Hearing a doctor mention your loved one need a stoma bag can bring up some concerns. Will it stink? How to sleep through the night with a bag full of waste? What to do if it leaks? How long will you have to wear it for?
This article aims to provide an essential guide to stoma care for people with a stoma bag as well as their caregivers. We explain typical reasons someone might need a stoma bag, how to care for and get comfortable with a stoma, what to watch out for, and when to contact a professional nurse or a doctor.
Table of Contents
1. What is a Stoma?
A stoma, or an ostomy, is an opening from the abdomen wall into the bowel or the urinary tract to eliminate body waste, namely stool or urine. The waste material is collected into a pouch or bag attached to the stoma outside the body. The procedure to create a stoma is known as an ostomy surgery.
A stoma becomes necessary when an underlying medical condition affects normal functioning of the bowel or urinary tract. Ostomy surgery in such cases helps an individual gain control over the bodily function involved and maintain independence in their daily activities. It can be temporary or permanent. In some situations, such as colorectal cancer, bladder cancer, or a congenital defect, it can be life-saving.
2. What is Stoma Care?
Stoma care refers to the care of the exposed part of the stoma after an ostomy surgery. It involves routine handling of the stoma bag, maintaining hygiene and health of the stoma, and management of any related issues or complications, such as irritation, bleeding, or prolapse. It may also involve making lifestyle adjustments to facilitate the maintenance of a stoma, as a person may need it for months or years, even in temporary cases.
Stoma care and ostomy care, while often used interchangeably, have slightly different meanings. Ostomy care often refers to the management of various medical and personal aspects of an individual with an ostomy, usually carried out by professionals. Stoma care implies the care of the exposed part of an ostomy, usually performed by the individual with the stoma, or their caregiver. Any complications should be promptly reported to and handled by medical professionals.
3. Common Reasons for a Stoma
A number of causes may necessitate an ostomy surgery and stoma care afterwards, including:
- Bowel diseases, such as Crohn's disease, ulcerative colitis, diverticulitis, other types of bowel infections or inflammation (Learn more about these conditions in our article on common gastrointestinal diseases here)
- Colorectal cancer - treatment for cancer affecting the colon or rectum may require a colorectal stoma, either temporary or permanently
- Bladder cancer - the type of stoma created as part of bladder cancer treatment is called an urostomy
- Blockage in the bowel, such as a polyp
- Traumatic injury to the gastrointestinal or urinary system
Treatment of the above conditions may require a surgery to remove a part or all of the colon, rectum or bladder as the case may be. An ostomy helps to divert waste from the affected organ to an external collection pouch, as a temporary redirect while the body heals or as a permanent solution. The duration required to wear the stoma bag depends on the condition and treatment progress. Should it be temporary to allow the bowel to recover, your surgeon will perform a stoma reversal and close the stoma site when your bowel function is restored.
Significant incontinence and physical impairment after a stroke or in late-stage dementia may also call for a stoma. A stroke may result in neurological bladder or bowel disorder that cannot be managed with stroke rehabilitation or medications. Similarly, people with advanced dementia may lose partial or complete control of their bowel and bladder. An ostomy can make it easier to manage toileting and avoid the risks of bathroom accidents, skin breakdown, and psychological distress, thereby improving quality of life for both the person with dementia or stroke and their caregiver. We wrote about caring for people with advanced-stage dementia here and post-stroke side effects here.
4. Types of Stoma
The type of stoma is linked to the type of ostomy surgery conducted. There are 3 common types of ostomy, differentiated by which part of the body the stoma is created from and its purpose:
- Colostomy - The stoma is connected to the colon to eliminate stool. Depending on which part of the colon the stoma is created from, we have 4 subtypes corresponding to 4 major parts of the colons, namely ascending colostomy, transverse colostomy, descending colostomy and Sigmoid colostomy.
- Ileostomy - The stoma is connected to the ileum, i.e., the end part of the small intestine. Digestive waste passes from the ileum to the external pouch through the stoma, bypassing the large intestine and the rectum.
- Urostomy - a part of the small intestine is removed and used as a conduit for urine to pass through, bypassing the bladder.
For each of these main types, there are multiple commercial types, varying in sizes and usages. You may need to try a few of the type you need to find one which fits the best.
5. Selecting the Most Suitable Stoma System for You
A stoma system consists of a stoma bag and the skin barrier. They may be attached (one-piece system) or separated (two-piece system). Two-piece stoma systems are secured together by a flange.
Ostomy bags are commonly made from plastic and sold in different sizes, including cut-to-fit type. They can be drainable (multiple-time use) or closed (one-time use). The skin barrier adheres the stoma bag to the skin around the stoma. It also helps protect your skin from stoma waste. People who have sensitive skin can use skin barrier cream or powder to prevent skin irritation without compromising the adhesion. Other accessories such as stoma belt and stoma cover can provide additional support to help you feel comfortable. The choice of one-piece or two-piece stoma, type of skin barrier, size and style is entirely up to the individual.
A well-fitted stoma system is the most effective way to prevent skin irritation associated with ostomy, which can occur in up to half of the people with ostomies. Below are some important considerations to find a good fit:
- Your stoma size and shape
- Whether your stoma sticks out from your skin
- Stoma output (loose or formed stool)
- Your skin condition (folds, wrinkles or hairs around the stoma site, whether you are sensitive to tape and adhesive)
- How often you can or want to change stoma bags (daily or less frequently)
- Your activity level and types of activities you engage in
- Other factors such as how much you perspire, clothes you want to wear, etc
Take note that the stoma may change size during the first month after the surgery, or as you gain or lose weight. You may need to adjust your stoma system as it evolves. It is advisable to measure your stoma occasionally when you change the appliance, or as often as instructed by your doctor.
6. Where to Learn Stoma Care
A stoma will be cared for by a stoma nurse specialist during your hospital stay after an ostomy surgery. During this time, you will also learn stoma care techniques such as how to clean the stoma, empty and change the stoma bag, identify and handle leakage early, control odour and gas accumulation, and more. Take the time to try things out on your own to be sure you are comfortable to start home care once you are discharged.
Professional nurses are also a great resource to consult about not only care techniques but also any psychological concerns you have. You can seek their advice on food you should and should not eat or drink, how to dress for the best comfort, how to manage the stoma bag in social situations, or how to return to work and activities you used to do before the ostomy surgery. Activities such as swimming or regular exercising (except for strenuous exercises or contact sports) are safe to be resumed with a stoma once you feel well enough to do so.
If you are new to stoma care or need a refresher course, you can look for a caregiver skill training course provider online. Ninkatec professional nurses also provide home-based hands-on stoma care training for caregivers and patients, details are available here.
7. Care for a Stoma at Home
Here are the most important aspects of ostomy care at home you need to pay attention to:
- Hand hygiene: Always wash your hands with soap and water before and after handling the stoma bag.
- Stoma cleansing: gently cleanse the stoma daily with warm water, then pet dry. If you use soap or wet wipes, it is best to check with a professional if they can be used.
- Skin health: When you remove the skin barrier, be sure to use one hand to push the skin away gently instead of pulling. This helps to avoid skin damage and discomfort. Always ensure the skin is completely dry before applying a new stoma bag. You can also use a protective powder or cream for better skin protection and a more secure seal, if recommended.
- Appliance fitting: A proper fit is essential to prevent leakage, odour and to keep you comfortable. You may need to try out different types and sizes to find a stoma system that fits you best. Take your time when changing the stoma system to ensure you have a snug fit.
- Regular emptying: It is recommended to empty the stoma bag when it is one third to half full to prevent it from leaking or becoming too heavy.
- Diet: You may need to follow diet instructions from your doctor in the first few weeks after the ostomy surgery. After that, you can eat and drink as usual, unless your doctor or nurse orders otherwise.
- Seek medical care when necessary: It is crucial to observe your stoma when you change the appliance and notice any signs of complications to seek professional advice promptly. The table below gives you an idea of when to ask for help from the professionals.
8. Top Concerns Associated with Having a Stoma
Logistical concerns involving integrating a stoma into daily activities are often the top worries. But since the stoma system can be discreetly and securely fastened to the belly, most people are able to learn to manoeuvre and live with it. There should not be any odour, as long as it fits you properly and does not leak. Thus, you do not have to worry about others knowing about your stoma if it affects you.
Ostomy bags are waterproof, you can shower, bathe and swim with it. There is no need to wake up during the night to take care of the bag. It can be a good idea to change the bag before sleep time if you anticipate high output. Sleeping on your stomach is not recommended, as it increases the risk of leakage.
Managing leakage
Leakage often occurs due to poor fitting. Change to a new pouch as soon as you notice leakage. To prevent the issue, invest in finding a well-fitted ostomy system. Note that your stoma may change size over time and your appliance will need to be updated accordingly.
Controlling gas
We all pass wind from time to time. This does not change with a stoma, and the ‘wind’ can find its way into the stoma bag. Stoma pouches have vents and filters to prevent them from ballooning under your clothes. However, sometimes gas may still get in when the filter is wet or blocked. You can fix this by pushing on the top of the bag a few times to get the air out. If this does not solve the ballooning, change the pouch as soon as you have a chance to.
If gas bothers you, it is helpful to identify and avoid foods that may cause it. The common culprits are high-fibre foods such as beans, sprouts, cauliflower, broccoli, whole wheat, etc. Also avoid drinking carbonated beverages or drinking while eating- they may increase air in your stomach.
Psychological issues
A stoma surgery and the temporary or permanent life changes following it can affect your mental health. If you find yourself overly worried about the stoma, or anxious about how your life has changed, try to get relief from family, close friends, or even professionals by speaking out about your concerns. You can also connect with other people going through the same experience to share your feelings, and learn tips to better incorporate a stoma in your life. The Ostomy Association of Singapore provides a network of people living with ostomies (i.e., ostomates) who offer emotional and peer support to members.
9. Common Problems and Complications To Watch Out For
Skin Irritation
This can occur in up to 50% of patients, with severity ranging from mild irritation to ulcer and infection. The elderly is at higher risk, as they may have difficulty carrying out daily care and are more prone to skin infection. Contact your healthcare provider if you persistently feel sore or itchy, or burning sensation, or see a rash around the stoma. Ulcers and suspected infections must be reported promptly.
Here are some tips to prevent skin issues associated with a stoma:
- Choose a well-fitted stoma system
- Change the stoma system routinely
- Change it as soon as you notice the skin barrier loosening or leaking, or if you feel itchy or uncomfortable
- Ensure the appliance and skin is well-dried after coming in contact with water (showering, swimming, etc)
- Consult your doctor for ostomy care powder, cream, skin sealant and other support products if you sweat a lot or have sensitive skin
Bleeding
Minor bleeding when you change the stoma system is not a cause of concern, as the bowel has a rich blood supply. However, contact your doctor immediately if bleeding does not stop quickly, or if you see blood in the stoma bag.
Prolapse and Hernia
Both prolapse and hernia occur when the supporting abdominal muscles are weak, or when you engage in activities that strain the abdominal muscles such as heavy lifting, strenuous exercises or forceful coughing or sneezing. You may see symptoms such as the stoma getting bigger in size, and/or a lump developing in the vicinity of the stoma opening.
You do not need medical intervention if the exposed part of the stoma looks healthy, and there is no bump near the site. Simply change to a larger-sized pouching system to accommodate it. Contact your healthcare provider if the stoma looks dark or unusual, or cause you discomfort, or if you can feel a lump nearby.
10. Takeaway Message
Having an ostomy is a significant change in life. Often, it is the necessary step to improve health, well-being and quality-of-life. Over a million people worldwide live with ostomies, and many more need short-term stoma care during their treatment for bowel or bladder related conditions. Having stoma care resources handy and learning from the experiences of others are steps you can take to shorten the adjustment period and to live fully again. It is what we wish to achieve with you through this article.
Ninkatec provides quality nursing care including stoma care, as part of our home care solution suite. Our home care services include adhoc doctor and nurse home visit, short-term and long-term packages customised to your personal needs. Chat with us or visit our web page to find out more Ninkatec’s Nursing Care services.
Learn caregiving tips on bedsore care and prevention, NG tube care, urinary catheter care, and wound care at home in our series of caregiver’s guides here.
*The above guide is provided for informational purposes only, and does not substitute for professional medical instructions. Patients and caregivers are recommended to seek and follow guidance from their healthcare professionals for their personal case.
