For those venturing out after stoma surgery, the gentle rhythm of a walk in nature has untold benefits say the experts at lIeostomy & Internal Pouch Association.
There are endless national trails and walking routes to discover in the UK, with many increasingly accessible for walkers’ differing needs – just search ‘Miles without Stiles’ to see the options.
Whatever your fitness level or ambition, Britain’s fine network of byways and permissive paths are the ideal place to restore good health.
For ostomy patients – those who have undergone surgery resulting in a bowel or urinary stoma – returning to some kind of fitness routine can be a worry, no longer knowing what you’re capable of or if you might end up overdoing things.
What is a stoma?
A stoma is a surgical opening on the abdomen over which a bag is worn to collect bodily waste (faeces or urine) which can be due to illness, injury or genetics.
While there’s little ‘ostomates’ can’t do once fully healed, whether that’s body building, pole dancing or conquering mountains, regaining mobility and fitness for people with stomas begins with a few baby steps, building their recovery gradually.
When upping the miles over time on favourite routes, perhaps challenging yourself to steeper terrain or a faster pace, walkers with stomas will need to be prepared for all eventualities, from being prepared for wet weather to packing extra stoma bags in case of leaks or the need to empty a filling pouch.
Hiking tips for people with stomas
Many of these may seem obvious but sometimes just knowing that you’ve got things covered can offer peace of mind and help you feel confident.
- If your stoma output is very loose, whether from a bowel or urinary stoma, one option is a Travel John (or similar alternative). These tough bags contain absorbent materials to empty into and solidify liquid into a spill-proof gel for later disposal.
- Don’t forget tissues to clean yourself in case you need to empty while you are out. Consider changing your bag before you go so that its adhesive is at its strongest. If you think there’s a chance your bag may peel at the edges due to the increase in exercise or perspiration, a roll of surgical tape in your rucksack can help patch things up (but won’t stem a leaky bag).
- If you have a loose or overactive bowel, think about what you are eating in the days before you go hiking. If certain foods upset you or are known to stimulate your bowel more, consider leaving these out of your diet for a few days before, but do remember to eat well too.
- Snacks for the journey can offer a quick fix of energy or fight hunger pangs, but in the case of an ileostomy stoma, they have other others benefits:
- Bananas can help to slow an active bowel as well as provide a good source of energy.
- Marshmallows can also slow the bowel, although research has shown the reduction in output is minimal. Seek advice from your nurse or pharmacist if you are, for example, diabetic.
- Crisps or salty pretzels can help replace lost salts in stoma output, especially if it’s hot, and help with absorbing fluids. Remember to properly hydrate.
Clinical exercise specialist Sarah Russell, who is an outdoor enthusiast and seasoned marathon runner who has lived with a stoma since 2010, also has these extra tips.
The satisfaction of building up your mileage and strength after stoma surgery is amazing – and helps you feel like you’re getting back to normal and that your life isn’t any different to before.
“I’m a huge fan of hiking and mountain climbing, whether it’s in the wilds of the Lake District or Scotland, or a more gentle environment such as East Sussex, where I live. Hiking is an awesome activity for both our physical and mental wellbeing.
The satisfaction of building up your mileage and strength after stoma surgery is amazing – and helps you feel like you’re getting back to normal and that your life isn’t any different to before. Here’s my advice for planning your next adventure:
1. Carry plenty of fluid
Be sure to take plenty of fluids with you in a backpack. I prefer to use a water bladder in my pack and usually head out with two litres for the day. Consider investing in a portable water filter so that you know you’ll always be able to access fluids wherever you are. Electrolyte drinks (sports drinks with added sodium) can be really useful for hot days and for those with a type of stoma called an ileostomy, where maintaining the correct levels of hydration can be a challenge.
2. Invest in a rucksack
Carrying a heavy rucksack can be a little scary to begin with, but you really don’t need to get your hiking buddies to carry your kit. Find a pack that fits well and doesn’t irritate the location where your stoma is, and one that spreads the load.
You might need to invest in something new but experiment as it can take a bit of time to find the right pack, especially if you want a waist belt on it. Take care putting it on and off, especially if it’s very heavy – set the pack on a table or chair and back into it, rather than swinging it up from the floor. Spend some time working on core training which will help your pack-carrying ability.
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3. Get fit to walk
When you first start hiking again after surgery, you may feel a little less agile than before. Muscle loss can lead to feeling vulnerable and less balanced, so it’s a good idea to work on your leg strength with home exercises such as squats, lunges and calf raises before you head out hiking, especially if you’re going somewhere a bit more rugged. Hiking poles can be really useful and will give you more confidence as you get back into things.
4. Take a dicky bag
My best top tip is to use something called a ‘dicky bag’ which is actually designed for dog walkers, but is super handy if you need to empty or change your stoma bag and take it with you. Double bag it into the dicky bag and clip it to the outside of your pack.
The important message is to find solutions to potential problems and scenarios and just get out there and enjoy yourself.
One of the biggest anxieties of hiking with a stoma is needing to find somewhere to empty your bag, and this option takes away that fear. It’s preferable to pack your waste and take it with you (to be disposed of later) rather than leaving it close to the trail for other hikers or dogs to find.
However, if you don’t have a choice the correct etiquette is to dig a hole in the ground (at least 10 metres from a water source or footpath), empty your bag into the hole and then cover it over with soil, sticks, moss or stones.
The important message is to find solutions to potential problems and scenarios and just get out there and enjoy yourself.
Sarah’s specialist core rehab programme, based on Pilates principles, is very popular with those who have recently undergone ileostomy and internal pouch surgery.
Niamh Magee was one of many ostomates to take part in the annual, two-mile Stoma Care Walk along the banks of the River Foyle in Derry-Londonderry, in aid of The Western Health and Social Care Trust.
"As someone who has always liked to keep active, both before and after stoma surgery, I have discovered through trial and error how best to prepare for walks of all lengths. My top tips are;
Map it out
Plan your route ahead of time – how long will it take you? How far are you planning to walk? Make sure not to overexert yourself, especially if recovering from surgery. Start small and build up your stamina.
Don’t forget your bag
I take supplies for a full stoma bag change with me wherever I go. I don’t often need it, but it gives me peace of mind.
Walking back to good health
If you’re facing stoma surgery, know you’re not alone say the experts. While getting used to the change in lifestyle can be tough for a while, it will get easier. And the more you focus on finding a way to get back to doing what you love, the less all-consuming it will feel.
Walking in nature works wonders on everybody’s mental health, so venturing out to your local park or off the beaten track could be just the tonic – rebuilding both strength and confidence. See you out there!
Visit iasupport.org or call 0800 0184 724 to find out how the Ileostomy & Internal Pouch Association can help you.