Colostomy

After colostomy surgery

Initially, you will be wearing a drainable bag as your stool may be liquid. The bag will most likely be transparent or have a viewing window, so that your nurses can check on the colour and size of your stoma easily.

The nurses will empty your bag until you are feeling well enough to
do this yourself.

You may have drips and drainage tubes attached to your body, but there is no reason to be alarmed – this is quite normal. If you are having a loop colostomy formed it is also possible that you may have a “bridge” which goes underneath the loop stoma. This is a supporting rod which keeps the loop stoma in place for the first few days. This, along with the drips and drains, will all be removed when appropriate and with very little discomfort.

Drainable Bag

When will my colostomy start to work?

Your colostomy will usually start to work within a few days of your operation. You will have no control over when it works and may not be aware of it happening. Your colostomy may produce wind, sometimes noisy!

All of this is normal and is to be expected.

Your stool will thicken as you start to eat and the noisy wind generally decreases.

Your Stomal Therapy Nurse may advise you to begin to use a
closed (non-drainable) bag which requires changing rather than emptying.

Closed bag

After a few weeks, most people choose to change their bag following a bowel motion. This can generally be between one and four times per day. This variance is normal and is personal to you. If you were prone to constipation prior to your surgery, you may well experience it again. It is recommended you follow general advice to prevent constipation.

If your rectum has not been removed, you may still feel like you need to go to the toilet via your anus. This is perfectly normal. When you do sit on the toilet you may well pass some old stool and/or possibly some mucus.

If you have had your rectum removed and anus closed, there is a possibility you may experience ‘Phantom Rectum’. This is a sensation of wanting to open your bowel in the usual way. It may help to sit on the toilet until the sensation has passed.

Wearing a closed bag

There are a variety of different bags for you to choose from. You can try a 1-piece or 2-piece products to see which type suits you best. It is your choice which bag you use. Your Stomal Therapy Nurse will usually show you options to help you decide which is the most suitable for you. There are a range of different sizes which are designed to be worn under your normal clothes. Closed bags have integral filters to allow wind to flow from the bag very gradually. The filter also contains a charcoal material which will absorb any odour. Bags are waterproof, so you can choose to have a bath or shower with it on or off. It is up to you. Just remember, you will have no control over when your stoma is likely to function.

Left: one-piece bag / Right: two-piece bag

After a while, you will establish a routine for changing your bag
and it’s a good idea to keep this as simple as possible.

Your stoma will work at different times of the day; for instance, it could be active shortly after a meal.
It may be easier to change your bag at an inactive time.

Changing your stoma bag

Ensure you have everything to hand before changing your bag:

A clean stoma bag
Scissors and template (if required)
Wipes for drying the skin (non-perfumed and moisturiser free)
Warm water

Tip: It is advisable to wash your hands before and after changing your bag

To change your bag

Draw the template of your stoma onto the adhesive of the bag, then cut it out. To remove the bag, carefully release the adhesive, working from the top down whilst supporting the skin.

Tip: It is most important that this hole fits snugly around the stoma to prevent the risk of leakage and irritated skin. Your Stomal Therapy Nurse will show you how to do this and it will become easier with practice. However, if you would like your bags to be cut to size, this will be possible once the initial post-operative swelling has reduced.

Cutting the hole

Once removed, fold the adhesive section of the used bag in half so it seals
Place your bag into a disposal sack
Use dry wipes (kitchen roll is an alternative) and warm water to clean around the stoma. Place these in the disposal sack (do not put them in the toilet as they may block it!)

Tip: To clean your stoma and skin, water is considered adequate and acceptable. However if you prefer to use soap, a simple non-perfumed, non-moisturised soap should be used. Ensure that it is rinsed away before drying your skin to prevent irritation.

Bag removal

Ensure the skin around the colostomy is dry
Remove the backing film from the adhesive of the new bag

Peel

Fold the top half of the adhesive back, then position it around the stoma, working from the bottom and smoothing upwards with your fingers. Take time to ensure there are no creases in the adhesive and use the warmth of your hands to mould the bag to your skin, making sure it is well stuck!

Position

Securely close the disposal sack and put in the normal household rubbish bin. DO NOT flush a used bag down the toilet, unless it is described as a “flushable” bag, as it will cause a blockage

Press

Caring for your skin

Caring for your skin is an essential part of looking after your colostomy.

Immediately after your surgery, your stoma and surrounding skin may look swollen and even a little irritated. This is all to be expected post operatively and with good care it should improve in appearance over time.

You may find that your product requirements may alter due to the changes in your stoma size and shape. Your stoma template will alter and should be checked at least weekly for the first 8 weeks, or particularly if lots of healthy skin can be seen through the hole.

The area of skin around your stoma needs ongoing care and attention to prevent and reduce the risk of soreness.

If you start to develop sore, irritated or even broken skin, do not delay in contacting your Stomal Therapy Nurse for appropriate advice on treatment and the need for alternative products.

Aim to keep your skin in optimum condition by considering:

Good nourishment and hydration – take some time to look at our section about foods and drink that aid healing and promote hydration.
This could be an excellent opportunity to stop smoking. Smoking affects how nutrients and oxygen might get to your skin and so results in a drier, dull skin that is at more risk of breakdown.
Regular exercise increases your body’s metabolism and encourages oxygen to reach your skin cells quicker and in greater supply.
Care for your skin on a daily basis; keeping it clean and moisturised as adaptation to life with a stoma depends largely on the health of the peristomal skin (skin around your stoma).
Remove any hair from the skin around your stoma. This is so the adhesive does not pull at the hair shafts causing inflammation and trauma to the skin. How often you need to remove hair from around your stoma is very individual, and you will get to know when removal is necessary.

Tip: To remove the hair around your stoma you might find it helpful to use a plastic deodorant lid or empty toilet roll cardboard to place over the stoma, for protection, and shave around it.