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The information on this page was reviewed and approved by

Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on November 15, 2021.

Ostomy and stoma care

Some cancers that affect parts of the digestive or urinary system can impair your ability to go to the bathroom. If the type of cancer you have—such as colorectal, prostate, ovarian, uterine, cervical or bladder cancer—prevents your body from eliminating waste through your rectum or urethra, you may need an ostomy. Depending on your individual situation, the ostomy may be temporary or permanent.

What is an ostomy?

When cancer damages or requires the removal of part of the digestive or urinary system—that is, the intestines or bladder—an ostomy may be needed to reroute urine or stool and gas out of the body. A surgeon creates a hole in the abdomen called a stoma and redirects waste out of the hole, where it collects in a pouch outside the body.

There are three main types of ostomy: colostomy, ileostomy and urostomy.

  • Colostomy redirects stool and gas from the large intestine through a stoma when the large intestine is blocked, damaged or partially removed. Most patients only need a colostomy for a few months while the large intestine heals.
  • Ileostomy redirects stool and gas from the ileum, the lowest part of the small intestine, through a stoma, when the large intestine is blocked, damaged or partially removed. Most patients only need an ileostomy for a few months while the large intestine heals.
  • Urostomy redirects urine from the bladder through a stoma when some or all of the bladder has been surgically removed. Urostomies are usually permanent.

How does a stoma work?

To perform an ostomy, the surgeon makes a hole in the abdomen and pulls a piece of the large intestine or bladder through the hole. The doctor then rolls the bit of tissue back like a shirtsleeve, leaving a small, round pinkish or reddish piece of flesh. Similar to a belly button, a stoma may lay flat on the belly or it may stick out some.

The reddish tissue typically looks raw and tender, but it doesn’t hurt or even feel tender because it doesn’t have nerves.

Ostomy care

Getting used to life with an ostomy is a big adjustment for many patients. At first, you may feel overwhelmed by the idea of ostomy care. There’s a lot to learn. But know ahead of time that, before you leave the hospital, your care team will lay out the steps you need to take and the potential concerns to look out for.

Specifically, your care team can be a resource for helping you figure out which products you’ll need, help you buy supplies and teach you how to care for your ostomy. Take advantage of any written materials or video instructions your team offers. The medical supply store where you buy your products may also have an ostomy nurse on staff who can answer questions.

The adjustment might be hard on you emotionally, too. But you don’t have to go through this experience alone. Ostomy support groups can help you navigate your new routine. Ask a member of your care team about support groups before you leave the hospital. You may also look at the United Ostomy Associations of America support group finder.

Ostomy bag and skin barrier

The two main supplies you’ll need are an ostomy bag, also called a pouch, and a skin barrier.

Your ostomy nurse can tell you which of these two types of pouches you’ll need:

  • Drainable pouch: This bag has an opening at the bottom so you can drain liquid or soft waste without having to remove the bag. You can use this type of pouch for three to five days.
  • Closed pouch: This bag doesn’t have an opening at the bottom. It’s typically used for solid stool. You’ll remove it and throw it away after each use.

Your care team can also teach you about skin barrier systems, which seal the pouch to the skin around the stoma. You’ll need one of two types:

  • One-piece system: This barrier comes attached to the pouch. You’ll attach the whole piece to your skin at once.
  • Two-piece system: This barrier is separate from the pouch. You’ll attach the barrier to your skin around the stoma, then connect the bag to the barrier.

How to protect and clean your stoma

It’s especially important to keep the skin around your stoma—called peristomal skin—clean and healthy. This helps avoid irritation, infection and potential complications.

You’ll need to clean around your stoma whenever you change your pouch. The key is to be gentle. This is delicate skin that doesn’t have nerve endings, so you won’t feel it if you rub too hard. Stomas have a lot of blood vessels in them, so it’s common to bleed a little when you clean yourself and change the pouch. If the bleeding doesn’t stop, contact your care team right away.

You can use soap, but you don’t have to. You can gently remove the adhesive with warm water. Use a soft cloth or soft paper towel. If you’d like, you can use wipes specially formulated for stomas.

You should avoid:

  • Regular baby wipes
  • Alcohol-based cleansers, perfumes or other harsh chemicals
  • Oil-based or moisturizing soaps which can make it hard to stick the pouch to your skin

After you clean the area, gently pat it dry. Make sure it’s completely dry before you reaffix the skin barrier.

Skin irritation around stoma

Even when you take good care of the skin around your stoma, it can still get irritated easily—just from pulling the barrier off frequently.

Peristomal skin may get irritated for several reasons, including:

  • Contact with stool
  • A reaction to the adhesive
  • A pouch and barrier left in place for too long
  • Forceful removal of barrier
  • A reaction to too much scrubbing
  • A fungus or yeast infection

If you see signs of irritation, make sure to address them right away. Ostomy supply stores carry barrier powders or ostomy skin protectants that help create a barrier between irritated skin and ostomy adhesive, but the adhesive will still stick.

Gently clean the area, apply a stoma powder or other skin barrier protectant, brush off excess powder, allow it to dry completely, then apply the adhesive barrier.

Some skin problems around the stoma may not get better on their own. If so, they’ll need medical care. Left untreated, these problems may get worse and make you vulnerable to infections or other serious complications.

If you experience any of these signs of skin problems, contact your care team right away:

  • Skin that looks infected or extremely red
  • Pus or discharge from or around the stoma
  • Skin that isn’t healing well after the surgery
  • Skin around the stoma that looks red, chapped, flaky, scaly, raw or burned
  • Skin that hurts, burns or changes color
  • Sores or breaks in the skin that develop where the barrier and pouch rest

Ostomy diet

Your ostomy team will most likely tell you to follow a special diet for the first six to eight weeks after your surgery. Follow their instructions carefully. You can also follow these tips:

  • Start small: Eat three or more very small meals per day.
  • Start simple: Eat soft, bland foods to go easy on your colon as it heals.
  • Chew well: Chew your food thoroughly to help the digestive process.
  • Avoid fiber: Don’t introduce high-fiber foods back into your diet just yet. For an ileostomy, ask your care team before you eat high-fiber foods.
  • Stay hydrated: Drink plenty of fluids, especially water, to stay hydrated. You may tolerate coffee and tea well, but keep in mind that they don’t hydrate you. (If you have an ileostomy, you may receive specific instructions about fluids.)
  • Drink in moderation: Alcohol is okay, but drink very little at first to see how your body responds. Start with a half a drink at a time at first until you’re sure you can tolerate it.

After you’ve recovered from surgery, your focus should be on eating to stay healthy. So, focus on a healthy diet that offers a balance and variety of nutrients and that follows the guidelines your care team gives you.

Eventually, you’ll be able to eat and drink most of the things you enjoy. But, there are a few things you may need to avoid as long as you have an ostomy. These foods tend to be hard to digest and may cause blockages:

  • Nuts
  • Seeds
  • Popcorn
  • Dried fruit
  • Mushrooms
  • Crunchy, raw vegetables (like broccoli, cauliflower, and kale)

Eat these foods in small amounts, and chew them up very well. If you think you have a blockage, call your ostomy nurse to ask what you should do. You may also want to avoid foods that you notice cause extra odor and gas.

Constipation

Patients who have a colostomy or ileostomy are more likely to get constipated, dehydrated or have a blockage, partly because your colon absorbs water to keep you hydrated. When you lose a piece of your colon, your body absorbs less water. A lot of the water you drink will exit through the stoma before your colon has a chance to absorb it. Any resulting dehydration may lead to constipation and blockages.

The foods you eat, just like before your surgery, may constipate you, too, so choose foods that help you have soft stools that are easy to pass. Some medicines, including painkillers, muscle relaxers, anti-anxiety drugs and iron supplements, may also make you constipated. If you take these medications and you’re getting constipated, talk to your doctor.

Medications

When a piece of your intestines is surgically removed, your body will process medications differently because the intestines absorb medications and then send them into the bloodstream. With shorter intestines, medications pass through more quickly, with less absorption.

As a result, some of your medicines may not work as well as they did before. You may need to change your dose, formulation or drug class. In general, liquid medications tend to work better for people who have a colostomy or ileostomy.

Your care team will likely advise you to avoid some types of medications, including:

  • Long-acting, sustained-release, enteric-coated medicines or hard capsules if you have an ileostomy
  • Laxatives if you have an ileostomy

Some medications may cause constipation or diarrhea or increase the production of urine. Ask your doctor whether your current medications may cause these side effects, and do the same whenever you get a new prescription.

Since medicines may affect you differently while you have an ostomy, make sure your doctors, nurse practitioners, pharmacists and anyone else prescribing you medication know of the ostomy. That information will help them prescribe medicines that are safe and effective for your situation. And when you buy over-the-counter medicines, ask the pharmacist whether they’re safe for you.

Daily life with an ostomy

An ostomy is a big adjustment, but they’re designed to allow you to continue with your regular activities, including work, exercise and sex.

Here are a few things you should know about daily life with an ostomy:

Exercise. You should be able to play sports and do other physical activities that you were able to do before your surgery. Just ask your doctor before you play contact sports, such as football or soccer. Keep in mind that sweat may loosen the adhesive on your pouch. If you do a lot of sweat-inducing physical activities, you may want to consider a pouch system designed for that.

Swimming and hot tubs are fine for people who have an ostomy. Make sure to empty the pouch before you get in the water, and use waterproof tape.

Bathing. You can shower or bathe just as you always do. If you choose to bathe without your pouch, you don’t have to worry that soap and water will flow into the stoma. They won’t, since—like the urethra and anus—the stoma functions by pushing liquid out, so it would take a heavy flow of water to penetrate it.

Avoid oil-based soaps, moisturizing soaps, lotions and moisturizers in the area where you attach the skin barrier—anything that may make your skin greasy and keep the barrier from adhering. Also stay away from strong chemicals or perfumed soaps, since these may irritate the delicate peristomal skin. If you have hair around your stoma, you may need to keep it shaved so the pouch will stick.

Avoiding accidents. As you get used to your ostomy, you’ll learn how to plan food and beverage intake so that your pouch doesn’t fill during a long meeting or trip. Plan to empty your pouch frequently. It’s best to do so before it’s half-full. You’ll also want to keep your ostomy supplies with you at all times. You never know when you will need them to take care of a leak or other accident.

Cancer treatment with an ostomy

If you have an ostomy while undergoing cancer treatment, know ahead of time that the treatments may cause fatigue, nausea or vomiting, so prepare to have your caregiver or other friend or loved one help you care for your ostomy.

If you undergo radiation treatment near the ostomy, you may need to remove the pouch during treatment. Be aware that the radiation may change or irritate the skin exactly where you need to stick the pouch. Ask your care team what you can do to take care of your skin during treatment.

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