Knowing how to care for and clean your stoma is essential for both physical and mental wellbeing. Effective stoma management promotes a sense of control and independence, contributing to overall health and confidence. Connecting with other ostomates can also provide valuable support and shared experiences, benefiting psychological wellbeing.
Caring for your stoma requires a holistic approach, encompassing both practical aspects like cleaning and broader considerations such as diet. Managing your diet helps prevent complications like constipation or diarrhoea, leading to a healthy and stable output, which is vital for the stoma site, physical health and mental wellbeing. The peristomal skin is vulnerable to breakdown and needs meticulous care through proper cleaning and aseptic bag changes. Maintaining the skin barrier is key to preventing complications like infection. Maria and Lieske (2023) emphasise the importance of mental health management in fostering acceptance of your stoma and motivation for self-care. Allow yourself time to adjust and remember that your stoma nurse can provide referrals for counselling and other support services.
Cleaning the skin and changing the bag
Let’s begin with the practical side of cleaning your stoma and changing your bag, before discussing good nutrition and avoiding complications.
What you will need
- Water
- Soft wipes (or unfragranced wet wipes)
- Clean scissors
- A new bag
- Plastic disposal sack
- Your preferred accessories (Colostomy UK, 2024a)
- Medical adhesive remover (available on prescription).
Step-by-step guide
- Tuck tissues or dry wipes around your waist to protect your clothes from any spillage
- Wash your hands thoroughly
- Cut the stoma bag to the correct size using scissors. Alternatively, your home delivery company can pre-cut bags for you, if applicable (Bladder & Bowel Community, 2024)
- Gently remove the old bag, starting from the top and working down to the bottom of the flange. Keep the skin taut while peeling the bag away, using the adhesive remover to spray the skin beneath as you go. Place tissues or wipes underneath to manage any spillage
- Dispose of the old bag in the disposal sack
- Clean the skin gently using dry wipes soaked in warm water or unfragranced wet wipes if you’re out and about. Pat the skin dry; avoid rubbing
- Dispose of used wipes in the disposal sack
- Assess your stoma for any changes that should be reported to your stoma nurse. A healthy stoma should be moist, above skin level and pink to red in colour. The surrounding skin should appear normal, without irritation or breaks (Maria and Lieske, 2024)
- If recommended by your stoma nurse, apply any barrier rings, sprays or pastes. Allow the area to dry completely
- Fold back the new bag, aligning the hole with your stoma. Starting from the bottom, roll the bag over the stoma while peeling off the paper backing. This ensures a secure fit and minimises leakage
- Hold the bag in place for 1 to 2 minutes to ensure a good seal (Maria and Lieske, 2024)
- If using a two-piece system, clip the bag to the flange. Attach the belt to the flange if you use one
- Tie the disposal sack and place it in your regular bin. Wash your hands thoroughly.
Remember: Your stoma nurse is a valuable resource for any questions or concerns you may have about stoma care.
To minimise risk of infection and other issues, such as odour or perforation, the bag should be changed every 5 to 7 days. If you notice any breakdown of the skin, irritation or a change in the appearance of the stoma, contact your stoma nurse for advice so they can check it and prescribe anything as required or make any referrals that are needed (Maria and Lieske, 2024). This can minimise the risk of any developing complications that are developing such as skin problems or infection. Being proactive rather than reactive is always the best way.
Eating, drinking and managing the associated complications
Another essential part in caring for the stoma is managing your diet to avoid uncomfortable problems such as wind, diarrhoea or constipation.
It is important to keep your diet balanced eating little and often (six to eight small meals a day may help rather than larger less frequent meals), and to drink enough water (six to eight glasses a day) (Bowel cancer UK, 2024).
Ileostomies
If you have just had an ileostomy, you may benefit from a low fibre diet, which you could discuss with your stoma nurse. This would involve avoiding fruit apart from bananas, which help to thicken the output unlike other fruits, and you then can gradually re-introduce fruit, for example adding stewed apple to your diet. By the eighth week post op you will be able to eat a larger range of foods.
To avoid stoma blockage, chew your food slowly and remove any skins or seeds. Avoid small, hard foods such as nuts, sweetcorn or raisins, as these can increase the risk of blockage. Instead, consider crushing or creaming these types of foods, as recommended by Bowel Cancer UK (2024).
Report any increased output from the ileostomy to your stoma nurse as it may be a sign of infection. It may also be caused by eating spicy food or drinking alcohol, in particular beer or lager (Bowel Cancer UK, 2024). When you have looser stools like this, it is important to replace the electrolytes you have lost. It is a good idea to add salt to your meals to help replace what has been lost but if you have high blood pressure, heart problems or renal problems check with your specialist if this is OK.
Keep a note of when you have a higher output and what you ate beforehand. You will get used to what foods increase output and therefore what foods to cut down on or replace.
It is always a good idea to avoid drinking alcohol or caffeine, as this will also increase output.
Bowel Cancer UK (2024) advises to thicken the stoma output by eating carbohydrate-dense foods such as bread, rice, potatoes, pasta, crackers, oats and smooth nut butters.
If high output persists you are at risk of dehydration. You may feel fatigued and notice your urine turns a darker yellow.
Tell your stoma care specialist nurse if you have increased output over a long period of time, feel thirsty or faint, or have dark yellow urine. These can be signs of a high-output stoma, which can cause dehydration. If your ileostomy stops working, you may have a blockage. This can cause pain in your stomach area (abdomen) and you may feel sick. Contact your stoma care specialist nurse for advice.
If your output is very low, you may have a blockage. Other signs of this include abdominal pain and nausea. The Bowel Cancer UK (2024) charity states your stoma nurse may then advise to increase fluid intake, stop eating solids, avoid use of laxatives, increase the stoma opening if there is swelling, massage your abdomen, and recommend warm baths to ease discomfort. The nurse may want you to go to A&E if you haven’t had any output of poo or wind from the ileostomy for more than 6 hours.
You must go to A&E immediately if you have severe abdominal pain, distension (bloating) and vomiting as a blockage requires urgent treatment.
Colostomies
Constipation or diarrhoea experienced before the colostomy may persist, and it is crucial to manage these to prevent complications like blockage or high output.
The dietary advice for colostomies is generally similar to that for ileostomies, with one key difference: you will likely tolerate fruit better. Bowel Cancer UK (2024) recommends consuming five portions of fruit and vegetables daily.
Be aware of potential complications and notify your stoma nurse if you experience watery stool, infrequent bowel movements, abdominal cramps, bloating, nausea, vomiting or a swollen colostomy (Bowel Cancer UK, 2024).
Wind, constipation and diarrhoea
Colostomy UK (2024b) explain that there is a certain type of sugar and starch found in beans, peas, onions, leeks, unripe banana and potato that can ‘escape digestion’, entering the colon where they ferment, producing gas. These may be worth avoiding this unpleasant side effect. Artificial sweeteners and fizzy drinks also increase wind. You may need a dietitian if you are diabetic. Another factor they note is if you eat quickly, at irregular times or after a long period without food. It is important to have a routine you stick to, without any fasting periods.
As mentioned earlier, spicy food and large amounts of lager or beer can irritate the lining of the bowels and cause diarrhoea. As advised earlier, combining with stodgier foods may decrease this potential problem. Another word of caution is with regard to pure fruit juices, which may cause diarrhoea. Artificial sweetener is in many foods and drinks and can also cause wind and diarrhoea, according to Colostomy UK (2024b). It is also important to note that diarrhoea may be the result of emotional distress or a stomach bug. It is important to manage your stress and mental health in order to decrease the issue of any complications such as this with your stoma, which may in itself worsen your mental health. Ask your stoma nurse about counselling if you feel this may help.
Constipation can be managed with a higher fibre intake. Choose whole-meal bread and pasta over white varieties, opt for whole-grain cereals like porridge, and ensure you drink plenty of water. Water combines with fibre to soften stools, aiding their passage. Regular exercise can also help alleviate constipation. Consult your nurse or pharmacist about the potential side effects of any medications you are taking, as many can contribute to constipation.
Conclusions
Effective stoma care is vital for maintaining your physical and mental wellbeing. Following the essential steps for cleaning and changing your stoma bag,
with a focus on gentle cleansing and proper technique to protect the peristomal skin, will contribute to good stoma health. Additionally, managing your diet effectively helps prevent complications like constipation and diarrhoea.
Remember, your stoma nurse is a valuable partner in your care journey. Don’t hesitate to reach out to them with any questions or concerns. By actively participating in your stoma care and adopting a holistic approach that encompasses both physical and emotional wellbeing, you can live a fulfilling life with your stoma.
References
Bladder & Bowel Community. Changing the stoma bag. 2024. https://tinyurl.com/3mmmv9b9 (accessed 14 August 2024)
Bowel Cancer UK. Stomas. 2024. https://tinyurl.com/29brjrps (accessed 14 August 2024)
Colostomy UK. Changing a stoma bag. 2024a https://tinyurl.com/5923b7nf (accessed 15 August 2024)_
Colostomy UK. Wind, diarrhoea and constipation. 2024b. https://tinyurl.com/2n2tta5p (accessed 14 August 2024)
Maria A, Lieske B. Colostomy care. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024
United Ostomy Associations of America. Emotional issues. https://tinyurl.com/25n9mm2y (accessed 14 August 2024)