Stoma Care: A Practical Guide for Care Teams

Stoma care means looking after a stoma, an opening on the tummy where part of the bowel or urinary system has been brought out, and the bag that collects what comes out of it. Day to day that means emptying and changing the bag, protecting the skin around it, supporting diet and fluids, and spotting problems early, all while protecting the person's dignity.

The three main types of stoma

A stoma can be temporary and reversed later, or permanent. The type decides what comes out and how the bag is managed.

• Colostomy: part of the large bowel (colon) is brought out through the tummy. The NHS lists reasons including bowel cancer, inflammatory bowel disease, diverticulitis, a blocked bowel and injury to the bowel or spinal cord.
• Ileostomy: the end of the small bowel is brought out. The NHS describes the output as liquid or soft, like porridge.
• Urostomy: a new route for urine, usually made after the bladder has been removed, often as part of bladder cancer treatment. A short piece of small bowel carries urine from the kidneys to the stoma, so urine flows steadily through the day. White, jelly-like mucus in the bag is normal.

Supporting someone with a stoma is a different skill from bowel or bladder care for people without one, which our continence care and bowel management courses cover.

What a healthy stoma looks like

The NHS describes a healthy stoma as soft, slippery and pink, like the inside of your mouth. It may sit flat against the skin or stick out a couple of centimetres. The stoma has no nerve endings, so handle it gently: it can bleed slightly when cleaned. Lots of blood from the stoma or in the bag needs urgent advice.

Get to know what is normal for each person: size, colour, shape and usual output. Staff spot a change far sooner when they know the baseline.

Bags and appliances

The stoma nurse will have chosen the bag (also called a pouch or appliance) that suits the person.

• One-piece: the bag has its own sticky back, so the whole thing comes off at each change.
• Two-piece: a separate sticky ring (flange) stays on the skin and only the bag is changed.
• Drainable: has an opening at the bottom for emptying into the toilet.
• Closed: sealed, and changed when full.
• Urostomy bags: have a small tap or bung for emptying, and a larger overnight drainage bag can be attached at night.

How often a bag is changed varies from person to person. Write the routine and product details into the care plan and keep enough supplies in stock.

Emptying and changing: the principles

Staff need practical training and your own supervised sign-off before doing this unsupervised. The principles that matter on shift:

• Follow the care plan for products and routine, and your local policy on infection control and disposal.
• Let the person lead. Many people manage some or all of their own stoma care. Ask how they like it done.
• Privacy first: a closed door, a calm pace and no comments about smell or output.
• Check the fit. A bag that fits closely keeps output off the skin. The NHS advises measuring the stoma regularly so the bag still fits well.
• Look and record: the stoma, the skin around it, and the amount and type of output. Report anything new.

Skin care and preventing leaks

Sore, red or broken skin around a stoma often means output is getting underneath the bag, and a poorly fitting appliance is a common cause. Leaks make the skin worse, the bag sticks less well, and the cycle continues.

Clean the stoma and nearby skin carefully at each change, as the care plan describes. If the skin is sore or leaks keep happening, contact the stoma nurse. Special sprays, wipes or a different bag can help, but the stoma nurse should decide which.

Diet, fluids and medicines

After ileostomy surgery, the NHS advises a low-fibre diet for about six weeks while the bowel heals, then most people can return to a balanced diet. Eating regularly without long gaps and chewing food well help prevent blockages.

The NHS says having an ileostomy or a colostomy makes it harder to stay hydrated. Signs of dehydration include tiredness, a dry mouth and lots of output from the stoma. Encourage regular drinks and record intake where the care plan asks for it.

Some medicines behave differently with a stoma. Modified-release and enteric-coated tablets may not be fully absorbed with an ileostomy. If staff see tablets that look whole in the bag, tell the pharmacist or prescriber.

Complications to report

The NHS lists these as reasons to ask for an urgent GP appointment or call NHS 111. In a care service, follow your local escalation policy and the person's care plan:

• a very high temperature, or feeling hot, cold or shivery
• lots of blood from the stoma or in the bag
• signs of dehydration
• no output for much longer than is normal for the person (for an ileostomy, the NHS says more than 12 hours)
• severe tummy pain, feeling sick or being sick

Cramps, nausea or swelling around the stoma can mean a blockage, and the NHS advises speaking to the stoma nurse urgently. Also contact the stoma nurse or GP about:

• Skin damage: sore, red or broken skin around the stoma.
• Hernia: a bulge or swelling around the stoma.
• Retraction: the stoma sinks back into the tummy.
• Prolapse: the stoma sticks out too far.
• Any change from that person's normal.

Dignity, privacy and emotional support

A stoma changes how someone sees their body. Some people are relaxed about it; others feel embarrassed or low, especially soon after surgery. The NHS notes that the stoma nurse can help with worries about sex, relationships and body image.

In England, Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 requires people to be treated with dignity and respect, including their privacy. On shift that looks like:

• using the words the person uses for their stoma and bag
• keeping spare supplies discreet and to hand, so a leak doesn't become a public event
• offering a change of clothes and a shower after a leak, without fuss
• noticing if someone avoids activities because they're worried about leaks

Our dignity in care training covers the wider picture.

Who does what

The stoma nurse advises on products, fitting and problems, and is the first contact for concerns that aren't an emergency. GPs prescribe supplies. Care staff and nurses do the day-to-day care, once trained and signed off by your service. This guide is awareness level: it doesn't replace hands-on training or the person's care plan.

How Kasorb can help

Our stoma care training teaches care staff to support people with a colostomy, ileostomy or urostomy with confidence and dignity: the types of stoma, appliances, changing and emptying, skin care and preventing leaks, diet, hydration and medication, recognising complications, emotional support, and when to contact the stoma nurse.

We deliver it on-site anywhere in the UK for up to 10 staff, at one flat rate for the group, built around the stomas and appliances your team works with. Your trainer has used these skills for real. Certificates are emailed the next day, ready for your own supervised sign-off against each person's care plan.

FAQs

What is the difference between a colostomy and an ileostomy?

A colostomy brings part of the large bowel (colon) out through the tummy. An ileostomy brings out the end of the small bowel. The NHS describes ileostomy output as liquid or soft, like porridge. Either can be temporary or permanent, depending on why it was needed.

What should a healthy stoma look like?

The NHS describes a healthy stoma as soft, slippery and pink, like the inside of your mouth. It may be flat or stick out a couple of centimetres. It can bleed slightly when cleaned, but lots of blood, or a change from the person's normal, should be reported.

How often should a stoma bag be changed?

It varies from person to person and depends on the type of stoma and bag. Drainable bags are emptied when needed and changed less often; closed bags are changed when full. Follow the person's care plan and the stoma nurse's advice.

Can care workers change a stoma bag?

Yes. Care workers commonly empty and change stoma bags as part of personal care, once they have been trained and signed off by their service. They should follow the person's care plan and local policy, and contact the stoma nurse with any concerns.

When should you call the stoma nurse?

Contact the stoma nurse about sore or broken skin, repeated leaks, a bulge around the stoma, the stoma sinking in or sticking out further, or any change in how it looks. Cramps, nausea or swelling around the stoma can mean a blockage and need urgent advice.