Some people with Inflammatory Bowel Disease (IBD) may require ostomy surgery to create a temporary or permanent opening (stoma) from an area inside the body to the outside. This may be needed for a variety of reasons, such as fistula, colorectal cancer or perforation.
An Ileostomy is a surgically created opening that redirects from the ileum, the last part of the small intestine, to the skin of the abdominal wall. On the other hand, a Colostomy is a surgically created opening redirecting from the colon, or large intestine, to the skin of the abdominal wall.
What is stoma?
Stoma is a medical word for “opening”. Through surgery, an opening is created as a way for bowel movements to leave the body, rather than through the anus. A bag is attached to the opening on the body surface. Bowel movements will exit through the stoma into a bag.
Why would I need a stoma?
Part of the bowel may be removed if you have:
- Complications such as stricture, a narrowing of the part of the bowel causing obstruction, pus-filled area in the bowel wall, or a perforated bowel
- Severe IBD that is not responding to medical treatment
- Cancer in the bowel
- High risk of cancer in the bowel
How should I manage my stoma?
A special nurse (Ostomy nurse) will show you how to care for stoma, including:
- How and when to empty the bag
- How and when to change the bag
- How to check for problems
There are different kinds of bags available. Some you throw out after each use, while others you empty, clean and reuse.
Do I need to change my diet or follow a special diet?
There is no need to follow a special diet, but you can start with foods that are easy to digest. It is easier to eat 5-6 smaller meals a day. Gradually increase the amount of fiber and fluids you consume to avoid getting constipated. The foods that you eat can affect the consistency and odor of the bowel movements.
Please follow the nurse or doctor’s instructions regarding eating or avoiding certain foods.
General guidelines of the effects of some of the foods after ostomy surgery
| Foods that are gas producing | Cabbages, turnips, kale, carbonated beverages, soy, dairy products, chewing gum, nuts, radishes, onions, beans, arugula |
| Foods that are odor producing | Garlic, onions, peanuts, cod liver oil, broccoli, baked beans, asparagus, strong cheese |
| Foods that cause color changes | Food coloring, beets, asparagus, iron supplements, Jello, licorice, strawberries, tomato sauce |
| Foods that make bowel movements looser | Raw vegetables, fresh fruits, spicy foods, green beans, broccoli, beer, green leafy vegetables, chocolate, spinach, prunes |
| Foods that make bowel movements thicker | Peanut butter, boiled milk, applesauce, bananas, cheese, marshmallows, toast, pretzels, rice, bread, pasta, yogurt, tapioca |
What problems or symptoms indicate that I should talk to the doctor or nurse?
- Rash or sores around the stoma
- A bulge under or next to the stoma
- Sudden belly pain, cramps or nausea
- Much diarrhea coming out of the stoma, and symptoms of dehydration such as dizziness, fatigue or confused. You may also not produce as much urine, or have dark yellow urine
- Stoma appears swollen or larger than usual
- Stoma appears smaller than usual
- Your insides stick out through the stoma more than usual
- No bowel movement for 4-6 hours, meaning your stoma may be blocked
What effect will stoma have on medicines?
The body does not always absorb medications as usual in people with stoma. Talk to your doctor, and try to use liquid medicines instead of pills. Do not take pills labeled “enteric coated”, “time release”, or “extended release.” Absorption may be affected with these types of pills.
Common worries of stoma patients:
The bag will leak or smell?
- The bags are designed to not leak or smell.
Will it be noisy?
- To reduce wind and noise, try avoiding certain foods and fizzy drinks such as beans, cheese, broccoli and beer. Also, avoid smoking, drinking through straws, and chewing gum, as these can increase the amount of air going into the bag.
- Physical activity can also help.
Will other people notice the bag under the clothes?
- You do not need to wear special clothes. People will not see the bag under your clothes.
Will I be able to take a bath or shower?
- You can take a shower or bath, with or without your bag on.
Can I go swimming?
- Swimming is not a problem with your bag. Be sure to empty your bag beforehand.
What extra precautions do I need to take while travelling?
You may want to take extra stoma supplies while travelling. If you are flying, be sure to divide the stoma supplies between your hand luggage and main luggage in case of loss or delays.
Will stoma affect my sex life?
It may take some time for you and your partner to get used to the stoma, but gradually you will adjust together. It should not be in the way if the stoma bag is attached properly. You can wear a special belt to protect and keep the bag in place. Because of the stoma, you may no longer have symptoms, which can improve your overall sex life.
Will I be able to play sports?
You will likely be able to play most sports. Doctors usually recommend avoiding contact sports, such as football or weightlifting.
Having a stoma is a big change, and may bring up many emotions. You may feel that you have lost control over your body, or feel relieved you no longer have IBD symptoms. The stoma can also affect how you feel about your body and how you see yourself. Ask for support from your family, friends or a counselor. Joining a support group for people with a colostomy can help. Living with a stoma should not detract from enjoying a fulfilling and adventurous life.
