Discharge information for colostomy patients

What is a colostomy?

A Colostomy is a stoma created on the large bowel (or Colon). The surgeon makes a small incision, usually on the left side of the abdomen, and brings an area of bowel to the skin surface. The stool is therefore diverted into a pouch that sticks onto the abdomen, which your stoma nurses will have taught you to change. The Colostomy is naturally bright red in colour and will be swollen at first, taking a few weeks to shrink to its permanent size. Colostomies can be temporary or permanent depending on the type of surgery you have had.

It can be daunting at first to adjust to life with ileostomy, but given time and some support from those close to you and the stoma nurses, you will grow in confidence and be able to return to all aspects of your life that you enjoyed before your operation.

Care of your colostomy

During your stay in hospital, the stoma nurse will have taught you how to look after your stoma.

The pouch on your abdomen will need to be changed once or twice a day.  You may want to change your pouch last thing before going to bed and first thing in the morning.

Some people prefer to shower with the pouch off, but it is water proof so you could chose to shower with it on. It is best not to use soap or perfumed wipes as this may irritate the surrounding skin.

Disposal

Once you have changed your pouch, you can dispose of it in the rubbish bags provided and this can then go into you every day waste.

Supplies

You will be provided with stoma supplies to take home by your stoma nurse. There is sometimes a period of experimentation and adjustment at this stage before a decision is made regarding which pouch you will use going forward. When it has been decided, the stoma nurse will inform your GP of the prescription details. The pouches can then be delivered by a medical delivery company (details over leaf) or from the chemist. If you choose a medical delivery company the first order will arrive usually within 2 days of your Stoma Nurse registering you and placing the first order. Thereafter, when you need more stoma equipment, you can reorder yourself directly with the delivery company, either by phone or via their website. Please remember to give 2 weeks’ notice, which allows time for the delivery company to obtain a prescription from your GP (they can normally request this for you). The delivery company offer a cutting service, so when your stoma has healed and no longer changing in size, your stoma nurse will let them know the measurements and the pouches will be delivered to you pre-cut. They will also be able to provide dry wipes and rubbish bags and are a great source of advice and information.

If you have chosen to have your supplies delivered to you at home, your delivery company is:

Coloplast Charter. Telephone:

England & Wales: 0800 132 787
Scotland: 0800 917 8639
Northern Ireland: 0800 581 220

Diet

You may find that your appetite is poor following your surgery, this is normal and it will return over time. The best way to eat is little and often. Try not to leave long gaps between eating as this will give you more wind.

It will take a few weeks after your surgery for your bowel movements to settle into a regular pattern. You will be given a booklet containing detailed dietary information on discharge which gives information about which foods can affect your stoma.

Everyone is different but in general you can eat a normal, balanced diet. To keep bowel movements regular and avoid constipation it is advisable to:

• eat five pieces of fruit and vegetables a day;
• drink 1.5-2 liters of water a day;
• Take your time eating, chew well and eat regularly.

Try and eat a portion of protein at each meal as this will help your healing. Protein is found in meat, fish, eggs, dairy and pulses (but remember pulses are high in fibre too).

You should also have a portion of carbohydrate. This will provide energy and help to thicken your stool which will help you stay hydrated (see hydration section). Carbohydrates are found in potatoes, pasta, rice and bread.

If you are worried about trying a new food, it is always best to try a small portion at lunchtime and see how you go. If it has undesired effects, it doesn’t mean you can never eat that particular food, try it again 1-2 weeks later.

Remember, you will need extra calories for healing in the early days so try and snack in between your meals while you are recovering. Good snacks include: crisps, cheese and biscuits, pretzels, cheese crackers and sweets containing gelatine such as jelly, marshmallows and jelly babies as these will also help to slow and thicken the output.

After a few weeks (around 4-6) you can begin to add more food to your diet, your stoma nurse can advise you.

Good meal options for the early days could include lasagne , spaghetti bolognaise, fish pie (without shell fish) macaroni cheese, white or seed free brown bread sandwiches with a protein filling such as chicken, cheese, tuna. Eggs in any form are fantastic as are quite binding and a great source of protein and nutrition.

There are lots of options and you will be given written dietary advice when you leave hospital.

Drinks

A good way to keep your-self hydrated is to drink a variety of fluids, not just water. Aiming for 6-8 glasses a day (1.5-2 litres). Drinks could include milky drinks, tea and coffee, juices and squashes, Remember that tea and coffee contain caffeine which can irritate the bowel, so be sensible with the amount you drink.

Exercise

Exercise is wonderful for our mental and physical health. Following your surgery, it is important to avoid strenuous activities for around 6 weeks while your abdomen is healing. Activities such as hoovering, mowing the lawn, and lifting heavy objects will put too much strain on your abdominal muscles and should be avoided for 6 weeks. Walking and swimming are great to begin with; you can then build up to more strenuous activities in the following weeks. A strong ‘core’ or abdominal muscles will help prevent you developing a hernia (a bulge of bowel behind the weakened abdominal muscles). You will have discussed hernias before or during your hospital stay with your Stoma Nurse. With this in mind, the Stoma Department at Chelsea and Westminster have developed a 3 week rolling Well Being Class, which is offered to our stoma patients. The class incorporates specially adapted core exercises that are safe to carry out 6 weeks post abdominal surgery, with the long term aim of building a strong core and help prevent hernias. We also talk about healthy eating, hydration and other relevant topics. It is a great opportunity to meet other people who have had similar surgery and share stories and tips.

Body image and intimacy

People with stomas have full sex lives in the same way as those without stomas, however, it can take some time to accept and come to terms with the new changes to your body. It is natural and normal to feel anxious about returning to a relationship or finding a new partner. If you are in a long standing relationship, it is good to share worries by talking to your loved ones about body image and return to a sex life. If you want to find a new partner, it is important to give yourself time to regain confidence.

The stoma nurses are used to discussing these issues and are there to offer support and guidance to support that is available.

Potential problems

Here are a few potential problems you may experience which you will need to call your Stoma care Nurse for advice about.

• Hernia

This is when the bowel bulges through the abdominal wall behind or around the stoma. Avoiding strenuous activities in the early weeks will help prevent hernias. Maintaining a healthy weight and not smoking will also help minimise your risk.

• Prolapse

This is when the bowel protrudes out of the stoma opening. This can look alarming but is not a medical emergency. Please contact your Stoma Nurse for advice.

• Sore skin

For good pouch adherence, healthy skin next to your stoma is essential. It is important that the template of your pouch is accurate. If your skin comes into contact with the output it can cause sore skin very quickly. Your stoma team will teach you how to monitor your template and check your skin.

• Constipation

You can still become constipated with a stoma so, as mentioned earlier, maintaining a healthy diet is important. Your GP or stoma nurse can prescribe a laxative if this is an ongoing problem.

• Diarrhoea

This can happen for a number of reasons. There is a list of foods to help thicken your stool in your dietary booklet. Keep yourself hydrated and contact your GP if it persists.

Follow up

If you live within our catchment area, we will phone you the day after your discharge to arrange your first visit with us. This will either be in our clinic if you feel strong enough to come in, or at home. You will be followed up once a week for the first six weeks and then at 3, 6 and 12 month intervals or more if you require it.

Otherwise, we will refer you to your local Stoma Care Nurse and you will be followed up a according to their protocol.