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Clearing the way forward

Gain a better understanding of ostomy and how people living with a stoma can carry on with their lives in the community.

An ostomy is a surgical procedure that connects an internal organ to the surface of the body to alter the way bodily waste is removed. A stoma is an opening created by this surgery through which waste is expelled, shares Dr Teo Nan Zun, Consultant, Department of Surgery, Changi General Hospital (CGH). These may be short-term (temporary) or life-long (permanent). Ostomies are usually performed for the digestive system, urinary system or respiratory tract. For the digestive tract, two common stomas are:

Ileostomy (small intestine stoma)
The diversion of bodily waste to allow a portion of the bowel to rest and heal (temporary); or when the large intestines are removed and connection to the anus is not feasible (permanent).

Colostomy (large intestine stoma)
When one part of the colon is removed and the cut ends are not ready to be joined; to relieve obstruction of the downstream colon; for the diversion of faeces to allow a portion of bowel to rest and heal (all temporary); or when a disease affects the end part of rectum which needs to be removed (permanent).

Colorectal cancer is the most common cause of stoma creation. The process involves bringing out the bowel through the abdominal wall, opening up a hole and attaching the stoma bag.

Left: Ileostomy
Right: Colostomy

Living with a stoma

CGH’s nurses educate
patients and their
families on how
to select, apply, and
manage the ostomy bag.

After an ostomy, living with a stoma can feel strange and requires adjustment. CGH Senior Staff Nurse Ong Yun Ting shares advice on how to make the transition back to the community smoother.

1. Choose the right ostomy appliances that fit your body

  • The type of wafer (the barrier that adheres to the skin around the stoma that connects to an ostomy bag) used is greatly determined by the size of stoma and flatness of the skin. The right ostomy appliances will provide a good seal around the stoma to prevent leakage, provide comfort and maintain good healthy skin around the stoma.

2. Engage in exercise and physical activities

  • Most patients can return to physical activities. Consult your colorectal/stoma nurses or surgeon before starting any form of physical activities or exercises.
  • Go at your own pace. It will take time for your abdomen to fully heal.
  • Most pouching systems are water-resistant so there is no issue with perspiration.
  • Always check the integrity of the stoma bag’s baseplate and change to an empty pouch before engaging in any activity.
  • Protect your abdominal area when playing contact sports.

3. Emptying of the pouch

  • Each person has different stoma outputs depending on the type of ostomy.
  • Pouches with charcoal filters built into the bag help control odours from your stoma and prevent “ballooning”.
  • It is recommended to empty your pouch when it is one-third full of output or gas.

4. Join support groups

  • Resources such as support groups are available for patients to reach out and find others in a similar situation. These groups also work on improving the quality of life for ostomates through advocacy. Contact your colorectal/stoma nurse to find out more.

What to eat and drink with a stoma

Opting for a low-fibre diet

When a stoma is newly created, a low-fibre diet may be advised to reduce the risk of blockage, and reduce swelling after surgery. Opt for foods such as low-fibre vegetables and refined grains (white rice, white bread, cornflakes) over wholegrains (brown rice, wholemeal bread, oats). Remove stalks, seeds and skins from vegetables, and ensure they are well-cooked before consuming.

Soft, ripe fruits that are suitable for a low-fibre diet include bananas, papayas, melons, peaches (without skin) or canned fruit. Avoid nuts, seeds and legumes (such as lentils, beans and peas).

Returning to a normal diet

After six to eight weeks of a low-fibre diet post-surgery, most individuals can return to their normal diet. There is no evidence to support a specialised diet for ostomates. “Every individual is different — some people can eat anything, while others may find that certain foods are not well-tolerated,” says CGH Dietitian Zakiah Halim. “Introduce new foods one at a time, and in small amounts, to monitor for any potential side effects. A food and symptom diary may help to identify items which may be causing a problem.”

Photo: HealthHub

Every individual with a stoma is advised to follow a well-balanced diet that includes all food groups to obtain the necessary vitamins, minerals and calories they need. Visualising the meal using “My Healthy Plate” can be helpful.

Avoid skipping meals to reduce the risk of watery stools and gas. To aid with the digestion and absorption of nutrients, chew food thoroughly. For some individuals, a soft diet featuring food that is cut-up or minced may allow for easier digestion. If you have concerns about your diet, consult a dietitian for more tailored advice.

Stay hydrated

As one of the main roles of the large intestine is to absorb salt and water, hydration is important for individuals with a stoma. Aim for six to eight cups (1.5-2L) of fluids per day. Watch out for signs of dehydration — reduced urine output (<1L per day), dark yellow/orange urine, or low blood pressure. For individuals with an ileostomy, a doctor may prescribe oral rehydration salts (ORS) to take with your fluids to ensure adequate replacement of salt and water in the body.

The toilet before (left) and after (right) the shelves were installed — enabling a patient to place the stoma appliances safely.

Recognising the needs of people living with stomas (ostomates), CGH’s Department of Patient Experience Transformation and the CGH Colorectal Patient Support Group — Gutsy Warriors — modified two handicap toilets in CGH’s Medical Centre. The toilets were fitted with shelves to enable ostomates to change their stoma appliances with ease.

Without the shelves, ostomates do not have a proper platform to place their appliances during changes. These improvements to CGH’s amenities, implemented since October 2022, allow ostomates to move around in the community with confidence, leading to a better quality of life.

Clearing the way forward