Ostomy surgery is a major event that may cause difficulties when adjusting to the previous lifestyle that the patient enjoyed. “Living with an ostomy can impact a person’s psychological health and affect social functioning. For instance, living with an ostomy can negatively impact body image, sexual function, mood, and daily activities, thus impairing a person’s overall psychological health. Lifestyle considerations and adjustments may also be required for aspects of daily life, such as diet, exercise, intimacy, and self-management of the ostomy. Despite so many challenges, if the right resources and supports are in place, it is certainly possible for persons to live an active and meaningful life after ostomy surgery.”1 Also, as long as there are no other health complications and a healthcare professional approves it, patients can perform almost any kind of sport or physical activity.
The following are exercises that ostomates can perform with the guidance of a specialist.
There is a positive correlation between weight-bearing exercises and bone density. Particularly with age, bones weaken and muscle tissue fades away. Weight training may delay this negative progression. However, avoid any lifting for at least 12 weeks after your ostomy surgery. Perform strength training with caution; use a mirror to follow proper technique.
Start working on the large muscles: legs and upper torso. Because of the ostomy, begin with a few repetitions and immediately stop if fatigued. As a general rule, if you cannot comfortably lift an object 20 times, it is too heavy for this purpose. Build up slowly and rest between sets. Drink during your workout and eat well afterward. If you are consistent, you will see the benefits. Lifting is a strenuous activity that creates considerable abdominal pressure. You should always wear an ostomy support belt to reduce the risks of injuries and parastomal hernias.
Core Muscle Conditioning
Strengthening core muscles facilitates most activities. They help maintain adequate back posture and alleviate stress from the back, reducing the chances of back pain. Core muscles run through the abs, back, and pelvis. The main ones include the Rectus Abdominis (better known as the “six-pack”); External and Internal Obliques (sides and front of abdomen); Transversus Abdominis (key abdominal muscle beneath obliques, extends around the backbone providing shield and support); Hip Flexors (pelvic front and upper thighs); Hip Adductors (mid-thighs); and Gluteus Maximus, Medius, Minimus (sides and back of hip).
Various exercises are meant for core muscles. You may do them at home on a mat or carpet, and require no equipment. Breathe deeply while performing them and do not hold your breath. Muscle core exercises are useful, but check your proneness to parastomal herniation with your health professional before engaging in a routine.
Inactivity causes abdominal muscles to weaken. It is highly recommended to use a support belt (preferably ventilated type). Doing sit-ups has the greatest risks of parastomal hernias as you might apply excess pressure on the debilitated abdominal muscles.
Appropriate crunch technique requires that you lie on your back with knees bent and a foot apart. Bring your arms to your chest (do not place them behind the head), contract your abdominal muscles, raise your torso away from the floor, hold your body for three breaths and lie back on the floor. Be gentle and repeat as many times as you can while maintaining form. You may also try reverse crunches.
Other Recommended Core Exercises
Try low impact activities such as Yoga, Tai-Chi and Pilates. They are smooth but very demanding workouts, and they all target and bolster core muscles. Incorporate isometric exercises like the plank (abdominal bridge), side plank, reverse plank, and the back bridge. Also, you might try the hip lift, oblique twist, lunge with twist, push-ups and squats. When doing these exercises, contract your transversus abdominis muscle. Do sets of five. As you progress, increase repetitions to 5, 10, and 15. You may add a Swiss ball, medicine balls, balance boards, or wobble boards to the routine.
“Multi Joint exercises (eg, chest press, shoulder press, squats, lunges, pushups) are recommended over exercises focused on a single joint, and all major muscle groups (chest, shoulders, arms, back, abdomen, and legs) should be incorporated into a resistance training program. For survivors who do not currently engage in resistance training, clinicians should recommend that they start with 1 set of each exercise and progress up to 2 to 3 sets as tolerated. A weight that would allow the performance of 10 to 15 repetitions is recommended; however, individualizing recommendations for resistance and strength training is important.”
Humans are designed to walk. Walking is a first good step to an exercise routine. Walking helps stabilize blood pressure and improves cardio conditioning. It is a low-impact and effective activity, but you must go slow and get comfortable sneakers. Do not assume that any shoe will serve, since it’s “just walking”. Start with short walks and gradually increase distance and pace. Monitor your workout based on time, not distance. Begin with 30 minutes and make an hour your ultimate goal. Do it at least 4 times per week. Aside from helping you get back in form, walking contributes to control your weight, improves digestion and discharge. It also relieves tension and improves blood circulation.
“You should begin walking in moderation after your surgery and do this regularly, every day after you get home. Walking stimulates the return of bowel function and will get you back on the road to regaining the muscle you lost while in hospital. Whatever sports you may have played in the past, you can enjoy them again with few exceptions. Common sense is required, of course and this mean no heavy lifting during the weeks immediately following surgery. Unless your surgery was done laparascopically, your abdominal muscles will have been weakened by incisions and must be given adequate time to heal. Improper lifting, or lifting too heavy a weight too soon could cause a hernia. Again, no lifting, not even a vacuum cleaner or laundry hamper for those first few weeks and then only introduce light loads gradually and carefully. If you want to return to the gym you can do this but you should avoid abdominal exercises for a while, and then only introduce these in gradual, gentle amounts. A personal trainer, if you can afford one, can work with you to develop a safe exercise regime.
Ostomates who regain previous fitness levels can and do return to a huge variety of sports and exercise -running, swimming, biking, snorkelling, golf, hiking, hunting, yoga, riding, team sports, triathalon- you name it. The list includes contact team sports as well -professional footballers have played with an ostomy. Unless your chosen sport before was power lifting or wrestling, you will probably be able to do it again.”3
Contact and Team Sports
An ostomy should not prevent you from practicing contact or team sports. As long as you re-build stamina and strength moderately, you may practice any sport: football, soccer, karate, wrestling, basketball, water polo, and more.
Damaging the stoma is rather difficult. So, coping with it in case of an accident is frequently easier than repairing a broken arm or a pulled knee ligament.
Aside from emptying and securing the bag before the activity for both comfort and to avoid any embarrassment (ripped bag), you do not have to worry about much else. Once those contact sports enthusiasts learn that the are no medical barriers to practice them, an ostomy should not impede their practice.
Swimming is an adequate sport for ostomates. It is gentle on the abdominal muscles and exercises the whole body. If you use a flange, make sure you change it a few hours prior to your session. Better yet, choose a product without a flange. If wearing a belt, go for the rubber type as cloth belts stretch.
“Swimming, hot tubbing and saunas may be resumed once your incision(s) heals completely. Prolonged exposure to water may cause the adhesive seal to loosen your pouching system. Applying surgical tape around the four sides of the adhesive seal of your pouch (e.g. like a picture frame) may help protect the seal. Smaller pouching systems are available and may be an option for wear during some activities. Some swimwear have patterns and various panels that may help to conceal the pouch. You may find a selection at retail outlets and at some medical/surgical (ostomy) supply stores.” 4
Learn to gauge your metabolism so that you can swim with a light pouch. If you are concerned about its visibility, you can cover it up. Use mini-bags (non drainable and with no filters) and wear a patterned suit. Try a waterproof tape around your bag, and a belt under the suit. For men, select a bigger size. Trunk suits and a tight lycra underpants work well. For women, choose lycra. It makes you look slimmer and will keep the bag in place. Suits with skirts, shorts or sarons are good alternatives. Colostomists may substitute the bag for a stoma cap.
Caring For Your Ostomy Pouch While Swimming
“Your pouch will remain intact when underwater, bathing or swimming. After bathing or showering with the pouch, you can activate the wafer adhesive for a tight seal. Follow these steps:
- Dry the skin well.
- Turn a hand-held hair dryer to the lowest setting (warm).
- Direct the dryer air flow along all the edges of the pouch/wafer.
- Keep the hair dryer at least 6 inches away from the body.
- Use the dryer for a total of no more than 5 minutes.
- Do not use the dryer if your skin is red or sores are present. On the day you change the pouch you can take the pouch/wafer off and shower. Water from the shower will not hurt your stoma. Remember to empty your pouch prior to swimming.”5
“The health benefits of resistance training include improvement in muscle strength and endurance, improvements in functional status, and maintenance/improvement in bone density. Studies in survivors have shown improvements in lean body mass, muscular function, and upper body strength. A recent systematic review of 15 studies of resistance training interventions during and/or after cancer treatment concluded that meaningful improvements in physiologic and quality-of-life outcomes can be achieved. A similar review of 11 randomized controlled trials came to similar conclusions.”6
Considerations Before Returning to an Active Life
“There will be a short period of time when your activities will be restricted to allow your body to heal. These are some general guidelines to follow. Do not drive for 3 weeks from the date of surgery. No heavy lifting (over 10 lbs.) is allowed for 6 weeks. If you had an exercise routine before surgery, please check with your doctor before resuming it. After your recovery, the colostomy should not interfere with exercise. Daily exercise is important for your body. Contact sports such as football, karate or wrestling are a concern, since injury to the stoma could occur. If you are interested in continuing any contact sports, check with your doctor or WOC nurse. Any non-contact sport should not be of concern.”7
Patience is the key to returning to an active life and performing exercises with an ostomy. Consult with your ostomy nurse or specialist on your particular case before practicing contact sports or lifting weights.
(1) Supporting Adults Who Anticipate or Live with an Ostomy. Registered Nurses Association of Ontario. Second Edition. 2019. https://rnao.ca/sites/rnao-ca/files/bpg/OSTOMY_FINAL_WEB.pdf
(2, 6) Survivorship: Healthy Lifestyles, Version 2. 2014. Denlinger, C., Ligibel, J., Are, M., Baker, K., Demark-Wahnefried, W., Dizon, D., Friedman, D., Goldman, M., Jones, L., King, A., Ku, G., Kvale, E., Langbaum, T., Leonardi-Warren, K., McCabe, M., Melisko, M., Montoya, J., Mooney, K., Morgan, M., Moslehi, J., O’Connor, T., Overholser, L., Paskett, E., Peppercorn, J., Raza, M., Rodríguez, M., Syrjala, K., Urba, S., Wakabayashi, M., Zee, P., McMillian, N., & Freedman-Cass, D. National Comprehensive Cancer Network. 2015. https://jnccn.org/configurable/contentpage/journals$002fjnccn$002f12$002f9$002farticle-p1222.xml
(3) A Handbook for New Ostomy Patients 5th edition. Rooney, D. Vancouver Chapter of the United Ostomy Association of Canada. 2012. http://www.vcn.bc.ca/ostomyvr/NEW%20PATIENTS%20EDITION%205th%20printing%20web.pdf
(4) A Guide to Living With a Colostomy. The Canadian Association for Enterostomal Therapy. 2007.
(5, 7) A Patient’s Guide to Colostomy Care. Developed by Wound, Ostomy and Continence Nurses. Northwestern Memorial Hospital. 2007.https://www.nm.org/-/media/Northwestern/Resources/patients-and-visitors/patient-education-care-and-treatment/northwestern-medicine-a-patients-guide-to-colostomy-care-2016.pdf?la=en