Chapter 09: The Stoma Routine
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This page will concentrate on the everyday routine of living with a Stoma. Principally cleaning and coping with any problems which may arise.
Initially you can expect to be quite slow at changing your appliances. But as with most things in life the more you practice it the faster you'll get.
It is helpful if you pick a time to be in the bathroom where you can be undisturbed for the duration of the change. The last thing you need is to have a knock on the door and a faint "I need the loo, hurry up will you!" coming your way when you've got your jeans around your ankles and are cleaning your stoma. So check no one needs the bathroom before you 'freshen up'. Try to get into a routine that works well.
Of course you do not necessarily have to change everything in the bathroom, you could use your bedroom if you wished and it made you more comfortable. Just take a small bowl of tepid water with you before you commence. I would however recommend the bathroom as it is a completely private place and has easy access to warm water and a toilet in case of emergency.
Before you start you need to get yourself a small container in which you can keep all your supplies and a few pouches. An ice cream container is ideal, or if you use a home delivery service you'll soon have a travel bag coming your way which is specifically designed for the job. The suggested contents for your wash kit can be found over the page.
Once you are safely locked away in the bathroom it is a good idea to prepare everything before you even consider removing the appliance, as you can guarantee the stoma will work while you are at your most vulnerable! Lay everything out so that you can easily reach them, on top of the toilet cistern or on a windowsill is ideal.
To start with you need to cut out your stoma shape onto the flange or bag. Cut this so that it fits snugly around the stoma. Your Stoma Nurse will show you how. Try to make sure it is neither too tight a fit or too large a hole. If too tight the stoma may be damaged, if too large then you may risk a skin irritation on the exposed skin.
Take your bag and add any odour control liquids or powders that you may need. These are not always necessary and you may be happy to manage without them.
With your flange or pouch cut to size you are now ready to remove your current appliance. Carefully peel away the adhesive from the skin working off any bits that may be resisting.
Wet a wipe with warm water and clean the skin around the stoma. No soap should be necessary but you can use a non-perfumed soap if you wish. Carefully wipe the stoma so it is totally clean. Try not to rub it too hard as the stoma will begin to bleed. It is very fragile. If it does begin to bleed despite taking care and attention do not worry, it will stop almost as quickly as it has started.
Pat the skin and the stoma dry with dry wipes. Avoid towels or cotton wool to do this. Towels may carry germs which could infect any areas of the stoma that are bleeding. Cotton wool is too fluffy and will leave bits sticking to the Stoma.
If you need to shave the area around the stoma to remove any body hair from the abdomen now is the time to do it. Be careful not to catch the stoma with the blade. Any hair on the stoma edge is best removed with rounded end scissors.
Next apply the second skin wipe if you are using one, and also any barrier creams and stoma pastes that you may be using. These help protect your skin, while the Stoma Paste fills in any natural grooves that may affect the adhesion to the skin.
Now you are ready to fit your clean appliance. Carefully bring the bottom edge of the stoma hole adhesive in line with the bottom of your stoma, use the mirror if necessary (as you get more practice the mirror will become redundant). Gently press into place starting at the bottom and working up being careful to avoid any wrinkles in the flange or bag adhesive.
If you are using a one piece system that is everything complete, if using a drainable bag just check that you've closed the pouch clip securely.
If using a two piece system you now need to clip on the bag. Again work the appliance onto the flange carefully from bottom to top. Once on check it is firmly in place by giving the bag a gentle tug, if it isn't you'll soon know as it will slip off easily.
To dispose of the soiled bag simply place it along with all used wipes in a disposal bag or wrap in a few layers of newspaper, and discard in the bin outside. You may empty the bag into the toilet if you wish before doing this but it is messy and best avoided. To do this simply cut the bottom off the closed bags or unclip the drainable one, and hold the stoma hole near the toilets main water flow in the bowl and flush through.
Do not, under any circumstances, attempt to flush pouches, flanges or wipes down the toilet unless the manufacture states the appliance is flushable. Being plastic and solid they will soon block up the drainage system.
A soiled pouch is classed the same as a dirty nappy as far as clinical waste goes so if you find it necessary to change in a public toilet it is perfectly acceptable for you to place any wrapped up soiled appliance in a public waste bin.
Back at home ask your GP if the local council operates a 'yellow bag' service. This is a clinical waste collection service that comes once a week to your home to remove all your waste and incinerate it free of charge. Not all councils operate this but most do.
Once you are finished make sure you wash your hands, return all items to your container or travel bag and stock up if supplies are getting low. Try to keep the container in a cool place like a cupboard or bedroom drawer.
When you are eventually back on our feet and feeling fit your desire to go out and about more will develop. If you intend to leave the house for the day it is best to take a small pocket size travel bag (this could be a specially designed one that repels heat or could be something as simple as a bum-bag!). The suggested contents for this can be found over the page.
If you are just nipping into town and back or intend on being out of the house for only an hour you can check your appliance before leaving the house and leave this kit at home. As you gain confidence around your stoma, you'll learn the limits of how long you can leave a bag on, how full it can be before problems arise with smell etc. However even if you are still only strolling to the post office or going out with the dog it is a good idea to tuck a spare pouch in your pocket before leaving. Once you've settled on your particular brand you can easily pop a spare appliance in side a pocket of all your coats so that you know that even if you've left everything at home you are not totally stuck.
The British Colostomy Association have a No Waiting card on offer. This is a card that can come in very handy at times. If you are in a busy shopping centre and for sake of argument your appliance does give up the ghost and starts to come off you can go into any large store produce the card and ask to use their staff toilet facilities. The staff would probably have to check with the Manager/ess before hand but they will not say no. Thankfully, I've yet to be placed in this situation but it is nice to know that you have that protection.
If you suffer from Colitis or Crohns disease and have joined the NACC you may already have one of these no waiting cards. Wherever you get one from, it is advisable you get one and carry it with you at all times either in your purse, wallet or coat pocket.
Now that you are a Colostomist you qualify for Radar's disabled toilet 'National Key Scheme'. For 2.50 you get your own key that opens the door to every disabled toilet in the British Isles. For a further 3.00 you can obtain a copy of the book which lists all the sites.
Because the doors remain locked there is less chance of the facilities being vandalised beyond use or recognition, as is the case with a lot of public conveniences these days.
Inside you'll find a toilet - no great surprise there - as well as a wash basin with hot and cold water. It will also be brightly lit and roomy which is a nice plus as a lot of cubicals in standard toilets are cramped.
There may be a clinical waste yellow bag in there too if not you can always place your carefully wrapped disposal bag in a street bin.
Quick Guide For Cleaning Your Stoma
1. Prepare new appliance and flange before removal of soiled appliance.
2. Remove peel away soiled pouch and flange.
3. Clean skin around stoma, followed by stoma itself using wipes and warm water.
Pat dry with wipes.
4. Shave area if necessary and wipe with damp cloth once finished.
5. Apply skin lotions, cream and pastes if necessary
6. Carefully stick on new appliances, be sure the fit is wrinkle free.
7. Wrap soiled appliances in disposal bag or newspaper.
8. Wash hands.
Suggested Pocket-Bag Contents
2. A replacement pouch (preferably already cut to your current size if one piece)
3. A disposal bag and a few wipes.
4. The all important clothes peg
5. A small packet of wet wipes (in case you are stuck in a cubical with no water)
6. A second skin wipe (if used)
7. The Radar disabled toilet key.
Suggested Bathroom Wash Kit Contents
1. A good pair of surgical quality scissors. Preferably with rounded edges.
2. A Razor. Not necessary if there is no hair growth on your tummy.
3. A pen. To draw the stoma template onto your new bag or flange.
4. A small mirror. To check positioning of appliance on underside of Stoma.
5. A Supply of disposal bags. Newspaper is a good substitute.
6. Lint-free cleaning wipes.
7. A fresh pouch and flange.
8. All your pastes and creams (if used).
9. A bag clip, if using drainable pouches.
10. A clothes peg.