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Becky, a Clinical Nurse Specialist in stoma care answers the most frequently asked questions on pre-surgery and post-surgery

I qualified as a general nurse in 1999, initially working on a general surgical ward at Hillingdon hospital.  Within 12 months I found an interest in colorectal nursing, taking a sisters post on the colorectal surgical ward within the same trust.

In 2001 I joined St Mark’s Hospital as a ward sister, completing my BSc (Hons) degree in colorectal nursing focusing on enhanced recovery in colorectal surgery and became a clinical nurse specialist in stoma care at St Mark’s Hospital in 2007.  Within my role as a clinical nurse specialist at St Mark’s I facilitated the enhanced recovery programme for patients undergoing stoma formation with twice daily in-patient teaching and an established outpatient follow-up programme to allow patients with a newly fashioned stoma adapt safely and quickly due to the reduction in hospital length of stay.

I have set up my own private stoma care practice and the first established stoma care/colorectal and nutrition service within one of London’s largest private hospitals, reviewing just over 600 colorectal patients per year, of which around 300 of these patients undergo stoma formation.

I have completed my MSc in Colorectal nursing, focusing on IBD, nutrition and intestinal failure as one of my key areas of interest are the management of patients with high output stomas and enterocutaneous fistula.  I have published multiple articles in relation to stoma care management and high output stomas that I feel benefit other specialist nurses within the field of stoma care and colorectal nursing.  I have taught both nationally and within central Europe on the subjects mentioned.  I continue to liaise with stoma nurse specialists with the NHS as this is imperative for our patients continuity of care and support both in the community and hospital setting.

I commonly get asked by patients prior to their surgery and stoma formation when or how long will it take for them to get back to normal activities and what type of exercise they cannot undertake and for how long.

Firstly it is important to highlight that if your surgery has been undertaken laparoscopically (key hole surgery) then your return to daily activities and exercises will be a lot quicker than if you have had open surgery (long incision down the middle of you abdomen, called a laparotomy incision).  Regardless of the type of surgical approach, it is still advisable not to undertake any heavy lifting or exercise that is a strain on the abdominal muscles for 8-12 weeks.

Return to normal activities after laparoscopic stoma surgery is usually within four weeks.  By the time you are four weeks post your laparoscopic surgery you should be driving, walking at a personal pace daily and if you enjoy swimming and/or cardiovascular exercise, undertaking this too.  (Although I do recommend not swimming if you still have a wound that requires a dressing).

Return to normal activities after open surgery/stoma formation is usually within 6-8 weeks as the incision through the abdominal wall is a lot bigger and the muscles will take approximately this length of time to heal back together although up to 12 weeks to heal completely.

There are many organisations and web sites that offer correct information with regard to getting back into exercise following stoma surgery and these will be listed at the end of my blog.  One web site that I find particularly informative and reader friendly is: www.exercise-works.org. This is a site based on obtaining information around exercise after surgery and for chronic illness but the founder, Ann Gates, has compiled an accurate section on exercise with a stoma.

It will take a while to adjust to life with your stoma and not everyone adjusts the same way or within an allotted time frame.  How well you adapt within the first few weeks following your surgery and mechanisms you adopt to learn to adapt will help you cope long term.  I always emphasise to my patients that everyone and every body is very different.  The condition that led you to requiring the formation of a stoma and your physical wellbeing will also have an impact on the length of time it takes you to feel normal again.

The first thing I can advises anyone with a newly fashioned stoma is to get into a good routine.  Initially you will feel like your stoma does not have a pattern and works constantly round the clock.  To help the stoma settle into a pattern of functioning, regardless of whether it is a colostomy or ileostomy, you should eat small portions of food at regular intervals, or, little and often as I say.

Ileostomy 

Try to stick to a diet that is low in fibre, especially within the first 8-12 weeks following surgery as this will help to slow down the activity of the stoma, thicken the consistency of the output and maximise the absorption of nutrients and electrolytes by slowing the transit time. Eat foods that are starchy, for instance: white bread, bagels, pita, wraps, crackers, non fibrous biscuits, potatoes, pasta, rice etc. Starchy foods will help to thicken the consistency of the stool. The small bowel is not as efficient at absorbing water and salt (this is mainly undertaken within the colon) and this is why the output from your ileostomy will never be formed stool.  To help with the absorption of salt and water and to slow down the length of time from eating to passing stool into the stoma appliance the starchy foods need to be the main base of your diet with a low intake of fibre (fruits, green leafy vegetables and juices).  Unless you are intolerant, all dairy products are allowed with an ileostomy and are a good source of protein and calories essential for healing post surgery and essential vitamins.

A lot of patients worry that they will not maintain a healthy varied diet so I emphasise that most foods in proportion will be fine. These bullet points are a quick example:

  • Blend a variety of vegetables to make soups to reduce the effect of fibre on transit time.
  • Cook vegetables or roast vegetables.
  • Do not eat raw vegetables and avoid salads as these will not get digested.
  • Peel apples and pears as the skins are not digested.
  • Do not eat whole nuts as these can cause obstruction.

It is best to seek advice from your local stoma nurse if you wish to discuss your diet in detail and concerned with getting a balanced diet.

Colostomy 

If you are unsure of the type of colostomy you have ask your local stoma care nurse about this as this will impact on the activity of the colostomy and how often it will function, as well as the dietary recommendations.

Most colostomists will enjoy a varied diet. I always advise my patients that have undergone a colostomy formation to adhere to a low fibre diet for approximately 8 weeks following surgery (see the diet that I have just described for a person with an Ileostomy).  As you are aware your new colostomy may be functioning at what seems all times with no particular pattern. By having a low fibre diet and eating little and often you can help to reduce the enhanced transit time that is occurring due to the stress imposed on the colon by undergoing surgery. The intake of the low fibre diet will help to slow down the amount of times the colostomy functions and thicken the consistency of the stool to that of semi-formed to formed.

Most colostomies function on average 1-3 times per 24 hour period (sigmoid colostomy) but this can be more in the early weeks following surgery. Once you are satisfied that the colostomy is settling into a pattern (being aware that it functions at particular times each day) you can start to re-introduce foods that you used to enjoy prior to having your colostomy fashioned.

You can still become constipated with a colostomy so you need to ensure you have a balanced diet that contains fibre and keep yourself hydrated.

Choosing products suitable for a person with an ileostomy

There are many different types of appliances and accessories available to aid caring for your stoma. A person with an ileostomy will wear an appliance that is drainable and these are available as a one piece and a two piece. A one piece appliance is a pouch with the adhesive flange in one. When the appliance is due to be changed the pouch is removed with the adhesive flange and the pouch is drained, not removed through the day. One piece appliances are designed to be worn for longer but I like to recommend not wearing for longer than three days.

Date: 9th March 2015  
Author: Becky
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