Digestive and urinary stomas

A stoma is a surgically created opening in the abdomen to evacuate stool or urine. The intestine or a part of the urinary tract is connected to this opening.

Some stomas are temporary while others are permanent. Among others, they may be required for the following reasons:

• In the event of a bowel or urinary tract disease (e.g., cancer, inflammatory bowel diseases, abscesses)
• To give part of the intestine a chance to rest
• Following an accident or trauma to the intestine or urinary tract
• Following the removal of part of the intestine or urinary tract

There are many types of digestive stomas. They are classified based on the portion of the digestive tract that is diverted out of the body. The two most common stomas are the colostomy (in the large intestine) and the ileostomy (in the small intestine). The size of the stoma will vary from person to person, but is usually a few centimetres wide.

A urinary stoma is also called a urostomy. Different types of urostomies exist depending on how they are created.

The stoma appliance

The stoma appliance is used to collect the output from the stoma. It is comprised of the following elements:

• A pouch to collect the digestive waste or urine
• An adhesive barrier to hold the pouch in place and protect the skin around the stoma.

There are a variety of stoma systems available. Some devices come in a single piece, meaning the pouch is attached to the adhesive barrier. Others are known as two-piece appliances. These are made up of a separate removable pouch and an adhesive barrier. The ring that connects the pouch and the adhesive barrier is called a flange.

Your health care provider may recommend a specific device for you. Here are a few features of existing pouches:

• Some pouches can be emptied while others can only be changed
• Several sizes and colours are available (e.g., clear or opaque)
• Some pouches come with accessories for enhanced comfort

Skin moisturizers (i.e., creams or pastes) and cleansing pads can also be purchased at the pharmacy.

Caring for your stoma

A healthy stoma should be shiny, wet, and pink or red in colour. It should never be black or blue. It may bleed slightly when you clean it; this is not a cause for concern.

When caring for your stoma, follow the instructions you were given at the hospital. Remember the following key principles:

• Clean the stoma and the surrounding skin daily using a cloth and warm water (with or without mild soap)
• When cleaning the area, do not use alcohol or other products not intended for stoma care (e.g., disinfectant wipes or baby wipes)
• Gently pat the skin dry or let it air dry
• Empty the pouch when it is one-third full
• Change the pouch once or twice a week, if necessary
• Never flush the pouches down the toilet

Some stomas will require irrigation to regulate stool frequency. This involves removing fecal matter by introducing water into the intestine through the stoma. This stimulates the intestines to move the stool forward and thus evacuate it. Your health care provider will explain the procedure to you if needed.

What to eat after an ostomy

Most people with a stoma can eat the same foods as they did before. However, some people may want to make certain changes to their diet to counteract unpleasant issues such as odour and gas. It's best to talk to a nutritionist before changing your diet.

Some stomas will also impact the absorption of water and certain salts (e.g., sodium, potassium). Accordingly, it's particularly important to drink more water and electrolytes during exercise or in hot weather.

Dealing with complications

Some people have issues with the pouch adhering to the stoma and may experience leaks. If this happens to you, make sure to take the following precautions:

• Ensure the skin is completely dry before applying the adhesive
• Change the adhesive barrier regularly (once or twice a week)
• Use an adhesive reinforcement if the pouch only detaches in particular situations (e.g., during a physical activity)
• Make sure the adhesive barrier is of an adequate size (depending on the size of the stoma)
• Consider using products to promote adhesion (e.g., Skin-Prep)

Some people may have trouble with their pouch ballooning. This often occurs due to digestive gas. The best solution is to avoid ingesting drinks and foods that generate a lot of gas (e.g., carbonated drinks). A nutritionist can also advise you if you have other digestive problems such as constipation or diarrhea.

When you have a stoma, it's also important to keep an eye out for infections. This is because stomas are moist environments that are conducive to infection. Maintaining good pouch and skin barrier hygiene is essential to prevent this type of complication.

Allergic skin reactions can also arise when using certain adhesives and other stoma products. In such cases, you may experience itching or a skin rash. Talk to your health care provider if this happens to you.

Living with a stoma

It's important to resume your normal life after an ostomy. Your health care team will help you adjust your daily routine. You should never hesitate to ask a health care professional for help if you are experiencing physical or psychological problems related to your stoma.

After an ostomy, digestion and medication absorption can change. Talk to your pharmacist about any prescription or over-the-counter medications and natural health products you are taking. It's not uncommon for adjustments to be required.

Here are a few tips for living with a stoma:

Baths and showers

You can wash with or without the pouch, depending on your preference.

Clothing

The stoma appliance is adapted to ensure you'll be able to wear the same clothes as before your ostomy.

Physical activity

You can still practise most sports with a stoma. However, you should avoid playing contact sports or lifting very heavy weights.

Sex

Sexual intercourse cannot damage your stoma. You can also get specialized undergarments to help keep the stoma in place or cover it.

Travel

You can absolutely travel with a stoma. However, you'll want to avoid exposing the appliance to extreme temperatures. You should also plan to bring more supplies than you think you will need. When travelling by plane, keep your supplies with you, in your carry-on.

When should I see a health care professional?

Speak with your health care provider if you experience any of the following symptoms:

• Significant bleeding around the stoma
• Signs of infection, such as redness, heat, swelling, fever, or pus
• Persistent problems with digestion (e.g., constipation, diarrhea)
• An abnormal change in the stoma or the surrounding skin (e.g., a lump, retraction of the stoma)
• Signs of dehydration: infrequent urination, dark urine, constant thirst and dizziness
• Significant stomach pain

For more information:

• Ostomy Canada Society