Looking After A Stoma
Everyone is different, and we will all have different ways of looking after a stoma. These are the notes that are relevant to me.
Emptying a bag.
Us people with Stoma's have strong stomachs - we need to - as the smell that comes from a bag comes from Satan's bottom himself. Not very pleasant.
You should empty a bag if possible when it is about a third full - the contents are often very watery, and the last thing you will want is a leak, which trust me, is nasty!.
There are several different types and styles of bags on the market - but I will only concentrate on drainable ones here as these (in my opinion), offer more flexibility.
Most of the drainable bags come with a velcro connector - so it is simply a case of disconnecting the velcro whilst the bag is hanging over the loo (or else watch your feet), and pouring the contents down the toilet, watching out for splash backs (I speak from experience!).
I have found it easier to kneel on the floor and hang the pouch over the toilet rim before putting some toilet paper into the bowl - I do this as the contents are sometimes very "sticky", and tend to cling to the bowl. They also "stain" very easily.
Have some soft wipes and a wet wipe handy - they will help you clean up the bag exit slots. Once the bag is empty and you have cleaned up, fold the ends of the pouch again until the velcro snaps into place.
Changing a bag.
There are two distinctly different types of bag on the market - one piece and two piece - both have advantages and disadvantages over each over.
- One piece - the advantage of a one piece is that it is self contained - stick it on, and leave it until it requires emptying. The largest disadvantage is that you have to remove the entire bag to change it.
- Two piece - a two piece bag has the advantage of allowing you to change the bag whenever you wish without having to unstick the old one first. The bag comes in two parts - a base plate, and the bag itself. The base plate adheres to your body, and the bag clips onto that. Unclip a bag and clip a new one in place, - simple!. The base plate can remain on your body for several days. In my opinion, a two piece system weighs more.
Obvious, but empty the bag first!
I have found it easier to remove the old pouch using a adhesive remover spray - this dissolves the glue holding the bag on the body, and is a less painful way of removing than just warm soapy water! Spray a tiny bit onto the flange of the pouch and pull it away gently from the skin. You will find that once removed, remnants of glue may remain on the skin. If this is the case, they also supply adhesive remover in wipe form!
Using a combination of wet and dry wipes, clean the stoma of excrement that covers it, and take time and care to include the area around the stoma itself.
I used to use a barrier wipe - this is basically a wet wipe that puts a thin layer of cream against your skin to protect you against the burn of excrement, but nowadays, I use a stoma cap - this covers the stoma and close skin and also protects it. Either way, apply cap/wipe. Leave for a minute or two to dry. Peel off the protective paper from the flange, then place the stoma through the hole in the flange, pressing firmly against the skin to help adhesion.
That's it for one piece, but remember to seal the bottom of the bag using the velcro, otherwise your shoes will get dirty!
Depending on which manufacturer you are using, simply unclip the bag from the flange - then dispose of the bag in the clinical waste bag (you do have a clinical waste collection?). The flange will stay on the skin.
Cleaning around the stoma is a little more trickier with the flange attached, but using wet and dry wipes, clean the stoma gently. I have found it easier to clean the inside edges of the flange with a cotton bud.
Once clean, snap on a new bag, and as before, remember to seal the bottom!
If replacing the flange as well, follow the method described for one piece bags.
There are many accessories on the market today that can help an Ostomist - some are available free on the NHS (for those of us in the UK), others not. The few items I have here are part of a huge list, but I have only included items I use on a regular basis.
- Medical Adhesive Removers (sprays and wipes).
- Thickening gels.
- Ostomy Deodorant spray.
- Skin barrier wipes / caps.
- Stoma cap (for use in bath).
- Ostomy belt (for use with cap).
- Bag covers.
- Sharp curved scissors (unless bags are pre-cut).
So, how do these help ? .....
- Medical Adhesive Removers - the bag adheres to the skin very well, and it is sometimes uncomfortable to remove (you have to peel it off) - the remover dissolves the glue, making bag removal painless.
- Thickening gels - sometimes the content of your bag is very runny - effectively watery. Use one sachet of this gel to thicken the contents - it has the added bonus of making leaks less likely.
- Ostomy Deodorant spray - there are times when you empty your bag, and smell is just awful. It is natural, but us Ostomists get it worse!. A couple of sprays into a clean empty bag will help stop your eyes watering!.
- Skin Barrier Wipes / Caps - Getting excrement on your skin is not a good idea - it can and does cause sores. Once you have cleaned your stoma and the associated skin around it, use a barrier wipe on the skin to help prevent these sores appearing. Once dried, it does not prevent adhesion - but allow a minute or two for the cream to dry. A stoma cap is a thin plastic cap that fits over the stoma and presses against the skin - thus making it impossible for excrement to touch your skin.
- Stoma cap - this is similar in size and shape to a deodorant cap, and is just that - a cap that covers your stoma, and thus allows you to have a bag/shower without your bag on. I have found them useful, but with a limited timescale. If you don't rush, you may find that the stoma is very active, and has filled the cap very quickly, to the point of overflowing!.
- Ostomy Belt - to allow the cap (as above) to hold onto your body.
- Bag covers - these cover the bags, so they are not so scary looking, and are available in a multitude of shades, patterns or colours.
- Sharp curved scissors - not really needed as most delivery firms will cut the bags to your size for you, but they allow the bag to be cut to the size of your stoma.
Now you have a stoma, you may find (as I have) that some foods that were previously inaccessible are now available. However, you need to be aware that some foods can now cause you problems. These are ...
Foods that can cause excess wind
- Beans & Pulses
- Fizzy Drinks
Foods that may loosen stools
- Raw Vegetables
- Green Leafy Vegetables
- Fresh Fruits
- Fried Foods
Foods that can thicken stools
- Boiled Rice
- Peanut Butter
- Apple Sauce
Foods that can cause nasty smells
- Baked Beans
- Green vegetables
Foods that can help control smells
- Tomato Juice
- Orange Juice
Foods that may pass through undigested
- Chinese Vegetables
- Coconut Skins
- Raw Coconut
- Raisins (and other dried fruits)
Potassium And Sodium
These two minerals are lost every day with the fluids that appear in your bag - you can help replace these by eating one of the following foods that are high in potassium .....
- Brussels Sprouts
and these are high in Sodium .....
- Peanut Butter
- Salad Dressings
- Tomato Juice
The main thing is that all this is trial and error - everyone is different, and some people have higher tolerances than others. Also, you must remember to chew your food well, so that is broken down into smaller pieces. This helps the digestion and allows your body to absorb as much goodness as is possible.
Also, as you no longer have a large intestine, you must drink a great deal more to compensate. Two litres a day is considered average.