesn’t put you at risk of damaging your stoma and most people are able to resume a healthy sex life. It is natural to feel nervous so only do what feels comfortable, take your time and talk to your partner.

There are small stoma pouches that can be used during intimate moments. Contact customer service for complimentary samples.

Holidays and travel
Having a stoma needn’t stop you from travelling. You may, however, need a bit of time to adjust to having a stoma and feel ready to travel. Start by taking short trips, and see how it goes from there.

Whether you are travelling by car, ferry, train or plane, it’s important to be well prepared. Pack a small, travel changing bag and keep plenty of extra pouches and any other supplies you may need with you.

Flying
If you are flying, make sure you pack plenty of supplies to take with you on the flight and for while you’re away, plus extra for contingencies. Divide up your supplies in different bags just in case your luggage is misplaced or your flight is delayed. Don’t forget that scissors aren’t permitted in hand luggage, so cut all of your bags to size before you fly.

Don’t be concerned about your pouch expanding due to the change in cabin pressure. Stoma pouches have been designed and tested to withstand pressure changes.

Travelling abroad
Before you travel abroad, check your travel insurance policy to see how your condition and circumstances are covered while away.

In warmer climates, you may perspire more and thus need to change your pouch more frequently. Always make sure your skin is completely dry before applying a new pouch ensure a good secure fit. If necessary, use a hairdryer to dry the area – but be careful not to have the heat setting too hot.

You may also be at increased risk of diarrhoea or dehydration. Drink plenty of water, and take rehydration sachets and medicine to treat diarrhoea, just in case.

Once you are on holiday, remember that you can still do all of the same activities you did before, and relax and enjoy yourself.

Holiday tips:

• Store stoma pouches in a cool place
• Use bottled drinking water to change your pouch when out and about
• Apply suntan lotion after you’ve put your pouch on, as the creams may affect the adhesive
• Empty and seal used pouches and dispose of them with normal rubbish
• If you feel a bit self-conscious about leaving bags in your hotel room, use public bins
• Before leaving for your vacation, find out where you can get professional healthcare assistance at your destination, just in case.

To help you better understand your stoma appliance and discuss your needs with your stoma care nurse, here is a glossary of commonly used terms.

Adhesive: The part of a stoma appliance that attaches the appliance to your skin while you are wearing it. The adhesive must ensure close contact with the skin surface so that output from your stoma does not touch the surrounding skin.

Baseplate: The part of a two-piece stoma appliance that is covered by the adhesive.

Coupling system: This attaches the adhesive baseplate to the pouch in a two-piece appliance, allowing the pouch to be changed without changing the baseplate. It can either be mechanical, or adhesive.

Convexity: A specially shaped baseplate with an oval shell that puts light pressure on the peristomal skin. It is designed to help pouch a stoma that is difficult to manage, for example, a retracted stoma that lies below the skin.

Extended wear adhesive: An adhesive that can be worn for a longer time period, or if there is “aggressive” output from your stoma. Some types of ileostomy or urostomy can have output that breaks down standard adhesives too quickly. Extended wear adhesives are generally used with two-piece appliances.

Filter: From time to time, your stoma releases flatus or wind. The filter included in the appliance has a deodorising action which helps ensure there is no odour, one of the things that people often worry about. It also controls the release of the deodorised wind, so that your bag doesn’t inflate (which is also called ‘ballooning’).

Non-return valve: Urostomy appliances have a non-return valve to stop urine from flowing back to the stoma and help prevent urinary infections.