What is Ostomy?
An ostomy is an artificial opening which is created by surgical procedure in the abdominal region to discharge body wastes. Ostomy can be permanent or temporary. Temporary ostomy allows the organ to heal whereas under permanent ostomy the organ is removed altogether.
There are three types of ostomies:
Ileostomy– A small opening is created in the small intestine, generally at the end of the ileum. The intestine is put through the abdominal wall to form a stoma. Ileostomies may be temporary or permanent, and may involve removal of all or a specified part of the colon.
Colostomy– An opening is created in the large intestine which results in a stoma. A colostomy is created when a part of the colon or the rectum is removed and the remaining colon is brought to the abdominal wall.
Urostomy– It is the surgical procedures in which urine is diverted away from a diseased or defective bladder. The ileal or cecal conduit procedure is the most common urostomy. A section at the end of the small bowel (ileum) or at the beginning of the large intestine (cecum) is surgically removed and relocated as a conduit for urine to pass from the kidneys to be discharged outside the body through a stoma.
How to Take Care of Stoma?
Once the surgery is performed, you can gradually return to your normal life, but it is important to care for your ostomy as well. Caring for your ostomy is not only necessary for health, but is important for maintaining quality of life. Ostomy care includes emptying your pouch when necessary, replacing your pouch system as needed, and skin care. Irrigating your colostomy is a good idea to control the flow when you eliminate waste. Irrigation requires the approval of your doctor and he or she provides the needed guidance. Vigilant hygiene helps prevent infection and ensures that your stoma functions properly.
Since an ostomy is a surgical procedure made necessary by an injured digestive system, a hole is made in the abdomen and the intestines are attached to the abdominal wall (the stoma) to facilitate waste disposal. The need to keep everything clean and infection free requires different supplies. Since there is no muscle around the stoma, you can’t control the waste or gas disposal. You will need pouch systems, barrier paste, skin wipes/powders to protect skin under the barrier and around the stoma, tape, and other medical supplies your healthcare provider may wish you to have.
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Ostomy Skin Care
People with ostomy often complain about infections and skin irritation from the stool, urine, or pouching system. It is important for ostomy patients to treat their skin gently and use the right ostomy products to decrease the chance of skin problems. Skin Paste In order to have a good seal around the stoma, a skin paste is applied in order for your system to work smoothly. The ostomy pastes act as fillers for uneven skin areas around the stoma in order to facilitate a better seal. The use of skin powders keeps moisture away from adhesives and the skin dry. It also reduces skin irritation. They also help with excoriated skin caused by adhesives. They are often applied by squeezing the bottle and puffing the powder onto the desired area for increased ease and convenience. Since colostomy/Ileostomy kits are attached via adhesives, it is important to remove those adhesives when changing your ostomy pouch kit.
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Ostomy- Diet and Nutrition
Having an ostomy should never stop you from having meals that you like. But you must be careful that the foods do not cause any medical problem. The first step is to always ask your doctor about the foods that are good for your health. One should take care of below points specifically:
- Regular and organized Eating
- Proper amount of liquids
- Avoid any blockages
- Chew your food well
- Take proper vitamins
- Try new dishes one at a time in small quantities
There are meals that are suitable for different types of ostomies:
Colostomy Meals– Water is of utmost importance and the consumption of at least 7 glasses of water in a day is a must. Fibers and fluid can be obtained from fruits and vegetables and one should eat good amounts of fruits every day. Don’t consume a lot of cereals and grams as they contain a lot of fiber. Avoid foods like eggs, beans, fish, alcohol, etc as these are gas producing foods and might create an embarrassing situation in public.
Ileostomy Meals– One should avoid high fiber foods after this surgery as the ileum is a narrow passage and these foods can cause blockages. Drink at least 6-8 glasses of water in a day. You should slowly increase the consumption of foods such as cereals, mushrooms, peas, nuts, etc. Always remember that different people react differently to different foods. Always consult your doctor if you notice pain or swelling around stoma.
Urostomy Meals– Usually, people who undergo a urostomy do not have to follow a strict diet, unless the doctor advises to do so. Urostomy patients should avoid foods like asparagus, eggs, fish, alcohol and onions which can produce a bad urine odor. Cranberry juice, buttermilk, parsley, and yogurt should be consumed to neutralize the bad odor.
Ostomy- Exercise and Fitness
One of the greatest benefits of exercise is the feel good factor. It will not only boost your confidence but also the ability to cope with your stoma and quality of life. Exercise is also important to avoid any post operative weight gain which could negatively affect the adherence of your ostomy pouch. Consult your physical therapist before beginning any exercise program, especially after surgery.
Walking– Walking is an excellent endurance exercise. It is an ideal choice and can be as gentle or brisk as you want. After your ostomy surgery it helps your bodily systems get moving and helps in recovery as well. Begin slowly and work up to a longer distance and at a brisker pace. Empty your ostomy pouch before you begin. Walking also helps reduce the possibility of constipation and is a great stress reducer. Before you begin, give some support to the pouch with support garments.
Jogging– Jogging is a great exercise and for this you do not have to change your current ostomy pouch. If comfort and security are major concerns, you could try a mini-pouch. Prefer wearing an ostomy belt to keep the appliance in place. It will also drastically reduce the bouncing. Drink water before, during, and after the jogging session.
Yoga– Yoga heals on cellular level, and deep breathing assists in rejuvenating cells. It will also improve your posture, strength, and flexibility. Ostomy patients can become dehydrated easily, so make sure you exercise with plenty of water. Low impact activities such as Yoga, Tai-Chi and Pilates are best to regain the muscle flexibility after ostomy surgery.
Gym– Avoid lifting any weights for at least 12 weeks after ostomy surgery. Start the session and target large muscles group like legs and upper torso. Go easy on yourself and do just a few repetitions. Take plenty of rest between sets. Keep yourself hydrated during workouts and eat well afterwards. Benefits will be visible if you are consistent. An Ostomy belt is a must in this situation to diminish risks of injuries and parastomal hernias.
Aqua Therapy– Your therapist may recommend aqua therapy. It can help strengthen and tone your lower body and larger core muscles. Just make sure if you are going to exercise in water, you should wear the appropriate appliance. You can use a waterproof tape which will stick even in water to help keep any ostomy appliance in place.
Intimacy and Ostomy
Many ostomy patients have doubts about intimacy and sex life after ostomy surgery. While there may be some restrictions after surgery, but the truth is there is not much to worry about. One of the biggest concerns is a return to healthy sex life after surgery. After you have accepted and adapted to new ways of doing things, you have already proven that you can achieve anything you desire. When it comes to the desire of companionship, romance, serious relationship, or social acceptance you have to take a step ahead. Being comfortable in your own skin can help your partner immensely. When you explain your surgery to your partner you do it in a manner that is clear and concise. Go easy on yourself. It is important to realize that ostomy does not change your ability to love and commit. People, who really care for you, understand this fact. It is always better to tell them in early stage of a relationship as the adverse reaction of a letdown is not as harsh as it might be later. Also it gives a good indication of the person’s real feelings and level of commitment.
To make the things easier in bed, you can wear brief with open crotch and built-in ostomy barrier support to safely tuck in ostomy pouch. These are available for both men and women.
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It is an understatement that any intimate moment can be ruined by anything unhygienic. Ostomy appliance cleaners and deodorizers are of great help. To help prevent leakage in ostomy pouches and make stomal fluids more manageable you can use absorbent gel packets that convert the stomal fluid into gel and eliminate pouch noise.
Travelling with Ostomy
There are a lot of things one has to be careful of while travelling with an ostomy. Go through the following list for complete preparation:
- Pre-cut all pouches at home, to avoid carrying scissors with you.
- Pack ostomy supplies in both carry-on and checked luggage.
- Carry extra supplies in case you are stranded and supplies are not available.
- Carry a statement from your physician that states that you might need ostomy supplies. Also carry a statement advocating a private area in case of an extended passenger search.
If you travel to a foreign country, it is recommended to have critical ostomy information written in their language. One of the 70 member associations of the International Ostomy Association (IOA) may be of help with this translation as well as with locating supplies while visiting their country.
In domestic flights within the United States, you are allowed to carry scissors in your carry-on luggage, as long as the cutting edge is shorter than 4 inches. Pointed metal scissors are banned from carry-on luggage worldwide. In the U.S., the Transportation Security Administration (TSA) declared in December 2005 that scissors with cutting edges up to 4 inches are allowed. Meanwhile, if you travel outside the U.S., you may face more severe restrictions on carrying scissors. Some countries allow regulated sized scissors while other countries may prohibit scissors in carry-on entirely. It s best to avoid scissors in your carry-on (you can always pack scissors in your checked luggage).
According to the rules, items such as liquids, gels, or aerosols must be carried in containers smaller than 100 mL (3.4 ounces), and you can carry only as many of these as fit comfortably into a single one-quart (one- litre) zip-top clear plastic bag. These rules are generally enforced worldwide. The most important ostomy supplies, such as pouches and barriers, are not liquids, gels or aerosols, so they aren’t subjected to these rules and you can carry as many as you want in your carry-on. But some related ostomy products do fall into the liquid-gel-aerosol category. If you need to carry a few of these on the airplane, it s usually easy to fit them into your zip-top plastic bag to comply with rules. If you need more of them, you can pack as many as you want in your checked luggage. Larger quantities of liquids-gels-aerosols which are medically necessary and must be carried on board the plane are allowed, but must be declared at the security checkpoint and require additional screening.
Dr. Haseena Hamdani, MBBS, DGO, PGD Endocrinology and Diabetes (USW) is a Gynaecologist, currently practicing in Gaborone, Botswana since last 17 years. Prior to setting up this clinic she has worked in India as well as in Zambia, as a Gynaecologist and Obstetrician and was also associated with an Infertility center. She is also an online tutor for University of South Wales.
Find her on LinkedIn