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Before your surgery

We offer counselling, advisory and educational support if you are about to undergo stoma surgery.

Topics we will discuss include:

• Stoma forming surgery
• Sexual related matters
• Nerve damage
• Diet
• Holiday and travel
• Body image
• Exercise
• The fitting of support garments

After your surgery

While you are on the ward we will introduce you to life with your stoma, carrying out initial checks and providing a care plan for you once you are discharged. We can help you make the best choice of pouch for your needs.

When you leave hospital we ensure that you are supported at home by the community stoma team and ourselves for as long as you need.

We also have a lot of relevant leaflets for you and your families, which we will give you before and after your surgery.

Kidderminster and District Colossus Stoma support group

Colossus stoma support is a support group run by volunteers. It aims to give help and support to people living with a stoma as well as providing information and support for family and friends.

They meet monthly at 2pm in Holy Innocence Church, Foley Park, Kidderminster.

Contact - Beryl Talbot 01299 824006

Purple wings is a charity which aims to help those with ostomies gain some self-esteem and confidence after surgery. For more information Email: lauren@purplewingscharity.com

We use information from a variety of organisations. This leaflet is produced by the Trust about our service:

Stoma care leaflet

The following inforatmation is provided as guidance for health professionals supporting patients with a stoma.

To refer a patient to our service, please contact the stoma care nursing team by phone or email. We provide support and advice 24 hours a day 7 days a week. Our teams work from The Alexandra Hospital and Worcestershire Royal:

Ileostomy

• The output is liquid faeces variable fromwatery to a porridge like consistency
• Patients require a drainable appliance that requires emptying 4 to 8 times a day
• Ileostomy pouches can be changed daily but we recommend they are changed every second day
• Each box contains ten to 30 pouches. 30 pouches should last the patient one to two months

Dietary advice for an ileostomate is to encourage a varied well balanced diet. Some foods may cause problems such as a high output or obstruction. Generally advice should include:

• Chew food well and eat slowly, in particular high fibre foods this is to aid digestion. It is also advisable to advise to peel fruit
• Drink at least 1.5 - 2 litres per day
• Some foods thicken a high output e g- over ripe bananas, marshmallows, Tapioca.
• Ensure adequate salt intake.

Bowel Obstruction

People with an Ileostomy must never suffer from Constipation. A blockage may cause pain bloating and vomiting. If conservative management does not resolve symptoms then refer to the hospital for intravenous hydration and to exclude causes such as adhesions parastomal hernia or a recurrence of disease.

High output (excess of 800mls)

A high output may be caused by early post operative functional problems, active crohn’s disease, partial small bowel obstruction, sepsis, enteritis or side effects of medication. High volumes (2000ml) of effluent from the ileostomy can lead to severe dehydration and electrolyte imbalance, which is potentially life threatening. Vital nutrients, sodium potassium and magnesium may be lost and need appropriate replacement.

Management includes treatment of underlying cause and repletion of fluid

• Blood tests should be taken in particular daily U&Es and Urine Na+

• Restrict oral fluids to one litre maximum per 24 hours (avoid caffeine)Only sip fluids with meals and drink one hour before and after eating.
• Low fibre diet, eating jelly babies and marshmallows may help and advise to add salt to diet i.e. crisps.
• Commence oral hydration solution as necessary such as dioralyte or when in hospital a St Marks solution which is an individualised solution made by pharmacy and dietician’s input.
• If output above 1000mls commence loperimide-start two to four mgs tds, then increase if output does not reduce. Anti-diarrhoea medication may be given 30 to 60 minutes before food or at bedtime to slow gastrointestinal transit and allow time for absorption to take place.
• Use a high output appliance to monitor output accurately.
• Refer to hospital for management of serious electrolyte imbalance.
• If weight loss please refer to dietician.

Colostomy

• Output is semi formed or formed stool

• Patients require a closed pouch although on occasions a drainable pouch may be more appropriate.
• Some colostomates choose to use a drainable pouch if their stool is softer or require emptying more than three times per day. Closed pouches are changed on average twice a day.
• Each box contains ten to 30 pouches. A box of 30 pouches should last a patient two to four weeks.

Dietary advice: There are no diet restrictions for colostomates but it is important to be aware they can still become constipated or have bouts of diarrhoea. General advice would be to eat a varied diet, drink 1.5 - 2 litres of fluids per day and avoid constipation.

Urostomy

• The output is always urine
• Patients require a drainable pouch that has a tap on, which requires emptying every two to three hours
• Urostomy pouches can be changed daily but we advise every two to three days
• Each box contains ten to 30 pouches, 30 pouches should last the patient one to two months

A night drainage system is also required. Each box of night bags contains ten systems which should be changed weekly. A box of ten night drainage bags should last a patient ten weeks. We teach all new patients how to clean the night system thoroughly and provide them with a night bag stand on their discharge. Please note that patients must have compatible pouches and night drainage bags.

Urostomate patients do not have any special diets to follow but we do offer general advice:

• Eat foods high in Vitamin C to help keep urine slightly acid to prevent urine infections.
• A glass of Cranberry juice may help reduce the amount of mucus produced by the urostomy, providing there are no contra indications i.e. patient on warfarin.
• Fish and Asparagus can cause an odour to the urine.
• We suggest patients drinks two to three litres per day  

There are a number of organisations and charities who provide useful information and support to patients living with a Stoma.

Colostomy association

Ileostomy association

Urostomy association

A bigger life

The following companies provide a range of services and support for people living with a stoma

Stoma clinical nurse specialists 

Our stoma team are part of the colorectal service offered at our Trust. The team provides a specialist service for patients of all age groups, as well as their relatives and carers. Information and support is delivered prior to surgery, during the patient’s hospital stay, and following discharge into the community.

If you have any concerns or require further information please contact the stoma nurses on 01527 512195 (Redditch) or 01905 760735 (Worcester).