HEALTH LIBRARY

1. What is a Stoma?

A stoma is a surgically created opening on the abdomen that allows stool or urine to exit the body when the normal passage is not possible. It is formed by bringing a part of the intestine (or urinary system) to the skin surface.

A healthy stoma is:

• Pink to red
• Moist, soft
• Painless
• Active (may move or pass flatus)

2. What are the types of stomas & expected output? 

Colostomy

• Formed from large intestine
• Output: thicker, paste-like stool
• Frequency: 1–2 times/day

Ileostomy

• Formed from small intestine
• Output: watery to semi-solid
• Frequent discharge
• Higher risk of dehydration

Urostomy

• For urine diversion
• Output: continuous urine + normal mucus strands

3. How should you clean & change your stoma bag? 

A. Supplies Needed

• New pouching system
• Lukewarm water
• Soft cotton pads/wipes
• Disposal bag
• Barrier wipes/rings (if advised)
• Scissors (if cut-to-fit)

B. Removing the Used Pouch

• Peel gently from top to bottom while supporting skin
• Use adhesive remover wipes if sensitive
• Discard in sanitary bag

C. Cleaning

• Use lukewarm water only
• Dab gently; do not rub
• Clean outward from stoma
• Small bleeding from stoma surface is normal

D. Drying

• Pat area fully dry
• Ensure the skin is dry, as moisture weakens adhesion and may cause leakage.

E. Measuring & Cutting

• Use measuring guide
• Cut opening 2 mm larger than stoma
• Ensure smooth edges

F. Applying New Pouch

• Apply barrier film/ring if required
• Center the stoma carefully
• Press adhesive base for 1–2 minutes
• Warm hands help secure the seal

G. Emptying the Pouch

• Empty when 1/3 - 1/2 full
• Clean the outlet tip before closing

4. How to protect the Peristomal Skin (skin around the stoma)? 

Healthy skin = comfortable stoma care. Every small irritation grows louder if ignored.

Watch For:

• Redness
• Burning/itching
• Rash
• Leakage marks
• Skin peeling
• Warts or bumps (hypergranulation)

Essential Tips:

• Ensure the opening fits snugly
• Avoid repeated rubbing
• Barrier films help protect sensitive areas
• Trim hair carefully to reduce painful removal
• If leakage happens frequently → appliance refitting is needed

5. Output, Diet & Hydration?

A. Understanding Output

• Ileostomy: watery → semi-solid
• Colostomy: paste-like → formed
• Urostomy: urine + normal mucus

Monitor changes:

• Sudden increase → dehydration risk
• Very watery output → risk of salt/mineral loss
• No output → possible blockage (seek help)

B. Diet Recommendations

First 2–3 weeks:

• Soft, low-fibre foods
• Small, frequent meals
• Chew very well

Foods that may cause gas:

• Beans
• Onion
• Carbonated drinks
• Cabbage
• Eggs

Foods that may thicken stool:

• Banana
• Potatoes
• Rice
• Chapati

Foods that may loosen stool:

• Spicy foods
• Coffee
• Leafy greens
• Too much fruit juice

Blockage-risk foods:

(Chew extremely well or avoid if advised)

• Corn/ Popcorm
• Coconut
• Nuts
• Pineapple
• Raw vegetables with tough skin

C. Hydration

Especially important for ileostomy:

• Drink 2–3 litres/day unless restricted
• Include ORS/rehydration solutions
• Watch for dehydration signs: dry mouth, dizziness, reduced urine output

6. Activity, Clothing & Lifestyle? 

Activity

• Start walking from day 1 unless restricted
• Avoid heavy lifting for 6–8 weeks
• Use a stoma support belt during exercise
• Swimming is allowed once the wound heals and bag sticks well

Bathing

• You may bathe with or without the pouch
• Avoid oily soaps or lotions around the stoma

Clothing

• Wear soft-waist clothing
• Tight elastic directly over the stoma may cause irritation
• High-waist undergarments often feel more secure

7. When to seek immediate medical help? 

Reach your doctor or stoma nurse if you notice:

• Stoma turning dark brown/purple/blue
• No output for 6–8 hours (ileostomy) or 12–24 hours (colostomy)
• Severe cramping or abdominal swelling
• Persistent bleeding from the stoma
• Recurrent leakage despite proper fitting
• Skin breakdown, ulcers or pus
• Fever or vomiting
• A bulge around the stoma (possible hernia)

8. Travel Tips

• Always carry extra bags, wipes, scissors (if allowed), and disposal bags
• Keep supplies in carry-on luggage
• Hydrate well during travel
• Carry a short medical note if flying

9. Follow-up & long-term care?

• Schedule regular reviews with your surgeon/stoma nurse
• Check pouch fit every few weeks—stomas often change size in first 6–8 weeks
• Replace the pouch as per advice (typically 2–3 days)