Ostomy News Physiotherapist

The Core of keeping physically well with a stoma

After stoma surgery, many patients are left wondering what happens now? When can I get back to my hobbies? How do I get stronger after being so unwell and going through major surgery? How do I keep myself physically strong for the future

The short answer to your rehabilitation needs after stoma surgery is strengthening your ‘core’ muscles. Some of you may have already heard of this group of muscles, some may be wondering what I am referring to. Your core consists of a range of muscle groups including: the abdominal muscles, spinal muscles, muscles in your side body, the pelvic floor muscles and your glutes (aka, the largest muscle in your body situated in your bottom). To put it simply, think of your core muscles like the foundations of a house. We want to build a house on strong foundations; therefore we want to build a strong and healthy body on a strong foundation. Without a strong foundation, we may run into problems.

The major muscle groups of the body’s core work in symphony as we move and go about our daily lives. The stronger our core is, the easier we can move and balance ourselves. After we have stoma surgery the integrity of the abdominal wall is compromised due to the formation of the stoma creating an opening in the abdominal wall. Furthermore, we must take into account the nature of the surgery. Some of you may have had a surgical incision down the centre of your stomach, this is called a Laparotomy. Others, like myself may have had key hole surgery. With this in mind, I think we can all agree that our ‘core’ muscles, particularly our abdominal wall may not be functioning as they once were pre-surgery. This is completely normal but does require work on our part in order to secure the best possible outcome of the surgery, prevent complications such as a parastomal hernia, and also help our body regain its strength and function.

If we focus on a few simple exercises such as the ones I have given in this article and keep them up as part of our new daily routine, we are minimising our risk of a dysfunctional core after stoma surgery. Not only that, exercise is scientifically proven to improve mental health and create an overall sense of well-being within us. Exercise also helps us to maintain a healthy weight, this is particularly important as a main risk factor  for a parastomal hernia is being overweight. It is never too late to start working on your core muscles. The exercises I have given in this article are safe immediately post op and beyond. They can easily be made more challenging if you wish to do so. I always encourage patients to maintain correct form and posture over high repetition and intensity. It is only once you have mastered the basic exercises and trained your core muscles to engage that you should increase frequency and intensity.
Now we have understood some of the basics of our surgery and why we must be proactive in looking after our physical health post-surgery, we can explore exactly what it is that we can do now that we have a stoma. The simple answer is anything! The caveat to this is that you must follow the fundamentals of training your core to be strong. You can do this by following the simple guidance in this article.

It usually takes around 3 months to recover from stoma surgery. I use the term ‘usually’ as our journeys leading up to surgery are all different. We have different reasons for the surgery, different illnesses. Our fitness levels pre-surgery is all different. The surgery it’s self is individual to us and our post op recovery is all different. It is very important to follow guidance from the physiotherapists you see after surgery. If you are unsure of anything relating to physical activity after your surgery your stoma nurse or surgeon will be happy to help you. Always get the go-ahead from your surgeon before starting any new physical activity.
As with anything we do, it is good to know why we do it. By taking ownership for your physical wellbeing after stoma surgery you will boost the healing process of the stoma as exercise promotes blood flow. You will help to prevent shortening of any soft tissues which may cause problems in the future. Training your core muscles will help to prevent stoma related complications such as a parastomal hernia.

Below are some basic exercises which are stoma friendly and will begin to fire up your core muscles. Consistency is key, they need to become part of your daily routine. They should only take 10 minutes to complete. These are also a great ‘warm up’ for those who are looking to participate in more strenuous physical activity.

Exercises 1: The corset squeeze:
Think of your ribs, tummy, back and pelvic floor like a corset.
Knit your ribs together by squeezing them towards each other and back towards your spine. Aim to pull your belly button towards your spine, and engage your pelvic floor as if your were stopping urine mid flow. Work with the natural flow of your breathing to create the engagement of your muscles. Complete 10 squeezes with the in and out of your breaths.
This exercise is also the base to which you should perform the other exercises in order to engage your core muscles and maintain good posture.
Try to do this as you go about your daily life, out walking is a great place to fire up your core muscles while moving.
Don’t hold your breath whilst working on this exercise!

Exercise 2: Pelvic tilts:
Lay on your back on a bed. Engage your core muscles as we have done in exercise 1. Then aim to peel your lower back from the bed approximately 1 inch or so then stop and hold. Check you are still holding your core correct. Then lower back to the bed and tilt your pelvis the opposite way creating a deeper curve in the lower spine. Aim for 10 repetitions of this exercise.

Exercise 3: Bridge:
Engage your core as per exercise 1. Begin a pelvic tilt as per exercise number 2, then fully lift your bottom and lower back off the bed. Aim to press your hands and arms into the bed. The key is to engage your core, push your heels into the bed and feel as if you are pulling your heels towards you bottom. Aim for 10 repetitions of this exercise. You can adjust the height of your lift as you get stronger. It is better to only lift a little but maintain a strong and engaged core than lift higher.

Exercise 4: Knee rolls:
Laying on your back on a bed, bend your knees and place your feet on the bed, hip width apart. Then, engage your core as per exercise 1, then gently and slowly roll your knees from side to side as if they were a windscreen wiper on a car. You can start off by moving the knees a few inches side to side if you don’t feel confident, aim to get your legs fully flat on the bed as your confidence grows. This is also a lovely side stretch for your lateral core muscles. Aim for 10 repetitions and build up as you get stronger.

Exercise 4: Mini air squat:
Standing in front of a chair or a kitchen work top, place your feet hip with apart. Engage your core as per exercise 1. Place your arms extended out in the air in front of you, the higher they are the more difficult. Slowly bend at your knees and hips to perform a squat. Go as low as feels comfortable for you. Ensure your knees don’t go over your toes as this can damage them overtime. Aim for 10 mini squats. Progress repetitions, depth of squat and arm position to add difficulty as you get stronger.

Walking:
Walking is an excellent way to improve your cardiovascular fitness and mental health. When out walking try to think of engaging your core as I have suggested in exercise 1. Walking is a great way to improve fitness and aid recovery after major surgery. Start with 5-10 minutes per day and gradually build up as you progress through your recovery. At around 3 months post op, provided you get the go ahead from your surgeon, you can then pick up activities such as running, swimming, cycling and more strenuous day to day work.

Pilates:
Pilates may not be for everyone, hear me out. In my own and professional experience, Pilates is one of the best forms of exercise you can add into your routine to support your physical health after stoma surgery. Pilates focuses purely on working core muscles in a slow, controlled and low impact way. You don’t have to be super fit or flexible to start, just head to a local class with a fully qualified teacher. Explain that you have had stoma surgery and they will be able to adjust exercises to your needs as they arise.

Final few tips: 
Ask your stoma nurse about a support belt for your stoma. I recommend wearing one while exercising or while carrying out any physical day to day tasks. 
In the first three months after surgery, ensure you are getting in and out of bed correctly. Avoid a ‘sit up’ or ‘abdominal crunch’. Instead, roll over to your side and use your arms to help you up. Likewise, use your arms to lower you down to your side body then roll over to your back to get into bed. 

• Quality over quantity and intensity. Good form is key to training your core muscles. 
• If it hurts, stop. These exercises shouldn’t be painful. The days following surgery, It may be uncomfortable of feel tight, this is normal. 
• Avoid any exercises that involve sit-ups.
• If you have an Ileostomy ensure to keep hydrated. 
• Empty your stoma bag before starting exercises. 
• Exercise can help with weight management. Research shows that carrying excess weight can increase the risk of complications such as a hernia. 

To conclude this article on the importance of the core muscles after stoma surgery, always chat to your surgeon or stoma nurse before taking on any new activities. Once you’ve got the go ahead from them, start to work on your core muscles as the foundation to your physical recovery. This will help prevent complications that can arise and aid recovery. Don’t do too much too soon, especially if you aren’t working on your core exercises. Having a stoma doesn’t mean you cannot live life to the full, you can play contact sports, do gardening, DIY, running, swimming….just make sure that core exercises, such as the ones I have recommended are part of your routine in caring for yourself and your stoma. An added bonus would be to try out Pilates if this is within your means to do so. 

If you have any further questions, I’d be more than happy to help answer them. 
Fern.