3 Major Lifestyle Changes to Expect After Having an Ostomy

In more severe cancer cases, parts of the colon, or even the entire colon or rectum, is removed through surgery to stop and prevent further cancerous growth, but how does a body function without a key component of the digestive system?

When patients undergo a colectomy, it is often accompanied by an ostomy, in which the surgeon creates a hole or stoma in the abdomen, and joins the healthy end of the ileum (the last part of the small intestine) or the colon to the stoma. This allows the body to continue removing waste from the body in the absence of a colon and rectum.

In cases where only part of the colon is removed, a temporary ileostomy (joining the small intestine to the stoma) may be done to give the colon time to recover from the major surgery. In temporary cases, the stoma can eventually be closed in a process known as ostomy reversal.

While it largely depends on your cancer diagnosis, having an ostomy (along with other aspects of cancer treatment) will have an impact on your quality of life, and you may need to adapt to a new way of life.

What are some of the lifestyle changes you can expect after having an ostomy?

Your bowels may not be able to resume normal function immediately after surgery for a few reasons — this condition is referred to as an ileus. Aside from an ileus, the remaining healthy sections of your colon need time to recover, as surgeries are after all, considered internal trauma. Abdominal surgeries can disrupt the absorption of nutrients, fluid and electrolytes. For ostomies, the consistency of waste being discharged also changes depending on the kind of ostomy you receive.

Types of colostomy include:

Sigmoid colostomy: The sigmoid colon is joined to the stoma. Most of the healthy colon up to the descending colon is retained, and as a result, the stool formed is more regular and solid, resembling normal bowel movement.

Transverse colostomy: The transverse colon is joined to the stoma when the descending colon is badly affected by cancer. The stool formed is usually semi-solid, but the consistency can be unpredictable at times.

Ascending colostomy: A short section of the colon is joined to the stoma that occurs near the start of the colon. As a result, the colon is not able to absorb the water from the food waste, resulting in liquid stool.

Ileostomy: When a stoma is created at the last part of the small intestine, this results in poor absorption of nutrients, water and electrolytes, giving rise to varying stool consistencies ranging from liquid to mushy or paste-like.

Because of your digestive system’s impaired ability to fully digest and break down food and absorb nutrients, a change in diet is required to manage the condition while giving your body time to adapt to a new way of functioning.

Your doctor may prescribe you a specific nutrition plan over the duration of your recovery or while you have the ostomy. Nonetheless, there are a few key do’s and don’t’s.

Immediately after the surgery, foods high in fiber should be avoided to prevent intestinal blockage. At the same time, bland foods are also recommended as spicy, greasy and fried food and foods high in sugar can cause diarrhea. And, as your body is unable to absorb water as well as before, a lot of water will be lost through stool and can quickly lead to dehydration. You will need to drink plenty of water (even more so than usual) to stay hydrated, as well as be aware of the early signs that your body is not getting enough water such as dark coloured urine or little to no urine.

Over time, you will be able to reintroduce different foods back into your diet. While you may not be able to eat as much as before, or as wide a variety of food, you will be able to resume a largely normal diet once your bowel is given time to recover and adapt.

Besides bowel movement and diet, colorectal cancer often has a negative impact on cancer survivors’ sex lives as well. Roughly 88% of men and half of women with colorectal cancer suffer from sexual dysfunction. This can arise from different aspects of the colorectal cancer treatment, but particularly for those who have an ostomy, studies have found that patients with an ostomy experience greater sexual dysfunction and body image distress compared to those without.

Having an ostomy can make one feel unattractive or insecure about exposing themselves in front of others. Sometimes, a fear of leakage or odor can cause one to avoid intimacy altogether. While sexual dysfunction can persist for over ten years after treatment completion, it is possible to still be intimate with the help of open communication, as intercourse is unlikely to cause harm to the stoma or dislodge any equipment.

As with many other cancer procedures, ostomies carry the risk of complications during the surgery and post-operatively. The complications can sometimes last many years after the surgery, or even occur later in life, especially for permanent ostomies. The complications also have an effect on overall quality of life.

Early complications

Inappropriate site: Prior to any ostomy surgery, the optimal site should be selected to minimize the consequences on the patient’s quality of life, and the site is usually determined by a specialist. Positioning the stoma accounts for how the patient’s skin folds and their standing and sitting positions to ensure that the stoma is always visible to the patient and will not cause any leakage, skin irritation or breakdown.

Peristomal dermatitis: Skin irritation around the stoma can also occur because of the highly alkaline fluids and digestive enzymes that are discharged through the stoma together with the stool. This can damage and irritate the skin around the stoma, and is usually more common in ostomates with an ileostomy.

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Parastomal ulceration: In more severe cases, the skin irritation could worsen and lead to inflammation at the site of the stoma.

Stoma necrosis: Necrosis, or tissue death, occurs when there is insufficient blood flow to the stoma. This typically happens within 24 hours after the operation.

Stoma retraction: Contrary to the common misconception, an abdominal stoma is not flat but actually protrudes from the skin by about 2.5cm. This helps prevent skin abrasion as a result of wearing a stoma bag, and stoma retraction happens when a stoma sinks to 0.5cm or more below the skin surface. This usually occurs within the first six weeks of stoma formation and requires corrective surgery.

Late complications

Stomal prolapse: A stomal prolapse happens when the stoma enlarges beyond the normal size and can either be dealt with surgically or by changing the equipment. While a prolapsed stoma does not cause any physical harm, its appearance can be distressing to patients.

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Stomal stenosis: A narrowing of the lumen of the stoma can occur within the first five years after the ostomy. While it does not typically result in acute intestinal obstruction, the narrowed hole can create noise, which may be embarrassing or startling to the patient.

Peristomal pyoderma gangrenosum: Over the course of the ostomy, lesions may form around it at any time. These lesions are usually pustular, but can sometimes be fistulous, and are painful and leave a scar when they heal.

While there will be difficulties throughout the treatment and recovery and living with an ostomy, it is still possible to lead a relatively normal life with the help and support of those around you. Over time, not only would you be able to return to work, but it would also be possible to resume physical activities like sports with proper preparation.