Expert Advice for Stoma Care

What is a Stoma?
A Stoma is an opening in the stomach that is connected to the digestive or urinary system that allows faeces or urine to pass out of the body. The stoma is covered by a pouch which collects this waste. There are three main types of stoma: colostomy, ileostomy and urostomy. A stoma is the result of an operation to remove a disease such as cancer, Crohn’s disease, diverticulitis or from obstruction or injury to the digestive or urinary system.
An ostomy pouch collects waste in a secure, discreet and convenient way. If fitted properly, the pouch will not be noticeable to friends and family unless you share with them that you are wearing one. Pouches are made from an odour resistant material and the type of stoma you have will determine the frequency you will need to change the pouch. Ostomy pouches can be a closed pouch or a drainable pouch. The type of stoma you have will determine the pouch that is used in your treatment.

The output from your stoma can sometimes cause irritation to the skin surrounding the opening. This is why skin care is vital to caring for your stoma to help prevent discomfort. Regularly cleaning the area with mild soap and water, using barrier creams or using pouch removal sprays help protect the skin surrounding the stoma. If your skin is red, sore and moist, maybe even bleeding a little, but you have not had any leakage, the issue could be 'mechanical'. That means your skin is simply being irritated from removing the pouch too often, too vigorously, or from cleaning or scrubbing the skin to roughly.
To avoid mechanical irritation, try to be as gentle as possible, both when removing your adhesive baseplate and when cleaning the skin. Try to peel the plate off slowly, rather than ripping or tearing off. Using the other hand to hold the skin tight can help reduce stress on the skin. Adhesive removers may also help when removing the appliance.

Tips to keep your skin healthy:

• Make sure your skin is clean and completely dry before applying the adhesive
• Adjust the hole in the adhesive so that is exactly fits around your stoma.
• Make sure that there is full contact between the adhesive and your skin -use a bit of light pressure with you hand
• Change your appliance as soon as you feel any discomfort or itching
• Check the size of the stoma regularly, especially if you have a hernia
• Make sure to use the stoma appliance and accessories most appropriate for your body profile

Diet.
A special diet is not necessary when you have a stoma but you may find that certain foods might cause wind or just not suit you. Keeping a food diary in the first few months after your surgery can help to adjust to having a stoma. If you feel certain foods are causing issues try cutting them out of your diet for a time before reintroducing them to see if the issue reoccurs. Be sure to keep you diet balanced when cutting out foods, it is important to have a balanced diet!

Food guide for ostomy patients:

Chewing your food well before swallowing can aid digestion and the amount of fluids you drink can affect the consistency of your output. Fizzy drinks and beers tends to cause wind in some patients. Alcohol is fine to drink but be sure to check it doesn’t interact with you medications with your doctor or pharmacist. Water, squash and fruit juices are generally well tolerated by ostomy patients, where as teas and coffee can be dehydrating.
Dining out and socialising can seem daunting at first after a stoma operation. It can be helpful to start with small targets such as using a public toilet for the first time or planning a day away. When dining out keep your order simple- rich foods and sauces may sometimes cause problems. It may be best to try new foods at home first and gradually add them to your diet before ordering them out in a restaurant.

Changes in bowel movement.
Everyone’s bowel movements are individual to themselves, normal for you may not be normal to someone else. Constipation (not passing stools regularly) and diarrhoea (loose stools) can affect you in a similar way you may have suffered before your surgery. Changes to your diet or increasing your fluid intake can help with constipation. If you do not get relief after a couple of days your doctor or pharmacist might recommend a laxative to help relieve your symptoms. If you are suffering with diarrhoea be sure to keep hydrated. Most cases will resolve itself in a timely manner but if symptoms persist seek advice from a healthcare professional.
Medication Tip! A liquid or dispersible tablet is preferable medication form as capsules can pass through the gut too quickly to be absorbed. In general liquids and non-coated tablets are better choices for ostomy patients as they will absorb better in the body.

Intimacy.
Any operation can affect how you look and feel about your body, know that it will take time to adjust to your new normal. Sexual activity doesn’t put you at risk of damaging your stoma and you will be able to resume a healthy sex life. It is natural to feel nervous, so it is important to do what feels comfortable to you. Be sure to discuss your worries and concerns with your partner. There are smaller stoma pouches that can be used during intimate moments.

Travel.
Travelling with a stoma may seem daunting but with a little preparation the world is your oyster!
Make sure to order enough supplies to last your entire trip, and carrying the supplies in your hand luggage avoids missing baggage issues. A letter from your GP to the airline to explain the need for you to carry your supplies can help with baggage hassles. Don’t forget to carry medications such as oral rehydration salts and diarrhoea relief in case you need them while abroad.  If you cut your bags to size, you should precut the bags before you travel as scissors are not allowed in your hand luggage!
Sometimes your ostomy bag can show up on a full body scanner. A travel certificate which can be obtained from your ostomy supplier or your doctor’s letter can be used to explain what an ostomy bag is to security staff at the airport. Security should not ask you to remove clothing to expose it or let them touch it. You may be asked to rub your hand against the pouch on the outside of your clothes, but that should be the extent of the examination.
During air travel, gases in the bowel will expand because of the reduced air pressure. This might cause your bag to balloon and so it would help to avoid gas producing foods and drinks while travelling such as fizzy drinks. If this does happen, all you need to do is go into the bathroom and remove the air. Booking a seat near the bathroom can make your trip a little easier too!
If you are heading to a warm climate you may perspire more than usual. This could cause  your pouch to lose adhesion and you may need to change the bag more frequently. Make sure your skin is completely dry before applying the bag and apply your sunscreen after you attach your pouch as the lotion can also affect adhesion. Be sure to store your ostomy products in a cool, dry area to ensure the heat doesn’t damage the products.
When going for a swim, make sure you have allowed for enough time for the barrier to stick properly. The water can reduce the adhesion of the product so your bag might have to be changed more frequently. Accessories such as elastic tape can help to keep the bag in place more securely.

Common issues that can occur.
Ballooning: When you swallow food or water, you also swallow a certain amount of air. Most stoma pouches have charcoal filters built into the bag. These allow the wind to be released. However, if the filter capacity cannot handle the amount of wind produced, or if the filter has become wet or blocked by the stoma output, ballooning can occur.
To help prevent or reduce the occurrence of ballooning eat regular meals during the day and try not to rush your meals. Be sure to chew food thoroughly and sip drinks. Eating live yoghurt or taking probiotics can help to balance the bacteria in your digestive system and reduce wind.
If ballooning does occur, you can release the gas from the pouch in the privacy of a toilet, if you use an open bag or use a two-piece system. Changing the pouch if the filter blocks can also help prevent ballooning. If the contents of your bag has soaked the filter you may need to change the bag more often. Sometimes the filter can get wet while swimming or showering. If this happens try covering it with a filter cover which is found in your box of bags.
Pancaking: Pancaking happens when there is a vacuum in the stoma bag and the bag sticks together. This stops the output from dropping to the bottom of the bag and can block the filter. There is then a risk that the pouch will be pushed off the abdomen. To help prevent pancaking you can blow air into the pouch before putting it on which helps to prevent a vacuum occuring. In addition, a drop of oil or lubricant in the pouch will help the output to get to the bottom of the bag.
Skin irritation: Skin irritation around your stoma is usually caused by leakage from your ostomy pouch and the output from your stoma getting underneath the adhesive and onto your skin. It is uncomfortable and can stop your pouch from working well.
The skin around your stoma should look similar to the skin on the rest of your body. Immediately after you take off the adhesive, it may be a little pink, but if this doesn’t fade or if the skin is broken or damaged, your skin may be irritated.
If your skin is red and ‘pimply’ it could be caused by an infection of the hair follicles around your stoma. This can occur if you shave the hair in the area around your stoma too often or incorrectly, or if you tear off the adhesive plate tearing out the hair as well. Using a scissors or electric razor generally will be gentler on the skin rather than a razor.
If your  skin is wet and ‘bumpy’ with itchy red or purple rashes or with a white substance over the affected areas you might be suffering from a fungal infection. Patients with a diagnosis of diabetes or a lowered immune system are particularly at risk. Prevention is key to preventing fungal infections which thrive in warm moist areas. Keeping the peristomal skin (skin around your stoma) clean and dry when changing your pouch helps to prevent fungal infections
If you skin is bleeding examine the source carefully. A little bleeding can sometimes be normal as the stoma tissue can bleed quite easily. This is similar to your gums when you brush or floss. If the bleeding is from around your stoma it may be a contact reaction. This may require treatment or preventative measures, so in this instance you should seek medical advice.

Further information.
This is a list of websites that provided the information in this article and has further information you may find beneficial. If you have any queries or questions do not hesitate to contact your local Pharmacy, Doctor or Stoma Nurse specialist.
Coloplast website: https://www.coloplast.ie/stoma/ostomy-appliance-users/before-stoma-surgery/
Convatec website: https://www.convatec.ie/stoma-care/#
Hollister website: https://www.hollister.ie/en-ie/ostomycare/educationaltools
HSE website: https://www.hse.ie/eng/health/az/i/ileostomy/
Stoma Association Ireland: https://stoma.ie/
Irish Cancer Society: https://www.cancer.ie/cancer-information-and-support/cancer-information/cancer-treatments-and-side-effects/coping-with-side-effects/stomas