Stoma Care and Implementing Effective Exercise
There is a huge misconception regarding exercising following stoma surgery. Many
healthcare practitioners instil fear in individuals following surgery stating phrases
such as “avoid lifting heavy objects, avoid exercising, don’t perform push/ pull type
movements as it can lead to the development of a parastomal hernia.”
These statements cause individuals to feel confused as to what they are able to do which
often leads to a sedentary lifestyle.
In this blog post, I will be explaining what a stoma is and the importance of engaging
specific muscle groups to allow one to have the confidence in performing activities of daily living.
A stoma is a surgical opening within the abdominal region that allows waste (faeces
or urine) to be removed from the body.
The most common conditions resulting in stoma surgery are colorectal cancer, bladder cancer, ulcerative colitis, Crohn’s disease and accidental injury.
Following surgery, the functioning of the deep core gets disrupted and as a result the
functional unit - the pelvic floor, transverse abdominis and diaphragm - gets altered.
In usual instances the above three mentioned “parts” work together to provide
maximal stability to the spine to allow one to perform movements in an efficient and
safe manner. However, with a stoma these three parts are almost out of sync
following surgery and therefore need to be retrained to enhance mind and muscle
connection. This co-activation allows one to tolerate the load of a specific movement
and manage one’s intra-abdominal pressure.
What is intra-abdominal pressure and why is it so important to manage?
We have pressure inside of our abdomen and as we breathe, laugh, sneeze, push or
pull causing the pressure to increase. If you have a stoma, there is a weak point
within your abdominal wall and therefore if this pressure increases it can lead to the
development of a hernia. In essence what happens is when this pressure increases,
it causes a bulge around the stoma site as it pushes the intestines outwards through
and around the stoma site. In turn this causes the hernia to develop.
It is therefore important to increase strength and abdominal activation to decrease
the pressure surrounding the stoma site as well as manage the pressure within the
abdominal region. This management of pressure will in turn decrease the risk of
developing a parastomal hernia.
One effective exercise that can be performed to manage one’s intra-abdominal
pressure and retrain the functional unit to enhance overall functionality is learning
how to breathe using your diaphragm.
Diaphragmatic breathing: this exercise is used to emphasise the simultaneous
engagement of the diaphragm, transverse abdominis and pelvic floor to provide
support and stability to not only the stoma site but the spine too.
Key points to remember when performing the movement:
- Breathe through your nose and out through your mouth to help control and regulate
your breath.
- Ensure your breaths are moving through your stomach, we don’t want your chest to
expand.
- Please do not hold your breath during the movement as this is doing the opposite of
the goal we are working towards.
- Perform 2-3 times per day with 10 breaths.
Remember that having a stoma is not something that should be considered a limiting
factor in reaching your physical goals. With corrective measures and the right
guidance, complete independence and a healthy lifestyle can be achieved.