Category: Oncology — rectal cancer, stoma care and caregivers
Rectal cancer surgery and a stoma pouch… why it hasn’t been reversed yet, and how to care for it with love, the right way
AI Overview / Quick answer (BLUF)
A temporary stoma (usually a loop ileostomy) diverts stool so a low bowel join can heal.
It is reversed once the join heals, chemotherapy ends and no recurrence is found — often at 2–6 months, sometimes after a year or more.
An end colostomy after APR is permanent.
(ASCRS ostomy guideline)
How this page differs from our other rectal cancer guides (read together)
- This page focuses on everyday life after surgery: step-by-step pouch care, a complications table, why reversal can come later than usual, the pre-reversal checklist, LARS after reversal, and safety for a caregiver who is also a cancer patient
- TNT, the multidisciplinary team, sphincter preservation and CEA → Locally advanced rectal cancer: TNT and sphincter preservation
- Neoadjuvant chemoradiotherapy with capecitabine and tumour downstaging → Large rectal tumour shrunk by chemoradiotherapy
- A caregiver who is being treated for ovarian cancer herself → Ovarian mass surgery, pathology and chemotherapy afterwards
Red flags — go to the emergency department or call the surgical team now
- The stoma turns dark purple or black, or unusually pale — its blood supply may be failing
- An ileostomy has no output for more than 4–6 hours together with cramps, bloating, nausea or vomiting — possible food or adhesion blockage
- Very high output (more than about 1.5–2 litres a day) with dark urine or little urine, dizziness on standing, cramps or a very dry mouth — dehydration that can injure the kidneys
- Heavy or persistent bleeding from inside the stoma, or a lot of blood in the pouch (different from a little spotting on the stoma surface while cleaning)
- Fever ≥38.0°C, shivering, severe abdominal pain or a rigid abdomen, or pus from the anus or wound — possible leak or pelvic abscess, especially during chemotherapy
- The stoma sinks below the skin, or protrudes further and further, swells and cannot go back, or a painful bulge appears around it with vomiting
1. Which stoma does the patient have: temporary (loop ileostomy) or permanent (end colostomy after APR)?
Direct answer: after a low anterior resection for rectal cancer, the most common temporary stoma is a loop ileostomy
(sometimes a loop colostomy). If the tumour involves the sphincter and an abdominoperineal resection (APR) is needed, the result is a permanent end colostomy, which is not reversed
(ASCRS rectal cancer guideline 2023).
Loop ileostomy (the most common temporary stoma)
- The surgeon brings a loop of the last part of the small bowel to the abdomen (usually lower right). It has two openings — one passes stool, the other leads to the “resting” bowel below
- Output is liquid to porridge-like, frequent, and contains enzymes that irritate skin — after adaptation it is often about 0.5–1 litre a day
- Its purpose is to rest the fresh join near the anus — if the join leaks, the harm is much smaller
End colostomy after APR (permanent)
- When the tumour is very low or invades the sphincter muscles, the rectum, anus and sphincter are removed and the anus is closed
- The large bowel opens on the abdomen (usually lower left); stool is thicker and more regular — dehydration risk is lower than with an ileostomy
- There is no reversal because there is no sphincter to reconnect — the goal is living confidently with the stoma
Ask the surgeon these 3 questions directly
- Is the stoma a loop ileostomy, a loop colostomy or an end colostomy?
- Was the original plan to reverse it, and when?
- What is blocking reversal right now — and what conditions must be met before surgery can be booked?
Comparison table: temporary stoma (loop ileostomy / colostomy) vs permanent stoma (end colostomy after APR)
| Point | Temporary: loop ileostomy / loop colostomy | Permanent: end colostomy after APR |
|---|---|---|
| Purpose | Divert stool so the low join near the anus can heal; reduce harm from a leak | A new permanent exit for stool after the rectum and sphincter are removed |
| Output | Ileostomy: liquid to porridge-like, frequent, irritating to skin; colostomy: thicker | Thicker, closer to normal stool, more regular |
| Typical reversal timing | Often about 8–12 weeks after surgery, or after adjuvant chemotherapy (often about 6 months); delays beyond 1 year happen | Not reversed |
| Reversal possible? | Intended — but about 1 in 5 are never reversed | No (no sphincter to reconnect) |
| Decision conditions | Join healed with no leak or narrowing, chemotherapy finished and recovered from radiation, no recurrence, adequate sphincter, fit for surgery | Focus on skin care, preventing parastomal hernia, and learning to live with the stoma |
| Specific risks | Ileostomy: high output, dehydration, kidney injury, food blockage, peristomal skin damage | Parastomal hernia, constipation, prolapse or stenosis in the long term |
For general understanding — the patient’s stoma type and plan are in the operation note and the surgeon’s explanation.
2. Why hasn’t the stoma been reversed a year after surgery? Common reasons
Direct answer: a temporary stoma is often reversed about 8–12 weeks after surgery, or after adjuvant chemotherapy (often about 6 months).
Delays beyond a year are not rare — in the TME trial about 19% of patients with a temporary stoma never had it reversed
(den Dulk M, Lancet Oncol 2007).
Typical timeline
The randomised EASY trial found that in selected patients without an anastomotic leak, early closure at 8–13 days was safe and had fewer overall complications than closure after 12 weeks
(Danielsen AK, Ann Surg 2017) — it does not apply to everyone.
Reasons reversal gets pushed back
- Adjuvant chemotherapy ongoing or just finished — teams usually avoid interrupting chemotherapy and wait for blood counts, immunity and strength to recover
- Effects of pelvic radiation — fibrosis and reduced blood supply slow healing of the join
- Anastomotic leak, abscess or a chronic pelvic sinus — must heal first; some need drainage or repair surgery
- Anastomotic stricture — needs endoscopic dilatation or other treatment, otherwise stool will not pass easily after reversal
- Confirming there is no recurrence — CT, CEA and endoscopy; if the cancer has returned, the plan may change
- Fitness and nutrition — weight loss, anaemia, low albumin, uncontrolled diabetes or heart disease raise surgical risk
- Sphincter concerns — if the sphincter is very weak, reversal could cause incontinence and worse quality of life than a stoma
- Waiting lists and referral systems — reversal is usually scheduled as non-urgent surgery, especially in busy hospitals
Said gently and honestly: not every temporary stoma is reversed
About 1 in 5 stomas intended to be temporary end up permanent — commonly because of problems with the join, recurrence, or overall fitness.
This does not mean the patient or caregiver did anything wrong, and life with a stoma can still be full. But knowing where you stand helps you plan.
Questions to bring to the surgeon
- Has the join healed? Is there a leak, narrowing or abscess — and which tests have checked this?
- What did the latest CT and CEA show, and has the oncology team agreed to reversal?
- Is the sphincter strong enough? Should it be tested, or trained first?
- If all conditions are met, roughly when could surgery be scheduled, and is a referral or paperwork needed?
- If reversal is not possible, should the stoma be changed to a type better suited to long-term use?
Stoma problems or symptoms during treatment — do you need to call the team now?
Get your severity level and personalized guidance from our Advisory team.
3. Pre-reversal checklist: what the team usually tests, and what the family can prepare
Direct answer: before reversal the team needs to be confident about 3 things — the join has healed (no leak, no narrowing), there is no recurrence,
and the sphincter and body are ready. Families can help with pelvic-floor exercises, nutrition and stopping smoking
(ASCRS 2023).
What the team usually checks
- Digital rectal examination — feels the join for narrowing and gives a rough idea of sphincter squeeze
- Endoscopy of the join (flexible sigmoidoscopy) — confirms healing and no tumour at the original site
- Water-soluble contrast enema — X-ray images to confirm no leak, cavity or narrowing
- CT of chest and abdomen ± CEA — confirms no recurrence before surgery
- Sphincter assessment — by examination, and in some people anorectal manometry, especially older patients or after radiation
- Blood tests and anaesthetic fitness — blood count, kidney function, electrolytes, albumin, glucose and other conditions
What the patient and family can prepare from today
- Pelvic-floor exercises — squeeze the sphincter for 5–10 seconds, relax for the same time, 10 times, 3 sessions a day (ask a nurse or physiotherapist to check technique); this prepares for LARS
- Nutrition — protein at every meal, weigh weekly, and tell the team about ongoing weight loss to see a dietitian (see the colorectal cancer nutrition guide)
- Stop smoking — smoking slows healing and increases complications after surgery
- Control blood sugar and blood pressure within the targets set by the doctor
- Gather documents — operation note, pathology, latest CT/CEA/endoscopy results and coverage details to speed up scheduling if a referral is needed (see the guide to costs under Thailand’s universal coverage)
4. Caring for the stoma the right way: supplies, pouch-change steps and skin care
Direct answer: the core of stoma care is keeping the skin around the stoma dry and away from stool — cut the baseplate opening only 1–2 mm larger than the stoma, clean with plain warm water, pat completely dry,
empty the pouch when it is about 1/3–1/2 full, and change it straight away if it leaks
(MedlinePlus — Ileostomy: changing your pouch).
Gather everything before you start
- A new pouch and baseplate (one-piece or two-piece, as currently used), curved scissors and a stoma measuring guide
- Warm water, soft gauze or a clean soft cloth, a sealable waste bag and disposable gloves
- Accessories recommended by the stoma nurse: adhesive remover, barrier powder, barrier paste or seal rings
- Always carry a spare kit when leaving home
Step-by-step pouch change
- Wash hands and put on gloves; choose a time when the bowel is quiet, such as in the morning before eating
- Empty the pouch first, then peel the baseplate slowly from top to bottom, pushing the skin away from the adhesive rather than pulling the baseplate off the skin; use adhesive remover if it sticks
- Clean with warm water and soft gauze — no alcohol, oily or perfumed soaps, or scented wipes, which stop the baseplate sticking and irritate skin
- Pat the skin completely dry — do not rub; damp skin makes the baseplate lift early
- Look at the stoma and skin — a healthy stoma is pink-red and moist, like the inside of the mouth; a little spotting of blood when wiping the stoma surface is normal; the surrounding skin should not be red or broken
- Measure the stoma — it shrinks over the first 6–8 weeks after surgery, so re-measure often, and again whenever weight goes up or down
- Cut the opening about 1–2 mm larger than the stoma (no more than about 3 mm) — too large exposes skin to stool; too small can cut the stoma
- Warm the baseplate in your hands, apply from the bottom up, and hold your palm over it for about 30–60 seconds so the adhesive seals to the skin
- Close the pouch outlet, put the old pouch in a sealed bag, remove gloves, and wash hands with soap for at least 20 seconds
How often to empty and change
- Empty when the pouch is about 1/3–1/2 full — a heavy pouch pulls the baseplate loose and leaks
- Ileostomy: the baseplate is often changed every 2–4 days; colostomy: often lasts longer, or uses closed pouches changed daily depending on the system
- Leak, itching or burning under the baseplate = change now, without waiting for the usual day
- Keep a log of change days and problems — it helps the stoma nurse adjust supplies precisely
Skin care and daily life
- Showering is fine with the pouch on or off; water does not flow into the stoma
- Trim hair around the stoma with scissors or an electric trimmer, not a blade razor
- Normal clothes are fine; avoid belts pressing directly over the stoma
- Empty before bed, and consider a night drainage bag if an ileostomy is very active overnight
5. If it is an ileostomy: watch for high output, dehydration and food blockage
Direct answer: an ileostomy bypasses the large bowel, which normally reabsorbs water, so water and salts are lost quickly — dehydration is the most common reason for readmission after a loop ileostomy
and can injure the kidneys. If output is above about 1.5–2 litres a day, or there are signs of dehydration, contact the team
(Messaris E, Dis Colon Rectum 2012).
Dehydration signs caregivers should watch
- Emptying far more often than usual, or output above about 1.5–2 litres a day (high-output stoma)
(Baker ML, Colorectal Dis 2011) - Dark urine, less urine, or no urine for more than 6–8 hours
- Dizziness or light-headedness on standing, marked tiredness, leg or abdominal cramps, dry mouth and tongue, constant thirst
- Risk is higher during chemotherapy that causes diarrhoea (such as capecitabine or 5-FU), in hot weather, with vomiting, or when eating little
(Paquette IM, Dis Colon Rectum 2013)
How to drink so the fluid actually counts
- Use a standard oral rehydration solution recommended by the team, sipped through the day — large amounts of plain water or sugary drinks alone can increase output
- Foods that thicken output, such as rice porridge, bread, ripe banana and mashed potato — adjust with a dietitian
- Some people are prescribed loperamide before meals to slow the bowel — only at the dose the team prescribes
- If dehydration signs continue despite drinking, vomiting prevents drinking, or urine is very scanty — go to hospital now; intravenous fluids may be needed
Preventing food blockage (food bolus obstruction)
- Chew thoroughly, eat slowly, drink between meals
- Be careful with tough fibrous foods such as corn, nuts, dried fruit, citrus membranes, fruit skins, mushrooms and stringy vegetables — try small amounts
- Signs of blockage: cramping in waves, bloating, a swollen stoma, little thin output or none — if more than 4–6 hours or with vomiting, go to hospital
Medicines may not be fully absorbed
Extended-release or enteric-coated tablets may pass whole into the pouch — if you see tablets in the pouch,
tell the pharmacist or doctor that the patient has an ileostomy so the formulation can be reviewed. Do not split or crush tablets without asking.
6. Common stoma complications: causes, first steps, and when to see the team
Direct answer: the most common problem is peristomal skin irritation from leaking stool, usually fixed by re-measuring and refitting the baseplate.
Problems that need urgent review are a colour change of the stoma, no output with abdominal pain, and heavy bleeding
(Colwell JC, J WOCN 2018 — ADVOCATE).
| Problem | Common cause | Immediate fix / prevention | When to see the team |
|---|---|---|---|
| Red, sore skin from leaks (irritant dermatitis) | Opening too large, uneven skin, baseplate lifting early, ileostomy enzymes on skin | Re-measure and cut 1–2 mm larger than the stoma; barrier powder, paste or seal rings as advised by the stoma nurse | Skin breaks down or weeps so the baseplate will not stick, or no improvement in 2–3 days |
| Fungal rash | Moist skin under the baseplate, sweat, antibiotics or diabetes | Dry the skin fully every time; antifungal powder or treatment as prescribed | Sharp-edged red rash with scattered spots around it, very itchy |
| Allergy to adhesive or baseplate | Skin sensitivity to adhesive or baseplate materials | Notice if the rash matches the baseplate shape exactly; switch products as the nurse advises | Itchy rash in the exact baseplate shape, or swelling or blisters |
| Parastomal hernia | Weak abdominal wall around the stoma, heavy lifting, chronic cough, excess weight | Avoid heavy lifting early after surgery, wear a support belt fitted by the nurse, manage weight | Bulge enlarging, baseplate hard to fit, or severe pain, firmness and vomiting (emergency) |
| Retraction (stoma sinks below the skin) | Weight gain, tension on the bowel, early after surgery | Convex baseplate as advised by the nurse to reduce leaks | Frequent leaks damaging skin, or rapid sinking early after surgery |
| Prolapse (stoma protrudes further) | More common with loop stomas; raised abdominal pressure | Lie flat to let it settle; use a pouch large enough so the edge does not cut the stoma — see the stoma prolapse pouching guide | Keeps lengthening, swells, darkens, or stops working (emergency) |
| Stenosis (narrowed opening) | Scarring around the opening, early poor blood supply | Notice thin, difficult output and cramping | Output getting harder, or signs of blockage |
| Granulomas (small red raised bumps) | Friction from the baseplate edge or stitches | Cut the opening to fit, reduce friction | Bleed easily, painful or growing — a nurse or doctor may treat them |
| High output | Early ileostomy, chemotherapy-related diarrhoea, infection, some foods | Oral rehydration solution, thickening foods, bowel-slowing medicine as prescribed | Above about 1.5–2 litres a day, or signs of dehydration |
| Food blockage | Tough fibrous foods, poor chewing, abdominal adhesions | Chew well, try new foods in small amounts, drink enough | No output for 4–6 hours with cramps or vomiting (emergency) |
The stoma nurse (ET nurse) — someone every family should know
- A specialist wound, ostomy and continence nurse (enterostomal therapy nurse / ET nurse) helps choose supplies, solve leaks and skin problems, and trains caregivers
- Many hospitals in Thailand run an ostomy or wound clinic — ask the surgical ward or surgical outpatient department for days and times
- Coverage for pouches and baseplates varies by health-coverage scheme and hospital — ask the ostomy clinic, social work service or the hospital’s coverage office directly
- Bring the pouches and baseplates in use, photos of skin problems, and a daily output log to clinic visits
7. After reversal: be prepared for low anterior resection syndrome (LARS)
Direct answer: after reversal many people have LARS — frequent small stools, urgency, clustering or incontinence, because the rectum that used to act as a “reservoir” has been removed.
Pooled studies suggest major LARS in about 4 in 10 people, and symptoms usually improve gradually over months to 1–2 years
(Keane C, Colorectal Dis 2020;
Croese AD, meta-analysis).
Common symptoms
- Frequent bowel movements (sometimes many times a day early on), small amounts each time
- Urgency — needing to rush to the toilet
- Clustering — several movements within an hour, then a gap
- Leakage of wind or loose stool, incomplete emptying, or difficulty telling wind from stool
The LARS score measures severity
A 5-question score from 0–42: 0–20 no LARS, 21–29 minor LARS, 30–42 major LARS
(Emmertsen KJ, Laurberg S, Ann Surg 2012)
— record it and discuss with the team to track whether things are improving.
What helps
- Pelvic-floor physiotherapy — squeeze and hold training; some centres offer biofeedback
- Diet adjustment — regular meals, notice triggers (spicy, fatty, caffeine, alcohol), and bulking fibre such as psyllium as advised by the team
- Loperamide — at the dose the team prescribes, to reduce frequency and urgency
- Transanal irrigation — for some people with severe symptoms, with training from the team
- Care for the skin around the anus — rinse with water, pat dry, apply a barrier cream
- If symptoms remain severe beyond 1–2 years, ask the team about further treatment, which for some people can include other options, including returning to a stoma
(Bryant CL, Lancet Oncol 2012).
8. When the caregiver is also a cancer patient: safety, energy and the hearts of both people
Direct answer: a caregiver being treated for cancer (for example ovarian cancer) can still change a partner’s pouch if she wears gloves every time and washes hands properly,
avoids her own low-white-cell periods, takes care with body fluids in the 48 hours after chemotherapy, avoids heavy lifting, and keeps her own treatment appointments
(NCI — Support for Caregivers).
Gloves, hand washing and body fluids after chemotherapy
- Wear disposable gloves every time you empty or change the pouch or handle soiled linen — remove and discard them straight into a sealed bag
- Wash hands with soap for at least 20 seconds after removing gloves, even if they look clean
- If the caregiver has a low white cell count from her own chemotherapy — ask another family member to change the pouch during that time if possible; if she must do it, wear gloves and a mask and wash hands carefully (see the first-week-after-chemotherapy guide)
- If the patient received chemotherapy within about the last 48 hours, body fluids, including stool in the pouch, may contain the drug — wear gloves, avoid splashes, empty into the toilet, close the lid and flush; some drugs need precautions for longer, so ask the treating team
- Wash soiled linen separately and promptly, wearing gloves to handle it
- Clean soiled bathroom surfaces with ordinary household cleaner
The caregiver’s energy: lifting, reaching and timing
- If the caregiver has recently had abdominal surgery (such as ovarian surgery) — avoid heavy lifting for as long as her own surgeon advises (often about 6 weeks), and do not lift or support the patient’s body weight herself
- Schedule pouch changes for when she has the most energy, such as mornings or days away from her chemotherapy
- Set up supplies at waist height and sit on a chair to reduce prolonged bending
- If the patient can, let him change the pouch himself or do some steps — this saves the caregiver’s energy and builds his confidence
Share the load: love does not mean doing it alone
- Teach at least one child or relative to change the pouch
- Ask the hospital to refer a home-visit or community nurse, or consult the ostomy clinic
- Keep both people’s appointments in one calendar so they do not clash
- Read more about caring for the caregiver in the advanced cancer caregiver guide
Watch for caregiver burnout and depression
- Exhausted but unable to sleep, irritable, crying often, or losing interest in things she used to enjoy for more than 2 weeks
- Tell her own oncology team directly that she is also caring for an ill partner — they can refer to a psychologist or social worker
- If there are thoughts of self-harm, call a mental health crisis line (1323 in Thailand) or go to hospital immediately
Intimacy and body image for couples living with a stoma
- Embarrassment, worry about odour or loss of body confidence are normal for both patient and partner — it is okay to talk about it with each other and with the team
- Empty the pouch beforehand, use a smaller pouch or a pouch cover, and choose positions that do not press on the stoma
- Sexual problems after pelvic surgery or radiation, and after ovarian cancer treatment, can be helped — ask the doctor or nurse without embarrassment
Both people must keep their own appointments
Caregivers who are patients often postpone their own visits to attend their partner’s — but the caregiver’s treatment matters just as much.
If the caregiver is waiting for pathology or starting ovarian cancer chemotherapy, see the
guide to ovarian mass surgery and chemotherapy afterwards.
but exhaustion is not something you have to prove. Resting, asking for help and caring for your own body let you care for each other for longer.
Scientific mechanism (synthesised by the author)
Synthesised by
Asst. Prof. Dr. Norawit Raatpiboon:
a low bowel join near the anus has a limited blood supply and faces high pressure from stool — a diverting stoma does not prevent every leak,
but it reduces the volume of stool crossing the join, so a leak is less likely to cause severe infection or re-operation.
The join heals through inflammatory, proliferative and collagen-remodelling phases over several weeks — but pelvic radiation narrows small vessels and causes fibrosis (radiation fibrosis),
slowing healing, promoting abscesses or strictures, and making the remaining bowel less compliant.
An ileostomy bypasses the large bowel, which normally reabsorbs several litres of fluid a day, so water and sodium are lost easily; the body responds by activating salt-retaining hormone systems, and if losses are not replaced, acute kidney injury follows.
After reversal, LARS arises from loss of the rectal reservoir, reduced sensitivity of stretch receptors, injury to pelvic nerves and the internal sphincter from surgery and radiation,
and uncoordinated contractions of the remaining colon — the body partly adapts over months, which is why pelvic-floor training and sphincter assessment before reversal matter.
Frequently asked questions (FAQ)
Why do people need a stoma after rectal cancer surgery?
There are two main reasons. A temporary stoma, most often a loop ileostomy, diverts stool away from a fresh bowel join made low in the pelvis near the anus, so that if the join leaks the consequences are much smaller, and it is meant to be reversed later. A permanent end colostomy is made after an abdominoperineal resection (APR), when the tumour involves or sits right against the anal sphincter so the sphincter has to be removed; in that case there is no reversal. Ask the surgeon directly which type the patient has.
Is it abnormal that the stoma has not been reversed one year after surgery?
Not necessarily. A temporary stoma is often reversed about 8–12 weeks after surgery, or after adjuvant chemotherapy is finished (often about 6 months), but delays beyond a year are not rare. Common reasons are ongoing chemotherapy or radiation effects, an anastomotic leak, a pelvic abscess or sinus, or a narrowed join that needs treatment first, waiting to confirm there is no recurrence, fitness or nutrition not yet ready, concerns about sphincter function, and surgical waiting lists. Ask the surgeon what is blocking reversal right now.
What is the difference between a temporary and a permanent stoma?
A temporary stoma after a low anterior resection is usually a loop ileostomy made from the end of the small bowel (sometimes a loop colostomy). It has two openings in one pouch, the output is fairly liquid, and it is intended to be reversed. A permanent stoma after APR is an end colostomy made from the large bowel; the output is usually thicker, and it is not reversed because the sphincter has been removed. People live full lives with either, but skin care, output volume and dehydration risk differ.
What tests are done before stoma reversal surgery?
The team usually checks several things: a digital rectal examination, a look at the join with a flexible sigmoidoscopy, a water-soluble contrast enema to confirm the join is not leaking or narrowed, a CT scan and CEA blood test to check there is no recurrence, and an assessment of sphincter strength, sometimes with anorectal manometry. Preparation includes pelvic-floor exercises, adequate nutrition and stopping smoking.
Will bowel habits be normal after the stoma is reversed?
Many people do not go straight back to how they were before surgery. The common pattern is called low anterior resection syndrome (LARS): frequent small stools, urgency, clustering of several bowel movements, or poor control of wind or stool. Pooled studies suggest major LARS in about 4 in 10 people. Symptoms usually improve gradually over months to 1–2 years. Pelvic-floor training, diet adjustment, bulking fibre or loperamide as advised by the team, and transanal irrigation in some people can help.
What if the stoma is never reversed?
In many studies about 1 in 5 stomas intended to be temporary are never reversed, for reasons such as persistent problems with the join, cancer recurrence, not being fit enough for surgery, or a weak sphincter where a stoma gives better quality of life. People with a permanent stoma can live, work, travel and have relationships with support from a stoma nurse. If a loop ileostomy is likely to stay long term, ask the team whether a different stoma type would suit better.
Can a caregiver who is on chemotherapy handle the patient’s stool?
Yes, with the right precautions. Wear disposable gloves every time, put gloves and waste in a sealed bag, then wash hands with soap for at least 20 seconds. If the caregiver’s own white cell count is low, it is better for someone else to change the pouch during that period if possible. If the patient received chemotherapy within about the last 48 hours, body fluids may contain the drug, so wear gloves and take extra care; some drugs need precautions for longer, so ask both oncology teams.
How often should the pouch be changed?
It depends on the pouch type and system. Empty the pouch when it is about 1/3–1/2 full. For an ileostomy the baseplate is often changed every 2–4 days, while a colostomy system often lasts longer or uses closed pouches changed daily. Most importantly, change it straight away if there is a leak, itching or burning under the baseplate, without waiting for the usual day, because ileostomy output contains digestive enzymes that damage skin quickly.
E-E-A-T and academic citations
Written by Asst. Prof. Dr. Norawit Raatpiboon (ผศ.ดร.นรวิชญ์ ราษฎร์พิบูลย์) — synthesised from ASCRS / WOCN / NCI guidance and research on PubMed.
- Hendren S, et al. Clinical practice guidelines for ostomy surgery (ASCRS). Dis Colon Rectum 2015 (PMID 25751793)
- Langenfeld SJ, et al. ASCRS Clinical Practice Guidelines for the Management of Rectal Cancer 2023 Supplement. Dis Colon Rectum 2024 (PMID 37647138)
- PubMed — WOCN Society Clinical Guideline: Management of the Adult Patient With a Fecal or Urinary Ostomy (search)
- den Dulk M, et al. Limiting factors for stoma reversal in rectal cancer patients in the TME trial. Lancet Oncol 2007 (PMID 17395102)
- Danielsen AK, et al. Early closure of a temporary ileostomy in patients with rectal cancer (EASY). Ann Surg 2017 (PMID 27322187)
- Emmertsen KJ, Laurberg S. Low anterior resection syndrome score: development and validation. Ann Surg 2012 (PMID 22504191)
- Keane C, et al. International consensus definition of low anterior resection syndrome. Colorectal Dis 2020 (PMID 32037685)
- Bryant CL, et al. Anterior resection syndrome. Lancet Oncol 2012 (PMID 22935240)
- PubMed — Croese AD, et al. Meta-analysis of the prevalence of low anterior resection syndrome (search)
- Messaris E, et al. Dehydration is the most common indication for readmission after diverting ileostomy creation. Dis Colon Rectum 2012 (PMID 22228161)
- Paquette IM, et al. Readmission for dehydration or renal failure after ileostomy creation. Dis Colon Rectum 2013 (PMID 23838866)
- Baker ML, et al. Causes and management of a high-output stoma. Colorectal Dis 2011 (PMID 19888956)
- Colwell JC, et al. Ostomy skin conditions and economic impact (ADVOCATE trial). J Wound Ostomy Continence Nurs 2018 (PMID 29300287)
- MedlinePlus — Ileostomy: changing your pouch
- MedlinePlus — Ostomy
- NCI — Rectal Cancer Treatment (PDQ®) – Patient Version
- NCI — Support for Caregivers of Cancer Patients
Medical disclaimer
This content provides general education about stomas after rectal cancer surgery, stoma reversal, LARS and caregiver safety —
it is not a diagnosis, a treatment instruction, or a guarantee that reversal will be possible. Research figures describe selected patient groups.
Stoma type, reversal timing and choice of supplies depend on assessment by the patient’s surgeon, oncologist and stoma nurse. Coverage for supplies varies by provider.
In an emergency, go to the nearest emergency department or call local emergency services (1669 in Thailand) immediately.