Destigmatizing the stoma: How life works with an ostomy bag. (2025)

Learning that you’ll need to live with a stoma and an ostomy bag can be overwhelming at first.

But Dr. Richard Huettemann, a colorectal surgeon who recently joined Novant Health Colon and Rectal Clinic - Clemmons, said stomas need not stand in the way of living a full life.

An ostomy is the potentially life-saving surgical procedure that alters how urine and/or stool leave the body and collects the contents in an external bag.

There is a stigma, but there shouldn’t be. “Between 725,000 and 1 million people in the U.S. have an ostomy,” he said. “That’s one in 500 Americans.” But for understandable reasons, not many people go around talking about theirs, so patients feel isolated, even scared.

Destigmatizing the stoma: How life works with an ostomy bag. (1)

Huettemann (pronounced HUT-uh-men) gets the anxiety. “It’s a huge deal for a patient,” he said. “I always explain that you can have a perfectly normal life with an ostomy. It just takes some getting used to.”

The surgeon, who completed a fellowship at Harvard Medical School, knew he wanted to go into the “family business” from a young age. Both his parents were pediatricians in Mobile, Alabama, and he saw “how much joy and fulfillment their work brought them.”

His mom hoped he’d become a pediatrician, but when all his med school mentors were surgeons, his path was set. “Surgery was a way I could have a direct impact on my patients,” he said. “For me, colorectal surgery was the right fit. Patients going through that need a doctor and a friend.”

He strives to be both.

We talked to Huettemann about ostomies – why they’re needed and how patients adjust.

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First, what is a stoma?

A stoma is a small opening in the abdomen used to remove bodily waste, which then goes into an external collection pouch. Most stomas are only temporary. We perform them with the intention of later reversing them. But some are permanent. The surgical procedure to create a stoma is called an ostomy.

An ileostomy is surgery to create a stoma by bringing the end of the small intestine out onto the surface of the abdomen. And a colostomy creates an opening for the colon (or large intestine) through the abdomen.

What are some reasons people might need a stoma?

Inflammatory bowel disease, diverticulitis, incontinence, cancer – usually rectal or anal – and birth defects are the main reasons. People with ulcerative colitis or Crohn’s disease may sometimes need an ostomy, too.

Is there ever another alternative to a stoma?

Not likely.

Nobody walks into their doctor’s office or hospital asking for a stoma. If we don’t absolutely have to do it, we try our best not to. But it’s often what the patient needs.

How young a person can get a stoma?

There’s no age limit, and there’s no minimum age, either. Some people live their whole lives with a stoma.

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Tell me about the ostomy surgery itself – and the recovery.

It’s a pretty straightforward surgery and straightforward recovery, too. We usually do them in the context of a bigger surgery. If a patient needs it reversed, that procedure is a lot less invasive than the initial one – and the recovery isn’t as prolonged, either. Surgery usually takes a couple of hours, and the patient usually stays in the hospital for a few days, depending on their recovery process.

Does someone with a stoma have to eat a special diet?

No. There are no long-term dietary restrictions.

How long does it usually take a patient to adjust to having a stoma?

You can be used to it within a couple of weeks. It helps to have the mindset of: This is a part of me now, and I’m going to learn how to take care of it.

However, if the work of emptying, changing and cleaning your stoma and ostomy bag seems daunting at first, be patient. It will come in time. And don’t hesitate to ask for help.

What maintenance is involved with a stoma?

Cleaning the bag before it’s full is the main thing. To avoid it bulging or leaking, it should be emptied when it’s about one-third to one-half full.

Keeping the stoma clean is important, too. You don’t need special medical equipment for that; tissue, toilet paper, baby wipes, etc. will do the trick.

It’s also important to protect the skin around the stoma. Stool can be irritating to the skin if not cleaned for prolonged periods. Using the right size pouch can help in this regard. Changing the pouch regularly can help you avoid leaks and skin irritation. Picking a regular schedule around your usual day-to-day activities – is also advised.

If you’re sensitive or allergic to the adhesive, skin barrier, tape or pouch itself, there are plenty of manufacturers and choices on the market.

I remind patients that they’re never alone in the process. Our whole office is ready to help. Most importantly, there’s an entire group of specialized nurses, and this is all they do. They teach patients how to take care of a stoma, and they’re available for anyone having issues with it.

How do you empty the ostomy bag?

The American College of Surgeons’ website has excellent primers on that topic at facs.org.

Once you’re used to the process, emptying the pouch doesn’t take any longer than any ordinary trip to the restroom.

How do you shower or bathe with an ostomy bag?

That’s not an issue. Water won’t hurt your stoma. Neither will soap, although it could interfere with the skin barrier. For that reason, we recommend using water alone while cleaning the skin around your stoma.

You can remove your pouch to shower, but it’s not necessary and generally not even recommended. If you take a bath, just leave the pouch in place. The main reason to wear the pouch in the shower or tub is to avoid stool slipping out.

Is it obvious when somebody has a stoma?

You probably can’t tell somebody has one unless they tell you. Ostomy pouches are fairly flat and tough to see when hidden under clothes.

If somebody is out in a social situation and needs to use a public restroom, is there any reason they’d be in there longer than normal?

No. You don’t need any special equipment. You just go into the bathroom like you normally would, empty the bag, wash your hands and be on your way.

Some people actually find it easier to have a stoma. People with hyperactive bowels who have to use the restroom more than the average person who’ve had to always be aware of where the nearest restroom is are often glad to have a stoma. These folks previously felt tied to the toilet, and that pouch gave them freedom. They don’t have to keep rushing to the bathroom; their stoma gave them a normal life again.

Can there ever be an accident with the ostomy bag?

Unfortunately, yes. We tell people to take their supplies with them, and we teach them how to address a leak if it happens.

Is a leak pretty rare with an ostomy bag?

It’s more common in the beginning, as you’re getting the hang of it. But as patients get used to it, accidents will happen less frequently.

What supplies are required to maintain an ostomy bag?

A new pouch and a pouch clip. Scissors, maybe. Skin wipes and something called “stoma powder” can be useful. I’ve had patients make a small kit they carry with them. Some people pre-cut their bags and keep a back-up handy in their car or at work.

You can order those online, from a medical supply store or get them at your pharmacy. A specialized ostomy nurse can recommend brands. Before ordering, check with your health insurance provider to determine which suppliers are in your network.

How do couples deal with intimacy when one person has an ostomy bag? And how does somebody who's single and dating deal with bringing it up to a partner? Is that something you discuss.

Yes, we talk about every aspect of life with a stoma. People can have completely normal sex lives with a stoma. It just involves being upfront and candid. Once you have the initial talk, patients tell me they’re perfectly happy with their level of intimacy.

Do patients ever tell you, after a few weeks of living with a stoma, that it isn't the big deal they thought it was going to be?

All the time.

Destigmatizing the stoma: How life works with an ostomy bag. (2025)
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