Stoma Care at Home in North Shropshire — Colostomy, Ileostomy and Urostomy
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Approximately 177,000 people in the UK are living with a stoma — roughly one in every 335 adults. Around 6,400 permanent colostomies are created in the UK every year.
The conditions that lead to stoma surgery — colorectal cancer, diverticular disease, Crohn's disease, ulcerative colitis, bladder cancer, and trauma — affect people of all ages, though the majority of people who require stoma surgery are in their fifties and beyond.
Stoma surgery was once called "the secret surgery." Surrounded by taboo and embarrassment, it was a subject that patients and families rarely discussed openly and that care providers often addressed with insufficient specificity. That has changed but not as completely as it should have.
Many people coming home from hospital after stoma surgery receive a discharge package, a stoma nurse referral, and an expectation that they will manage from there.
The practical daily reality of living with a stoma, the pouch changes, the skin care, the dietary adjustments, the equipment management, the specific complications that arise in the weeks and months after surgery — requires more support than a referral alone provides.
At North Shropshire Homecare we provide specialist stoma care for people with colostomies, ileostomies, and urostomies across Whitchurch, Wem, Prees, Whixall, and the surrounding villages of North Shropshire. This page explains what living with a stoma actually involves, what the specific care challenges are, and how we support people to manage their stoma confidently and safely at home.
Understanding Stomas — The Types and What They Mean for Daily Care
A stoma is a surgically created opening on the surface of the abdomen that diverts the flow of faeces or urine. The word comes from the Greek for mouth or opening. The person with a stoma is sometimes called an ostomate.
There are three main types, each with different clinical characteristics and daily care requirements.
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A colostomy is formed from the large bowel (colon). It is typically sited on the left side of the abdomen. The output of a colostomy is largely formed or semi-formed stool — similar in consistency to normal bowel movements, though the timing and control are different. The output volume of a colostomy is approximately 150–220 grams daily.
Colostomies are created for colorectal cancer (the most common indication), diverticular disease, bowel obstruction, and trauma. They may be temporary — created to protect a surgical anastomosis downstream while it heals, with reversal planned — or permanent, where the rectum and anus have been removed (an abdominoperineal resection, for example).
People with colostomies typically use closed bags — sealed at the bottom — which are changed once or twice a day, or may use a two-piece system. Some people with a well-established end colostomy achieve sufficient control to use colostomy irrigation — a technique involving introducing warm water into the stoma to empty it at a predictable time — which can allow them to wear a stoma cap rather than a bag for part of the day.
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An ileostomy is formed from the small bowel (ileum). It is typically sited on the lower right side of the abdomen. The output of an ileostomy is liquid to paste-like in consistency — because it has not passed through the large bowel where water is reabsorbed — and it is continuous rather than intermittent. Ileostomy output can be high volume, particularly in the early post-operative period, and contains active digestive enzymes that are corrosive to the peristomal skin.
Ileostomies are created for ulcerative colitis, Crohn's disease, familial adenomatous polyposis, and as covering stomas in colorectal surgery. They may be loop ileostomies (temporary, created to protect a low anastomosis) or end ileostomies (typically permanent, following proctocolectomy).
The high-output, enzyme-rich nature of ileostomy output creates specific management challenges — particularly around hydration and electrolyte balance, and around peristomal skin protection. A skin barrier that is well-fitted and intact is more critical with an ileostomy than with a colostomy.
People with ileostomies use drainable pouches — emptied into the toilet several times a day rather than changed — because of the continuous and high-volume output.
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A urostomy diverts urine from the urinary tract through a stoma when the bladder has been removed (cystectomy) or when the bladder can no longer be used. The most common type is an ileal conduit — a short section of ileum used to connect the ureters to the stoma. Urine drains continuously into a drainage bag worn on the body.
Urostomies are created primarily following bladder cancer treatment, or for neurological conditions affecting bladder function. The management of a urostomy is distinct from colostomy or ileostomy management in several specific ways, including the continuous nature of urine drainage, the different bag systems used, and the specific infection risks associated with urinary diversion.
We provide care for all three stoma types. The specific care approach differs significantly between them, and we build care plans around the type, the site, and the individual person's established management approach.
The Clinical Challenges That Shape Daily Care
Peristomal Skin Complications
Peristomal skin — the skin surrounding the stoma — is one of the most clinically significant care considerations in stoma management. Skin problems are more common in males and in people with ileostomies, where the high-enzyme output is corrosive to skin on contact.
The reported incidence of peristomal skin complications ranges from 2.9% to 81.1% across studies — a wide range that reflects the diversity of stoma types, appliance systems, and management approaches. Common peristomal skin problems include:
Contact dermatitis — redness, erosion, and pain caused by stoma output contacting the skin, typically because the bag aperture is incorrectly sized, the seal has failed, or the skin barrier has been compromised.
Moisture-associated skin damage — maceration and breakdown caused by prolonged contact with urine or liquid stool.
Folliculitis — inflammation of hair follicles under the adhesive flange, particularly in people with significant peristomal hair.
Medical adhesive-related skin injury (MARSI) — damage caused by the adhesive of the appliance system, particularly in people with fragile skin, on corticosteroids, or with other conditions affecting skin integrity.
Fungal infection — candida overgrowth under the appliance, typically appearing as satellite lesions and producing itching and discomfort.
What we do: We inspect peristomal skin at every pouch change, using good lighting, and document what we observe specifically — the location, the character, the severity, and whether it has changed since the previous change. We communicate any skin concern that is new, worsening, or not responding to current management to the stoma nurse. We never persist with an appliance system that is causing skin breakdown — the appliance needs changing, not the person's skin routine.
Parastomal Hernia
According to Colostomy UK, 50–70% of ostomates will develop a parastomal hernia — a protrusion of abdominal contents through the weakened abdominal wall around the stoma site. Parastomal hernias are more common with end stomas and with age. They produce a visible bulge around the stoma, can affect the appliance seal (because the stoma surface is no longer flat), and in severe cases require surgical repair.
Hernias are the most common late complication of stoma surgery and one of the most significant quality-of-life impacts for long-term ostomates. They cannot be prevented entirely but are worsened by heavy lifting and can be managed with appropriate hernia support garments prescribed by the stoma nurse.
What we do: We are trained to recognise parastomal hernia development and report it to the stoma nurse when it first appears. We do not attempt to reduce a hernia, and we are alert to the signs of bowel obstruction within a hernia — pain, nausea, a hard non-reducible bulge — that require emergency medical assessment. We support the use of hernia support garments where prescribed. For clients with established large hernias, we adapt the pouch change technique accordingly, because the appliance must sit on a different surface than it would on a flat abdomen.
High Output Ileostomy
High output stoma — defined as more than 1,500 ml of output in 24 hours — is a significant complication, particularly in ileostomies. It causes dehydration and electrolyte imbalance (particularly sodium and magnesium depletion), which produce symptoms including cramping, fatigue, and in severe cases acute kidney injury.
The risk of high output ileostomy is highest in the weeks after surgery and in any period of illness. Older adults are particularly vulnerable to the effects of dehydration and electrolyte imbalance.
What we do:We are trained in the early recognition of high output — monitoring output volume at pouch emptying, observing for the thirst, reduced urine output, and muscle cramps that indicate dehydration. We ensure that clients with ileostomies are drinking adequate fluid — the type and volume of which is specific to ileostomy management.
We communicate output concerns promptly to the stoma nurse and GP, because high output ileostomy requires prompt clinical management.
Stoma Leakage
Leakage of stoma output from the appliance — under the flange, around the seal, from a bag that has detached — is one of the most distressing and practically significant challenges ostomates face. A UK study on the prevalence of leakage and its impact on quality of life found that it significantly affects confidence, social participation, and wellbeing.
Leakage is caused by poor appliance fit, incorrect aperture size, peristomal skin irregularities (scars, creases, contours that the flange cannot follow), high output overwhelming the adhesive, or appliance failure. It is frequently manageable with the correct products and technique — but requires experienced assessment to identify the specific cause.
What we do: We apply stoma appliances with the attention and technique that prevents leakage — the correct aperture size, appropriate skin barrier paste or rings where the skin surface is irregular, adequate pressure on the flange for complete adhesion, and awareness of the specific conditions (hot weather, sweating, high output) that increase leakage risk. We never rush a pouch change. We document episodes of leakage — timing, circumstances, output volume — as information for the stoma nurse. And we communicate persistent leakage promptly rather than managing around it, because leakage that is happening repeatedly indicates a problem with the appliance system that needs professional assessment.
The Pouch Change — What Good Technique Actually Involves
The pouch change is the central daily procedure for every ostomate, and it is worth describing what it actually involves — because good technique matters clinically, not just practically.
A pouch change at NSHC involves:
Preparation — assembling all equipment before starting. Warm water, soft cloths or wipes (not alcohol-based, which damage peristomal skin), the new appliance in the correct size, any additional products (paste, seals, barrier sprays) that are part of the individual's management regime, a clinical waste bag.
Removal of the old appliance — gentle removal by supporting the skin with one hand while peeling the flange slowly from one edge, avoiding any pulling or tearing that could damage fragile peristomal skin. A silicone-based adhesive remover spray makes this significantly easier and less traumatic, particularly on sensitive or fragile skin.
Cleaning and assessment — cleaning the stoma and peristomal skin with warm water and a soft cloth. No soap (soaps leave a residue that impairs adhesion), no alcohol wipes, nothing that disrupts the skin's natural barrier. During cleaning, we inspect the stoma — its colour (should be red or pink; pale or dark purple indicates circulation problems requiring prompt attention), its size (stomas may change size in the early post-operative months), and the surrounding skin.
Skin preparation — barrier spray or wipe applied to the peristomal skin and allowed to dry completely before the appliance is applied. For irregular skin surfaces, paste or rings applied to fill the contours. For fragile skin, protective dressings where indicated.
Appliance application — aperture measured and cut to the correct size (typically 2–3mm larger than the stoma itself to avoid constriction while preventing output from contacting the skin). The appliance applied from below the stoma, smoothed onto the skin, and held firmly for 30–60 seconds to ensure the adhesive has bonded.
Completion — closure of the drainage bag if drainable, or attachment of the drainage bag to a two-piece flange if using this system. Disposal of the used appliance in a clinical waste bag. Hand hygiene.
This process, done carefully and correctly, takes 10–15 minutes. It cannot be done in five minutes without compromising either the skin care or the appliance seal. We build appropriate time into every stoma care visit.
Nutrition, Hydration, and Dietary Management
More than 70% of stoma patients change their diet following surgery. The dietary implications differ significantly between colostomy and ileostomy.
Colostomy and Diet
A colostomy places fewer restrictions on diet than an ileostomy, though certain foods can affect output consistency and gas production. In the early post-operative period, a lower-fibre diet is typically recommended while the bowel recovers. Over time, most people with a colostomy return to a relatively normal diet, identifying through experience which foods produce undesirable output patterns or excessive gas.
We support our colostomy clients in maintaining the dietary habits that work for them, and we flag to the stoma nurse or GP any dietary concern — significant changes in output consistency, signs of obstruction (no output, abdominal pain, nausea), or nutritional concerns.
Ileostomy and Diet
Ileostomy management places more specific dietary demands. Because the large bowel — where water and electrolytes are reabsorbed — is bypassed, fluid and electrolyte management is a constant consideration. Certain foods can cause specific problems:
Blockage risk — high-fibre foods including nuts, seeds, dried fruit, raw vegetables, and the outer skins of certain fruits and vegetables can cause ileostomy blockage, where undigested material obstructs the stoma. We support clients in following their stoma nurse's dietary guidance on fibre management and are trained to recognise the signs of blockage — reduced or absent output, abdominal cramping, nausea — that require prompt clinical attention.
High output triggers — spicy food, alcohol, and certain vegetables can significantly increase ileostomy output. We are aware of these triggers and communicate with families and stoma nurses when output changes following dietary changes.
Hydration — people with ileostomies need to drink more than the general population to compensate for the fluid and electrolytes lost through stoma output. Plain water is not the most effective hydration fluid for ileostomy patients — isotonic drinks or oral rehydration solutions are more effective at replacing the sodium that is lost alongside fluid. We support adequate fluid intake at every visit.
Urostomy and Diet
Urostomy management involves specific attention to urinary health. We support adequate fluid intake to reduce the concentration of urine and the risk of urinary tract infection, which is more common following urinary diversion. We monitor urine appearance — cloudiness, blood, or unusual odour — as early signs of infection requiring prompt GP assessment.
The Emotional and Psychological Dimension
More than half of stoma patients report feelings of depression following surgery. This is not a surprising finding. Stoma surgery often arrives in the context of a serious and frightening diagnosis — cancer, inflammatory bowel disease at a debilitating stage, emergency surgery following a perforation or obstruction. The surgery itself is major. And living with the result — managing a pouch on one's abdomen, adapting one's daily routine, navigating anxiety about leakage and odour in social situations — represents a profound adjustment to body image and identity.
The experience of having personal care involving one's stoma provided by another person is, for many people, one of the most difficult aspects of accepting home care. Stoma surgery was called "the secret surgery" for a reason. Many people are deeply embarrassed by their stoma — not because it should be embarrassing but because the cultural stigma around bowel and urinary function is deeply ingrained, and stoma surgery places that previously private function into daily management by oneself and, for some people, by another person.
We approach stoma care with complete matter-of-factness. Not clinical detachment — genuine, warm, unhurried care that treats the pouch change as exactly what it is: a necessary, skilled, daily procedure that we are trained to do well and that the person has every right to receive without embarrassment.
We do not comment on output, make observations about smell, or communicate through our manner that this is anything other than a routine part of the care. We take our cue from the person — if they want to talk during the change, we talk; if they want quiet, we give them quiet; if they want to learn more about the procedure and take it over themselves, we support that.
And we observe and communicate mood concerns. The depression that follows stoma surgery is frequently undertreated. A person who has become significantly withdrawn, who avoids social situations due to anxiety about their stoma, or who expresses persistent distress about their altered body deserves referral to psychological support — and we communicate this to the clinical team.
Practical Equipment and Supplies
Stoma appliances and accessories are prescribed on the NHS for everyone with a permanent stoma. This includes:
Pouches (closed, drainable, or urostomy) in the appropriate size and style
Skin barrier flanges and wafers
Paste, seals, and rings for irregular skin surfaces
Adhesive remover products
Barrier sprays and wipes
Deodorant products for pouches
Disposal bags
NHS prescription charges (for those who pay) apply, though many stoma patients qualify for prescription prepayment certificates or medical exemption. Colostomy UK provides a prescription support service.
Our carers work with whatever appliance system the stoma nurse has prescribed and established for each client. We do not change the system without clinical agreement. Where we believe a system is not performing adequately — causing leakage, skin problems, or significant difficulty for the client — we communicate this to the stoma nurse and support the client in requesting a review.
Working With the Stoma Nursing Service
Stoma specialist nurses — sometimes called Clinical Nurse Specialists or Stoma Care Nurses — are the primary clinical resource for people with stomas. They provide:
Pre-operative stoma siting and education
Post-operative education and appliance fitting
Ongoing support for complications, appliance changes, and product selection
Review when problems arise — leakage, skin breakdown, output changes, hernia
We work alongside the stoma nursing service rather than replacing it. We implement the appliance system and care routine the stoma nurse has established, and we communicate clinical observations to the stoma nurse and GP when something needs reviewing.
Stoma nurse support is available through the Royal Shrewsbury Hospital for patients in North Shropshire. Community access to stoma nurses varies — and the gap between hospital discharge and the first community stoma nurse appointment is often when problems develop. We bridge this gap with skilled daily care and prompt escalation when something is not right.
When a Stoma Is Temporary
Not all stomas are permanent. Loop ileostomies and loop colostomies created to protect a surgical anastomosis are typically reversed after a period of recovery — usually 3–6 months, once the anastomosis has healed and the person's overall health allows.
For people with a temporary stoma awaiting reversal, the daily care requirements are the same as for a permanent stoma, but the emotional context is different. The person is managing a temporary state while looking forward to reversal — and the quality of that management affects both their quality of life in the interim and the success of the reversal procedure.
We provide the same quality of care for temporary stomas as for permanent ones, and we support the person in understanding that temporary does not mean less important.
Arrange a Free Home Assessment
If you or a family member is returning home following stoma surgery, or is managing a stoma at home in North Shropshire and finding it increasingly difficult — we would be glad to talk.
A free home assessment costs nothing and commits you to nothing. We visit, we listen, and we give you an honest picture of what we can provide.
📞 01948 411222 — 24 hours, 365 days
✉️ mail@nshomecare.co.uk
North Shropshire Homecare
The Coach House, 15/17 Green End, Whitchurch, SY13 1AD
Providing specialist stoma care at home across Whitchurch, Wem, Prees, Whixall, Higher Heath, Tilstock, Ash, and the surrounding villages of North Shropshire. CQC Rated Good. Independently Owned. Locally Staffed.
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The information on this page has been checked for clinical accuracy and aligns with current best practices for Stoma Care at Home.
REVIEWED BY: Alice Allen CQC Registered Manager
Next review July 2027.
