Taking good care of your stoma after surgery can take some time to get used to, especially with how to properly look after your stoma and living with it for a long time if it is a permanent one. There will be plenty of things you will need to learn, but you should take as much time as you need to adjust to living with a stoma.
This guide will help you navigate the complexities and concerns of managing your stoma properly. We hope the advice provided here will be valuable in helping you understand the importance of stoma care and how to live with your stoma and take care of it with the utmost confidence.
Immediately After Surgery
When you first wake up after surgery, you may feel dizzy, dazed, and confused at first; you may then notice you have drips and drains attached to various parts of your body. Rest assured that this is all part of the post-surgery procedure: the drips help provide you with much-needed hydration intravenously, while the drains remove waste matter from your gut while it is still healing from the surgery. It will take some time for your gut to start functioning again, and once it does, the drains can be safely removed.
You may also notice your stoma protruding from your lower abdomen: it will appear moist and pinkish-red, much like the inside of your mouth. It will also look swollen, but that will slowly subside over time (typically taking anywhere between six to eight weeks or up to three months) as you heal. Your stoma has no nerve endings, so you will not feel any pain when you touch it, though it might seem a little weird at first.
For the first few days, you should focus solely on resting and regaining some of your energy. As you recover, your doctor and nurses will attend to your current needs and closely monitor your progress. They may also apply a clear bag to your stoma from the get-go to help them monitor its shape, size, and general outlook.
Recovering While Hospitalised
You will usually only need to stay in the hospital for about three to ten days to ensure that your stoma does not develop complications.
Pain Management
You may experience varying levels of pain or discomfort in the initial days following surgery.
Pain medications may be prescribed to help with coping with it, and most times, you will feel pain or soreness around your stoma and the surgical area, as well as other places around your abdomen. If the pain feels too much to bear, notify your doctor immediately for prompt medical attention.
Stoma Begins Functioning
You may experience uncomfortable or painful bloating before your stoma begins to work, but thankfully, this is part of the healing process and will go away on its own. After a few days, your stoma will start to function, creating a strong-smelling, watery liquid at first; unpleasant as it is, your bowel has been “frozen” for some time due to the surgery and is now starting to recover.
As time passes, the consistency will improve, and the stench will not be as prominent, especially once you return to having food as usual.
A balanced diet is the best way to minimise the unpleasantness of stoma output, but for now, you will still need to stay on a liquid diet until the doctor says otherwise. After a few weeks, your bowels should settle down to a normal pattern, and you should be able to start a soft diet per your doctor’s advice.
Moving Around
A good way to help get your health back on track is to move about in your ward, but ensure that you take your time and start slow at first. You may feel a little shaky when you move around at first as you are still weak from the surgery; pace yourself accordingly by starting with moving from one end of the bed to the other. Slowly intensify your walking as your health gradually improves.
Walking helps restore your energy levels, but it is also essential for avoiding bed sores by lying down for hours at a time, preventing chest infections, and getting your bowels to start functioning sooner.
Preparing for Discharge
If your health looks good, your doctor may allow you to be discharged soon. In the meantime, you may want to be mindful of a few things before your discharge.
The doctor or attending nurse will also show you how to change your stoma bag to prepare you for caring for yourself once you are discharged. They will also share other valuable tips, such as maintaining proper stoma hygiene when using or changing bags, among other topics. At this point, you may also have plenty of questions about your stoma care, so take this opportunity to ask them. It might help to prepare some questions beforehand so you can ask them all in one go or while you are still warded.
You may also notice that the stoma occasionally bleeds when you touch or clean it, but this is normal and will subside and stop after a few days. If bleeding persists, even if you did not clean it, contact your doctor immediately.
Once your digestive tract has “woken up,” your doctor will give you the green light to start a soft diet with easy-to-digest foods and a low-fibre content to minimise bowel movements and help your gut recover. It helps to cut your food into smaller pieces and chew it thoroughly before swallowing so you do not choke on food or cause other complications.
On some occasions, your stoma will have wind noisily escape from it without warning, or you may feel you need to use the washroom more often than usual. Rest assured that these are perfectly normal and will gradually subside to more normal levels.
Before discharge, you may also be given additional care tips to consider, which are especially important for the first few months after you are discharged. For one, your doctor may advise you to avoid lifting heavy objects at any point in time; this is to prevent the surgical wounds from opening up again and causing a significant health scare, but also to ensure you do not accidentally hurt your stoma or cause a hernia in the process. Typically, your doctor will advise you against lifting anything heavier than a full kettle, but it varies from person to person.
As a safety precaution, you should continue moving around the house as much as possible, preferably with someone to watch over you.
Ask for Help
Even once you are discharged, you might still need help or a reminder to do specific tasks to care for your stoma. It helps to have your doctor or designated nurse’s number so you can contact them when you need help. If you have family members who will care for you, it is essential to prioritise your well-being and ask for their support when needed. Every little bit of support can do a lot to see you through your recovery period.
Recovering From Home
Even after you return home, you may still feel tired and lethargic, with occasional pain, discomfort or tenderness around your abdominal area. Get as much rest as needed, but continue to do some light walking around your house so you can slowly restore your energy levels and get back on your feet.
Fitting Your Stoma Bag
Your doctor or designated nurse would have taught you how to properly apply the stoma bag to your skin to allow proper drainage and prevent output from leaking and causing skin irritation or damage. There are various types of stoma bags available on the market, so your choice of stoma bag may depend on what you are given at the hospital at first; you can always change to a different type later on if it may be a more convenient option compared to what you are currently using.
You can also find various resources to help you fit your stoma bag properly, including those provided by accredited sources like hospitals and qualified care centres. You can use these resources to help you with fitting your bag correctly and avoid complications from a poorly fitted bag. You should also remember to keep your skin dry before applying the stoma bag so the adhesive can stick to your skin.
If you want to try a new stoma bag, test it at home first to avoid unwanted accidents. Take a few days to familiarise yourself with the stoma bag; if it is not suitable for you, revert to your usual bag and wait a few days before trying another new one.
Dietary Considerations
If all is well, you should already be moving on from a soft diet to your regular dietary habits based on your doctor’s recommendation. While you do not need to abide by a special diet, you may notice that some foods will affect your digestive tract very differently pre-surgery. For example, some foods may cause more gas than usual, while others may affect your stool’s consistency.
It is a good idea to try some foods at home first and see how your digestive system reacts to them. That way, you can get a good idea of what foods you can have more often while avoiding those that may cause gas or other reactions while you are out. Start with small portions first and see how you feel after. If a specific food is giving you problems, stop taking it for some time before you try to reintroduce it much later; if this still causes issues, you might want to cut out that food item from your diet.
Taking care of your digestive health goes a long way to help with your stoma care. Consider adding other foods you have never tried before, especially those with nutritious benefits your gut needs, while cutting down on oily and fatty foods and fizzy drinks that can cause gas or bloating that can be uncomfortable. Ensure you also stay hydrated with water and fruit juices (with no sugar) as often as possible to help minimise other digestive complications like constipation.
You may also develop short-term intolerances to some foods while you are still recovering. Once your digestive system is feeling better, you can slowly reintroduce some of these foods to your diet but do take note if they still cause you complications later on.
Maintain Stoma Hygiene
Proper stoma hygiene is essential, as faeces or urine expelled through the stoma can cause irritation or inflammation if they come into contact with your skin. You should always ensure that your stoma bag is fitted correctly to your stoma to ensure the output is expelled into the bag and does not leak onto your skin. When handling the stoma bag, wash your hands first with soap and water to ensure safety; you should then wash them again after handling the stoma bag to maintain hygiene.
You can take baths and showers as usual, and you can choose to either wear or remove your stoma bag when you do so. We recommend keeping it off so you can gently wash your skin with warm water (never hot water) and then carefully pat the peristomal area (the area surrounding the stoma) with a dry cotton wipe or soft cotton towel. You will have to be careful with the bathing products you use for cleaning your stoma; ideally, pick fragrance-free products or those that leave residue on your skin that can prevent the stoma bag from adhering to your skin.
You should also avoid skincare products that contain alcohol, fragrance, and certain preservatives or chemicals that can dry your skin, including baby oil.
Checking Your Stoma
Besides your stoma’s hygiene, you will also need to pay close attention to your stoma during your daily routines. You must keep a close eye on your stoma, as it can still change in shape and size; that means you need to regularly measure it so you can prepare your stoma bag’s baseplate accordingly for a proper fit. You should also note any changes you observe on the surface of the stoma, as well as the presence of any stoma output or erosion on the adhesive of the baseplate; contact your doctor immediately if you notice anything out of the ordinary.
If you are experiencing pain, discomfort or itching on or around the peristomal area, carefully remove the stoma bag and look for any signs of redness or inflammation. Notify your doctor at once if you spot any concerning signs.
If your stoma seems to be sticking out of your body, use a cold compress to “push” it back into your body and to its normal position. If it seems to have partially inserted itself into your abdomen, you may need to use a convex baseplate that is designed for such instances where the stoma seems to have sunk into the abdomen. While it can happen to anyone with a stoma, if it appears to be deep inside your abdomen or if it is causing issues with fixing the stoma bag, you should consult your doctor immediately.
Exercising with a Stoma
Even with a stoma, you can include exercise in your daily routine. Once your energy levels are back to normal and your doctor has okayed it, you can have brisk walks every once in a while to keep your physical health up. If you have already been warming up before this with short walks in the house, you can continue to build up your stamina; we recommend that you stick with brisk walking and some light exercises to stay in shape.
You can also take yoga or pilates to improve your physical well-being; swimming is an excellent low-impact exercise option, too. Whichever you choose, consider wearing a support band or belt around your stoma to keep your stoma bag in place and avoid getting a hernia. You can also find suitable sportswear that can cover up your stoma while providing comfort for your exercise sessions.
Regardless of how you are feeling, it is vital that you do not rush your exercise sessions. Take as much time as you need to build up your strength and endurance, but do not put unnecessary strain on yourself, as you can hurt yourself or cause harm to your stoma.
Getting Back to Work
Once you are feeling better, you may eventually get back to your job as usual. If you are still feeling tired or need to readjust to your regular schedule, it might be helpful if your employer is willing to arrange flexible hours until you fully recuperate. It may also be handy to try and practice planning your work days, especially when it comes to managing your diet and how frequently you need to check, empty or replace your stoma bag while at work.
It is also worth considering bringing a small changing bag to the office, which you can discreetly take to the bathroom when you need to change your stoma bag.
If your work involves manual labour, you may want to postpone your return to work until your doctor says you can lift heavy objects again. Even so, you should minimise how often you do such lifting work or have someone to help you; proper lifting postures may also be helpful to minimise harm, but we always recommend being safe than sorry.
Frequently Asked Questions
What should I do if I encounter problems with my stoma bag?
An adequately fitted stoma bag ensures that output is excreted into the bag and away from the skin. If you are having trouble fitting the bag, or if the bags you use are causing skin irritation or other problems, speak to your doctor immediately. They can help you refresh your memory on the proper fitting techniques or advise you to get a different type of stoma bag that may be easier to work with.
How long does post-operative stoma pain last?
Pain and discomfort levels may vary from person to person; some may experience pain over a few days, while others will take a week or so before the pain subsides. We advise that you speak to your doctor if the pain does not seem to be subsiding a few days after surgery or if it is unbearable.
What foods are known to cause gassiness?
Some examples are broccoli, cabbage, onions, cauliflower, beans, peas, and asparagus. If some of these are your favourites, you can still have them in small quantities or for home meals.
Is it normal if my stoma changes colour?
A healthy stoma looks pinkish-red and is moist to the touch due to the mucous lining, but if it seems to have changed to a darker colour, you should seek medical attention immediately.