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You will need to learn how to care for your colostomy when you go home. You might also want a family member, caregiver, or friend to learn in case you need help.

There is more than one way to care for your colostomy. Before you leave the hospital, make sure that you are comfortable choosing a pouching system, emptying and changing your pouch, and managing problems that can come up when you have a colostomy.

You will most likely be taught how to manage your colostomy by an ostomy nurse or other special nurse.  An ostomy nurse or Wound Ostomy Continence nurse, sometimes called a  WOC nurse, is a specially trained nurse who takes care of and teaches people how to take care of their ostomies.

Recovery from surgery

Right after surgery, your colostomy will likely have a clear pouch placed over it. The type of pouch used right after surgery is usually different from those you’ll use at home.

Right after surgery, your stoma may be quite swollen. There may also be bruises and stitches around it. While a stoma normally is moist and pink or red, it may be darker at first.

Your stoma will change a lot as it heals. It will get smaller and any bruising will go away, leaving a moist red or pink stoma. This could take several weeks.

Colostomy irrigation

If you have a descending or sigmoid colostomy, you might choose to use irrigation to manage your ostomy output. Irrigation means putting water into your colon through your stoma. This stimulates your bowels to empty into your pouch. like an enema.   

Not everyone benefits from irrigating their colostomy. Whether you can irrigate your colostomy depends on:

• Whether your colostomy is permanent
• How firm your stool is
• How often stool comes out of your colostomy
• Whether you would like to try to irrigate your colostomy

If you are interested in learning to irrigate your colostomy, talk to your doctor or ostomy nurse. They can teach you how to do it.

Emptying and changing the pouching system

You’ll be taught how to empty and change your pouching system before you leave the hospital.

How to empty the pouch

Empty your colostomy pouch when it is 1/3 to 1/2 full to keep it from bulging and leaking.

If you are using a drainable pouch:

• Sit as far back on the toilet as you can or on a chair facing the toilet. Some people prefer to sit backwards on the toilet seat.
• Place a small strip of toilet paper in the toilet to decrease splashing.
• Hold the bottom of your pouch up and open the clip or Velcro on the end or tail of the pouch.
• Slowly unroll the tail over the toilet.
• Gently empty the contents.
• Clean the outside and inside of the pouch tail with toilet paper.

Roll up the end of the pouch and clip or Velcro shut. Closed-pouch systems will need to be removed, disposed of and replaced with each use.  For two-piece systems, just the pouch will need to be replaced. If you  use a one-piece system the whole pouching system will need to be replaced.

When to change the pouching system

Most people change their pouching systems twice each week (every 3to 4 days). You may need to change your pouch and skin barrier more often if it is leaking or if your skin is irritated. If your skin around your stoma begins to itch, burn or feel wet you should change your pouching system.

It’s easiest to change your pouching system when you usually have less bowel activity. This might be in the morning before you eat or drink . Or allow at least 1 hour after a meal, when your digestive system has slowed down.

Right after surgery, your ostomy output may be thin and watery. As your stool gets firmer, it should be easier to find the best time to change your pouch.

Factors that affect the pouching system seal

The skin barrier of your pouching system must stick securely to the skin of your colostomy. When you apply the skin barrier, be sure to apply gentle pressure so that it can create a good seal on your skin.

The length of time the barrier will stay sealed to your skin depends on many things, such as:

• The weather and your body’s heat. If you sweat, you might need to change your pouching system more often.
• Your skin texture. If you have more oily skin, you might need to change your skin barrier more often.  
• Weight changes. Weight gained or lost after ostomy surgery can change the shape of your abdomen. You might need a different skin barrier or pouching system.
• Your diet.  Foods that cause watery stool, such as raw fruits and vegetables, milk, fruit juice, or prune juice, are more likely to break a seal than a more formed stool.
• Physical activities. Swimming, very strenuous sports, or anything that makes you sweat may shorten wear time.

If you have problems keeping a tight seal, talk to your ostomy nurse or health care team about other skin barrier options. Different products might help you keep the skin barrier intact for longer.

Bathing with a colostomy

Exposure to air or contact with soap and water won’t harm your colostomy. Water will not flow into the stoma. Soap will not irritate it, but rinse the soap off well before putting on the new barrier.

If you want to leave your skin barrier and pouch on while you shower or bathe, it can help to dry the collar of your skin barrier with a towel or hair dryer after you are done. This can help prevent your barrier from coming loose.

What to wear when you have a colostomy

You will not need to wear special clothes over your colostomy. Many colostomy pouches are fairly flat and hard to see under most clothing.

Snug undergarments such as cotton stretch underpants, t-shirts, or camisoles might give you extra support, security, and help conceal pouches. A pouch cover can add comfort by absorbing body sweat and keeps the plastic pouch from forresting against your skin.

Managing colostomy problems

Colostomies change the way your bowels work, but there are ways to handle any problems.

Diet

You don’t have to eat a special diet when you have a colostomy. But there are a few things to keep in mind.

• Eat plenty of whole grains, vegetables and fruits to help prevent constipation.
• Drink plenty of fluids to lower the risk of constipation or dehydration if your stools are watery.  
• Be sure to chew high fiber foods well, such as nuts, popcorn, and corn. Otherwise, they might cause cramping in your colostomy.
• Keep track of foods that seem to cause you to have diarrhea or constipation. It may be best to avoid them.

Gas (flatulence)

When you first get your colostomy, you might have a lot of gas. This can happen after most surgeries on your abdomen (belly).   While this gas is not harmful, you may feel uncomfortable with the noises that can happen.  

If you worry about other people hearing the rumbling,  you could say, “Excuse me, my stomach’s growling.” If you feel as though you are about to release gas when you’re with people, casually fold your arms across your belly so that your forearm rests over your stoma. This will muffle most sounds. Check with your ostomy nurse or doctor about products you can take to help lessen gas.

Certain foods may cause gas, for example: eggs, cabbage, broccoli, onions, fish, beans, milk, cheese, spicy foods, carbonated drinks, and alcohol. To help decrease the amount of gas you get:

• Eat regularly and don’t skip meals.
• Eat smaller meals up to 6 times a day.   
• Avoid smoking, chewing gum, or drinking through a straw.

Odor

Many things can affect the odor of the gas and stool that comes out of your colostomy. Certain foods, medicines and vitamins can cause odor. Even the normal bacteria in your intestine and illness can contribute.

• Foods that can produce odor include eggs, cabbage, cheese, cucumbers, onions, garlic, fish, dairy foods, and coffee. If you find that certain foods bother you, avoid them.
• Use an odor-proof pouch.
• Check to see that the skin barrier is stuck securely to your skin.
• Empty your pouch often.

Use odor eliminators such as ostomy deodorant liquids or tablets in your pouch.

Medicines also might help. Some things many people have found help with odor are chlorophyll tablets, bismuth subgallate, and bismuth subcarbonate. Check with your doctor or ostomy nurse about these products and how to use them. And think about using air deodorizers in the room when you empty your pouch.

Spots of blood on the stoma

Spots of blood on your stoma are not a cause for alarm. Cleaning around the stoma as you change the pouch or skin barrier may cause slight bleeding. The blood vessels in the stoma's tissues are very delicate at the surface and are easily damaged.

Any bleeding should stop quickly. If it doesn’t, use gauze to put pressure on the stoma and call your ostomy nurse or your doctor for guidance.

Finding medicine pills or capsules in your pouch

If you find pills or capsules in your pouch, it could mean you may not be getting all the medicine you were prescribed. This is more likely to happen with ascending or transverse colostomies.

If you notice this, talk with your health care provider or pharmacist. There may be other medicines or formulas you can use to make sure you’re getting what you need. Liquid or liquid gel medicines tend to absorb faster and may work better for you.

Shaving hair under the pouch

If you have a lot of hair around your stoma, you might have trouble getting your skin barrier to stick well. The hair might also pull out when you take off the skin barrier which can be painful.  Shaving or trimming the hair with scissors may help with this.

It’s recommended that you use stoma powder to dry shave the skin around your stoma. Soap and shaving creams have lotions and oils that might make it hard to get a good seal with the skin barrier. After shaving, rinse and dry the skin around your stoma well before applying your pouching system.

Severe skin problems around your stoma

Your stoma most often will not cause pain or discomfort since there are no nerves in your bowels. But the skin around your stoma might become irritated. 

Skin breakdown around a colostomy stoma may be caused by damage from skin barrier removal, being too rough when cleaning the skin around the stoma, and reaction to skin barrier or pouching system materials. Breakdown can lead to skin that is red, sore, and sometimes weeping (wet all the time).

Skin problems can keep you from getting a good skin barrier seal around your stoma. It’s important to treat minor irritations right away.

Get in touch with your doctor or ostomy nurse if your skin irritation doesn’t get better or gets worse over time. They can help you determine the cause of your skin problems and give you medicine or other options to help heal your skin. The pouching system could need changes to give a better seal.

Constipation

How often you have a bowel movement into your colostomy bag will be different for each person. Some people have 2 to 3 movements a day, while others have a bowel movement every 2 to 3 days. It may take some time after surgery to figure out what’s normal for you.

There might be times when you don’t move your bowels as often or your stool is harder than usual. This may mean that you are constipated and  should take steps to soften your stools more. Here are some tips for preventing and managing constipation.

• Eat 20 to 35 grams of fiber a day. Good sources of fiber include whole grains, vegetables and whole fruits.
• Drink at least 1.5 – 2 quarts of fluid each day. Warm fluids might help get your bowels moving.
• Get some physical activity, such as walking, each day to help keep your bowels moving.
• If you are taking medicines that can cause constipation, such as pain medicines, ask your health care provider if you can take a stool softener or laxative.

Diarrhea

Diarrhea from a colostomy usually means that something is irritating the bowel. Diarrhea is defined as frequent loose or watery bowel movements in greater amounts than usual. Diarrhea can come on fast and may cause cramps. It can cause your body to lose a lot of fluids and electrolytes.

Loose stools that come from eating certain foods, such as raw fruits and vegetables, milk, fruit juice, and prune juice, are not usually a reason to worry. If your loose stools only last a short time, they usually don’t need to be treated.

Several things can cause diarrhea:

• Infection or food poisoning, which may also cause fever and/or vomiting
• Antibiotics and other medicines
• Partial blockage, which can also cause smelly discharge, cramps, forceful liquid output, and a lot of noise from the stoma. It can be caused by food or other factors. Get medical help if this happens to you.

If you have diarrhea, be sure that you are drinking enough fluid to prevent dehydration. You should drink at least 1 cup of liquid (such as water, sports drinks, or bouillon) after each loose bowel movement to replace lost fluids. 

Talk with your doctor or ostomy nurse if you have ongoing diarrhea. Let them know what you eat and drink, when you eat, how much you usually eat, and any medicines you are taking. You may be given medicine to help slow things down.

Phantom rectum

If you had a perineal resection for rectal cancer, you might still have the urge to move your bowels the way you did before surgery. This can happen at any time and may go on for years after surgery. Some people who have this feeling say that it is helped by sitting on the toilet and acting as if a bowel movement is taking place.

During cancer treatment

Some people with cancer may need an ostomy while they are receiving other cancer treatments. You may need help caring for your ostomy if you are too tired or sick after treatment. If you are getting radiation therapy in the area of your ostomy, you may need to remove the pouch during treatment. Radiation therapy may also cause skin changes near your ostomy. Ask your health care team about any special precautions you should take to care for your ostomy during cancer treatment.

When you should call the doctor

You should call the doctor or ostomy nurse if you have:

• Cramps lasting more than 2 or 3 hours
• Continuous nausea and vomiting
• Cramps, pain, and/or nausea when your bowels are not moving like they usually do
• Severe watery stool lasting more than 5 or 6 hours
• Bad odor lasting more than a week (This may be a sign of infection.)
• A cut or injury to the stoma
• Red, sore or weeping skin around your stoma.
• A lot of bleeding from the stoma opening (or a moderate amount in the pouch that you notice several times when emptying it)
• Continuous bleeding where the stoma meets the skin
• Unusual change in your stoma size or color

Call your doctor or ostomy nurse if anything unusual is going on with your ostomy. They can help you figure out what the problem is and how to deal with it.