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Coping with a stoma can be difficult, and if the person has dementia, there may be additional challenges.
This information has been produced with Colostomy UK.
It is not always possible for a person with dementia to care for their own stoma, but it’s a good idea to encourage them to do as much as they safely can.
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’s best to change a stoma bag when it’s about three-quarters full. It is usually carried out in the bathroom.
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
- 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.
- 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.
- Remove the used bag, using adhesive remover if required.
- Check the skin around the stoma for any signs of irritation.
- 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.
- 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.
- If the person uses a two-piece bag, then attach the bag to the base-plate.
The used stoma bag should be sealed inside a disposal bag (provided free by suppliers).
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.
If the person with dementia fiddles with their bag or tries to remove it, these tips may help:
- 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
The bowel plays an important role in the absorption of medication, so if the person has had a portion of their bowel removed in stoma surgery, this might affect how well any medicines work.
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.
If you have any questions or concerns about stoma care for a person with dementia, or any other aspect of dementia, please call our free Dementia Helpline on 0800 888 6678 (Monday-Friday 9am-9pm, Saturday and Sunday 9am-5pm, every day except 25th December), email firstname.lastname@example.org or you can pre-book a phone or video call with a specialist dementia nurse.
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