Types of stoma
- Colostomy: the colon is brought out, usually on the left. Stools are formed or pasty and pass once or twice a day. It is usually permanent in very low rectal tumours (abdominoperineal resection) and sometimes temporary.
- Ileostomy: the small bowel is brought out, usually on the right. Output is liquid or pasty and continuous, and the main risk is dehydration. It is almost always temporary: it protects the join (anastomosis) after rectal surgery and is closed months later.
The stoma has no nerves: it does not hurt. It is red and moist, like the inside of your mouth, and it is normal for it to bleed a little when cleaned.
The key person: the stoma nurse
Almost every hospital has a stoma care clinic. The stoma nurse teaches you to change the appliance, chooses the model that best fits your abdomen, solves skin problems and leaks, and provides the report for your supplies. If you have not been referred, ask: it is the difference between suffering the bag and managing it. Before planned surgery, the stoma site is marked with you standing and sitting; insist that this is done.
The appliance and the skin
- There are one-piece systems (bag and adhesive together) and two-piece systems (a baseplate that lasts 2-4 days and a bag that is changed or emptied). Closed bags for colostomy; drainable bags for ileostomy.
- Supplies are funded by the Spanish public health system on prescription; the monthly quantity is set by your region.
- Cut the baseplate to the exact size of the stoma (it changes size in the first weeks). Clean skin with water, pat dry, no greasy creams under the adhesive.
- Red, sore skin or repeated leaks are not "normal": they are the most common reason for a clinic visit and are almost always fixed with a different appliance or accessories (paste, rings, powder).
- Hernia around the stoma: common over the years. A specific support belt, avoiding heavy lifting in the first months and guided abdominal-wall exercise partly prevent it.
Diet
With a colostomy you can eat almost everything after the first few months; each person learns which foods cause more gas or odour (pulses, cabbage, onion, eggs, beer) and which reduce them (yoghurt, parsley, cranberry).
With an ileostomy there are two golden rules:
- Salt and fluids: the small bowel does not recover water or salt well. Drink throughout the day (include broths, oral rehydration solution or drinks with salts, not just water) and add salt to food unless told otherwise. If the bag fills with liquid more than 8-10 times a day, you pass little urine or get cramps, report it: that is dehydration.
- Chew thoroughly and take care with fibrous foods in the first months: fruit skins, nuts, sweetcorn, mushrooms, pineapple, celery and sausage skins can block the stoma. Introduce foods one at a time.
Foods that thicken output: rice, pasta, banana, potato, white bread, peanut butter, cheese. Foods that loosen it: raw fruit, juices, leafy vegetables, spicy food, coffee, alcohol, sweets.
Daily life
- Showering and bathing: with or without the bag; water does not get into the stoma. Swimming pool and beach, with a small bag or stoma cap and slightly higher-waisted swimwear if you want discretion.
- Clothes: the bag shows less than you think. There are support belts, bands and underwear made for it.
- Sport: walking from the start; everything else gradually from 6-8 weeks. Avoid direct contact sports or use a shield.
- Work and travel: carry a change kit with you and spare supplies in your hand luggage. For flying, supplies do not count as liquids; stoma travel cards are available.
- Sex: empty the bag beforehand, use covers or bands if they make you feel secure, talk to your partner. After rectal surgery there may also be changes in erection, lubrication or ejaculation because of the pelvic nerves: these can be treated, so ask.
- Emotions: initial reluctance to look at or touch it is normal. Ostomy patient associations and psycho-oncology help a great deal in the first months.
Reversing a temporary ileostomy
It is closed once the anastomosis has healed and, if there is chemotherapy after surgery, usually when that finishes: in total it is typically between 3 and 9 months. Beforehand the join is checked with a contrast enema or an endoscopy. It is a minor operation compared with the first one (1-4 days in hospital).
What nobody tells you and is worth knowing: after closure, the bowel takes time to retrain. For months, many people have urgency, fragmented stools, difficulty telling gas from stool or some leakage: this is low anterior resection syndrome. It improves with time, bulk-forming fibre, loperamide, pelvic-floor exercises and, in persistent cases, transanal irrigation or neuromodulation. Ask for help rather than putting up with it.
Support
A stoma entitles you to apply for disability recognition in Spain (the assessment depends on each case), and supplies are funded on prescription. Ask the hospital's social work department.
What to ask at your appointment
- Is my stoma temporary or permanent? If temporary, when is closure expected?
- Do I have an appointment with the stoma nurse before discharge and afterwards?
- How many supplies am I entitled to each month, and how is the prescription renewed?
- Which signs of dehydration should I watch for (if ileostomy)?
- What can I expect of my bowel function after reversal, and what help is there?
