Exercising is beneficial for everyone, and also crucial for people who have undergone ostomy. Once a patient has recovered strength after an ostomy procedure and it is certainly safe, health professionals recommend ostomates to enjoy physical activities as they did before the surgery.
Before any exercise or activity, patients need to check with their doctor that they will have no complications that could compromise their post-surgery recovery.
For ostomy patients, one of the most significant benefits of exercising is that it will help them feel good. They will enjoy learning that they can exercise and maintain regular activity levels for physical and psychological improvements 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)
Regular walking or pole walking
Cardiovascular exercise is a great place to 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 walkers use their entire body. Also, more benefits in muscular strength are gained 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, or whether the patient is young or old. Patients usually gain weight after an ostomy procedure and that extra weight can lead to obesity in some cases. This may cause difficulties for the proper adherence of some skin barriers/wafers due to creases in the skin from fatty tissue, especially sitting down when these creases become more pronounced. As a result, leakage can occur, giving rise to skin problems which may lead to emergency room visits or complications.
“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)
Contributing causes of stoma hernia
- “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)
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.
“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.
- Kneeling. “ (6)
Here are considerations for stoma patients with co-occurring diseases (comorbidities)
The most common problems among the elderly are falls and constipation. An elder 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.” (7)
The leading cause of disability in people over 65 is osteoarthritis, and most patients with a colostomy fit that 65-year-old group of people. That is why many patients over the age of 65 may suffer from constipation or arthritis or a combination of both.
Bicycle Riding and Swimming are also great cardiovascular exercises for ostomy patients.
Ostomates can enjoy beautiful days at the pool, the beach and have all the fun and pleasantries of being in the water. All they need to do is choose the right products. There are many new products available today that can be used to feel and be more comfortable with these kinds of sports practices. 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
Using these products can give ostomy patients total confidence for swimming and doing water sports.
“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.” (8)
“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” (9)
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)
Nowadays, there are many amazingly comfortable and ideal options for pouching systems. Patients have more choices than they used to.
Now they can find 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.
It is vital and imperative for patients to use common sense after a colostomy. That’s why you need to follow this advice:
- No heavy lifting weeks after the surgery because it may cause a hernia. Besides, muscles are weaker and need the proper time to heal unless the surgery was done.
- This will give the muscles a quicker healing time.
- Avoid abdominal exercise for a while before returning to the gym.
- Start gradually and slowly ONLY after the doctor’s advice
- Begin a safe exercise regime with a professional.
Remember, 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, some contact sports and much more.
(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) Colostomy Guide. Hooper, J. United Ostomy Associations of America. 2017. https://www.ostomy.org/wp-content/uploads/2018/03/ColostomyGuide.pdf
(8) 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
(9) 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
(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