Adjusting to a colostomy can be difficult at first, but it doesn't mean you can't enjoy a full and active life.
Modern colostomy equipment is discreet and secure, and you should be able to do most of the activities you enjoyed before.
This page covers:
Colostomy bags and equipment
Smell and wind
Colostomy bags and equipment
A colostomy bag is often used to collect your poo (stools). It needs to be removed and replaced when full, usually one to three times a day.
There are also drainable bags that only need to be replaced every one or two days. These may be suitable for people who have particularly loose stools.
A specialist stoma nurse, who usually sees you before and after the colostomy operation, will help you choose the most suitable colostomy equipment.
There's a wide range of colostomy appliances available, including:
- a one-piece pouch – the bag and flange (part that sticks to your skin) are joined together; the appliance is removed when full and then disposed of
- a two-piece pouch – the bag and flange are separate, but can be connected; the flange can be left on your skin for several days, and the bag removed and disposed of several times a day
Colostomy appliances are made from non-allergic (hypoallergenic) materials to reduce skin irritation. They also contain special filters to prevent any unpleasant odours.
If you have regular and predictable bowel patterns, you may not always need to wear a colostomy bag. But as occasional leakages can happen, it's recommended that you wear a small stoma cap.
Additional products that can make living with a colostomy more convenient include:
- support belts and girdles
- deodorisers that can be inserted into your appliance
- protective skin wipes
- sprays to remove adhesive
- protective stoma rings
- specially designed underwear and swimwear
Your stoma care nurse will be able to give you more information and advice about equipment.
You'll be given an initial supply of colostomy appliances, as well as your prescription information, before you leave hospital. You can get further prescriptions from your GP.
Your prescription can either be taken to the chemist or sent to a specialist supplier, who will deliver the products.
You won't have to pay prescription charges for permanent colostomy equipment. But you'll have to pay prescription charges for a temporary colostomy, unless you're over 60 or being treated for cancer.
Read more about prescription charges and help with prescription costs.
If you have to pay prescription charges, it'll probably be more cost-effective for you to buy a prescription prepayment certificate (PPC), which entitles you to a discount on repeat prescriptions.
Irrigation is an alternative to wearing a colostomy appliance. It involves washing out your colon with water either every day or every other day.
To do this, you gently insert a small device into your stoma and attach it to a bag full of water.
You slowly move water into your colon so it washes it out. The equipment is then disposed of once the process is complete. A cap is used to cover your stoma in between irrigations.
Advantages of irrigation include:
- you choose when you want to perform irrigation
- you don't have to wear a colostomy appliance (but may have to wear a small cap)
- you should be able to enjoy a more varied diet
- you should have less gas (flatulence)
Disadvantages of irrigation include:
- it's a time-consuming process that takes 45 to 60 minutes to complete, usually on a daily basis
- for the best results, irrigation should be carried out at the same time every day, which may be difficult when you're away from home on holiday or with work
Irrigation isn't always possible. For example, it's not suitable for people with Crohn's disease or diverticulitis, or if you're having radiotherapy or chemotherapy.
Irrigation probably isn't advisable for young children as it's quite time-consuming.
In the first few weeks after having a colostomy, you'll probably be advised to have a low-fibre diet.
This is because a high-fibre diet can increase the size of your stools, which can temporarily block your bowel. After around eight weeks, you'll usually be able to go back to a normal diet.
As you recover, you can start to eat a healthy, balanced diet that includes plenty of fresh fruit and vegetables.
You should be able to return to the diet you previously enjoyed. If you previously had a restricted diet, you should be able to reintroduce the restricted foods.
Smell and wind
Many people worry that their colostomy will give off a smell that others will notice.
All modern appliances have air filters with charcoal in them, which neutralises the smell.
Most people will be aware of the smell of their colostomy because it's their own body. But someone standing next to you won't be able to smell the stoma.
You'll have more wind than usual immediately after having a colostomy, but this will slowly reduce as your bowel recovers.
Your stoma nurse can advise you about products you can use to help reduce any smell and give you dietary advice to reduce wind.
Many medicines are designed to dissolve slowly in your digestive system. Having a colostomy shouldn't alter the effectiveness of your usual medication.
If you notice any tablets in your appliance, tell your pharmacist or GP, who will recommend an alternative medication.
In the weeks after surgery, some gentle exercise is usually recommended to help recovery.
How well you recover will determine how much exercise you can do. If you feel any pain, stop immediately.
Once you've recovered from the operation, you should gradually be able to return to your previous exercise routine.
Most types of exercise are possible with a stoma, including swimming, as all colostomy bags are waterproof.
The Colostomy Association website has more information about sport and exercise with a colostomy.
Once your bowel has healed, there's no reason why you can't return to work.
If your job is particularly strenuous and involves a lot of heavy lifting, you may need to wear a support belt or girdle. Your stoma nurse can advise you about this.
It's likely to take several months before you're ready to return to work. It depends on how well you recover and the type of work you do.
You may find it very tiring when you return, so to start with it may be possible for you to work fewer hours than normal and do lighter duties.
Discuss the potential options with your employer before having the operation.
You don't have to tell your work colleagues about your colostomy unless you want to. Some people find it's a good idea to tell one person in the workplace in case they need any support or advice.
There's no reason why you can't travel after having a colostomy, but you'll probably need to plan extra time into your journey.
Most stoma companies have a small information leaflet you can carry with you at all times, available in several different languages.
One essential item for people with a colostomy is a RADAR key. This gives you access to public disabled toilets so you can change your colostomy appliance when you need to.
You can get a RADAR key by contacting the Colostomy Association.
There are several practical issues that could have an impact on your sex life and your relationships.
Women who've had their rectum removed may find having sex in the traditional "missionary position" painful because the rectum supports the vagina during sex. Trying different positions may help.
After surgery, many women find their vagina is much drier, which can make sex uncomfortable. Applying a lubricating jelly before sex may help.
Having weight placed on your stoma during sex can be painful, so you may want to avoid positions that could cause pain. Alternatively, you could protect the stoma with a cushion or pillow.
Your stoma nurse can give you more advice.
Having a colostomy can affect the blood supply and nerve endings to the penis. This can make it difficult to get or maintain an erection (erectile dysfunction).
There are many treatments for erectile dysfunction, including a medication called sildenafil (Viagra), which helps increase blood supply to the penis.
Other sex-related issues
As well as the practical issues, you may be concerned about body image, self-confidence and how your partner may react to your colostomy, which can also have an impact on your sex life.
It's important to stress that many people with a colostomy enjoy a good sex life, but it can take several months to build up the confidence and trust to make this possible.
If you have a long-term partner, you may want to see whether they'd like to look at your stoma and colostomy equipment.
Some people want to take an interest, but others find it too upsetting, at least in the short term. There's no right or wrong way to react, so try not to take a refusal as a personal rejection.
If the appearance of your stoma and colostomy equipment is off-putting during sex, you can always cover them.
Other tips that may improve your sex life include:
- changing your appliance before having sex
- changing your appliance to a small stoma cap before having sex
- covering the appliance if the feel of the appliance against your skin is a distraction
- keeping your sense of humour
You should avoid having anal sex (if the rectum hasn't been removed) after a colostomy because it can cause painful tearing and bleeding. Speak to your stoma nurse for more information and advice about this.