If you’re new to the world of stomas, you may have just found out that a stoma is a surgically created opening which links a person’s intestine through the abdomen. The procedure (called a colostomy) is usually a surgical solution for people who are unable to have a bowel movement through the rectum.

There are various reasons for having this surgery, and they include bowel cancer, bladder cancer, birth defects, prostate cancer, a blockage to the colon or inflammatory bowel disease. The type of stoma used depends on the reason for the surgery so before surgery is performed, an assessment is made to determine the best bag to use as well as the best position for the stoma for convenience and easy access.

A stoma resembles a pinkish, bud-like structure on the surface of the abdomen and it can be placed temporarily or permanently. Initially, the stoma will appear dark red but over time this red colour should fade to adopt a light red or pinkish colour. It shouldn’t stop you from carrying on with your life as normal, however, you will need to learn how to change the bag and manage the stoma hygienically.

How to care for your stoma

• Following your stoma surgery, the in-hospital care team will demonstrate how to change the stoma bag you have been fitted with, and it might take some time to get used to this.
• The stoma bag will need to be changed a few times each day. This includes when the pouch is a third full to prevent leaks, as this can cause skin irritations.
• Removing the stoma pouch is quite easy. With most bags, this can be done by carefully pushing down on the skin to separate it from the sticky part of the pouch. The contents should be emptied into the toilet before the bag is discarded or washed if the bag is reusable. It is important to remember to maintain a strict hand washing regime after each bag change to prevent the spread of infection.
• It is also important to remember to clean the skin around the stoma gently with a wet washcloth or paper towel, patting the area dry before putting the pouch back on.
• One common problem that stoma users face is that of skin irritation. It is important to always keep the skin dry to help avoid redness and soreness.
• You might notice after some time that the pouch gets smaller in size. If this happens, you may need to change the opening of the pouch to ensure that it is the right size for the stoma, as stool can leak out openings which are too wide. Contact your doctor about skin barriers and sealants you can use around the opening of the pouch to keep stool from leaking. If you are worried about your bag rustling or leaking during exercise, you can get a body belt on prescription which holds the bag more securely against your body.
• Excess bowel gas can cause the bag to over expand, so in this case, it might be worth taking some medicine to reduce gas or using a bag with a vent which releases excess gas. In addition to this, you can try to limit gas-producing foods such as broccoli, cabbage, beans, and cauliflower.
• You may notice that you have watery stools after a colostomy. If this happens, it is important to stay hydrated to replace the fluids that have been lost. Drink lots of fluids including sports drinks, which can also replace some of the sodium, potassium, and other electrolytes that have been lost.
• The stoma may bleed a little bit when you clean it. Call your doctor immediately if the bleeding doesn't stop, or if you notice blood inside your pouch.

Very rarely, a piece of the bowel can push out through the stoma, and the medical term for this is a prolapse. This is a condition which may require surgery, so it is important to contact your doctor if you notice any abnormality with the stoma.

You can still enjoy swimming with a stoma without needing a special swimsuit. Some stoma bag covers are swim-friendly, however, it is advisable to empty the contents of the bag before swimming.

If there is a concern about an odour coming from the stoma, you may want to get an ostomy deodorant spray to neutralise the smell.

How to change your stoma bag

As mentioned earlier, changing your stoma bag is not difficult even though it may seem daunting at first. After some practice, you will get used to changing your bag routinely and you will find that stoma bag changes are not time-consuming at all.

• Ensure that all the accessories you need for the bag change are handy. This may include wet wipes, dry wipes, stoma bag adhesive remover spray, stoma bag, barrier spray/rings or paste and a disposal sack.
• Wash your hands thoroughly at the beginning to avoid the risk of contamination or infection.
• You might find it helpful to tuck some tissues around your waistband to avoid any spillages on your clothes.
• Holding the skin around your stoma bag cover, and starting from the top, peel back the stoma bag slowly and carefully use the stoma bag adhesive remover spray. It can be helpful to place some tissue or dry wipes over the top of the bag where you have peeled it back to avoid any spillages from the opening.
• Remove bag and place in a designated bin.

How often should you change your pouch?

You can change your colostomy pouch as often as you want, usually after a bowel motion. For a one-piece closed pouch, you may need to replace the entire pouch. With a two-piece pouch, you can replace the colostomy pouch as often as required and usually replace the baseplate once or twice a week. If you use drainable pouches, they can be emptied whenever necessary. One-piece drainable pouches are usually replaced every 2-3 days according to personal preference. With two-piece drainable systems, you can replace the pouch itself as often as required, and usually replace the baseplate once or twice a week.

If you find that you or a loved one are struggling with managing a stoma bag, you can request the services of a visiting carer. A carer can help get supplies of wipes, stoma bag, adhesive remover spray, stoma bag, barrier spray/rings or paste and a disposal sack as well as cutting your stoma bag to the correct size if need be. If you’re in London or it’s environs, HP Homecare can provide you with a visiting carer who can help you ensure that your stoma is properly looked after each day. If you need to discuss this with our expert stoma care team, please reach out to us. In our next article, we will cover how to look after yourself after a different kind of surgery - Caeserean surgery.