When you leave hospital after major colorectal surgery or bowel resection, your abdomen is likely to be swollen and bloated. It can feel full and tight, and waistbands might not fit properly, or indeed at all.
This is a normal consequence of surgery, even if surgery is performed through a key hole (laparoscopic surgery). The abdomen usually takes around 10–12 weeks to go back to how it looked prior to surgery. This is gradual process and cannot be rushed.
Shrinking stomas
Stomas don’t always stay the same size. It is perfectly normal and expected after surgery for a stoma to change in height, width and depth, as well as overall shape, such as from oval to round, or from round to bell-shaped. These changes are typically an indication that your insides are returning to normal and that the bowel is beginning to settle down.
Over the weeks when the abdomen changes back to its normal shape, it’s likely the stoma will change with it. The stoma can reduce in size by as much as as 15–30mm in this time, especially if the bowel was very swollen prior to surgery. The biggest changes occur in the first 5–6 weeks after surgery, becoming more gradual after that and more-or-less stopping by 12 weeks.
Telling the nurse
It is essential that you keep in touch with your stoma care nurse, whose input is invaluable, especially during the first few months. When you speak to the nurse, mention any changes to your stoma. This will allow the nurse to help make any necessary modifications to the stoma template, thus ensuring that the flange—the plaster that sticks to the abdomen—is cut accurately and fits the stoma snuggly. A well-fitting flange prevents leaks and reduces the risk of sore skin developing. For an ostomate, there are few things that make a bigger difference than being able to look after long-term skin health.
Dips and folds
When changes take place between the abdomen and stoma, the surface of the skin may develop dips, creases, indents or folds. Unfortunately, there isn’t really anything that can be done to stop this from happening, and it will happen of its own accord. These changes can happen for a number of other reasons, including weight loss, a stoma that is changing quite quickly, a stoma that is under tension or an uneven skin surface around the immediate stoma site.
The appearance of new dips and folds can make it more difficult to form a perfect seal between the appliance flange and the skin. An appliance that once fit perfectly could start to leak, causing the skin to become sore.
Bloating after surgery is perfectly normal and usually goes down within 10–12 weeks
Filling in
Although uneven skin can cause real problems, it is perfectly possible to get these under control and form a perfect seal again. There are a variety of accessories available to flatten folds or fill in dips and creases, and there are appliances designed to work on all kinds of body shapes. If you notice a leak, don’t hesitate to try out new accessories and appliances. It is entirely logical and normal that, as the abdomen changes, so too do its stoma requirements.
Your stoma care nurse is the best source of advice on products and will be able to help you acquire samples and modify your prescription. Their job is to help ostomates perfect their individualised stoma care routines and form a safe and effective seal that works for their body shape.
Regular review
Regular reviews with a stoma care nurse will make sure that serious problems are avoided or resolved and that the stoma and surrounding skin stay healthy. Even if there are no particularly pressing issues, and you are putting into practice everything that you’ve been taught, it’s still always worth attending these clinical reviews at least once a year, for reassurance and to head off any future problems.
If you ever have a concern or a question, no matter how small, please don’t worry about troubling your stoma care nurse; there is no need to wait for your next scheduled review. After all, supporting you is what the stoma care nurse is there for, and we genuinely want to help.
Elaine Cronin is the lead stoma care nurse at Whittington NHS Hospital in North London
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