Stomas And Ovarian Cancer

About stomas

A Stoma is an opening in the abdomen which allows faeces to leave the body if the bowels areblocked or stop working. This can happen if ovarian cancer grows on the bowel.

The opening is created by a surgeon and the bowel is attatched to it. This allows faeces to leave the body by-passing the damaged sections of the bowel. Faeces are collected in a bag which is attatched to the opening. The bag is emptied and replaced.

There are three different types of stoma, depending on which part of the body is being connected to the outside.

Ileostomy - this is when the stoma is on the small bowel (a structure made of tubes between the stomach and the large bowel. It digests food coming from the stomach and absorbs nutrients and water).
Colostomy - this is an opening from the large bowel (a long tube starting at the small bowel including the cecum which joins them, the colon, rectum and anus. It turns food waste into faeces and passes it out of your body).

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(You may hear the small and large bowels referred to as small and large intestines)

Urostomy - this is a stoma from the urinary system to drain urine.

You can find more information about these different types of stoma here.

A stoma can be permanent or reverable and temporary. If it’s intended to be permanent, the surgeon will often cut through the bowel and this end is brought through the abdomen and stitched in place. This is called an end ileostomy or end colostomy. Food will pass from the stomach, through the remaining part of the bowel and out of the stoma.

If the stoma is intended to be temporary, a loop of bowel is brought through the opening in the abdominal wall, opened and stitched in place. This is called a loop ileostomy or loop colostomy and has two bowel openings, one leading from the remaining bowel and the other towards the rectum/anus.

This means the part of the bowel connected to the stomach will continue to transport contents from the stomach. The part leading to the rectum/anus will be inactive unless the stoma is reversed. It may continue to produce mucus which usually helps to lubricate the passage of waste.

Mucus is naturally produced by the bowel, so will continue even if the bowel is no longer functioning. The amount of mucus varies and some people find that it lessens over time. The mucus can need management. If it’s thicker, it can build up and form a plug in the anus, which may be painful. If it’s thinner and more liquid, it can leak onto the surrounding skin and onto underwear, causing irritation.

You can find more information on rectal discharge and strategies for reducing and managing it on the Colostomy UK website.

Stomas help to manage or relieve symptoms such as constipation and abdominal pain, and help you to recover from your treatment. For many people the thought of having a stoma is worrying and upsetting and living with a stoma can be difficult to adjust to at first. With support, you can adapt to living with your stoma and managing it around your activities and lifestyle. Different types of stoma equipment are available and you will find out which work best for you.

There are specialist stoma nurses who help people through preparing for surgery, learning to care for their stoma day to day and dealing with any issues that arise. They can support you with the emotional and lifestyle aspects of the process such as body image, sexuality and socialising.

You can also find more information about stomas through:

Colostomy UK

Ileostomy & Internal Pouch Association

Urostomy Association

Stoma surgery

Surgery for ovarian cancer may sometimes include creating a stoma. Your surgeon will not know if this is needed until they operate. Scans can show where the cancer has grown, but they don’t always show everything.

This means that when you give your consent before surgery, a stoma may be discussed, even if it’s not clear yet whether one will be needed. So, if the surgeon finds that they do need to create a stoma, they can do it.

If a stoma is planned, or thought to be likely, the stoma nurses will be involved. They can help with the practical and emotional aspects of preparing for a stoma. This can include planning the location of the stoma based on your lifestyle, for example the clothes you like to wear. The nurse can put a dot on your abdomen where you’d prefer the stoma to go. A colostomy is usually on the left side and an ileostomy on the right.

Before surgery, the stoma nurses can explain the options for daily stoma care and show you the different types of bags and products and help you to prepare. You will find out what works best for you and your lifestyle, but having an initial plan may help you to feel more confident.

There are two types of bowel stoma: an end ileostomy or colostomy and a loop colostomy or ileostomy.

An end stoma is permanent. The surgeon cuts through the bowel bringing the end closest to the stomach through the abdomen and stitching it in place. Food will pass from the stomach, through the remaining part of the bowel and out of the stoma.

A loop stoma may be reversible. A loop of bowel is brought through the opening in the abdominal wall, opened and stitched in place. It has two openings, one leading from the large bowel and the other towards the rectum and anus. The part of the bowel that becomes the stoma will continue to transport contents from the gut out through the stoma into the bag.

Recovering from your surgery

When you wake up from surgery with a stoma, you will have a transparent bag in place with a clip or clamp or Velcro at the bottom to allow emptying. This first bag is to help nurses monitor output and empty it while you recover. The bags that you will use at home are sometimes smaller and have a soft cover.

The stoma will probably be bigger than its eventual size due to swelling from the surgery and will get smaller over the next few weeks. The stoma won’t be painful, as it doesn’t have a nerve supply, but you will be given painkillers to manage pain from the surgery.

At first, you will only pass wind through the stoma, and there may be some bleeding and discharge. Within two or three days you will pass your first stool, which will probably be quite liquid. As your bowel function returns to normal, the stools will become more solid. The output from an ileostomy is usually looser than from a colostomy because it comes from a part of the small bowel where the contents are more liquid.

During your recovery, the stoma nurses will work with you while you learn how to care for your stoma. You will need to make sure you’re using the right size bag, especially while the stoma is new and hasn’t yet reached its normal size. You will need to learn how to empty and change the bag and keep the stoma clean and dry. The nurses can also provide emotional support while you adjust to having a stoma.

You will probably stay in hospital for between three and fourteen days. This depends on how extensive your surgery was, how your recovery is progressing and the support you have at home. You won’t be able to do any heavy lifting or strenuous activities for the first few weeks and you will probably feel very tired. You may need help during this time with daily activities such as bathing, housework and cooking.

You can find more information on stoma surgery and recovery here:

Travelling with a stoma

Travelling with a stoma involves some planning and preparation to help the trip to go smoothly.

It’s worthwhile ordering more products for your trip than you use at home and to order them in advance, so you have them in good time before you leave. Your return home could be delayed, or you may change your bag more often than usual due to diet changes and stoma output, normally associated with swimming or sweating in hot weather.

You should also take a list of the products that you use, including their product codes, and the contact details for your supplier in case you need to buy or order more while you’re away.

You may also want to use different products, such as drainable bags for travelling or in case of stomach upsets, bags with disposable liners for while you’re away or mini bags for swimming.

If you don’t feel comfortable in ordinary swimwear, there are companies that make swimwear designed for people with stomas, including:

ComFizz Tel: 0113 266 2096 comfizz.com

CuiWear Tel: 0800 2792050 cuiwear.com

Respond Tel: 0800 220 300 respond.co.uk/swimwear-range

Vanilla Blush Tel: 0141 763 0991 vblush.com

White Rose Collection Ltd Tel: 0345 460 1910 whiterosecollection.com

If it would help your confidence away from home, you can get disposable bed pads in case of a leak. Your stoma nurse can recommend suitable products and companies.

You may prefer to pack your stoma supplies in your hand luggage, as hold luggage can occasionally get delayed or lost. If any products going on the plane need to be cut to size, remember to do this beforehand, as scissors and other sharp objects are not allowed in hand luggage.

You may need to carry more hand luggage than is normally allowed.The airline can confirm their current rules on hand luggage. If you have a letter from your GP confirming your needs and the products you’ll be taking, the airport security manager may be able to provide a letter allowing you to exceed the usual hand luggage allowance. You should contact the airport in advance to ask whether this is possible and arrange it.

You can also get a travel certificate signed by your doctor explaining that you have a medical condition and have a stoma. Your stoma nurse, the Ileostomy and Internal Pouch Association, The Colostomy Association and The Urostomy Association can provide these certificates in different languages.

It’s a good idea to tell staff about your stoma when you enter the security area. Some airports offer lanyards to anyone with a hidden disability or condition who might need extra support. You can contact the airport in advance to ask what assistance they can offer.

Security staff are trained to recognise stoma bags but it’s a good idea to empty or change your bag before going through security, as the body scanner could flag it as something that needs to be checked.

Your stoma supplies should be stored somewhere cool and away from direct sunlight. In warmer destinations, you may need to keep them in a coolbox.

Its common for anyone travelling to another country to experience digestion issues and stomach bugs. Consider packing some over the counter medication for dehydration, diarrhoea and constipation. Your GP, stoma nurse or pharmacist can advise on what to take.

It’s important to drink enough water to avoid getting dehydrated and avoid foods that could cause an upset stomach or other issues with your stoma. If the tap water isn’t safe to drink, use bottled water and avoid ice cubes or foods such as salad that may have been washed in tap water.

If irrigating with a colostomy while you're away, use bottled water if there is any doubt about the local tap water.

If you would like to share your experience of travelling with a stoma, or if you have any tips on doing this, please comment on this post. You can find more information on travelling with different types of stoma through:

IA Support

Colostomy UK

Urostomy Association

Stoma reversal

Loop colostomies and loop ileostomies are usually reversible, whereas end colostomies and end ileostomies aren’t; these are usually permanent. In this post we’ll focus on reversal of loop ostomies.

You can ask your team if a stoma reversal could be an option for you. They can give detailed information about the surgery, how long your hospital stay might be, how long you may take to heal, potential complications, and your expected bowel function in the short and long-term.

Not everyone chooses to have stoma reversal surgery. You may be comfortable living with your stoma and not want to have another operation if you are feeling healthy and well.

If you do have your stoma reversed it’s unlikely that your bowel habit will go back to the way it was before your diagnosis. The operations, cancer treatment and a period of a non-functioning rectum are likely to have a long-term effect on your bowel. You may also have had a section of bowel removed, which will affect its function.

Your surgeon and stoma nurse can explain in more detail what you can realistically expect depending on what operation you previously had.

If you decide to have your stoma reversed, you may be able to do this within a few months to a year of finishing treatment. The timing will depend on how you are recovering and your general health. You may have some tests before surgery to check that your bowel has healed sufficiently and that your anal sphincter muscles are working well. There is no time limit for having the reversal surgery; some people have their stomas reversed from weeks up to several years after the stoma is created.

The reversal operation

Before you have the surgery, your stoma nurse may advise you to be working on pelvic floor exercises. This can work the muscles around the anus after the surgery, helping control bowel movements and managing continence.

When you have the operation, the surgeon will open the abdomen at the site of the stoma. They will return the stoma to the inside of the abdomen and join the bowel together again so that faeces can pass through the intestines and out of the anus.

After the operation you will have a small surgical wound with stitches or clips, covered by a dressing. A catheter isn’t usually needed, so you can use the toilet to pass urine if you’re well enough to walk to the bathroom.

You will have painkillers prescribed to manage any pain issues. You may also have abdominal pain or discomfort that feels like trapped wind and can be very uncomfortable. If you’re able to drink, warm water or peppermint tea may help with this pain. If the pain is severe and the medication isn’t controlling it, you can ask the nurses for stronger painkillers.

You should start to pass bowel movements a couple of days after the operation. It is normal to experience urgency and frequency, diarrhoea or constipation while your bowel starts to function again.

Recovery

It can take several months for the bowel to settle into a regular habit, particularly for people who have had chemotherapy. During the period of adjustment after stoma reversal, you may experience effects including:

Increased frequency – needing to open your bowels more times each day;
Urgency – a sudden strong need to open your bowels;
Diarrhoea;
Passing a smaller amount of stool more often and feeling like you haven’t fully emptied your bowels;
Leaking stool from the anus;
Difficulty telling whether you need to pass wind or stool;
Constipation;
Traces of blood in your stools, which is temporary;
Sore skin around the anus.

While your bowel is recovering from the surgery and hasn’t yet settled into its new pattern, you will probably experience a period of adjustment similar to when you first had the stoma. You will find out how different foods affect your bowel movements and how long after eating you will need to open your bowels.

You can monitor how your diet affects your bowel habit. Foods high in fibre can make stools softer or increase the frequency of bowel movements, caffeinated and alcoholic drinks can make bowel movements looser and fizzy drinks can increase the amount of wind and cause more explosive bowel movements. While your bowel habit is settling down after the surgery, you may wish to avoid or limit your intake of foods and drinks including:

High-fibre foods such as vegetables, fruit and cereals, especially vegetables likely to cause flatulence such as cabbage, onions and Brussels sprouts;
Caffeinated, alcoholic and fizzy drinks (you can leave fizzy drinks to stand for a while before drinking them;
Acidic and citrus fruits like strawberries and grapefruit;
Very spicy foods such as chilli and curries;
Large fatty meals;
Large amounts of beer or cider.

If you’re experiencing discomfort or your bowel habit is causing problems for your daily life, you can speak to your doctor or stoma nurse for advice. They may also recommend or prescribe medication for diarrhoea or constipation.

It’s important to be aware that you can still have very loose bowel movements when you’re constipated. This is because liquid stool higher up in the bowel can pass any firmer stool blocking the bowel lower down. This is called ‘overflow diarrhoea’ and can cause very watery diarrhoea. Ask your stoma nurse or another healthcare professional for advice before taking any medication.

Opening your bowels more often than you’re used to can cause the skin around your anus to get irritated and sore. Using moist toilet wipes can help with this. You can also use a barrier cream to reduce the irritation. It’s best to gently wash the area with warm water and dry it before applying the cream. You can ask your stoma nurse about this.

You may also worry about protecting your underwear and clothes if you’re experiencing urgency and might leak stool. You can use pads in your underwear to protect your clothes, especially if you’re going out and don’t know whether you’ll be able to easily get to a bathroom. Some people continue to wear small liners in their underwear for a while to give them added reassurance.

You can find more information about stoma reversal on:

The NHS website

St Georges Hospital website

Colostomy UK