The importance of stoma care

Proper stoma care is essential for preventing complications such as skin irritation, infection, and dehydration, while supporting patient confidence and quality of life. From maintaining peristomal skin to managing pouch systems, effective care helps individuals adapt, stay independent, and avoid long-term problems.

Nurses and healthcare staff will encounter patients with a stoma at some point in their careers, across a range of settings including nursing homes.

It is therefore important that staff understand how to manage a stoma and can provide appropriate advice and support. Ongoing training is essential to ensure safe, consistent care.

📌Related: Stoma Care Training.

👉Relevant: Stoma Care Train the Trainer.

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What is a stoma and what is stoma care?

A stoma is a surgically created opening on the abdomen that redirects waste (faeces or urine) from the bowel or bladder into an external pouch.

Common types include colostomies, ileostomies, and urostomies. The stoma itself is pink, moist, and contains no nerve endings. Stoma care involves the daily hygiene and management of this opening.

Stoma care focuses on keeping the stoma and surrounding skin clean and healthy. This includes gentle cleaning, regular emptying and changing of the pouch, protecting the skin, and monitoring for changes.

With the right support, patients can manage their stoma confidently and maintain independence.

Key Steps in Daily Stoma Care

• Pouch management: Empty or change the stoma bag regularly. Drainable bags (common for ileostomies) should be emptied when about one-third full (when 1/3 to 1/2 full) to prevent pulling on the seal.
• Skin care: Gently clean the skin around the stoma (peristomal skin) using warm water and soft wipes. Avoid perfumed soaps, oils, or alcohol-based products, as these can irritate the skin or affect adhesion.
• Correct fit: Ensure the opening of the bag (wafer or flange) is cut to match the size and shape of the stoma. A snug fit helps prevent leaks and skin irritation.
• Monitoring: Check the stoma regularly. Light bleeding can be normal, but any change to dark red, purple, or pale colour should be reported promptly.

Proper care, often guided by a specialist nurse, ensures skin health and prevents complications.

The Importance of Effective Stoma Care

Proper stoma care helps prevent complications such as skin irritation, infection, and blockages, while improving comfort, confidence, and overall quality of life.

It enables individuals to manage their condition independently, reducing the risk of leaks and odour and supporting everyday activities.

In the UK, it is estimated that between 165,000 and 205,000 people are living with a stoma, with around 13,500 to 21,000 new stoma surgeries performed each year.

This highlights the importance of ensuring both patients and healthcare staff are confident in providing safe, effective care.

Key components of stoma care include:

• Skin protection: Caring for the peristomal skin prevents soreness and damage from output.
• Preventing complications: Regular cleaning and monitoring help identify issues early, such as skin problems or hernias.
• Infection control: Good hygiene keeps the stoma and surrounding area healthy.
• Emotional support: Effective care helps individuals adjust and reduces anxiety.
• Independence: Building confidence in self-care supports a return to normal activities.
• Monitoring: A healthy stoma should be red or pink and moist; any darkening or unusual changes should be reported promptly.

What conditions require a stoma?

A stoma is required when a person’s digestive or urinary system is damaged, diseased, or cannot function normally, making it necessary to divert waste through an abdominal opening.

Common conditions causes include bowel or bladder cancer, inflammatory bowel disease (Crohn’s or ulcerative colitis), diverticulitis, severe infections, injuries, or bowel obstructions.

Key reasons for requiring a stoma:

• Cancer treatment: Removal of tumours in the rectum, bowel, or bladder may require a temporary or permanent stoma, especially if the sphincter muscles cannot be preserved.
• Inflammatory Bowel Disease (IBD): Severe Crohn’s disease or ulcerative colitis can necessitate removing part of the bowel, creating an ileostomy or colostomy to allow healing.
• Diverticulitis and infections: Severe inflammation or perforation of the bowel may require emergency surgery and a temporary stoma.
• Obstruction or injury: A blocked or damaged bowel may need diversion to prevent rupture.
• Incontinence or fistulas: A stoma can improve quality of life when bowel control is lost or to manage fistulas.
• Congenital or other conditions: Birth defects such as Hirschsprung’s disease or other disorders may require a stoma.

Are Stoma Bags Considered a Disability in the UK?

Yes, having a stoma bag is generally recognised as a disability under the Equality Act 2010.

It is classed as a hidden disability because it is a long-term condition that can significantly affect daily life, giving rights to reasonable adjustments and access to support.

Key points about stomas and disability in the UK:

• Legal recognition: The Equality Act defines disability as a physical or mental impairment with a “substantial and long-term negative effect” on daily activities. A stoma often meets this definition.
• Workplace rights: Employers must provide reasonable adjustments, such as extra bathroom breaks or a private, hygienic space to change the bag.
• Support & access: People with a stoma can apply for a Radar Key to access accessible toilets nationwide. You can get a free Radar key if eligible from the bladder and bowel community.
• Benefits (PIP/Blue Badge): Having a stoma does not automatically qualify you for benefits, but eligibility may be granted based on how the condition impacts daily life and mobility.

Can You Live a Normal Life with a Stoma?

Yes, someone with a stoma can live a full, active, and normal life after a recovery period of around 8 weeks.

Modern, discreet appliances make it possible to return to work, exercise, travel, swim, and maintain intimate relationships.

While some adjustment is needed, most people find life with a stoma manageable and often more comfortable than before surgery.

Key aspects of life with a stoma:

• Physical activity: You can swim, play sports, and exercise, using waterproof covers or support belts if needed.
• Clothing & appearance: Low-profile, secure bags allow most clothing choices, though very tight waistbands may be uncomfortable.
• Daily routine & odour: Bags have charcoal filters to neutralize odours, and emptying or changing them takes just a few minutes.
• Intimacy: A stoma should not prevent a satisfying intimate or sexual life.
• Diet: Most people can return to a normal, balanced diet, with minor adjustments to reduce gas or avoid blockages.

How to Identify the Correct Stoma Bag

Choosing the right stoma bag involves measuring your stoma, matching it to your stoma type (colostomy, ileostomy, or urostomy), and selecting the appropriate system and baseplate for comfort and leak prevention.

Support from a stoma care nurse is recommended, especially in the first 6–8 weeks post-surgery.

Steps to Identify the Correct Bag:

1. Measure your stoma: Stomas change size during the first 6–8 weeks. Measure the widest part each time you change your bag using a stoma measuring guide.
2. Select bag type:
   • Colostomy: Usually closed bags for formed stool, changed 1–3 times daily.
   • Ileostomy: Drainable bags for liquid or porridge-like output, emptied 4–6 times daily.
   • Urostomy: Bags with a tap or spout for constant urine drainage.
3. Choose system style:
   • One-piece: Bag and adhesive barrier are integrated; simple and suitable for active lifestyles.
   • Two-piece: Flange stays on the skin while the pouch is replaced; better for sensitive skin or frequent changes.
4. Select flange type:
   • Flat: For slightly protruding stomas with firm surrounding skin.
   • Convex: For flush, recessed, or retracted stomas; gently pushes the stoma out to prevent leaks.
5. Consider material and transparency: Opaque for discretion or clear for monitoring, especially with new stomas.
6. Check fit and size: The opening should fit snugly, leaving minimal skin exposed. Too large exposes skin; too small can injure the stoma.

Additional considerations:

• Skin sensitivity: Use skin-friendly adhesives if prone to irritation.
• Body shape & hernias: Flexible or soft convex flanges may be needed.
• Expert support: Trial different brands with guidance from your stoma care nurse to find the best fit.

🟣Related Course: Bowel Care Management Training – Book Today.

How to Support Someone with a Stoma?

Supporting someone with a stoma involves practical help, emotional reassurance, and patience as they recover.

Key support includes assisting with bag changes if needed, ensuring they have supplies for outings, and encouraging gentle activity like walking. Listening to their concerns and respecting their privacy is essential.

Practical Support:

• Prepare for “firsts”: Offer help with changing or emptying the bag during the early, overwhelming days.
• Supplies check: Ensure a “stoma kit” is available when going out, including spare bags, wipes, adhesive remover, and disposal bags.
• Dietary support: Prepare nutritious, easily digestible meals and encourage adequate hydration.
• Mobility and clothing: Encourage gentle walks to build confidence and suggest comfortable clothing that accommodates the bag.

Emotional Support:

• Be patient and maintain a positive attitude without minimising their struggles.
• Listen to concerns about leakage, body image, or daily challenges.
• Encourage independence in managing their care, which helps restore confidence and normal activities over time.

Medical and Specialist Support:

• Follow stoma care nurse instructions for diet, medication, and bag management.
• Attend support groups, such as Colostomy UK, for peer advice and community.
• Monitor for skin irritation or stoma issues and seek professional advice if needed.

Extra Tips:

• Always carry spare supplies for emergencies.
• Use protective pads between clothing and the bag during leaks.
• Stay well hydrated, especially for ileostomy patients, keeping urine pale straw-colored.

Remember, everyone’s experience is different, so tailor support to their individual needs.

📌Helpful Post: What is complex care and why is it important.

Should I Learn Stoma Care if I Support Someone?

Yes, it is highly recommended to learn stoma care if you are supporting someone. Understanding how to manage a stoma allows you to provide practical help, boost your loved one’s confidence, and support their adjustment to a new way of life.

Why Learn Stoma Care

• Provides essential support: You can assist with bag changes, which is vital if the person has reduced mobility, weakness, or limited dexterity (for example, due to arthritis).
• Reduces anxiety and isolation: New stoma users often worry about leaks or embarrassment. Knowing how to help can ease their fears and increase confidence.
• Improves safety: You can recognise complications such as skin irritation, leaks, or infection and know when to contact a stoma care nurse.
• Builds trust: Sharing care responsibilities strengthens relationships and provides a sense of security.

What to Learn (The Basics)

• Familiarise yourself with the equipment: Understand different bag types (one-piece, two-piece, drainable) and accessories like adhesive removers or barrier films.
• How to change a bag: Learn the steps—emptying, removing, cleaning the stoma with water (no soap), drying, and applying a new bag.
• Recognising problems: Spot issues such as soreness, unusual colour, or inflamed skin around the stoma.
• Understanding common issues: Learn to prevent “pancaking” and “ballooning” with correct bag placement and sealing.

Training Option:

For a caregiver, face-to-face training is usually best.

While e-learning covers the theory, an in-person session lets you practise with real equipment, feel the textures of adhesives, and receive immediate feedback from a nurse.

Both face-to-face and live virtual classes allow you to ask questions, share experiences, and gain practical insight.

This hands-on practice is essential for building the confidence and muscle memory needed to manage leaks or skin issues safely and calmly.

What are my legal and care responsibilities when supporting someone with a stoma in the UK?

Caring for someone with a stoma requires following legal regulations on health and safety, data protection, and patient rights, while providing safe, hygienic, person-centred care that maintains dignity.

Key Legal Requirements:

• Care Act 2014 & Safeguarding: Promote wellbeing, independence, and dignity. Professional carers must follow safeguarding protocols.
• Mental Capacity Act 2005: If the person cannot consent, a “best interests” assessment guides care.
• Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Care must be safe, appropriate, and delivered by competent staff.
• GDPR & Data Protection: Keep all health and stoma information confidential.
• Health and Safety at Work Act 1974: Dispose of clinical waste safely, including stoma bags.

Supporting Independence and Rights:

• Person-Centred Approach: Care should be agreed with the individual and documented in a personalised care plan.
• Rights to Free Prescriptions: Anyone with a permanent stoma is entitled to free prescriptions; those under 60 must apply for a medical exemption certificate (form FP92A).
• Discrimination Protection: Under the Equality Act 2010, individuals with a stoma are recognised as having a disability and are protected from discrimination.

Practical Responsibilities:

• Infection Control: Wash hands, use PPE, and clean the stoma with warm water.
• Stoma Appliance Management: Change bags per care plan, empty drainable bags when one-third full, and check skin for redness or damage.
• Safe Disposal: Wrap used bags securely; check local council if clinical waste collection is available.
• Emergency Escalation: Contact NHS 111 or a district nurse for severe pain, bleeding, no output for 24+ hours, or dehydration signs.

What Skills Will I Gain to Support Someone with a Stoma?

You will learn practical skills such as measuring and cutting wafers, changing pouches, and maintaining healthy skin to prevent irritation.

You’ll also develop clinical observation skills to recognise early signs of infection or blockages.

Beyond the physical tasks, you’ll gain emotional support skills to help your loved one adjust to body changes and build the confidence to manage their stoma independently.

What additional skills or short courses will help provide better care?

Beyond basic pouch changes, consider courses in Skin Integrity to prevent painful peristomal irritation and Nutrition for Ostomates to manage output and hydration.

First Aid is invaluable for handling medical emergencies, while Counselling Skills or Mental Health First Aid will help you support the emotional transition and body image challenges your loved one may face during their recovery.

Does Caring for Care Offer Practical Stoma Care Training?

Yes, we do. Our practical stoma care training is delivered as a group session for up to 12 people. To book for 3 or less, please visit our open course page to see available course dates.

It can also be combined with other half-day courses, such as tissue viability, continence, or wound care training, saving you over 40% when booked on the same day at the same venue.

Families, friends, and carers are welcome to attend, giving them the skills and confidence to effectively support someone living with a stoma.

Can I change a stoma bag myself, or do I need a nurse?

Yes, you can change a stoma bag yourself. While a stoma care nurse will perform the changes initially and teach you the technique, the goal is for the individual or their carer to manage it independently.

Once the stoma has healed and you have been trained, you do not need a professional for routine changes.

At Caring for Care, we specialise in practical stoma care training specifically to build this independence.

Most people find that after a few guided practices, they can confidently handle changes at home, only contacting a nurse if they notice skin issues, leaks, or changes in the stoma’s appearance.

For large teams, to save costs, we recommend that team leaders take the Stoma Care Train the Trainer course. They can then teach other team members, significantly reducing training expenses and improving efficiency and compliance within the facility.