Exercising is beneficial for everyone, including people with an ostomy. Once a patient has recovered strength after an ostomy procedure, health professionals may recommend ostomates to enjoy physical activities, as long as it is safe. Before any exercise or activity, patients need to ensure they have no complications that could compromise their postoperative recovery.
For ostomy patients, a significant benefit of exercising is the feeling of general well-being. They enjoy learning that they can exercise, and maintain regular activity levels for physical and psychological improvement in their lives.
“The physical and mental benefits of exercise are well documented but, for someone with a stoma, maintaining a healthy weight and keeping your muscles strong can also help to prevent parastomal hernias developing. One of the greatest benefits of exercise is the ‘feel-good’ aspect. Being able to participate in sport or fitness is good for your mental wellbeing. It is empowering and boosts your confidence. In turn, it helps you to cope with your stoma and enhances your quality of life. Exercise also improves your body’s circulation, which further aids the healing process. It can help you be more active without feeling weak and also stimulate your appetite. Even if you were fit before surgery, it is important to start exercising slowly at first and build up gradually. You have been through a major operation and your body will take time to recover, so don’t rush and don’t expect too much of yourself to begin with. If you’re new to exercise it can be harder to get motivated, so build up slowly and seek advice from a fitness trainer or physiotherapist if you have any concerns or queries.”1
Cardiovascular exercise is a positive start for ostomates. “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.”2
Pole walking or Nordic Walking is an excellent exercise for stoma patients because it uses their entire body. Also, it offers additional benefits in muscular strength in a shorter period.
“Nordic walking, originally known as ski walking, is a physical activity consisting of walking with poles similar to ski poles. It is easily integrated into one’s daily lifestyle and it increases health benefits for all ages and ability levels.”3
10 Benefits of Exercise for Ostomy Patients
- Maintains a healthy weight
- Prevents muscular atrophy and promotes muscle strength.
- Improves blood circulation
- Enhances concentration
- Promotes flexibility and balance.
- Improves body shape and posture
- Increases energy.
- Enables faster recovery
- Boosts Self-confidence
- Encourages outdoor activities
Health-wise, exercising will always play a very important role for everyone with or without an ostomy, whether the patient is young or old. Patients usually gain weight after an ostomy procedure, which can occasionally cause obesity. Excess weight gain may impede the proper adherence of some skin barriers/wafers. due to creases in the skin from fatty tissue (especially while sitting down, when these creases become more pronounced). As a result, leakage can occur, producing skin problems, which may cause emergency room visits or complications.
Even a modest exercise will help:
- Ease any abdominal pain, bloating or frequent constipation.
- Regain energy after radiation-related fatigue.
- Manage day to day or medical-related stress.
- Prevent falls in elders by improving their balance and flexibility.
Contributing Causes of Stoma Hernia
“A hernia can occur at any time. It can happen weeks, months or years after surgery. It starts gradually and may get bigger over time. You might notice a bulge when you cough, sneeze, laugh or when you use your abdominal muscles to sit up. For most people, it is most noticeable when standing.”4
Other causes of stoma hernia may be:
- “Coughing, being overweight or having developed an infection in the wound at the time the stoma was made
- Improper lifting, lifting too heavy an object anytime after surgery (less than 5 lb for 6 to 8 weeks postoperatively is recommended)
- Engaging in strenuous sports”5
Remember not to put excessive pressure on yourself. “Gentle exercise is a vital part of getting better after an operation. During your hospital stay, you will gradually be able to do more and more until you are fit enough to be discharged. It is important that you continue to progress when you are at home. The exercises that follow encourage core strength and can be repeated daily. As you will see, some of them can even be done while you are watching the television. Each of them works deeply, increasing the strength of your back and stomach muscles, helping to reduce back and posture problems as well as the risk of post–operative hernias. They can be performed on the bed, lying on a thick mat so that your spine is gently cushioned, or sitting on a chair.
- Pelvic floor exercise.
- Arm raises.
- Pelvic tilts.
- Leg Lifting.
- Knee rolls.
Swimming as an Ostomy Patient
Swimming is also great cardiovascular exercise for ostomy patients. They can enjoy spending time at the pool, the beach and have all the benefits of being in the water. All they need to do is choose the right products to feel comfortable with these kinds of activities. Some of these products are:
- Drainable pouches
- Closed-end pouches that can be used and thrown away after exercising.
- Stoma caps – These can provide discretion and can be used in shorter periods of time.
- Support belts – Ostomy belts and stoma guards
- Stealth belts and Neoprene extreme stealth belt
“Many ostomates use a special, smaller bag for sports such as swimming, and will undertake exercise only after a major bowel movement. Some ostomates choose to arrive at the pool already changed, perhaps wearing a tracksuit, to minimize the time their application is visible. Some choose to wear swimwear specifically designed to securely cover external bags, or may simply keep a T-shirt on whilst swimming. All these points are, however, simply a matter of personal choice, and none in any way should be regarded as a pre-condition of usage.”7
Using these products can give ostomy patients total confidence for swimming and doing water sports. However, it is not the case for every ostomate. “The biggest problem an individual with a stoma or catheter faces is their own self-esteem. Initially, they live in constant fear of ‘being different’ and/or having the appliance fall off or leak. In reality, a well-fitted appliance is very secure. If clients are reluctant to participate in aquatic activities, they might be encouraged to observe pool activity while dressed in their pool attire”8
Considerations for stoma patients with co-occurring diseases (comorbidities)
The most common problems among the elderly are falls and constipation. An elderly person with a descendent colostomy has a high-risk potential to become constipated.
“Constipation is often the result of an unbalanced diet, too small an intake of food or liquids or certain medications. These are matters to talk over with your ostomy nurse or physician. If you have had constipation problems in the past, before surgery, remember how you solved them and try the same methods. Do not use laxatives without asking your physician.”9
The leading cause of disability in people over 65 is osteoarthritis, and most patients with a colostomy fit that group. For that reason, patients over 65 may suffer from constipation, arthritis, or a combination of both.
Exercising With a Stoma Requires Preparation
Proper preparation and hygiene before any exercise are essential for colostomy patients.
- Make sure the pouch system is empty and well placed.
- Use waterproof tape for better security to avoid any leakage due to sweat.
“Keeping your pouch on securely for sports is easy to do. For active sports involving running or jumping, a sports brief or close-fitting underpants will hold your pouch snugly against your body. For times when you will get wet, either from perspiring heavily from exercise, the sauna, or from being in a pool or jacuzzi, you can temporarily use waterproof tape to hold the edges of the pouch to your skin. Your ET nurse can show you how to do this.”10
Currently, several options for pouching systems are available to practice sports, such as new lightweight and flexible options:
- One- or two-piece
- Closed-end mini pouches
- One-piece flexible closed-end or drainable pouches
- Two-piece closed-end pouches with stick-on couplings.
Recommendations Before Engaging in Physical Activities
It is vital to use common sense after a colostomy. Therefore, please follow these recommendations:
- No heavy lifting weeks after the surgery as it may cause a hernia. Besides, muscles are weaker and need the proper time to heal.
- Avoid abdominal exercise for a while when returning to the gym.
- Start gradually and slowly only after the doctor’s advice
- Begin a safe exercise regime with a professional.
Ostomy patients can return to their usual sports gradually, as long as their doctor provides approval. A few examples would be walking, running, biking, golfing, snorkeling, hiking, yoga, and some contact sports. However, each case is different. Consult with your ostomy nurse or physician before engaging in physical activities or sports.
(1, 6) Sport And Fitness after stoma surgery. Colostomy UK. 2018. http://www.colostomyuk.org/wp-content/uploads/2018/06/Active-Ostomates-Sport-and-fitness-after-stoma-surgery.pdf
(2, 5) A Handbook for New Ostomy Patients Fifth Edition. Vancouver Chapter of the United Ostomy Association of Canada. 2012. http://www.vcn.bc.ca/ostomyvr/NEW%20PATIENTS%20EDITION%205th%20printing%20web.pdf
(3) Yukon Nordic Walking Leader Guide. Sparks, C., & Vowk, L. Recreation and Parks Association of the Yukon. 2012. https://rpay.link/guide/pdf31.pdf
(4) Caring For Your Ostomy What You Should Know. Vancouver Coastal Health. 2016. http://colorectal.providencehealthcare.org/sites/colorectal.providencehealthcare.org/files/FK.235.Os7.PHC%20Caring%20for%20Your%20Ostemy%20%28Nov-16%29%20Nov23-16%20web.pdf
(7) Access to sport and recreation opportunities for people using a colostomy bag. Institute of Sport and Recreation Management. 2003. http://www.stomadata.com/ISRM_Information-1-.pdf
(8) Stomas, Ostomies, and Appliances: Implications for Aquatic Therapy, Volume 9, Issue 2. Skaros, S., Lundeen, S., Mathison, C., & Otterson, M. Aquatic Therapy Journal. 2006. https://www.ostomy.org/wp-content/uploads/2018/03/ostomy_aquatic_therapy.pdf?direct=1
(9) Colostomy Guide. Hooper, J. United Ostomy Associations of America. 2017. https://www.ostomy.org/wp-content/uploads/2018/03/ColostomyGuide.pdf
(10) Having a Colostomy: A Primer for The Colostomy Patient. Van Horn, C. The Cleveland Clinic Foundation. 1999. https://my.clevelandclinic.org/ccf/media/files/Digestive_Disease/HavingColostomy.pdf