The first thirty days with a stoma are the most demanding – and the most misunderstood. Much of what frightens patients during this period is entirely expected, while some things that seem trivial need immediate assessment. This guide separates the two.
Week 1: still in hospital
Your stoma is swollen right now. That is normal: the oedema subsides gradually and the stoma shrinks over the next six to eight weeks. This is why you should not buy large quantities of pre-cut baseplates at the start – the size that fits today will not fit in a month.
The colour of the stoma should be pink to red and moist, like the inside of your cheek. The stoma itself has no sensory nerves: it does not hurt when you touch it. Slight bleeding during cleaning, like gums bleeding when you brush, is common.
Before you leave, ask your stoma nurse to watch you change the pouch entirely on your own at least once. It is the most useful hour of the whole admission.
Weeks 2–3: the first steps at home
Re-measure the stoma every week. The opening of the baseplate should sit about 2 millimetres from the edge of the stoma – far enough not to squeeze it, close enough that no skin is left exposed. The most common cause of leakage in the first month is exactly this: a baseplate cut to yesterday's size.
The output changes character. With a colostomy the stool gradually gains consistency. With an ileostomy it stays watery to porridge-like and the volume is larger – that is not diarrhoea, it is how the small bowel works.
Eat small, frequent meals, chew well and introduce one new food at a time so you know what upsets you. Drink water steadily through the day.
Do not lift heavy loads. Most surgical teams advise avoiding heavy lifting for six to eight weeks, because that is when protection against a later parastomal hernia is built – or lost. Ask your surgeon what your own limit is.
Week 4: the routine starts to return
By this point most people have found their own changing rhythm. Showering happens normally, with or without the pouch. Sleep improves when you empty the pouch before lying down and avoid a large meal in the last two hours.
If you work, this is the moment to think about a gradual return – not to rush it.
What is normal this month
- A swollen stoma that gradually shrinks
- Slight bleeding during cleaning
- Wind, especially in the first weeks
- Changes in consistency and frequency
- Fatigue that lifts slowly
- Strong and conflicting emotions
When to call the doctor or stoma nurse immediately
- The stoma turns dark, dusky or grey
- No output and no wind for several hours, especially with abdominal pain, bloating or vomiting
- Watery and very high-volume output, with thirst, dark urine, dizziness or cramps – signs of dehydration
- Bleeding that does not stop
- Severe pain, fever, or skin around the stoma that breaks down and does not heal
- The stoma suddenly protrudes much further or, conversely, retracts
It is not excessive to call. A stoma nurse would rather take ten unnecessary calls than one that came too late.
What is worth having at home from day one
- Pouches and baseplates in at least two sizes, because the stoma shrinks
- Stoma scissors and a measuring guide
- Soft cloths and lukewarm water – nothing with alcohol or fragrance
- Skin protection and, if needed, paste or a sealing ring
- Disposal bags and a small kit for outside the house
The psychological side is not secondary
It is common to feel sadness, anger or estrangement from your own body in the first month. It does not mean you are not coping. But if the mood stays heavy beyond the first weeks, or if you avoid looking at your stoma, speak about it – to a stoma nurse, a psychologist, or another patient who has been through it.
Read also
- How to Choose the Right Ostomy Products – A Practical Guide to Fit and Comfort
- Skin care around the stoma: Practical guide & solutions B. Braun
- Nutritional Tips For Colostomy, Ileostomy & Ureterostomy
- All the answers to the 10 most frequently asked questions of people with a stoma
If you need guidance on which system suits your stoma, or samples to try before you decide, get in touch with us.
Sources
The clinical information in this article is based on the following published sources:
- Davis BR, Valente MA, Goldberg JE, Lightner AL, Feingold DL, Paquette IM. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for Ostomy Surgery. Dis Colon Rectum. 2022;65(10):1173-1190.
- Hedrick TL, Sherman A, Cohen-Mekelburg S, Gaidos JKJ. AGA Clinical Practice Update on Management of Ostomies: Commentary. Clin Gastroenterol Hepatol. 2023;21(10):2473-2477.
- Carville K, Haesler E, Norman T, Walls P, Monterosso L. A Consensus on Stomal, Parastomal, and Peristomal Complications. Adv Skin Wound Care. 2022;35(8):435-441.
- Colwell JC, Bain KA, Hansen AS, Droste W, Vendelbo G, James-Reid S. International Consensus Results: Development of Practice Guidelines for Assessment of Peristomal Body and Stoma Profiles, Patient Engagement, and Patient Follow-up. J Wound Ostomy Continence Nurs. 2019;46(6):497-504.
- National Health Service (UK). Ileostomy. NHS Conditions.
Content last updated: August 2026.
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This information is educational and does not replace medical assessment. For any clinical decision, consult your treating physician or your stoma care nurse.