Christmas With A Stoma: Advice From Our Stoma Care Nurse

Advice from SecuriCare Stoma Care Nurse Sally Chester

The Christmas holiday period tends to bring with it changes to our daily routines and this can impact upon the function of a stoma for various reasons. I would like to share with you some of the issues you may experience caused by Christmas changes in diet and routine. I will look at the effects these may have on your stoma function, whilst sharing some advice to help you manage these.

Diet

Most of us tend to eat more over the Christmas holiday period. We indulge in different foods that are often richer than our usual fare and our meal patterns may be irregular.

If our food intake increases, our waste output will increase. For those with an ileostomy this is likely to necessitate emptying the pouch more often in a 24-hour period or, for those with a colostomy, this means more pouch changes if you are using a closed pouch. So ensure you have sufficient pouches to account for this change in habit. Look to place your order to cover the Christmas period at the beginning of December. SecuriCare’s team can help you decide exactly what you need to order for the Christmas period. 

Different foods will also have an effect on the consistency of the stools that are produced. Foods that are high in fibre stimulate the gut and may produce more wind and looser stools as the waste passes through the gut much quicker giving less time for water to be reabsorbed.

A high fibre intake can cause a blockage, particularly if you have an ileostomy. This is caused by the indigestible fibre part of the food forming a bolus that can then block the flow of waste into the pouch. It tends to be associated with colicky abdominal pain and the stoma stops working. Should this happen the following steps may help relieve the blockage:

• Stop eating for up to 24 hours but continue drinking plenty of water. This can gently help the blockage release itself.
• Gently massage the abdomen in a big circular clockwise motion. This may ease the pain and help the blockage pass through the bowel.
• Soaking in a warm bath may relieve the spasm and help the food blockage to pass through.

If these measures are successful the ileostomy will start functioning, first passing the food bolus that caused the problem then most likely looser copious stools as the floodgates are opened. 
You may start eating again but keep to a light diet for the first 24 hours or until stools return to your normal consistency. Continue drinking well to replace the excess fluid you lose through the ileostomy to prevent dehydration.

If these measures are unsuccessful or your pain becomes worse or is accompanied by vomiting you need to seek emergency medical help.

If you start vomiting you can become dehydrated very quickly, especially if you have an ileostomy.

Some of the high fibre foods that may be encountered at Christmas are dried fruits, pineapple, nuts, coconut, citrus fruit pith and skins, celery and sweetcorn. So watch out for how many mince pies or how much Christmas cake and Christmas pudding you are eating.

Most people with a stoma can eat all these foods in moderation and as long as the food is chewed particularly well to aid the digestion process you should be fine. You tend to run into problems if you eat a lot of these foods at any one time. It is always advisable when introducing a new food to your diet to have a small portion first such as one or two tablespoons worth to see what effect it has on your stoma function. Everybody is different in their tolerance and response to foods, plus there is the effect the surgical operation has had upon their bowel function to consider.

Brussels sprouts are notorious for making those who eat them more windy and odorous, as is the case with other vegetables in the brassica family such as cauliflower, broccoli and cabbage. Cooking them in water rather than steaming or microwaving will wash away some of these problem chemicals and cooking them on the softer side will help the digestion process. 

Other Christmas foods that make an appearance and may have an effect on your stoma are:

• Beetroot, which can colour urine and stools red and can easily be mistaken for bleeding.
• Stilton and other smelly cheese, which can increase odour from the stoma output.
• Spicy pickles and pickled onions, which may increase odour, wind or affect your stool consistency.

Drink

Before we get to the alcohol and its effect on stoma function it is worth remembering that not drinking enough fluid will also have an effect on the stoma output.

If you have a colostomy and do not drink enough fluids, your stools will become firmer. This may cause pancaking of the stools so that it does not drop into the pouch or it is hard and pellet like. This can lead to problems which can cause the pouches to leak. It also means you will pass less urine which will become a darker amber colour.

If you have an ileostomy and are not drinking enough you may notice you do not empty your pouch as often but you will also notice you pass less urine and it becomes darker. You may suffer headaches and feel more lethargic and light headed.

If you have a urostomy and do not drink enough the urine becomes darker and smelly and you will become more aware of the mucus in the bag. Not drinking enough can also put you at a higher risk of developing a urine infection and becoming constipated.

We should all be aiming to drink about 8-10 mugs of fluid a day to maintain good health and body functions. This can consist of tea, coffee, squash, juices etc. You will know you are drinking enough and are well hydrated when your urine is pale yellow and your stools are soft but formed and pass without pain or difficulty. Drinking enough is the first measure you should take before reaching for the laxatives (and those with an ileostomy are not advised to use laxatives under any circumstances)!

Fizzy Drinks

Fizzy drinks will increase the amount of wind that you pass in your ileostomy or colostomy pouch. It is likely to make your stoma more vocal and can cause ballooning of the pouch.

To reduce this avoid fizzy drinks or drink them in moderation. Let it stand once poured for 10 minutes or stir with a spoon to allow some of the gas to escape.

You can drink alcohol if you have a stoma but it is advised only in moderation. Gassy drinks such as beer and lager can cause a lot of wind and loosen the output of the stools. Overindulgence can lead to problems emptying or changing your pouch and could lead to some embarrassment if you become incapable! 

Excess alcohol will affect you just as it affects people without a stoma. Alcohol has a diuretic effect, making you pass more urine. This can make you more susceptible to becoming dehydrated if you have an ileostomy.

For further nutritional advice you can request the Securicare Nutritional Advice Booklet from customer services or your SecuriCare Stoma Nurse.

Supplies

Remember that over the holiday period the SecuriCare Home Delivery Service will operate reduced opening times as will GP surgeries, Stoma Care Nurses, chemists and other suppliers. You need to be sure that you obtain your supplies in good time before the holiday closure. Also ensure you have enough supplies to see you through the holiday period with enough to cover any problems or increased usage. Also take into account the risk of delays to your orders getting delivered in the event of adverse winter weather and snow fall.

Holidays Away

If you are going away for Christmas remember to take more than your usual amount of supplies. SecuriCare can provide a travel certificate translated into a number of languages which includes information that security officials need about your medical appliances and can help with passage through airport security.

It is a good idea, if you are out for the day, to always carry a spare set of equipment either in the car or with you, so that you can deal with any issues and then carry on with your day rather than having to return home.

If you need to use public toilets, remember you can use disabled toilets which are usually better equipped with bins, basins and mirrors.

Checking out toilet facilities in an unfamiliar area before you need them will help to give you peace of mind. If one is not suitable you can find another before an issue occurs. As a user of the SecuriCare Home Delivery Service you can request a Radar key to enable you to access the Radar network of disabled toilets. It is useful to carry some spare toilet paper and wet wipes in case the facilities are lacking.

We hope this advice helps you to embrace the festivities of the Christmas season and enjoy it to the full. 

Happy Christmas from the SecuriCare Stoma Care Nursing Team.