Caring for a person with a stoma and dementia

You are likely to be the best judge of how well the person you care for can look after their stoma.  

These tips may help:  

• when teaching a person with dementia to care for their stoma, break the process down into small, simple steps. You may need to go through it several times  
• try to ensure bag changes take place in quiet, familiar surroundings 
• some people benefit from written instructions – see below. Others might find it easier to understand diagrams
• take into account any other conditions that might affect the person’s ability to learn how to care for their stoma, such as hearing or sight impairments 
• if the person needs someone to change their bag for them but is resistant, distraction might help – for example, they could clean their teeth or brush their hair while their bag is changed. Standing them in front of a mirror may help them focus on the task they are performing rather than on the bag change 
• bag choice is important. One-piece bags with a pre-cut opening (‘flange’) may be less complicated to use. Two-piece bags have a separate ‘base-plate’ – the part that attaches to the skin, which the bag connects to. The base-plate can remain in place for up to three days, which helps protect the skin if the bag needs changing frequently 

It is easiest if the person is standing, as changing the bag while sitting can make it difficult to achieve a good seal between the skin and the bag.  

If it is difficult for the person to stand, an alternative might be for them to lie flat on a bed. 

You will need: 

• disposal bag 
• adhesive remover, if used 
• disposable gloves 
• warm water and a towel 
• new stoma bag 

1. Check whether the hole in the adhesive flange/base-plate has been pre–cut to the size and shape of the stoma. If not, use a template to mark the outline of the stoma and, using curved scissors, trim to the correct shape. 
2. If the person with dementia is actively involved in changing their bag, encourage them to wear gloves. This reduces the risk of infection and spreading faeces. 
3. Remove the used bag, using adhesive remover if required.  
4. Check the skin around the stoma for any signs of irritation.  
5. Gently clean the stoma and surrounding skin with warm water – do not use soap or baby wipes as these may affect how the flange/base-plate sticks, or irritate the skin.  
6. Gently pat the skin until it is completely dry. Press the flange/base-plate in place for at least 30 seconds to make sure the seal is secure. 
7. If the person uses a two-piece bag, then attach the bag to the base-plate. 

In some areas, a clinical waste collection service is available – contact the rubbish and recycling department of your local council for more details.  

Otherwise, the used bag may be wrapped up well and put in the dustbin. Some people prefer to empty the bag into the toilet first.  

If the person lives in a care home, bags can be disposed of with other clinical waste. 

• encourage the person to wear net pants with normal underwear on top 
• tuck their person’s vest/shirt/blouse into their pants 
• keep them occupied throughout the day with small tasks as a way of distracting their attention 
• note the usual timings of their bowel movements so you can change the bag promptly – they may be more likely to fiddle with it if it is full and heavy  

You should discuss this with the person’s healthcare professional (eg their surgeon or stoma care nurse) before and after the surgery, and if there are any changes to their medication.  

Dementia UK resources

• Continence
• Coping with distress
• Dealing with restlessness

Support from Colostomy UK

• Website
• Helpline: 0800 328 4257 (24 hours)
• Facebook group
• Factsheets and booklets
• Support groups