A diagnosis of a disease can come as a surprise to you. Whether you are the patient or a relative, your world has suddenly turned upside down. And just like that , you will have to undergo ostomy surgery and you will certainly have countless questions about it .
Without warning, you will have to understand illnesses and potential treatment options, make complex decisions with long-term impact, change habits and completely reorganize your daily life, face fears and anxieties, and accept or provide moral support and encouragement.
At times like these, it is important to have honest, easy-to-understand information to guide you through this difficult time and beyond. Below you will find helpful facts, patient experiences, and information about colostomy and ileostomy products and treatments , which we hope will help you make the right decisions for your situation.
B. Braun ostomy materials are specially designed with a primary focus on safety, comfort and discretion, offering real solutions to everyday problems such as irritation, odor and gas .
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Is it possible for my stoma to move inward or outward in an unusual way?
Both can happen, but they are not serious. It is normal for the mucous membrane to move slightly in and out due to the peristaltic movement of the intestine. The phenomenon of a stoma falling abnormally inward is called retraction, while when the stoma falls outward, it is a complication that can reach the stage of prolapse.
You should immediately adjust the ostomy materials you use accordingly to avoid the risk of leaks, and consequently, skin irritation. Only in some cases may surgery be required to reposition the bowel.
In any case, contact your doctor or Traumacare nursing staff.
Withdrawal
Usually the stoma protrudes slightly above the skin level. How much depends on whether you have a colostomy or an ileostomy (ileostomies tend to protrude more) and the size of your bowel. In the case of retraction, the stoma is at or below the skin surface level.
Retraction can become problematic, as it can prevent the bag from fitting properly and can also cause leaks, which in turn can lead to pain and irritation.
The withdrawal can be restored using:
- An ostomy bag with a curved base to push the stoma outward
- An ostomy belt to support the area
- A protective barrier paste to protect the skin
Only in very extreme cases, your doctor may suggest repositioning the stoma.
Prolapse
In this case, the stoma extends excessively outward and if left untreated is more susceptible to abrasions or infections.
Prolapse is most commonly found in bronchial colostomies but can also occur for other reasons such as:
- Weak abdominal wall
- Sudden weight gain
- Pregnancy
- Surgical technique chosen during the operation
- From sudden pressure in the abdomen caused by coughing
If you have a prolapse it is important to monitor your stoma carefully for changes in size and color as this can affect the blood supply to the area. Another important side effect is that the stoma can become blocked, making it impossible for stool to pass .
Seek immediate medical advice if either of these occurs. There is no need to worry as you will usually just need to change your pouch to fit the extended stoma .
Again, your doctor may decide to reposition your stoma, if and only if he or she deems it absolutely necessary.
My stoma is changing shape. Is this normal?
Yes! The change in shape is a normal development in both new and old stomas. Indeed, at first your stoma will be swollen and may increase in size during the postoperative period. Unfortunately, no one knows how much the stoma will swell immediately after surgery, nor what its size will be when the swelling subsides in about 6 weeks after surgery.
Regularly measuring the base of your stoma is very important during these 6 weeks, so that you use the correct size for the base of the stoma bag. Traditionally , the base should be 3-4 mm larger than the stoma . The correct size of the base of the bag helps prevent irritation of both the skin and the stoma itself.
Soft-backed ostomy bags do not require high precision
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However, changes in the size and shape of a stoma can occur over time for a variety of reasons . Weight gain or loss of 4.5 kg or more, pregnancy, aging, and the development of peristomal hernias all require attention, requiring a re-evaluation of the ostomy materials you are using .
What type of ostomy bag should I use?
Immediately after surgery and for the first few days until you leave the hospital, you will use the ostomy bag that the nursing staff has chosen. As usual, these are transparent bags so that the medical team can assess the progress of the treatment and you can get used to how the bag is changed .
However, when leaving the hospital, you can choose from many types of bags from various manufacturers.
It's a matter of trial and error, as one type of pouch may work for you in the first few weeks and then not. First of all, the diameter of your stoma will shrink over time, and you can use different pouches depending on the activity, such as when you're traveling, exercising, having sex, etc.
I have frequent leakage problems. What can I do?
Depending on the type of stoma and the type of waste, the consequences of these leakage problems will vary. Knowing the cause behind the leakage will help you and your doctor find a solution. The skin around the stoma is not always smooth but often has folds whose number and depth vary from person to person.
If the skin around your stoma is completely healthy, it should look like the skin on the rest of your abdominal area.If it is redder, hurts or itches, there may be many causes, but in the case of leaks, the most common is moisture, as the uneven surface of the skin can prevent the bag from fitting properly, resulting in leaks under the adhesive, leading to skin irritation even when the folds are very small.
Check the adhesive for signs of leakage, as well as the condition of the skin around your stoma when you remove the base of the pouch.
A solution may again be a protective paste to smooth out the folds in the area as well as a protective silicone skin spray to prevent skin damage caused by moisture and friction .
More generally, in the case of irritation, it is recommended that adhesive bags be changed at least once a day, while 2-piece ostomy systems should be changed every other day, but the pouch should be changed daily.
Make sure the base of your ostomy bag is the right size. If it doesn't fit properly, it may be time to try a bag with a soft, curved base .
As a leakage problem is a great inconvenience, know that there are many reasons behind a leakage. If the problems continue or you have any doubts about the condition of the skin you should quickly contact your doctor or Traumacare nursing staff, in order to determine the real cause of the leakage and treat it immediately.
Can my stoma become blocked?
The function of the stoma can slow down or even stop working completely, that is, there can be stoma obstruction . There are two types of obstruction:
- Partial stoma obstruction occurs when liquids and gases pass during a bowel movement but most solids are blocked.
- Complete obstruction of the stoma where nothing passes.
In the case of a colostomy, the blockage may not be noticed at first as it may take several days for it to develop before you feel constipated. In contrast, in the case of an ileostomy, the blockage usually occurs rapidly without any sensation of constipation and you will notice it when your pouch remains empty when it should have been full.
Symptoms of stoma obstruction
- Slowing the outflow of secretions
- Cramps
- Abdominal pain
- Swollen belly
- Constipation
- Nausea
- Swelling or discoloration of the stoma
- Dryness of the stoma
- Decreased urine output
- Vomiting (only in severe cases)
What to do in case of blockage
Many times the blockage can be due to food debris. Washing the stoma with a solution of warm water and salt (saline) can address the problem. However, if the blockage is due to a stricture, then the stoma will be discolored and swollen. In this case, we advise you to contact your doctor without further delay.
If the blockage lasts more than 8 hours without any movement, you should be taken to the hospital immediately, as you may need surgery.
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- Stop eating solid foods
- Increase your fluid intake
- If the stoma is swollen, replace the bag you are using with a larger one
- Take a warm bath to relax your abdominal muscles.
- Massage your belly
- Pull your knees towards your chest and move from side to side.
- Call your doctor if the pain is severe or you have symptoms of dehydration, even if the symptoms have not lasted 8 hours.
- Ask someone to drive you to the doctor or hospital
- Do not use a laxative or any other medication without consulting your doctor.
- Do not drink or eat anything if you are vomiting or not passing stool at all or both.
- Do not insert anything into the stoma unless instructed to do so by your doctor.
- Don't wait too long to call your doctor.
Gwen B. Turnbull (RN, BS, CETN), IA (Ileostomy & Internal Pouch Association)
Is there a risk of skin irritation around the stoma?
As long as you simply follow your daily stoma care routine, the risk of irritation is lower. Keep in mind that the adhesive part of the base or pouch also acts as a skin protector, meaning that its role is to both adhere to the skin and protect it.
However, there are ways to reduce the risks of irritation to a minimum:
- Use lukewarm tap water to clean the skin.
- Avoid products that contain fragrance
- If you have watery stools that cause you itching, you can cover the exposed skin with a protective paste such as B.Braun Superfiller.
After colon cancer, I will have to start chemotherapy. Will there be changes to my stoma and digestion?
During chemotherapy, changes are to be expected. Your stoma may become more sensitive and swollen, and even the slightest friction may cause slight bleeding. Although this is nothing to worry about, you should still be extra careful in caring for your stoma.
Also, stools may become more liquid and irritate the skin around the stoma. Make sure you cut your base or pouch correctly. Sometimes you may need to use adhesive paste for extra protection to prevent liquid stools from leaking.
This means that once again you will need some products for the best possible protection of the skin around the stoma .
It is also recommended that you use bags that can be emptied during chemotherapy if your stool is liquid, to avoid too frequent changes.
Finally, it is necessary to adjust your diet accordingly .
I have gas and feel uncomfortable. What can I do?
It is a common concern for people living with a stoma, but you don’t need to worry. Modern colostomy and ileostomy bags have a special filter that allows gas to escape automatically, without odor . It is effective for at least 12 hours. However, this filter can become saturated or wet. In this case, your bag will swell with gas. This can happen if you wear the bag continuously after 12 to 24 hours or at the end of the night.
Do not puncture the bag under any circumstances, as this will allow odors to escape. Remember that it is important to close your filter when bathing (or when swimming, water sports, diving), by applying a sticker to the filter. You will find these stickers in the boxes of your bags. Remember to remove the sticker after the activity is over so that the filter starts working again automatically.
For your own comfort, you can reduce the daily amount of gas produced by following a few simple guidelines:
- Limit your consumption of certain foods
- Eat meals at regular intervals.
- Eat moderate meals
- Chew your food well and eat slowly.
- Carefully monitor the health of your teeth
- Eat certain foods, such as whole wheat bread,
high-fiber cereals, bananas, and vegetables without their skins - Drink at least 1.5 liters of fluids per day (e.g. water or tea)
Learn from Traumacare's nursing staff about foods that can help you reduce gas.
Note: If you have a left-sided colostomy, there are solutions that can mask gas noises. You can use a stoma plug, in conjunction with an enema method, or a petroleum jelly covering the stoma opening.
Most of the time, the sound of gas sounds like your stomach gurgling. If you are embarrassed by the noise, especially when you are outside, you can simply say, “Excuse me, my stomach is gurgling.” You can also cross your arms over your stomach, above your stoma. This will mask the noise.
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Is there a chance that odors will leak from the bag?
The ostomy materials used today do not allow any odors to escape. You may initially think that you can smell the stoma, but don't worry. This is something that will go away with time as you get used to it.
If there is indeed an odor from your bag, change it and discuss it with the specialized staff of Traumacare. For more safety, you can also use B.Braun DeOdour product which neutralizes all odors of bacterial origin in ostomy bags . One small sachet per bag offers hours of confidence.
Should I tell my children and relatives about my stoma?
Children need a climate of trust, so you should talk to them and explain the situation in simple terms. They should not feel like you are hiding something from them, and in this case what they imagine is often much worse than reality.
Just because someone says they have a stoma doesn't mean they have to show it! As for relatives, it's up to you to decide whether it's necessary to talk about it. You're the one living with the stoma, so it's your choice whether to do it or not. You may feel more comfortable talking about it with some people, and less so with others.
It would certainly be better to talk about your stoma with your partner calmly and openly to get rid of any fears you may have.