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A Guide To Living With A Stoma


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DISCLAIMER


100% accuracy at time of writing cannot be guaranteed.  A listing in this website is provided for informational purposes only, and does not mean it is an endorsement.  All companies listed are tried at the reader’s own risk.  All information provided is intended as a supplement to any professional help already

given.  Before acting on suggestions from anyone, ostomates are advised to check with a doctor or stoma care nurse that the course of action is suitable

for them. Whilst every care is taken, the author will not be held responsible.


AT HOME








Changing stoma appliances is not difficult, but it makes it much easier and stops leaks, if a few simple rules are followed.  It is a good idea to get into a routine for changing your pouches.  There is no set rule, where ostomates should change their appliances.  Some ostomates prefer the bathroom, some choose the bedroom.  However, it is preferential to select a time when one can be undisturbed for the duration of the change.

                           

When changing a stoma product, cleanliness is very important, but there is no need to worry about keeping everything sterile.  Obviously, though, try to be as hygienic as possible.


Always change a pouch that is leaking or has separated from the skin.  Do not try to reinforce it with tape.


Some of the following tips may be helpful:

●  Wash your hands thoroughly.  Hand hygiene is extremely important.


●  Protect clothes, bed linen, the floor, etc. with an old towel, paper towels, etc. in case of spillages. Some ostomates use a clothes peg to keep clothes out of the way, whilst changing an appliance.


●  Unless your pouch/flange is already pre-cut, get it ready by cutting a hole to fit the size of your stoma.  Cut the hole in the flange just a little larger than the stoma, so that the flange will stick neatly and closely around the stoma.  Leave about 1/8” to 1/16” between the cut and the edge of the stoma.  If the hole is too tight, the stoma may be damaged.  Likewise, if the hole is too large, there is a risk of leakage or skin irritation.


●  From time to time, it is important to re-measure the exact stoma size to ensure that the appliance fits as snugly as possible round the stoma.  For this purpose, it can be useful to make a template.  The date and the size of the template to go against the skin should be written on the template. If it is made of a washable material, the template may be used more than once, and could be hygienically cleaned to avoid unnecessary infections.


●  Before changing an appliance, make sure you have everything you need by laying out all necessary items on a clean and convenient surface, so that you can reach them, e.g. pouches, flanges, accessories, etc.  This will make the changing process much easier and quicker.



 

















●  Make sure that you are either standing or sitting in a comfortable position.


●  Empty the old pouch as normal.


●  Hold the skin around the stoma with one hand, applying slight pressure.  With the other hand, carefully lift the old flange/pouch from the skin.  Throw away the old flange/pouch into a disposal bag or wrap in newspaper.  Do not rip the flange/pouch off the skin.  If it is difficult to remove, use some medical adhesive remover whilst lifting the flange.


●  Examine the skin and stoma for signs of redness, soreness or ulceration.  Sore skin will probably happen to everyone at some stage, but if it persists, contact a stoma care nurse.


●  Wash the stoma and surrounding skin with warm water until clean, and pat the skin dry with absorbent dry wipes.  Avoid baby wipes, as some of these contain lanolin or moisturiser.  As a general rule, it is advisable not to use soap.  Definitely do not use perfumed soaps, or soaps with oils as these scented soaps leave a film, and the flange will not adhere correctly.  Should an ostomate feel more comfortable using a soap on the skin around the stoma, baby soap or a non-perfumed soap could be used, but it should be well rinsed off.  However, water alone is perfectly adequate and acceptable for cleaning purposes.  


●   Detergents, disinfectants and antiseptics should not be used as they can cause dryness and irritation.  


●   Try not to rub too hard, as the stoma may start to bleed. Despite being careful, if the stoma does begin to bleed slightly on the outside, it should stop very quickly. This can be normal, but obviously if the bleeding continues, contact a stoma care nurse.  However, if the bleeding is coming from the stoma opening, contact a doctor or stoma care nurse as soon as possible.   


●  Adhesive remover can eliminate any undesirable residue left from the old flange.


●  Using dry, lint free cleaning wipes, make sure that the skin is completely clean and dry to enable the appliance to adhere securely, and to prevent skin soreness.

Avoid using lint/fluffy towels or cotton wool, as these may leave fluff, etc. sticking to the stoma.


●  Apply any barrier creams, stoma paste, etc.  If a barrier cream is used, massage in well so that there are no problems with the flange/pouch sticking.  


●  When placing the new flange/pouch onto the skin, make sure that the stoma is in the centre of the flange hole, carefully aligning the bottom edge of the flange hole with the underneath of the stoma.  Some ostomates prefer to stand in front of a mirror to help position the new appliance, and some suck in the tummy before applying a flange, since this helps prevent the flange from creasing and the consequential leaks.


●  After the flange is placed around the stoma, gently press by starting at the bottom and working up, smoothing out any wrinkles.  It may be helpful to hold one hand over the newly applied pouch for about two minutes.  The warmth of the hand can help to mould the flange into place.


●  After fitting a new pouch, give it a gentle tug to ensure that it has stuck correctly, and if wearing a two piece, make sure that the pouch is correctly fixed to the flange.


●  If the bottom of the pouch has a tap or clip, ensure that this is closed.


●  For additional security of the flange/pouch, some ostomates prefer to use tape to ‘picture frame’ the edges of the flange/pouch, e.g. 3M Micropore Surgical Tape. Under the guidance of a stoma care nurse, it may be possible to use security frames (sometimes called flange extensions), which offer additional security to an appliance, by providing a reliable and effective way to secure a pouch, and to prevent leaks.


●  Finally, wash hands thoroughly.

●  New flange.


●  New pouch, plus clip/tie, if necessary.


●  Relevant accessories, e.g. adhesive remover, barrier cream, etc.


●  Disposal bags.


●  Scissors.


●  Dry and moist wipes, not tissues.


●  Towel.


●  Bowl of warm water.

CHANGING STOMA APPLIANCES








As far as clinical waste is concerned, a dirty pouch is classed the same way as a dirty nappy.  After emptying the contents of the pouch, rinse it out and throw away pouches, flanges, etc. in a disposal bag or wrap in newspaper, and then place in a clinical waste bin, normal waste bin or dustbin.  Wash hands thoroughly.


Some local authorities provide a weekly, home collection service for clinical waste.  The appropriate council will be able to advise on local arrangements.


If it is necessary to change in a public toilet, it is perfectly acceptable to place any wrapped-up, soiled appliances in the public waste bin.


Some manufacturers/home delivery companies supply disposal bags in which a used flange/pouch can be wrapped for easy disposal.  Other than that, disposal bags for baby nappies can be purchased in many places, and are pleasantly scented.


There is also a product on the market, which is a nappy disposal system.  It is a disposal system for baby nappies, but at home some ostomates find this system to be more hygienic and easier to use.  The unit requires refill cassettes, containing the inner plastic liner, which can be purchased separately.  Both items can be bought from a leading mother and baby chain, either in store or online.  Some ostomates even use this system when travelling around the UK, as it is compact and light and solves a potential problem of where to put disposal bags, when travelling.  


Normally pouches should not be put down the toilet, since this will cause a blockage in the plumbing system.  However, some modern pouches are designed with a biodegradable inner pouch, so that

they can be flushed down the toilet.  For colostomates, CliniMed offer a one-piece flushable pouch,

Aura Flushable Colostomy Bag.


It is very important not to flush any wipes down the toilet, since these will cause a blockage in the plumbing system.  Dispose of wipes along with the used stoma appliances in the usual way.



DISPOSAL OF APPLIANCES

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