When you are told you are to have a stoma it can be a shocking experience,
irrespective of the fact that it is the inevitable outcome for someone with
inflammatory bowel disease or intractable incontinence. For the person with
cancer or trauma, they have to deal with the shock of their diagnosis and also
with having a stoma, be it temporary or permanent.
Stoma is a Greek word meaning mouth or opening. It is a surgically created
opening from the abdomen to the bowel or urinary tract. It is used as a method
of elimination for either bowel or bladder waste. It protrudes through the abdomen
wall, has a moist, soft, fleshy feel and is pinkish-red in colour, similar to
the inside of your mouth.
There are three basic types of stoma:
A colostomy is an opening into the large bowel (colon) and is usually sited
on the lower left side of the abdomen. A transverse colostomy, which is sited
above the waist, can be on the right or left side.
An ileostomy is an opening into the ileum (small intestine) and is usually
sited on the right lower side of the abdomen.
This is an opening into the urinary tract and usually sited on the right lower
side of the abdomen.
Sometimes the stoma will have to be sited differently because of scarring from
previous surgery, stomas or skin problems. It can be temporary or permanent.
What preparation will I receive in hospital before I have my
Undergoing stoma surgery will mean adjustments to your life, so good preoperative
preparation will greatly enhance your recovery and rehabilitation. This may
start as an outpatient or when you are admitted to hospital. It will also depend
on your disease or condition, the type of surgery and stoma.
When you go to hospital (most major hospitals in Ireland carry out stoma surgery)
you will meet the multidisciplinary team who will care for you. This team include
doctors, ward nurses, stoma care nurse, physiotherapist, dietitian, social worker
and a member of the pastoral care team.
On your work-up for surgery you will have several investigations such as blood-tests,
urine tests, x-rays and an electrocardiogram (ECG), which traces the electrical
impulses in your heart to ensure that it is working properly. Further investigations
and tests may be needed to aid the management of your treatment plan.
These investigations may include:
- Ultrasound scan.
- CT scan.
- MRI scan.
- Barium follow-through/enema.
The stoma care nurse will discuss and explain your diagnosis, surgery, the
type of stoma and its management. You will have the opportunity to ask questions
and discuss your fears and anxieties.
Some of these feelings may include:
- Denial of your condition.
- Fear of problems with self image, relationships.
- Sexual problems.
- Fear of death.
It is very important that you explore these feelings and how to cope with them
before your surgery. Reading relevant literature and booklets, and talking with
a person who has a stoma is also very helpful. Your family or carer will also
have the opportunity to meet with the stoma care nurse to increase their understanding
of your condition, stoma and management.
The day before surgery you will have a bowel preparation to empty your bowel
of faeces. This may mean that you must have a series of enemas or oral preparations,
depending on the surgeons specific instructions. You will also meet the
anaesthetist, who will explain about your anaesthetic and pain control following
The stoma care nurse will mark the site for your stoma. It is important that
you express your opinion and or doubts, as this will help in siting your stoma
in the best possible location so that you will enjoy optimum quality of life
How will I feel and what can I expect after my stoma surgery?
After surgery you can expect to feel drowsy and weak for the first few days.
You will have some discomfort, which will be relieved with medication. You will
be out of bed within the first 12-24 hours and discharged from hospital in 10
-14 days. As you will not be eating for the first few days you will have a drip
(intravenous line) usually inserted in your arm, which will replace your fluid.
Other tubes you may find attached to your body include a nasogastric tube,
which passes through your nose down to your stomach to keep it empty. This will
ensure that you are not nauseated and that you do not vomit.
You will also have a urinary catheter (tube) into your bladder and sometimes
a small drain at your operation site to aid healing. These tubes are there to
make your recovery more comfortable and will be removed in a few days. The wound
will be closed with either staples or stitches, which will be removed within
eight to 10 days.
Your stoma is covered in the operating theatre with a clear plastic drainable
appliance (bag). This is to allow the colour and output of your stoma to be
observed. Initially your stoma will be a little swollen and red, with the stitches
that hold it in place visible. These stitches will dissolve within about six
weeks and the stoma will reduce in size.
There may be a large volume of liquid output initially but this will settle
to a porridge-like consistency (if you have an ileostomy) or to formed stool
(if you have a colostomy).
For the first few days the nursing staff and stoma care nurse will look after
your stoma. The stoma bag is usually attached to the skin by a toffee-like adhesive
called a flange. This protects the skin around the stoma and keeps the bag in
I am nervous about caring for my stoma. How will I look after
When you are feeling better you will be shown how to look after it yourself
or a family member/carer is welcome to join in these sessions.
The practical management of your stoma should be kept as simple as possible.
Always have your requirements ready before you start, such as:
- A new appliance cut to fit.
- Warm water.
- Soft tissues or gauze wipes.
- Deodorant spray.
- Disposable bag (to dispose of old appliance).
Changing your appliance:
- Empty the appliance (if drainable).
- Wash your hands.
- Remove the old appliance carefully from the top down and avoid dragging
- Wipe excess waste with soft tissue.
- Wash the stoma and surrounding skin, gently removing all waste and flange.
- Use unperfumed soap if needed and rinse skin well to avoid dryness.
- Gently dry the skin with wipes.
- Check that your stoma has not change size with the measuring guide.
- Place prepared appliance over stoma.
- Spend a few minutes moulding flange to skin.
- Rest for a few minutes to allow for adhesion to skin.
- Do not forget to attach the clip (drainable bag) or close the tap (urostomy
- Empty contents of closed bag in toilet.
- Place the empty old appliance in the disposal bag and discard in bin.
- Wash your hands.
The type of appliance you will wear on discharge will depend on the type of
- Ileostomy: drainable with clip.
- Colostomy: closed appliance.
- Urostomy: appliance with tap.
What sort of appliance will I need for my stoma?
The stoma can be a one-piece appliance (flange and bag are moulded together)
or a two-piece appliance (flange and bag are separate pieces that can be fitted
together). Modern appliances with improved adhesives are now available in soft
opaque covers and in various sizes.
All closed appliances and some drainable ones have activated charcoal filters
which allows flatus to be released and absorb the odour, making them more discreet
and comfortable. There are also a wide variety of accessories available if needed
for extra comfort and security. The stoma care nurse will give you help and
advise you when choosing what is suitable for you to wear.
All appliances and accessories are available from your chemist or by direct
delivery service. The cost is covered by both the medical card and the drugs
repayment scheme. On your discharge from hospital you will be given a prescription
for your appliances and some supplies for the interim period. Follow-up care
will be arranged in the community or as an outpatient.
Im really worried about what could happen when I have
my stoma. Is there anything I should be aware of?
There are several issues that many people express concern about during their
recovery and rehabilitation. Most people with a stoma worry about social and
- They frequently worry about issues such as:
- What if they have an accident?
- Will the bag leak, or fall off?
- Will the stoma make embarrassing noises?
- Will it smell?
- Will others notice it underneath my clothes?
There is no doubt that accidents do happen. In many areas of your life you
take precautions to ensure that they dont, so why not do the same with
It is very easy to focus on the worst possible scenario, so instead of worrying
and avoiding situations why not think about how you would cope?
Be prepared. Make a coping plan for yourself. Think about:
- How you would feel.
- What you would say.
- What you would do.
It is more than likely that you will never need to put your coping plan into
action but it does give you the confidence to cope with any situation if you
Make your first outing somewhere local, maybe to family or friends. If you
wish, tell them in advance about your stoma so that they will understand if
you make a quick exit. It will help to build your confidence before embarking
on a bigger social outing.
Is it possible that my bag could leak?
Leakage of the appliance can happen occasionally especially in the beginning
when you are less experienced. Leakage can cause skin soreness and excoriation,
so early detection and correction is advisable.
Some of the reasons for leakage are as follows:
- Overfull appliance (empty more frequently).
- Appliance left on too long (change appliance sooner).
- Poor changing technique (re-read your information on changing your appliance).
- Poor vision (wear your glasses or use a mirror).
- Incorrectly-fitting appliance (check that the size and shape of stoma and
Inspection of stoma for causes of leakage:
- Has your stoma shrunk or enlarged? Measure with measure guide or
check with your stoma nurse.
- Have you lost or gained weight? You may need to reduce or increase
the size of flange or change the type of appliance to either a one or two
piece, convex flange, or a belt. Discuss this with your stoma care nurse.
- Have you developed skin folds or creases? Use paste or cohesive seal
or consult your stoma nurse.
- Have you developed sore skin? Establish whether it is caused by leakage
or allergic reaction to adhesive. Use cohesive seals, change the type of appliance
you are using and consult your stoma nurse.
- Have you developed a parastomal hernia Change to a soft flexible
flange. See your doctor or stoma care nurse for assessment.
It is always advisable to carry a spare appliance, some tissues and disposable
bag with you as a precaution. If in doubt, consult with your stoma nurse.
I know it may sound silly but since I got my stoma I have a
problem with embarrassing wind. What can I do to help reduce this?
Certain food will cause more flatus than others so it is important to experiment.
It is important to have a good balanced diet, so do not eliminate food from
your diet until you have tried at less three times. You may be able to reintroduce
that particular food at a later date.
Hint to reduce odour: Try taking peppermint oil, yougurt or buttermilk.
In the bathroom use:
- Deodorant sprays.
- Scented candles.
- Strike a match.
- Essentials oils such as lavender and eucalyptus oil.
- Burn joss or incense sticks.
In appliance use:
- Day drops.
- Biotrol C 60 capsules.
- Soluble aspirin.
- Vanilla essences.
In urostomy use:
The consistency of my stools varies. What foods should I eat
to counteract the problem?
Foods that may cause loose stools:
- Apple juice.
- Baked beans.
- Prune juice.
- Highly spice foods.
- Raw fruits.
Foods to help reduce loose stools:
- 10-12 marshmallows.
- Very ripe banana.
- Live yogurt.
- Apple sauce.
- Potatoes without skins.
People with colostomies may sometimes suffer with constipation, which may be
simply rectified by:
- Increase fluids (water).
- Fresh orange juice or prune juice.
- A mild laxative, perhaps Duphalac.
If constipation continues contact your stoma care nurse or doctor.
Sometimes the faeces sits in the mouth of the stoma and refuses
to budge. What can I do about this?
Pancaking occurs when the stool sits on the stoma and fails to drop down into
the appliance. It can sometime be a problem for people with colostomies, causing
leakage and sore skin.
To avoid pancaking, before applying your appliance:
- Place filter cover on filter.
- Place a wet tissue into the appliance.
- Grease inside of appliance with oil (olive oil or baby oil).
- Increase your fluids.
If problem persist try one sachet of Fybogel daily or contact your stoma care
How soon can I return to work after my surgery?
Most people return to work within two to three months following surgery depending
on their general health. Do not be in a rush as you can feel tired for several
months. If you job involves heavy lifting it is inadvisable to return to work
until the muscle are completely healed.
Discuss with your employer about initially taking up lighter duties until you
feel more able. Return to work part-time initially and gradually increase.
I enjoy many sports. How soon can I resume them?
Returning to sport depends on your general health and fitness. When you return
to sport develop your fits gradually. It is possible to participate in most
sports. If you are participating in very energetic sports be careful to replace
your fluids, especially if you have an ileostomy or ureostomy.
- It is advisable to wear a stoma guard to protect your stoma during contact
- Get used to wearing your swimming costume at home before going to the swimming
pool or beach.
- A patterned swimming costume and sarong can conceal your appliance.
- Wearing a smaller appliance can be more discreet.
What should I know about travelling abroad with my new stoma?
People with stoma can feel anxious when embarking on their first trip away
from home or going on holidays. It is important to plan in advance ensuring
you have suitable accommodation and travel arrangements. If you feel unsure
do seek advice from your stoma care nurse, doctor or fellow ostomist.
Travelling by air:
- Drink plenty
- Arrange your seat in advance near the toilets to facilitate emptying your
appliance. Use the toilets before meals as the gangway will be blocked for
a long time with meal trolleys and after meals there is usually a queue.
- For people with colostomies (colostomists) a change in air pressures in
the cabin can cause more flatus, so avoid fizzy drinks.
- Bring double supplies split between your hand and main luggage.
In hot climate:
- You may need to change your appliance more frequently.
- Dehydration can be a problem particularly for those with ileostomies (ileostomists).
It is recommended that you drink extra fluids (water).
- Bring rehydration fluids such as Dioralyte in case of severe dehydration.
- Do not drink too much alcohol as it accelerates dehydration.
- Bring anti-diarrhoea medication, especially if you are eating unfamiliar
- Store supplies in a cool place such as a wardrobe.
- It you are worried you might have a leak at night bring a light plastic
mattress cover or a plastic bag.
- Have insurance cover.
When can I start driving again?
Driving is usually allowed within two months but you should check with your
surgeon. Seat belts should sit across your hip bone and pelvis not across your
stoma and abdomen. An extension bracket can be fitted to lower the angle, or
for reel belts use a clip device or hold with a peg to stop it dragging across
I am embarrassed about having sex again after my stoma. What
should I do?
Some people may experience problems both physical and or psychological regarding
sexual activity following stoma surgery. You may feel a sense of loneliness
and fear of being rejected. This problem is not uncommon but it is important
to discuss it with your partner and or stoma care nurse or surgeon.
Does having a stoma mean that I wont be able to have
children later on?
Many women have successfully conceived and had normal deliveries with stomas.
Before contemplating pregnancy check with your doctor or surgeon that you are
fit to do so. If you are having difficulties in conceiving do not presume it
is because you have a stoma. Seek advice and discuss any possible difficulties
with a gynaecologist.
Pregnancy will not damage your stoma, but as your abdomen enlarges your stoma
will change shape and may become flatter and more oval shaped. You will need
to measure your stoma frequently and adjust your size accordingly. You may also
need to change your type of appliance. Following delivery your stoma should
return to it original size.
Written by Grace McEvoy, Stoma care nurse, St Vincents University Hospital,
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