Stoma care

Sometimes, during surgery, it may be necessary for the surgeon to form a 'stoma' on the wall of your abdomen. The stoma may be temporary (to allow the bowel time to heal) or permanent.

What is a stoma?

A stoma (from the Greek word for 'mouth') is an artificial opening on your abdomen to collect waste. There are different types of stoma and, if you need one, the type you have depends on the location of your tumour and the type of surgery you need.

Ileostomy

An ileostomy is a stoma formed by bringing the end or loop of small bowel (the ileum) out on to the surface of your abdomen. The intestinal waste passes out of the ileostomy and is collected in an external pouching system (generally known as an ileostomy bag). Ileostomies can be formed during surgery to allow the colon to rest and heal after surgery. Usually, following a period of 8 – 10 weeks, the ileostomy is reversed and you go back to using your bowels in the usual way.

Colostomy

A colostomy is a stoma formed by bringing part of your colon (large bowel) out on to the surface of your abdomen. The intestinal waste usually forms into soft lumps, having passed through the rest of the colon where water is re-absorbed. It then passes out of the colostomy and is collected in an external pouching system (generally known as a colostomy bag).  A temporary colostomy can be formed to divert the faeces away from the section of the colon which has been operated on.  A second operation is later carried out to reverse the stoma and allow the patient to resume a more normal bowel function.  Permanent colostomies need to be formed for some patients if the surgeon is unable to join the remaining ends of the bowel if your anus has been removed due to the location of the tumour.

Before surgery

Your doctor will tell you before surgery if you might need a stoma. It's not always possible to know 100% either way as the decision can sometimes only be made during the surgery, once he / she can see the tumour and what needs to be removed. If this is the case, you should also meet with the stoma care specialist nurse before your operation. He / she has the skills and expert training to support and manage patients who need a stoma. They will discuss with you where the stoma will be on your abdomen and answer any questions or concerns you have. They will also introduce you to the special bags and equipment you will need to manage the stoma afterwards.

Before your planned operation, the nurse specialist or the surgeon will carefully examine you and mark the exact site of the stoma on your abdomen with a marker pen, to make sure it is in exactly the right position for you to manage easily.

Managing your stoma after surgery

You will meet with the stoma care nurse again after your operation. They understand it can be very daunting at first and that learning to manage your stoma will take time and practice. No-one expects you to be an expert overnight. For the first few days, the stoma care nurse and the nurses on the ward will help you with your stoma.

As soon as you are well enough, the stoma care nurse will show you how to clean your stoma and how to change the bag. He/she will give you hints and tips on how to manage the stoma yourself at home. Simple, common sense advice will quickly help you to build your confidence, including how to be thoroughly prepared before you start changing the bag and have everything you need to hand in the bathroom. If it is appropriate, the nurse may also talk to you about irrigation as a method of managing your stoma (colostomies only) or other new techniques that may be useful.

The stoma nurse will also talk to you about the different types of appliances (bags) that are available as you become more accustomed to managing your stoma, as there are very many different types available, and it can take some trial and error to find which one might be best for you. You might wish to have a relative or friend with you while you are learning about your stoma,  in case you need help or support when you get home.

You may find it useful to talk to one (or more!) of our Patient Voices who have a stoma to hear their practical and personal experiences and how they have got used to living with their stoma. They may also have diet hints and tips which may be of help to you too - many of them can be found in our booklet 'Living with bowel cancer - eating well'

Louisa, our nurse answers your question "I have got a new stoma but I am passing mucus and feeling like I need to go to the toilet. Is that normal?"

Managing your stoma at home

When you are able to manage your stoma independently, and the specialist team are happy with you, you will be able to go home - with a plentiful supply of stoma bags. Once home, you will be able to order new supplies from your chemist, dispensing GP or a home delivery company. All stoma products are free, but require a prescription from your GP. You should also make sure you have the contact details of your stoma nurse and local district nurse in case you have any concerns or queries.

Louisa, our nurse, answers your question "The skin around my stoma (or on my bottom) is getting very red and sore. What can I do to make it better?"