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Stoma Care

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Stoma Care

A stoma is a surgically created opening on the abdomen to allow waste (urine or stool) to exit the body. Proper stoma care at home is crucial to prevent complications and maintain quality of life

Types of Stoma

Colostomy

  • Created from the large intestine (colon).
  • Output: Formed or semi-formed stool.
  • May be temporary or permanent.

Ileostomy

  • Created from the small intestine (ileum).
  • Output: Liquid to semi-liquid stool.
  • Usually more active than a colostomy.

Urostomy (Ileal Conduit)

  • Created for urine diversion using a piece of the small intestine.
  • Output : Continuous flow of urine.

GENERAL GUIDELINES

1. Daily Care Routine

  • Clean the stoma and surrounding skin with warm water and a soft cloth.
  • Colostomy patients can enquire regarding colostomy irrigation – if fit can do it regularly as a routine.
  • Avoid soaps with oils, perfumes, or lotions — they may affect appliance adhesion.
  • Pat skin dry before applying a new pouch or wafer.
  • Consume sufficient fiber and fluids in diet to prevent constipation/ dehydration

2. Changing the Appliance

  • Change the pouch every 3–7 days, or sooner if it leaks or smells.
  • Best done in the morning before eating or drinking (less stoma activity).
  • Make sure to measure the stoma size periodically — it may change over time.
  • Cut the wafer opening to fit snugly around the stoma (2 mm larger than stoma).

3. Emptying the Pouch

  • Empty when it’s 1/3 to 1/2 full to avoid leaks.
  • Sit or stand over the toilet; open the outlet (bottom of the pouch) and empty it gently.
  • Clean the outlet with toilet paper before closing it.

✅ Dos of Stoma Care

  • Keep the area around the stoma clean and dry.
  • Check the skin for irritation, redness, or rashes.
  • Trim body hair under the wafer to avoid painful removal.
  • Use stoma powder or barrier rings if skin is sensitive or irritated.
  • Stay hydrated, especially with ileostomies (to avoid dehydration).
  • Eat a balanced diet; reintroduce foods slowly post-surgery.

❌ Don’ts of Stoma Care

  • Don’t use alcohol or harsh chemicals on or around the stoma.
  • Don’t pull the appliance off quickly — remove it gently to avoid skin damage.
  • Don’t pull the appliance off quickly — remove it gently to avoid skin damage.
  • Don’t flush any stoma care product down the toilet unless labeled flushable.
  • Don’t wear tight belts or clothes that press on the stoma.

PRECAUTIONS AND SIGNS TO WATCH FOR

Issue

Sign

What to Do

Skin Irritation

Red, weepy, itchy skin

Use barrier wipes, powder, and ensure snug appliance fit

Stoma Infection

Foul odor, pain, bleeding, pus

Contact your doctor

Hernia

Bulge near stoma

Avoid heavy lifting, wear support belt if prescribed

Blockage (esp. in ileostomy)

Cramping, no output, nausea

Seek medical help immediately

When to Call a Healthcare Provider

  • Continuous bleeding from the stoma.
  • No output for more than 4–6 hours (especially ileostomy).
  • Severe or persistent skin irritation.
  • Change in stoma size, shape, or color (e.g., purple, black).
  • Signs of a hernia or prolapse.

COLOSTOMY IRRIGATION: A CLEAR GUIDE

Colostomy irrigation is a procedure to flush out the colon through a colostomy stoma using water. It helps regulate bowel movements, often eliminating the need to wear a pouch between irrigations. This can be initiated from about 6 to 8 weeks after the colostomy has been made surgically. However this should be done after getting a proper training for the same from your health care provider.

Who Can Do Colostomy Irrigation?

Irrigation is not for everyone. It’s mainly suitable for people who have:

  • A descending or sigmoid colostomy (left side of the colon)
  • A regular bowel pattern
  • A permanent colostomy
  • Good vision, mobility, and manual dexterity (or caregiver support)
  • Been cleared by a stoma nurse or doctor

Not suitable for

  • Ileostomies or ascending colostomies
  • People with frequent diarrhea, IBS, or Crohn’s disease
  • People with cognitive or physical limitations that make the process unsafe

Colostomy Irrigation Equipment

You Will Need:

  • Irrigation bag or container with tubing and cone
  • Irrigation sleeve (long drainable pouch)
  • Water (lukewarm, body temperature ~37°C or 98°F)
  • Clamp for tubing
  • Stoma cap or patch (used after irrigation)
  • Hook to hang the irrigation bag at shoulder level

When and How Often to Irrigate

  • Usually once every 24hours at the same time each day.
  • Best done after a meal or when the bowel is naturally active
  • Pick a time when you can relax and not be interrupted — the process takes 30 to 60 minutes.

Colostomy Irrigation: Step-by-Step Technique

1. Gather Supplies

  • Wash your hands.
  • Assemble the irrigation equipment and fill the bag with 500–1000 mL of lukewarm water.

2. Set Up

  • Hang the irrigation bag at shoulder height while sitting.
  • Sit on or near the toilet, or place a basin nearby.
  • Attach the irrigation sleeve to the stoma.

3. Prime the Tubing

  • Let a bit of water run through the tube to remove air, then clamp the tube.

4. Insert the Cone

  • Lubricate the cone tip with water-based lubricant.
  • Gently insert it into the stoma (about 2–3 inches) while seated and relaxed.

5. Infuse the Water

  • Release the clamp to allow water to flow in slowly over 5–10 minutes.
  • If cramping occurs, slow down or pause water flow.

6. Wait for Return

  • Remove the cone and let stool and water drain into the irrigation sleeve.
  • This may take 15–45 minutes.
  • Gently massage the abdomen if needed.

7. Clean Up

  • Remove the sleeve, clean the area, and dry the skin.
  • Apply a stoma cap or small patch if you don’t need a full pouch.

✅ Dos

  • Use clean, lukewarm water only — never hot or cold.
  • Do it at the same time each day for best results.
  • Stay relaxed — read, listen to music, or breathe deeply.
  • Keep a record if you’re new to it — time, volume, response.
  • Consult your stoma nurse regularly if you notice changes.

❌ Don’ts

  • Don’t force the cone into the stoma — be gentle.
  • Don’t irrigate if you have diarrhea, cramps, fever, or feel unwell.
  • Don’t use soaps, antiseptics, or additives in irrigation water.
  • Don’t stop suddenly once your body is used to the routine — it can cause irregularity.
  • Don’t reuse water or contaminated equipment.

Precautions and When to Seek Help

  • Mild cramping is normal during irrigation but should go away.
  • If you feel pain, stop immediately.

Watch for:

  • Blood in the irrigation return
  • Persistent nausea or cramping
  • No return of water/stool
  • Changes in stoma color, size, or output
  • Skin irritation or stoma bleeding

Contact your stoma nurse or healthcare provider if you experience any of these.

Precautions and When to Seek Help

  • Give your body a few weeks to adjust to irrigation.
  • Some people achieve predictable bowel control and only wear a stoma cap afterward.
  • Hydrate well, eat a balanced diet, and maintain regular physical activity.
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