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the family or close friends are closely involved during all stages and are supportive, patients are better able to adapt to the threat of mutilating surgery and altered pattern of elimination (Price 1990). The family or close friends are also likely to require support and information so that they are in a position to help the ostomate. Acceptance of the stoma is a gradual process and, on discharge from hospital, patients may only be beginning to adapt to life with a stoma (Salter/RCN 1997).

Ongoing care

Body image

Stoma formation creates many issues for the patient and many struggle with body image. Studies suggest that this is often overlooked (Opus 2010). The circumstances in which the stoma is formed will influence psychological recovery (Black 2000). Communication is key and it is important to allow the patient and family to discuss their concerns and anxieties. Therefore stoma care nurses play a vital role in supporting the patient and family. It is important to promote patient independence and acceptance.

Diet

All patients should be encouraged to eat a wide variety of foods. Our digestive system reacts in an individual way to different foods and so it is important that patients try a wide range of foods on several occasions and that none should be specifically avoided (Bridgewater 1999). Patients can then make decisions about different foods based on their own experience of their own reaction. Explanations should be given of how the gut functions, how it has been changed since surgery and the effects certain foodstuffs may cause.

Colostomy and ileostomy formation means the loss of the anal sphincter so passage of wind cannot be controlled. High-fibre foods such as beans and pulses produce wind as they are broken down in the gut; hence individuals who eat large quantities of these foodstuffs may be troubled by wind. There are several non-food causes of wind, such as chewing gum, eating irregularly and drinking fizzy drinks, which should be considered before blaming a particular food (Bridgewater 1999). Eating yoghurt or drinking buttermilk may help reduce wind for these patients. Green vegetables, pulses and spicy food are examples of foods that may cause colostomy and ileostomy output to increase or become watery. Boiled rice, smooth peanut butter, apple sauce and bananas are some of the foods that may help thicken stoma output (Black 2000, Bridgewater 1999).

Some foods, for example tomato skin and pips, may be seen unaltered in the output from an ileostomy (Black 1997, Blackley 1998, Hulten and Palselius 1996). Celery, dried fruit, nuts and potato skins are some of the foods which can temporarily block ileostomies (Black 2000, Bridgewater 1999). The blockage is usually related to the amount eaten (Wood 1998). The offending food can be tried at another time in small quantities, ensuring it is chewed well and not eaten in a hurry (Bridgewater 1999).

There are no dietary restrictions with a urostomy. It must be stressed, however, that an adequate fluid intake must be maintained to minimize the risk of urinary tract infection. The recommended fluid intake for all individuals is 1.5–2.0 litres per day (Bridgewater 1999). Fluid intake should be increased in hot weather or at times when there is an increase in sweating, for example exercise, fever. Beetroot, radishes, spinach and some food dye may discolour urine; some drugs may also have this effect, for example metronidazole, nitrofurantoin. Urine may develop a strong odour following consumption of asparagus or fish (Bridgewater 1999).

Fear of malodour

This is a common fear for patients with bowel stomas, often based on hearsay or experience with other ostomists in hospital or the community. Appliances are odour free when fitted correctly. Flatus may be released via charcoal filters and deodorizers are available. The individual must be reassured, however, that any problems that occur postoperatively will be investigated, with a good possibility of their being solved by such means as the use of alternative appliances (Black 2000, Burch 2004).

Sex and the ostomate