Working, walking, exercising and travelling are often possible with a stoma. At first, you need to learn how to change the bag, protect your skin and understand your bowel's new pattern. These skills should be demonstrated before you leave hospital, and you should have someone to contact with questions after returning home.
A stoma is a part of the bowel brought out onto the abdominal wall during surgery. Stool passes through it into a special bag attached to the skin. Adjusting to a stoma takes a different amount of time for everyone: one person may get used to the bag quickly, while another finds it harder to accept the change to their body. You can discuss these difficulties with your care team.
The difference between a colostomy and an ileostomy
A stoma made from the colon is called a colostomy; one made from the last part of the small bowel is called an ileostomy. With a colostomy, stool is often firmer, although this depends on which part of the colon remains in use. Ileostomy output is usually more liquid and may collect more frequently throughout the day.
This difference also affects fluid intake. Because the colon helps absorb water and salts, losses may be greater with an ileostomy. Advice suitable for someone with a colostomy does not apply in exactly the same way to someone with an ileostomy.
Both types can be temporary or permanent. A temporary stoma is sometimes created to protect a new bowel join from the passage of stool while it heals. If the natural passage cannot be restored, the stoma remains permanent. You cannot tell from the shape of the bag whether the stoma can be closed later.
Daily bag and skin care
The right bag depends on the size of the stoma, the contours of the abdominal skin and the nature of the output. In a one-piece system, the bag and adhesive surface are changed together. In a two-piece system, the base attached to the skin and the bag are separate. A nurse trained in stoma care can help you try out which is more comfortable.
The bag is emptied before it becomes too full. Its weight can pull on the adhesive area and cause leakage. When changing it, gently clean the skin with warm water, then dry it carefully. Oily creams and unsuitable products can reduce adhesion; any product applied to the skin needs to be compatible with the bag system.
The opening in the adhesive surface should neither squeeze the stoma nor leave the surrounding skin exposed. As swelling after surgery goes down, the size of the stoma may change. An opening that fitted at first may therefore need to be measured again.
You do not have to live with burning, itching and repeated leakage. Adding more adhesive over a leaking bag and waiting can make skin damage worse. The fit of the bag and the condition of the skin need assessment. Although a small spot of blood may appear when the stoma is touched, ongoing bleeding or blood collecting in the bag is not a routine care problem.
What changes in eating and drinking?
A lower-fibre diet may be recommended during early recovery, particularly after an ileostomy. Fibre is the part of vegetables, fruit and grain products that is not fully digested. Foods are gradually reintroduced later. There is usually no need to limit yourself to just a few foods for life.
Eating small portions and chewing food well can help, especially at first. Trying new foods at separate times makes it easier to identify which increase bloating, odour or liquid output. If restricting your diet too much causes weight loss, the plan is reviewed with your doctor and a dietitian.
If ileostomy output suddenly increases and becomes watery, drinking more plain water alone may not solve the problem. Salts are lost along with water. In these situations, the doctor may prescribe a special oral solution to replace lost water and salts, together with an appropriate fluid plan. Restricting fluids on your own is not appropriate either.
Passing less urine or darker urine, a dry mouth, dizziness and weakness suggest dehydration. If these symptoms occur, seek medical advice the same day. Being unable to drink or becoming confused requires emergency care.
Work, activity and travel
Returning to work depends on the extent of the main operation, your overall strength and the physical demands of your job. Desk work is different from work involving heavy lifting. Shorter working days, access to a toilet and somewhere to keep spare bags may make adjustment easier in the first few weeks.
Walking is increased gradually. While the abdominal wall heals, follow your surgeon's individual advice on heavy lifting and strenuous exercise. A hernia can develop around the stoma, so a sudden return to intense exercise is not appropriate. Swimming may also be possible once healing is complete; learn beforehand how to use the bag system in water.
For travel, keep bags, skin-cleaning supplies, disposal bags and spare clothing in an easily accessible bag. Extra supplies are useful if the journey takes longer or luggage is delayed. Pay closer attention to fluid loss in hot weather, particularly with an ileostomy. After recent surgery, check with your surgeon when you can fly.
Closing a temporary stoma and when to seek help
Closure is a separate operation. First, the team assesses whether the bowel join below has healed, whether the passage is open and your general health. Sometimes a camera examination or special imaging is needed. Ongoing cancer treatment and previous complications may affect the timing.
“Temporary” describes the original intention. For some people, a later closure operation is not safe, or the expected bowel function does not appear satisfactory. Toilet visits may also become more frequent after closure, and a new period of adjustment may begin. These possibilities are discussed before a decision is made.
Urgent medical care is needed if output stops along with cramping, abdominal swelling and vomiting, if the stoma turns dark purple or black, or if there is heavy bleeding. If bowel obstruction is suspected, do not take laxatives on your own or insert instruments into the stoma. Let your care team know about any clear change from your usual output pattern.