Living with - Colostomy

Adjusting to a colostomy can be difficult at first, but it does not mean you cannot enjoy a full and active life.

Colostomy equipment is discreet and secure, and you should be able to do most of the activities you enjoyed before.

Colostomy bags and equipment

A colostomy bag is used to collect your poo. How often it needs to be changed depends on which type of bag you use.

Closed bags may need changing 1 to 3 times a day.

There are also drainable bags that need to be replaced every 2 or 3 days. These may be suitable for people who have particularly loose poos.

A specialist stoma nurse, who usually sees you before and after the colostomy operation, will help you choose the most suitable colostomy equipment.

There's a wide range of colostomy appliances available, including:

• a 1-piece pouch – the bag and flange (part that sticks to your skin) are joined together; the appliance is removed when full and then disposed of
• a 2-piece pouch – the bag and flange are separate, but can be connected; the flange can be left on your skin for several days, and the bag removed and disposed of several times a day

Colostomy appliances are made from hypoallergenic materials to reduce skin irritation. They also contain special filters to prevent any unpleasant smells.

If you have regular and predictable bowel patterns, you may not always need to wear a colostomy bag. But as occasional leakages can happen, it's recommended that you wear a small stoma cap.

Additional products that can make living with a colostomy more convenient include:

• support belts and girdles
• deodorisers that can be inserted into your appliance
• protective skin wipes
• sprays to remove adhesive
• protective stoma rings
• specially designed underwear and swimwear

Your stoma care nurse will be able to give you more information and advice about equipment.

Ordering supplies

You'll be given an initial supply of colostomy appliances, as well as your prescription information, before you leave hospital. You can get further prescriptions from your GP.

Your prescription can either be taken to the pharmacist or sent to a specialist supplier, who will deliver the products.

Colostomy irrigation

Irrigation is an alternative to wearing a colostomy appliance. It involves washing out your colon with water either every day or every other day.

To do this, you gently insert a small device into your stoma and attach it to a bag full of water.

You slowly move water into your colon so it washes it out. The equipment is then disposed of once the process is complete. A cap is used to cover your stoma in between irrigations.

Advantages of irrigation include:

• you choose when you want to perform irrigation
• you do not have to wear a colostomy appliance (but may have to wear a small cap)
• you should be able to enjoy a more varied diet
• you should have less gas (flatulence)

Disadvantages of irrigation include:

• it takes 45 to 60 minutes to complete, usually on a daily basis
• for the best results, irrigation should be carried out at the same time every day, which may be difficult when you're away from home on holiday or with work

Irrigation is not always possible. For example, it's not suitable for people with Crohn's disease or diverticulitis, or if you're having radiotherapy or chemotherapy.

Diet

In the first few weeks after having a colostomy, you'll probably be advised to have a low-fibre diet.

This is because a high-fibre diet can increase the size of your stools, which can temporarily block your bowel. Your doctor or stoma nurse will be able to advise you when you can go back to a normal diet.

As you recover, you can start to eat a healthy, balanced diet that includes plenty of fresh fruit and vegetables.

You should be able to return to the diet you previously enjoyed. If you previously had a restricted diet, you should be able to reintroduce the restricted foods.

Smell and gas

Many people worry that their colostomy will give off a smell that others will notice.

All modern appliances have air filters with charcoal in them, which neutralises the smell.

Most people will be aware of the smell of their colostomy because it's their own body. But someone standing next to you will not be able to smell the stoma.

You'll have more gas than usual immediately after having a colostomy, but this will slowly reduce as your bowel recovers.

Your stoma nurse can advise you about products you can use to help reduce any smell and give you dietary advice to reduce gas.

Medicine

Many medicines are designed to dissolve slowly in your digestive system. Having a colostomy should not alter the effectiveness of your usual medicine.

If you notice any tablets in your appliance, tell your pharmacist or GP, who will recommend an alternative medicine.

Exercise

Get advice from your health care team about exercising after your surgery.

In the weeks after surgery, some gentle exercise is usually recommended to help recovery.

How well you recover will determine how much exercise you can do. If you feel any pain, stop immediately.

Once you've recovered from the operation, you should gradually be able to return to your previous exercise routine.

Most types of exercise are possible with a stoma, including swimming, as all colostomy bags are waterproof.

Colostomy UK has more information about sport and exercise after a colostomy

Work

Once your bowel has healed, there's no reason why you cannot return to work.

If your job is particularly strenuous and involves a lot of heavy lifting, you may need to wear a support belt or girdle. Your stoma nurse can advise you about this.

It's likely to take several months before you're ready to return to work. It depends on how well you recover and the type of work you do.

You may find it very tiring when you return, so to start with it may be possible for you to work fewer hours than normal and do lighter duties.

Discuss the potential options with your employer before having the operation if possible.

Travel

There's no reason why you cannot travel after having a colostomy, but you'll probably need to plan extra time into your journey.

One essential item for people with a colostomy is a RADAR key. This gives you access to public disabled toilets so you can change your colostomy appliance when you need to.

You can get a RADAR key by contacting Colostomy UK.

Sex

You may find that some sex positions you enjoyed are now uncomfortable after having surgery. Try different positions until you find what works for you.

After surgery, many people find their vaginas are much drier. Applying a lubricating jelly before sex may help.

Having a colostomy can also affect the blood supply and nerve endings to the penis. This can make it difficult to get or maintain an erection (erectile dysfunction).

There are many treatments for erectile dysfunction and your stoma nurse can give you more advice.

You should avoid having anal sex (if the anus has not been removed) after a colostomy because it can cause tearing and bleeding. Speak to your stoma nurse for more information and advice about this.