Patients with a recent colostomy tend to wonder when is it a proper time to start working again. Numerous questions may arise, such as: Can I work with a colostomy bag? How soon can I come back to work after having had an ostomy? Patients also wonder how often should they change an ostomy bag while at work? Or, how far can they travel with an ostomy? The following are some basic considerations when returning to work after having a colostomy.
What is a Colostomy?
A colostomy is a type of ostomy that involves a section of the large intestine, where a surgeon removes or temporarily treats part of the colon. It is a common procedure on patients who have colon cancer, obstruction of intestines or diverticulitis, among other health disorders.
A colostomy is not an illness. It is a modification of some internal parts of the digestive tract system to allow the discharge of body waste through a surgical opening in the abdomen known as a stoma. With a colostomy, a patient will discharge solid waste matter (stool) through the stoma and not through the anus. For most colostomy procedures, a colostomate -a person living with a colostomy- has no control over how or when he or she discharges stool, so they require a colostomy bag and an adaptation period.
“Learning to live with a colostomy may seem like a big undertaking. It is similar to other major changes in your life. Beginning a new job, moving to another city, marriage and having children are all examples of adapting to a new way of life. Initially, you have to adjust to the unfamiliar aspects of these experiences and this may take some time. Having a positive outlook on life, patience and a sense of humor are keys to adjusting to any new situation. Talking to a trusted friend, nurse, clergy and certainly, another person with an ostomy may help you work through these feelings.”1
What is a Colostomy Bag?
A colostomy bag is a container that holds the stool coming out from a stoma. It is available in sets called pouching systems, which include a bag or pouch and a wafer (skin barrier).
“Today’s pouches are discreet and no one ever needs to know that you are wearing one.”2
Additionally, pouching systems have numerous accessories, including pouch covers, different types of adhesives and ostomy belts, which help maintain the pouch attached to the abdomen.
What Is the Purpose of a Bag?
“When a colostomy is performed it alters the usual way you pass feces. After surgery, instead of the feces coming out through your anus, it will pass through the stoma instead. Normally the way you pass feces is controlled by a special sphincter muscle in the anus. However, the main difference you will notice when you have a stoma, is that you will no longer be able to hold on to or have control over when you need to pass feces. You will also not have any control over when you pass wind or flatus.
There are several types of colostomy bags and your Stomal Therapy Nurse will show you ones that are most suitable for you.
Colostomy bags are specially designed to help you with these challenges so that you can live life to the fullest.”3
How Does a Colostomy Bag Work?
“The bag is designed to stick onto your abdomen where it will collect the feces and flatus from your stoma. A colostomy bag has several special features including a filter.
The filter works by releasing wind so your bag doesn’t inflate (which is called ‘ballooning’). The filter also has a deodorizing action which makes sure that the smell is minimized – the one thing that people often worry about the most.”3
Can I Work with a Colostomy Bag?
The answer is yes. However, you must discuss with your doctor or ostomy nurse before deciding how and when is the most convenient time, since every individual and every ostomy are different.
Jobs that require special conditions such as those related to weightlifting require longer recovery times. Ask your ostomy nurse or doctor about the type of work you can do.
Returning to work after surgery or entering a new job, requires informing your boss about your ostomy, primarily because you could get priority in case of an emergency. For the same reason, you should inform some co-workers. Maintaining your colostomy as a secret could cause you trouble.
“It is natural to be concerned about what to say to other people. In general, if you feel uncomfortable, other people will too. Be open and honest with those people you think need to know and say nothing to others, unless you think it is important.
It is up to you to decide who you will tell and how you will go about it. If you have been very ill over a period of time, your friends, relatives, and co-workers are concerned about you. When they see you looking better, they will not only be pleased, but they may want to know what type of treatment you had. It is, of course, for you to determine what details you reveal to others.
People with stoma surgery react to different emotions and responses. People express their feelings by talking with friends, family or others who have had similar experiences. Some find reading and learning about their situation works best for them.”2
What Sort of Bag Should I Choose?
“There are two main types of systems:
This consists of the collection bag with an integrated base plate attached which firmly fits around your stoma.
This has the collection bag separate from the baseplate and the two parts are securely clipped or sealed together. This means that you don’t have to remove the baseplate from around the stoma every time you change the bag.
Both systems will be kind to your skin, lightweight, leak-proof and odor-proof which means that they will be virtually undetectable to anyone else so you can carry on with life as normal. The bags are available in a variety of sizes to suit your specific needs.
There are many different types of closed and drainable bags available and your stoma.
Therapy Nurse will be able to help you choose the most appropriate one for you.” 3
Clothing and Appearance
“One does not need to purchase special clothing after colostomy surgery, but some minor adjustments may be needed for comfort and preference. The pressure of undergarments with elastic will not harm the stoma or prevent the function of the bowel; however, tight waistbands directly on the stoma should be avoided.
Cotton knit or stretch underpants may give the support and security you need. Pantyhoses are also comfortable. A simple pouch cover adds comfort by absorbing perspiration and keeps the pouch from resting on the skin. Men can wear either boxer or jockey-type underwear.”.1
How Soon Can I Come Back to Work After Having an Ostomy?
“The time for this varies from person to person. The severity of the disease, the reason for your surgery, your recovery time, your age, and the type of job you do, all affect how long it will take you to get back to work. Talk to your healthcare professional about this.
Persons with colostomies can do most jobs; however, heavy lifting may cause a stoma to herniate or prolapse. A sudden blow in the pouch area could cause the barrier or pouch to shift and cut the stoma. Still, persons who have colostomies do the heavy lifting, such as firemen, mechanics and truck drivers. Belts may be worn to support the abdomen when lifting. There are athletes who have stomas.
Check with your doctor about your type of work. As with all major surgery, it will take time for you to regain strength after your operation.”1
Once you feel capable of handling your ostomy at home, having healed and recovered from your surgery, managing pouch changing and your doctor approves it, you can begin the process of returning to work.
Consider going slow and avoid forcing yourself, so first try short and non-exhaustive activities. Thus, you can progressively adapt to a full day´s job, especially if the workplace is far away from home and you have to travel with an ostomy back and forth to get there.
“Feeling tired can be a real problem, even months after your operation. If you are experiencing low energy, it may help to know that this can happen to almost anyone. If it is an option, you may want to return gradually, perhaps by working part-time before going back full-time
Take your time. Going back before you are ready may cause more problems in the long run.
Some people wonder if a stoma will interfere with their work. If your job involves sitting at a desk all day, your stoma and pouch should present no problems.
For some who have had rectal surgery, they may find sitting for extended periods to be problematic. The solution is to make sure you have a comfortable chair or a cushion. These problems with the perineal wound, to give its proper name, usually disappear within a few months. If the discomfort does not improve, talk to a healthcare professional.
Bending and Stretching
If you have a job that calls for a lot of bending and stretching, two useful things can help. First, wear a pouch that can be attached to a stoma belt while you are working for added security. Secondly, wear loose-fitting clothing and avoid constrictive belts and tight trousers
If your job is fairly active, you may perspire at the area where the pouch is attached to the skin. This can be particularly frustrating because sweat and/or oily skin can reduce the effectiveness of the adhesive holding your pouch in place. You may need to change your pouch more often. An option is to use a skin barrier that copes better with perspiration. Your WOC/ET nurse or your supplier can provide recommendations.”2
How Often Should an Ostomy Bag be Changed While Working?
Your bag should be drained when it is one-third full at least to prevent inconveniences.
“This will vary from person to person. The stoma bag only needs to be changed when required – usually between one to three times per day depending on the amount of feces and how often you open your bowel.”3
However, inquire your nurse about changing times for your particular case. For pouching systems, maintaining hygiene is a priority. Depending on the circumstances, ostomy bags may require changing at least once while at work.
Maintain bag supplies and accessories in your workplace, either by carrying them with you every day or safely storing them in your office or locker. This allows you to change the bag comfortably.
How far can I travel with an Ostomy?
You can travel as far as you require. Consider taking extra supplies, pouching systems, and accessories since they are the most useful pieces of luggage when traveling or staying far from home. Live long and prosper while traveling and working with a colostomy bag.
“Your ostomy nurse specialist and the floor nurses caring for you after surgery will teach you and your family how to care for your ostomy before you leave the hospital.4
There are one or two other precautions you can take to help maintain your peace of mind. Carry a change of supplies with you in the car or in your work bag. Do not leave products in a car during heat or extreme cold. Also, keep a change of supplies in your desk drawer or locker at work.
As a general rule, you’re ready to return to work if:
- You can empty your pouch without assistance
- You are able to change your pouch without too much difficulty
- You are confident you have enough energy to do a day’s work
- You feel comfortable about traveling to work
- You know what to do if your pouch leaks and needs to be replaced in an emergency
Does the patient want to return to work? Do they want the opportunity of time off? How well do they cope with pain? Motivation will be governed by what the patient can do, what they believe they can do and what they want to do. This will vary enormously, even between patients who have had identical procedures.
Pain or discomfort is a difficult issue. It is not necessary to wait until a patient is symptom-free for a return to work, and in many cases, pain does not equate to harm. Analgesia and reassurance can be very important in overcoming worry about pain. But persistent pain should be taken seriously, particularly if it is associated with erythema.
Safety considerations will vary depending on the patient’s profession. If a job involves machinery, the employee must be able to use and control it safely. Anybody who drives at work must be able to execute an emergency stop. The employee must also feel safe, particularly if they have demanding physical duties such as control and restraint of offenders.
With patience, perseverance, and a sense of realism, you can manage your stoma as part of a regular routine and lifestyle. It should not be an obstacle in your personal or professional life.”2
Your colostomy may qualify as a disability and certain conditions of employment could benefit the patient or the employee. Thus, stay informed about Disability Acts and Laws and how they apply to your case.
Work environments may require adjustment. For instance, facilities for bag disposal in toilets, such as clinical waste cans if you qualify as a disabled person.
Watch what you eat. Some foods could thicken your stool or have the opposite effect. Also, some may generate more gas and odors. These things can lead to colostomy bag leakages. In turn, they can make you and your co-workers uncomfortable. Experiment with the effect of different types of food on your stool and control your diet at home and at work. Seek an ostomy specialist if you have difficulties finding out how to work with a colostomy bag.
(1) Colostomy Guide. https://www.ostomy.org/wp-content/uploads/2018/03/ColostomyGuide.pdf
(2) Living with an Ostomy: Home and Work-Life. https://www.hollister.com/~/media/files/pdfs%E2%80%93for%E2%80%93download/ostomy%E2%80%93care/living%E2%80%93with%E2%80%93an%E2%80%93ostomy_home%E2%80%93and%E2%80%93work%E2%80%93life_923126-0417.pdf
(3) Colostomy Advice. https://www.coloplast.com.au/Global/Australia/Ostomy/Professional/Colostomy_Advice.pdf
(4) University of Pennsylvania Heath System Division of Colon and Rectal Surgery. Colostomy Surgery http://www.uphs.upenn.edu/surgery/clinical/Colon_Rectal/Ostomy/Colostomy_Surgery.pdf
(5) Fitness for work after surgery. http://www.fom.ac.uk/wp-content/uploads/Pulse-12-03-14-FFW-after-surgery.pdf