Making a Treatment Plan for Rectal Cancer

In order to develop the best plan of care for your rectal cancer diagnosis, your doctors and other members of your healthcare team will look at the stage of the disease through several tests that are given. Some tests that your doctor could order include an MRI and a CT. Blood tests are often ordered as well in order to look at various levels. 

Once the results of your tests are available, they can help the team decide on the best types of treatment that should be used, such as which medications might be needed or if surgery might be an option to consider. Chemotherapy and radiation could be used to shrink the tumor before surgery is performed. Doctors can look at test results to determine the stage of your rectal cancer as this is a factor for determining your treatment as well. Other factors that could come into play when deciding on the best treatment plan include the size of the tumor and the location. Your healthcare team will also look to see if the tumor has metastasized or spread to other areas of your body. 

Stage 0

At this stage, the tumor is usually small and hasn't spread to other areas. In most situations, surgery can be performed to remove the tumor without any further treatments. 

Stage 1

Tumors are usually within the wall of the rectum. However, they typically haven't invaded the areas surrounding the rectum. The tumors are typically removed surgically with additional areas removed as well to prevent the spread of any cancer cells. Endoscopic surgery is sometimes performed if there are larger tumors that need to be removed. Sometimes, incisions might need to be made to allow the doctor to better see the tumors or reach areas that are higher up in the rectum. These incisions are typically made in the lower part of the abdomen. 

Stages 2 and 3

A component of stage 2 rectal cancer is that the tumor has started growing outside of the rectum. The lymph nodes usually aren't involved. However, during stage 3, cancer cells have usually invaded the lymph nodes, which could require various treatments including radiation or surgery. Some patients might undergo chemotherapy or radiation before surgery while other patients might have a treatment plan that is significantly different due to the location of the tumor and the severity of the progression of cancer. 

Prior to Surgery

Before your doctor performs surgery, radiation or chemotherapy options are typically explored to try to minimize the size of tumors that are present. This can make recovery from surgery a bit easier as the procedure could be less invasive. It could also decrease the possibility that you would need a colostomy. Radiation treatments are often given over the course of six weeks. The tumor will be assessed once again to see if the therapy worked before another treatment plan is put into action. 

Some of the treatments after surgery include a colostomy or an ileostomy. With a colostomy, there is an opening through the abdominal wall that allows for fecal matter to be eliminated into a bag. An ileostomy is a treatment that is used once the bowels are functioning again. 

Stage 4

Other tissues or organs are affected by this stage. As with other stages, chemotherapy and radiation are looked at first, but surgery is often the best treatment to remove the tumors. 

Is Your Ostomy Pouch Gassy (Let Me Help)

Yes that is correct - probably the most annoying thing about having a stoma is the infamous problem of gas. Flatulence is not usually a big deal for most people, especially because you can generally control when your gas is released. However, if you have an ostomy, you cannot control when your gas comes out. It is just constantly filling up the ostomy pouch, which can lead to some pretty embarrassing moments. If your ostomy pouch gets too filled with gas, it can even leak out of the ostomy system and fill the room with quite possibly the worst smell that has ever been smelled in the history of mankind. That’s why it is really important for people with stomas to know all there is about having gas with an ostomy and know how to prevent it. If you don’t really know anything about gas, then let me enlighten you a little bit about how it works. Gas is mainly caused by two different things; the first cause of gas is by swallowed air. I was surprised to learn this facg a while ago, but it is actually true. I guess it makes sense that if you tend to swallow air, it needs to go somewhere after it is sitting in your stomach. The problem is that it is often mixed with various stomach and intestinal gas which makes it smell absolutely awful when it comes out. 

The other cause of gas is from bacteria that forms in the colon, and it is my belief that this type of gas smells even worse than the other one I mentioned. Now that you know a little bit more about how gas is formed, let’s relate it back to the world of ostomy so we can get a better idea of what we are up against. Firstly, it is important to note that producing gas through your stoma is normal and, to a certain extent, completely unavoidable. So if you are reading this article and looking for a way to completely eliminate any gas for the rest of your life, then I have some bad news for you; that is just not possible. However, since we have identified two of the main causes of gas, we can better figure out how to avoid as much gas as possible, and hopefully prevent your ostomy pouch from being filled to the brim with nasty gas every 15 minutes.  

The problem of swallowing too much air can be addressed by a couple different methods. Firstly, there are some things that can cause you to swallow a lot more air than normal. One of these is chewing gum, which actually causes you to swallow quite a bit of air each time you do it. So before you think about trying to chew gum everyday, think about the consequences it may have on your stoma’s quality of life. Personally, I do not chew very much gum ever, so this one is not a problem for me. But also, I do not even have a stoma, so none of this is a problem for me! Anyways, you can also swallow a lot of air if you drink beverages through a straw throughout the day, or if you drink a lot of carbonated beverages. Hopefully this is helpful for you on your next day out!

Eating After a Stoma

So you just had surgery and got an ostomy huh? I bet you’re worried about a lot of things right now. I know for me, recovering from my surgery and adjusting to life with a stoma was a very stressful process. However, I am here to tell you that things are not that bad. I do not want you to feel worried and feel like you are alone in this struggle. There are plenty of people who have had this surgery before you and completely recovered and got back to living normally again with the addition of a stoma. One of the hardest things about recovering from surgery is trying to eat normal foods again. I know from personal experience that it is most helpful to spend a lot of time in sweatpants and a sweatshirt for the first couple weeks after surgery. Listen, you just got a whole put in you, it’s okay to take some time for yourself and to rest up a little bit!

One thing that people struggle with after surgery is figuring out what to do about eating. I know that a lot of people worry that they will never be able to eat the same foods again because of their ostomy and their stoma. Well, the good news is that you will be able to enjoy lots if not all of the same foods you enjoyed before surgery! However, the time frame for these things might look a bit different depending on your recovery process and how you are adjusting your body to the stoma. For the first few weeks after surgery you will definitely want to be eating very bland foods. This is because your body is very weak and your stoma is very fresh, and you would not want to eat any foods or drink beverages that could potentially harm your new stoma. I suggest eating the most basic diet for a few weeks. I know that this is not a super good time; in fact, I absolutely hated eating bland foods for such a long time after surgery, but your doctor will also tell you that it is super important to be able to fully recover from surgery.

Once you have had several conversations with your doctors and follow up visits about your surgery, your doctor may clear you to start eating more normal foods again. However, this does not mean that you need to go hog-wild at your local Golden Corral. Your body is still adjusting to life after an ostomy which means you are going to want to be careful in any way you can. I suggest you slowly start introducing foods back into your diet that you used to eat regularly. You want to do these things slowly so that you can better analyze how your body is reacting to each new food and then make adjustments based on what your body is telling you. I know this can be a bit of a process, but it is really not too bad of a time once you find the foods you are not super comfortable with. 

I had to stop eating beans after my stoma. Beans used to make me gassy anyways, but it is a bit more of a problem to be gassy while having a stoma put in because then your pouch fills with gas and it can be really annoying.

All the options of ostomy bags

Finding the right ostomy bag can sometimes be a long and strenuous process. After going through surgery and coming out with a stoma on the other side, the last thing you want to do during your recovery process is try to figure your way through finding the ostomy bag for your needs, tastes, and preferences. I remember spending a lot of time on the couch recovering from surgery and looking at different websites online to try and find the best ostomy supplies for my new stoma friend. The good news is that there is a lot of information online that can help you in determining what ostomy gear works best for you. You really aren’t limited in how you want to approach your shopping experience, so long as your doctor has cleared you to be going out and about. However, I would much rather do my shopping in sweat pants from my couch.

So basically, there are three different types of bags that you have to choose from on your ostomy bag search. They each come in a variety of sizes and other options as well, and it is essential to pick the one that you like and that the doctors recommend for you. The three different bag types are for the three different types of ostomy that one would receive; a colostomy, ileostomy, or urostomy, and they each have their own special purpose and correct way of using them. Personally, I use a colostomy bag because that is the type of surgery I had done on my colon. With each bag, there are two different variations that you may come across during your ostomy bag shopping spree. One piece ostomy bags are, as the name suggests, pouches that have the skin barrier connected to the pouch and hence come in one piece. Two piece ostomy bags have a separate piece where the skin barrier is put into place inside the pouch. 

I have always personally liked one piece ostomy bags more than the two piece ones. I have found that it is just much more convenient to have just one thing to worry about when changing my ostomy pouch; after all, I’m clearly already not having a good time if I have to change out my bag of literal poop in the McDonald’s bathroom. There’s no need to further complicate things by having another piece of the pouch to worry about. One piece bags are also way easier to carry and hide under clothes. Most one piece bags are virtually unnoticeable underneath clothing, so it makes it really easy to pretend like I’m a normal person for a little bit. The disadvantages to one piece bags, though, are that it requires a bit more care when changing because you have to come into contact with the skin barrier at every bag change. The two piece bag allows for changes that do not necessitate removing the second piece of the pouch that is in contact with the skin barrier. What’s more, a one piece bag requires more care and accuracy when placing it on your stoma to prevent leaks.

For me, the pros outway the cons as far as I’m concerned when it comes to a one piece bag. Don’t just take my word, make sure to try out different types of bags to see which ones work best with your stoma!

Steps in Changing Your Ostomy Pouch

Simply put, a colostomy is a surgical procedure that creates an opening for the large intestines through the abdomen. It is usually done to treat bowel problems or let the body part heal quickly after surgery. Diseases like colon cancer are the most significant causes of a colostomy. There are two types of colostomies: permanent colostomy and temporary colostomy. 

After a colostomy is performed, your sphincter muscles are removed, eliminating the ability to control your bowel movements. For this reason, your doctor might issue you with colostomy bags, also known as ostomy bags, to help you collect the wastes from your body. Initially, changing the pouch might feel complicated but with time, changing the appliance gets easy, taking less than 15 minutes. This article will answer more questions about colostomy bags and how you should change them. Please keep on reading.

How often should you change your colostomy bag? 

Several independent factors determine how often you change your ostomy pouch. They include

1. The location of your ostomy

The location of your colostomy plays a significant role in determining the number of times that you change your appliance. People with transverse and ascending colostomies have looser and irritating stools and hence require frequent pouch changes. On the other hand, those with sigmoid and descending colostomies produce semi-liquid stools that do not require care more often.

2. The nature of your skin

If your skin is oily and moist, you will likely require frequent changes to prevent leaks as the pouch will not adhere well with the body.

3. Your activity level

People involved in vigorous exercises will be required to change the bags regularly because of increased amounts of sweat compared to people who rarely exercise.

Other factors that determine how you change your appliance are

4. Your bowel movement and consistency

5. Indoor and outdoor temperatures

6. The type of appliance that you use

Supplies you should have to change your colostomy bag

Before you change your ostomy pouch, make sure you have everything immediately at hand. The things you will require are:

• A new colostomy pouch
• A pair of scissors
• Stoma powder
• Skin adhesive
• A clean towel and soap
• Disposable plastic shopping bag

Get your supplies together and choose a location where you will empty the old bag. Changing your appliance while sitting is preferable as it is more comfortable, but you can still change it while standing.

 Step by step guide when removing a colostomy bag

Step 1: Remove the old appliance

This involves opening a clip in your drainable pouch and draining the wastes into a toilet before removing the used bag. Always ensure that you do not splash wastes into your skin as it can cause unnecessary stress to the skin. It can also result in irritation and bleeding in the stoma. After removing the used appliance, dispose of it in a disposable plastic bag and tie the top with a knot to eliminate bad odor.

Step 2: Wash the skin and stoma

Clean the skin around the stoma and the stoma itself with warm water and soap and a clean washcloth and dry the region with a dry towel.

Step 3: Attach the pouch

Carefully cut the opening in the center of the wafer to ensure it fits in your stoma if you have a two-piece system. For those with a one-piece pouch, the hole is usually pre-cut for them. The wafer opening should match your stoma, as having a large hole will irritate the skin due to leakages. Similarly, a small hole will make your stoma become inflamed.

After the procedure, apply skin prep if your skin is moist, followed by a skin wipe over the stoma powder. The next step involves applying stoma powder to the hole in the wafer and, lastly, to your skin. Hold the wafer in position for some time to create a good seal. Clean your hands gently.

 When to call your doctor

• It is necessary to consult your ET nurse if:
• The skin around your stoma is bulging
• Your stools are looser than normal
• You get a purulent discharge around the stoma
• The stoma is not producing gas for long
• You are nauseous
• There is blood in your stool

Do People Notice Your Stoma?

I am seriously wondering. Anyone else have problems with people noticing their stoma in public? For me, it has happened quite a few times this summer and I am just completely sick of it. It started when I got a colostomy a few months ago, and have since been trying to adjust to life with a stoma and ostomy pouch. Some days are not bad, but there are other days in which I feel that people are constantly staring at me and at my ostomy pouch. I was told that it is pretty easy to hide an ostomy pouch underneath clothing, and I feel that this is true for the most part. However, now that it is summer time, I want to be wearing more of my summer outfits and clothes and I feel like that makes it harder to be discreet about my ostomy pouch. 

Since the summer has begun, I have started really wearing anything I want. My philosophy is that if people have a problem with my ostomy pouch then that is their deal not mine. Well, I used to feel that way. Lately I have been feeling a lot more insecure about it. I have always enjoyed going to the beach with my family and friends ever since I was younger, and boy has it been a struggle to do that ever since getting my ostomy pouch put in. It can be really frustrating to have to worry about everyone wondering what the heck I have attached to my body, let alone worrying about all the sand and other junk that can make changing my pouch a lot more problematic on the fly. Does anyone have suggestions about going to the beach with an ostomy pouch on? I feel like I am the only person I know who struggles with this problem, because I do not really have anyone in my life who also has a stoma. 

Another thing I noticed is that there are certain days where my ostomy pouch will fit closer to my body than others. Maybe it has to do with how I’m wrapping up my pouch, but I am really not sure. I’ve searched the internet far and wide to find some ostomy products that offer more discretion in social situations, but almost all of them involve putting on more layers of clothing to actually be effective. What’s the deal with that? I am not going to be wearing several layers of clothing in the summer, especially when it is 90 degrees outside. I feel like some ostomy supply companies are just so out of touch with their actual customers. 

I think for me personally, I am just going to start wearing my ostomy pouch however I please. So people might stare at the beach, so what? Like I said earlier, if they have a problem with my ostomy pouch, they can go ahead and look the other way. They won’t ever know the experiences and problems associated with having a stoma like me until they’ve actually had an ostomy. Let me know if anyone out there is struggling with the same issues as me this summer regarding your ostomy pouches. I would really appreciate some tips and tricks from your end if you have anything of value to share with me.

Can You Still Enjoy The Outdoors With a Stoma?

One of my biggest hobbies is enjoying the outdoors. I’m no stranger to extreme sports, hiking, camping, rock climbing - you name it. I absolutely love the outdoors and it has always been a huge part of my life. Growing up in rural west Michigan has given me plenty of opportunities to get outdoors and enjoy the great wonder of nature. Long summers spent with my grandparents in northwest Michigan will always be great memories in my heart and have fueled years of excitement well into my adulthood about getting out to the woods or the beach. A few months ago I underwent surgery due to some unfortunate circumstances that left me with a whole new development in my life. That’s right; I’m talking about a colostomy. Not a lot of people understand what a colostomy is, and that’s okay - it’s not something that I hope very many people have to experience in their lifetime. My ostomy left me with a whole in my lower abdomen called a stoma, in which the waste in my body will basically filter into a pouch that’s connected to the outside of my stoma.

Now there are a lot of changes that happened in my life after getting a stoma. I had to take a couple months off work to get through the whole ordeal of surgery and recovering from the ostomy, and I can tell you right up front that it was not at all a pleasant experience. To make things worse, I was super afraid that my stoma will affect my love for going outdoors. Not only does a stoma limit you because you need to have ostomy supplies and gear on hand in the event of an emergency, but you also need to be wary of any movements that could cause complications for your stoma. I talked with the doctors a lot about what I would be allowed and not allowed to do as far as exercise; I told them with tears in my eyes that I absolutely love exploring the outdoors and that I need it to continue to be a big part of my life.

Fortunately, I felt a lot better about my situation after talking with the doctors. They explained that I would need to rest for a while after my stoma was put in and that it is not great to go running around outdoors after an ostomy. But after the recovery process, I was free to return to my normal activities for the most part! There are still a few things that I don’t feel completely comfortable with doing with my stoma, like swimming, but for the most part I am able to completely continue my hobbies outdoors. 

This summer, I have been super into kayaking and canoeing. It’s always a good time to stroll lazily down a river or lake and stand as a witness to the beauty of nature. I also have spent a lot of time cycling; I even found stoma pouches online that are more form fitting and allow for more comfortability during sports or athletics. This has been a game-changer for me when I’m going on hikes or runs outdoors. Overall, I want you to know that your ostomy won’t ruin your life; in fact, your life will continue to basically be how it was before your ostomy in a lot of ways. Don’t be discouraged, you will get through this!