Navigating Cancer Treatment with a Stoma or iPouch: What You Need to Know

A worried woman points to a man who appears to be a patient with a migraine or headache. The man has his hand on his forehead, and a cold pack on his stomach. He is sitting in a hospital or medical room with a IV bag and medical charts in the background.
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A woman appears concerned as she points to a man sitting with a headache in a medical scan room, with an X-ray image and radiation therapy equipment visible in the background.

For individuals living with a stoma or an ileoanal pouch (ipouch), undergoing chemotherapy or radiotherapy can present a unique set of challenges. While these treatments are vital in the fight against cancer, they can also impact the function, comfort, and care of a stoma or ipouch in ways that are often under-discussed.

Understanding these effects and how to manage them can make a significant difference in the quality of life during treatment.

It is also important to note that a stoma is often created before the start of chemotherapy or radiotherapy, including for individuals with an ipouch. Surgical and oncology teams may recommend a temporary stoma during this period to help manage treatment more effectively and reduce potential complications.

Chemotherapy: A double-edged sword for stoma and ipouch patients

Chemotherapy works by targeting rapidly dividing cells, which include not only cancer cells but also healthy cells in the digestive tract, bone marrow, and hair follicles. This can lead to a wide range of side effects, including:

  • Nausea and vomiting

  • Hair loss

  • Fatigue and weakness (due to anaemia)

  • Increased risk of infection (due to low white blood cells)

  • Bruising and bleeding (from low platelets)

  • Peripheral neuropathy (tingling, pain, or numbness)

  • Digestive issues like constipation or diarrhoea

For people with a stoma or ipouch, these effects can be amplified or take on new dimensions.

Changes in Stoma Output

Chemotherapy can cause diarrhoea or constipation, both of which affect the stoma and ipouch output. Diarrhoea can lead to dehydration, electrolyte imbalance, and skin irritation. On the other hand, constipation may require dietary adjustments or laxatives, which can be tricky to balance with ongoing treatment.

Tip: Monitor your output closely and stay well-hydrated. If output becomes too watery or too infrequent, speak to your stoma nurse or oncology team.

Skin Sensitivity

Chemotherapy can make the skin, including around the stoma, dry, flaky, or fragile, which may affect how well your stoma bag adheres. This can lead to leaks, discomfort, and poor quality of life.

Tip: Use skin barrier products to ensure the skin is protected and hydrated. Consult your stoma nurse, as you may require different skin products.

Stoma or iPouch output changes

During episodes of high output, you may need to switch to a maxi drainable bag or a high-output bag to best manage your stoma and prevent leakages. These are designed to handle increased volume and reduce the frequency of emptying.

For those with an ipouch, it’s important not to delay toilet trips, as looser stool can be harder to control. Consider dietary changes to manage the consistency - e.g. eat low-fibre and binding foods; avoid greasy, sugary and processed foods; stay hydrated.

Tip: Keep a variety of stoma and ipouch products on hand and do not hesitate to trial new products with your stoma and ipouch care team.

Appetite, Diet, and Digestive Upset

Chemotherapy often causes nausea, vomiting, and reduced appetite, which can affect your nutritional intake and stoma or ipouch function. Malnutrition can also slow healing and increase fatigue.

Tip: Eat small, frequent meals and focus on easily digestible foods. If eating becomes difficult, ask your team about nutritional supplements.

Emotional and Psychological Impact

Managing a stoma or ipouch is already a significant adjustment. Adding chemotherapy to the mix can feel overwhelming. Feelings of anxiety, isolation, or depression are common and valid.

Tip: Reach out to stoma nurses, mental health professionals, or support groups. You are not alone, and support is available.

Stoma Bruising, Swelling, and Bleeding

Some chemotherapy regimens can cause your stoma to bruise, swell, or bleed more easily. This may be due to low platelet counts or increased fragility of blood vessels. Your ipouch may also occasionally bleed, especially if inflamed due to various reasons.

Tip: Inform your stoma or ipouch nurse if you notice any changes. You may need to resize your baseplate or use a different stoma bag to accommodate swelling. For those with an ipouch, it is always important to be assessed and see what may be causing the issues, such as bleeding.

Risk of Stoma Prolapse or Hernia

Chemotherapy can increase the risk of stoma prolapse (where the stoma protrudes more than usual) and parastomal hernia (a bulge around the stoma). This is due to:

  • Weakened abdominal muscles

  • Increased intra-abdominal pressure from vomiting or constipation

  • Nutritional deficiencies affecting tissue repair

  • Delayed wound healing

  • Reduced immune function

Tip: Avoid heavy lifting, wear a support garment if advised, do light abdominal exercises, and report any prolapse, bulging or discomfort to your care team promptly.

Radiotherapy: Skin and Gut Under Fire

Radiotherapy, especially when targeted near the pelvis or abdomen, can also affect stoma and ipouch function. The peristomal skin and the stoma itself may be exposed to radiation, leading to:

  • Redness, dryness, or peeling of the skin

  • Blistering or ulceration

  • Inflammation of the stoma or ipouch mucosa

  • Changes in output (often diarrhoea)

  • Loss of appetite and nausea

These effects are often dose-dependent and may worsen over the course of treatment.

Managing GI Side Effects

Radiotherapy can cause nausea, vomiting, and diarrhoea, which in turn affect stoma and ipouch output and hydration.

Tip: Keep anti-diarrheal medications (like loperamide) on hand, and work with your stoma/ipouch nurse or dietitian to maintain adequate nutrition.

The Importance of Teamwork

Whether you are undergoing chemotherapy, radiotherapy, or both, regular communication with your healthcare team is essential. Your stoma o ipouch nurse, oncologist, dietitian, and GP all play a role in helping you manage side effects and maintain quality of life.

Tip: Keep a symptom diary, bring questions to appointments, and do not hesitate to ask for help, especially if something does not feel right.

Final Thoughts

Cancer treatment is never easy, but for those living with a stoma or ipouch, it can feel like navigating a storm with extra sails to manage. The good news? With the right support, proactive care, and a bit of planning, it is entirely possible to weather the journey with dignity, comfort, and confidence.

If you are struggling to manage your stoma or ipouch during cancer treatment, seek support, and do not assume it is normal and nothing can be done. You can also contact us for advice, if unsure.