Managing properly your stoma
After your surgey, you may have some questions about the way to manage your stoma properly. Here are some answers that will help you and your family to cope easily with this new situation. Don't hesistate to contact your ET nurse for further explanation or tips to manage your colostomy or ileostomy properly.
When do I have to change my pouch or base plate?
It is up to you to decide, eventually everyone finds their own routine and is able to do it alone. The process usually becomes regular a month after surgery. Usually the base plate in a 2-piece system is changed every 3 days and the pouch (both for 1-piece system and 2-piece system) is disposed once filled.
However each individual is different. In time you will find your own routine. When removing your appliance, check the gum. If the gum is thinned out then change your appliance more often.
Is it possible that my stoma goes in or out abnormally?
Both are possible, either way it is not serious. It´s normal that the mucous nippel goes a little in and out due to peristaltic movement of the bowel. A stoma that goes in permanately is said to be invaginated. The immediate consequence may be the adjustment of your appliance to avoid any risk of leakages, and therefore skin irritation. A stoma that goes out abnormally is a complication that can reach the stage of prolapse. This may require surgery to reattach the intestine. Prior to that, it is essential to adjust your appliance.
In any event contact an E.T. nurse.
My stoma changes shape, is it normal?
Yes! Shape changing is a normal evolution. Indeed at first your stoma will appear to look swollen and can become larger a few days after the operation. At the beginning measure your stoma (at skin level where the bowel is coming out) at least once a week as your stoma will normally get smaller with time. A change in shape might mean a change in the appliance you need to use. An E.T nurse will check its size and will adjust the order if necessary.
Can my stoma get clogged?
Yes, this results in a colic and a stop of the emission of stool and gas. The obstruction can be due to food debris : instillation of warm salt solution can address this problem.
However if the obstruction is due to a stenosis then the stoma will be pale and edematous. You are then advised to contact your doctor or E.T. nurse without further delay.
After a rectum cancer I need to go through chemotherapy. Will my stoma and my digestion be modified?
During chemotherapy, changes are to be expected. Your stoma can become more sensitive and edematous, the slightest friction can cause some blood to drip. Although this is not alarming you should be even more careful and gentle. Also stools may become more liquid and aggressive for the peristomal skin. Make sure to correctly cut out your skin protector sometimes it can be necessary to use paste or paste rings to have extra protection to prevent that the (liquid) stools can go under the skin protector. It is also advisable to use a drainable pouch during the treatment if the stools are liquid in order to avoid too frequent changes. It is necessary to adapt your diet accordingly.
Food and Drinks
Since my surgery, I have lost my appetite. Is this normal?
Yes! In the first month after your operation your appetite may be quite poor. Your taste buds may also make food taste strange. As a result, some people cannot eat or drink what they have always enjoyed. No worries, this won't last. If you are feeling this way, drink more water, eat smaller meals more often and try new fruits and vegetables, the fruits without the skin in the beginning.
What can I eat?
No need to follow a special diet, the important thing is to eat healthy meals. However, it is important to remember that every individual is different and their eating habits may vary. Here are a few easy guidelines in order to have a daily well-balanced diet.
- Start with small portions then ease into bigger amounts until eating normally
- Eating every 3 hours (for example) can be easier then eating 3 large meals
- To reduce wind, avoid talking while eating
- Include fibres in your diet ( wholemeal bread, bananas…)
- Drink (water, tea…) at least 1,5 L of fluid daily. (If you are constipated make sure you increase your fluid intake)
- Certain foods can help to reduce odors these include: yoghurt, peppermint, water, parsley...
- Avoid certain foods that may cause diarrhea such as highly spicy food, fatty foods, under-cooked vegetables…
- Avoid certain foods and beverages that may cause wind such as beer, cider, beans, dairies...
- Avoid certain foods that may cause odors such as beans, broccoli, cabbage
Tips: If you are suffering from diarrhea you may find it beneficial to decrease your fruit and vegetable intake.
If constipation or diarrhea persists, consult your doctor and/or E.T. nurse.
Should I drink a lot?
Yes! Due to your surgery you have to drink more water since your colon is not absorbing as much water as it should. To compensate for this loss, you should drink on average at least 1.5 liters of water per day. The amount of water you will have to drink will depend on the type of stoma you have (between 1.5 to 2L per day).
What should I do if I have diarrhea, constipation or bloating?
If you experience diarrhea:
- Keep your body hydrated! Drink one glass of water per hour
- Avoid dairy products for 24 hours
- Eat food with low fiber content
If you experience constipation:
- Eating a kiwi may help you to empty your bowels
- Practice a physical exercise
- Do NOT take any laxatives without telling your doctor or your E.T. nurse.
If you feel bloated:
- Avoid foods that cause fermentation such as dired vegetables, beans, chickpeas, peas, whole wheat bread,...
- Have your meals at regular hours. Chew properly, drink plenty (preferably between meals) and avoid soft drinks (Tip: If you want to drink a soft drink, stir your drink with a spoon to remove the bubbles before drinking).
Tip: If either of these symptoms persist, it is important to contact your doctor or an E.T. nurse who may prescribes you the apporiate medication.
Every day life / Coming home
I have wind and I feel embarrased. What can I do?
It is a common worry amongst people living with a stoma. Don’t worry most colostomy and ileostomy pouches have a filter allowing gases to escape automatically, without odors. It is effective on the whole for at least 12 hours. However, it may happen that the filter becomes saturated or moistened by liquids. The pouch then remains inflated by the gas. This occurs most often after 12 to 24 hours of wearing the pouch or at the end of the night. Never make a hole as, at that time, odors escape. Remember that it is important to close your filter during water immersion (bathing, water sports, diving), by applying an adhesive patch on the filter. These patches are supplied in the pouches’ boxes. Remember also to remove the patch at the end of the immersion for the filter to start functioning again automatically.
For your comfort, you can decrease the amount of gas produced daily by following a few simple guidelines:
- Limiting the consumption of certain foods.
- Have your meals at regular times.
- Consume certain foods such as wholemeal bread, high-fibre breakfast cereals, bananas and peeled vegetables.
- Drink at least 1.5 liters of fluids daily (For example water or tea).
Note: For left colostomies, there are existing solutions that can cancel the gas noises. You can use a stoma cap for stomas, paired with colonic irrigation or a knob of Vaseline in the opening of the stoma.
Can odors come out of my pouch?
You may at first imagine that you can smell the stoma but no worries this passes with time as you will get used to having a stoma. If there is a smell from the pouch, change it and discuss with an E.T. nurse. For more security you can also use B. Braun’s DeOdour.
What is a phantom rectum?
Phantom rectum is similar to “phantom limb” experienced by amputees, where they feel like the amputated limb is still present. If you feel movement in the way you did prior to surgery, that is normal. This may even occur for years post-surgery. If the rectum was not removed, you may experience this sensation and may also pass mucus when you’re on the toilet. Some people who had their rectum removed have reported that the feeling is greatly alleviated by just sitting on the toilet and acting as though a bowel movement is taking place.
Can I take medicines?
Be aware that tablets or capsules may come out whole in in the pouch. In most cases, this means you did not get the medicine. If you noticed this, talk with your health care provider or pharmacist. There may be other medicines you can use to make sure you are getting what you need. Liquid or liquid gel medicines tend to absorb faster and may work better for you.