Every ostomate struggles with body changes after surgery. With body, changes come the emotional changes of social anxiety, loss of everyday routine, fear, anger, sadness, and sometimes denial. A stoma also impacts self-esteem and confidence. The fears and anxiety are real but over time, knowledge and acceptance are the keys to overcoming these changes.
Some emergent surgeries can result in a stoma. Some are temporary, others permanent. For those going in for emergent surgery, preparing for a stoma beforehand is a missed opportunity. Many come out of surgery with the “dreaded” realization they have “a bag!” This leaves the patient depressed and unable to cope with the dramatic and unexpected change in their body.
Others going into emergent surgery are so sick, they are simply grateful to be alive and accept the change as an unavoidable cost. This group accepts the life of an ostomate a little better.
There are many reasons for temporary ostomies.
The new ostomate has a poor appetite in the immediate post-operative period. The body needs protein and nutrients for healing. If surgery was emergent, oral intake of food is delayed. The digestive tract needs time to “wake up,” meaning the peristalsis or wave-like motion that pushes food through the digestive tract is slow after surgery. Getting out of bed and walking will help stimulate peristalsis. Once bowel sounds or gurgling are heard by the doctor, or the stoma begins expelling gas, the diet is advanced slowly.
Abdominal pain and soreness are present. Some pain medications not only slow peristalsis but also tire patients, most of whom don’t want to get out of bed to walk. New methods of pain control are now being used to prevent this situation.
Swelling of the abdomen is present for the first 2-3 months after surgery. The tenderness is usually resolved 3-4 weeks after surgery unless complications arise. Average weight loss with an emergent surgery is about 15-20 lbs. A planned surgery without infection or complication is about 10 lbs.
Most new ostomates will change how they dress. If the stoma is below the waistline, less change is needed. The pouch will sit under slacks or pants. Wearing leggings or slim-fitting pants can be a challenge with an ileostomy. The pouch fills more frequently and the ballooning of the pouch will be evident with tightly fitted clothing. If the stoma is in the upper abdomen, loose-fitting shirts are needed. A colostomy can have different outputs depending on where in the colon the stoma is placed. Right-sided and mid-upper abdominal stomas will have loose stool but left-sided mid to lower abdominal stomas can have formed stool with output 1-2 times a day.
The emotional changes that affect a new ostomy are many. Changes in body image can easily affect confidence and self-esteem. They cause feelings of inferiority, disfigurement, loss of femininity, and low self-worth. The alteration from “normalcy” can last for some time. The physical loss of control of a natural bodily function is strong.
The mind makes you think “everyone knows I have a stoma!” In the beginning, the presence of the pouch is constant. It’s all you think about. With time, the pouch is “like wearing shoes.” You know you have shoes on but you don’t feel them. Eventually, you are able to forget about the pouch as your mind is occupied with current endeavors.
Many suffer from depression initially. Getting to know how your stoma functions on a day-to-day basis take time. The difference is hard to get used to. Prior to surgery, you don’t typically think about going to the bathroom. After surgery, that is all you think about. Many try to alter their diet to reduce the number of times they need to empty the pouch. It’s a mind-body thing. Negative feelings about the ostomy can affect biological function and digestion.
Social anxiety is related to the unknown factors of the stoma. New ostomates are fearful of leakage while out. The fear of uncontrollable noises from the stoma at inopportune times is always on the mind. If out and need to empty the pouch, fears of odor come into play. If social anxiety is excessive and causing withdrawal from the friends and things you enjoy, please talk to someone, a stoma nurse, primary care doctor or a therapist to help you adjust.
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Christine Kijek is a colorectal nurse at Danbury Hospital in Danbury, CT. She has a wealth of knowledge in this field as well as personal experience. HPFY is thrilled that she has been ...
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