Ostomy Care During Cancer Treatment

This page is for people living with an ostomy during cancer treatment, and the people who help them. An ostomy is a surgical opening, called a stoma, that lets stool or urine leave the body into a pouch. It covers daily care, fluids, food, and the signs that need a call.

The word covers three different operations, and the daily routine is not the same for any two of them.

A colostomy brings the colon to the skin. Output depends on which part of the colon was used. The American Cancer Society says an ascending colostomy puts out liquid stool, a transverse one soft or paste-like stool, and descending and sigmoid ones firmer, more regular stool.

An ileostomy brings the small bowel out, upstream of the colon. The colon reabsorbs water, so bypassing it means output stays liquid or pasty. Expect to empty the pouch 5 to 8 times a day.

A urostomy drains urine. A surgeon uses a short piece of intestine as a channel and attaches the ureters to it. Because it is built from bowel, some mucus in the urine is normal, and so is minor bleeding at the stoma.

Ask your surgeon in writing which one you have and whether it is permanent or meant to be reversed. That single answer drives supply orders, insurance codes, and diet.

Moist. Pink or red. Most stomas stick out a little over the skin, but some are flat. That is the baseline you are comparing against every time you change the pouch.

Changes are worth knowing. MedlinePlus lists a stoma that pulls in below the skin, sticks out more than usual, gets a narrower opening, or has skin bulging around it as reasons to contact your provider.

Many skin problems trace back to one measurement. MedlinePlus says the edges of the opening you cut in the barrier should be close to the stoma, but should not touch it. Too wide and waste can leak onto skin.

Measure again often in the first weeks. MedlinePlus says the stoma is swollen after surgery and shrinks over the next several weeks.

Press the barrier in place and hold your hand over it for about 30 seconds to help it seal. MedlinePlus says to change the pouch every 5 to 8 days, or right away if it itches or leaks. Empty the pouch when it is about one third to one half full.

For skin, MedlinePlus is specific. Wash with warm water, or a mild soap with no perfume or lotion, and pat dry. Skip alcohol-based products, which dry the skin, and oil-based products, which stop the pouch from sticking. If hair stops the pouch sticking, MedlinePlus suggests trimming scissors, an electric shaver, or laser hair removal, and says not to use a straight edge. Ask your ostomy nurse before shaving the area.

Write it down. MedlinePlus says to contact your provider if ileostomy output is more than 2,000 mL in a day. Ask your team whether your number should be lower.

MedlinePlus advises 6 to 8 cups of fluid daily, which is 1.5 to 2 L, and notes ileostomy raises dehydration risk. Ask your own team for your target, since a high-output stoma needs more, and plain water alone may not replace what you are losing.

This is where an ostomy stops being a stable routine. NCI reports diarrhea rates as high as 50 to 80 percent with fluoropyrimidines, the class that includes fluorouracil and capecitabine, and with irinotecan. Radiation to the abdomen, pelvis, or rectum can cause radiation enteritis, a bowel disorder that appears during or after treatment.

Two problems follow. First, an ileostomy already loses fluid, so added diarrhea moves you toward dehydration much faster than it would someone with an intact colon. Second, grading is harder to pin down. The scale NCI reproduces grades diarrhea by stools per day above baseline, with grade 3 set at an increase of 7 or more daily plus hospitalization indicated. It also grades ostomy output, but only as a mild, moderate or severe increase over your baseline, with no volume attached. So the grade depends on knowing your usual volume. Ask your oncology nurse to record milliliters per 24 hours and to write your personal call threshold in the chart.

Colostomies swing the other way. NCI notes that patients with colostomies should be assessed for constipation, looking at diet, fluids, activity, and opioid use.

An ileostomy shortens the road a tablet travels. MedlinePlus states that medicines with a special enteric coating are not absorbed properly, and that liquid forms are preferred. It also warns that birth control pills may not be absorbed reliably. Bring every bottle, including antinausea and pain medicines, to your pharmacist and ask which need a different form.

Introduce new foods one at a time. Eat 5 or 6 small meals on a schedule, chew well, and skip gum and straws, which push air into the pouch.

MedlinePlus names foods that drive odor: onions, garlic, broccoli, asparagus, cabbage, fish, some cheeses, eggs, baked beans, Brussels sprouts, and alcohol. Parsley, yogurt, and buttermilk help. Gas producers include cucumbers, radishes, sweets, melons, beer, and carbonated drinks.

Blockage is a serious problem. MedlinePlus lists warning signs as sudden cramping, a swollen stoma, nausea, and a sudden increase in very watery output. Nuts, seeds, corn, popcorn, and raw pineapple are the classic offenders. Hot tea may help move things. MedlinePlus says to contact your provider right away if the bag stays empty for longer than 4 to 6 hours. Do not just take a laxative.

• Stoma turns purple, black, gray, or white
• Stoma swells more than half an inch beyond its usual size, or pulls below skin level
• No output for 4 to 6 hours with cramping or nausea
• Dry mouth, much less urine, or lightheadedness when standing
• Ileostomy output above 2,000 mL (2 L) in 24 hours, or above any lower number your team gave you
• Bleeding beyond a light smear, or foul-smelling drainage
• Temperature of 100.4 degrees Fahrenheit (38°C) or higher during chemotherapy, which is CDC's fever threshold for possible infection. Do not wait for the same day for this one: CDC calls it a medical emergency and says to call your doctor immediately. For emergencies call 911 or go to the ER
• Skin around the stoma is raw, blistered, or bleeding

Ask for a referral to a wound, ostomy, and continence nurse, often listed as a WOC nurse. This is their specialty, and they can help with leaks and fit.

• https://medlineplus.gov/ency/patientinstructions/000071.htm
• https://medlineplus.gov/ency/patientinstructions/000070.htm
• https://medlineplus.gov/ency/patientinstructions/000074.htm
• https://medlineplus.gov/ency/patientinstructions/000477.htm
• https://medlineplus.gov/ency/patientinstructions/000072.htm
• https://www.cancer.org/cancer/managing-cancer/treatment-types/surgery/ostomies/colostomy/types-of-colostomies.html
• https://www.cancer.gov/about-cancer/treatment/side-effects/constipation/gi-complications-hp-pdq
• https://www.cancer.gov/about-cancer/treatment/side-effects/infection
• https://www.cdc.gov/cancer-preventing-infections/patients/fever.html