Returning to exercise...but HOW?!

[Richie]

Ileostomate here, presently 10 weeks out from surgery. Was very active before surgery - fast walking, hiking, running, biking, swimming, light lifting, yoga, rock climbing, skiing, zumba.

So far, post surgery, I've just been walking. I can get up to about an hour a day now, but not too fast. But now what?! I'm not sure what to turn to next SAFELY. I'm very worried about hernias but it seems like you're damned if you do, damned if you don't. Lift too much or place too much strain on the core by strengthening, and you've got a hernia. Let your core weaken or lounge too much, and boom, you've set yourself up for one too.

So how did you return to physical activity? How long did you wait? What precautions did you take? What support belts or binders did you wear? Did you end up with any hernias in the process? Would you do anything different next time?

I have the Coloplast binder but find it very uncomfortable. It rises too high to uncomfortably cinch around my ribcage and the hole cut for the flange is irritating. I hope as my abdomen becomes less sensitive in time, this will be less of a concern. I also don't like that binders don't hold the bag itself, as is the case with NuHope products too. I've been recommended the Stealthbelt, but am unsure how great those are for hernia prevention as they aren't binders to my understanding.

Anyways, hoping to learn from a variety of experiences, so don't be shy! Thanks in advance.

[ot dave]

Hey Richie,
Exercise/recovery is like an ostomy. It's going to be unique to the individual. Lots of factors play into it as well. Prior level of function, age, disease process, nutrition, etc, etc. So far, it sounds like you are doing everything recommended. Waking is huge in recovery from most surgeries. I was 37 at the time of my ostomy. I had 2 young kids, I'm a pediatric occupational therapist, so I was moving and active a lot with family and work. I played softball, I'm a scuba diver. I enjoy hunting/fishing and outdoor activities. I was a scout leader. But, I was also over weight. Initially I didn't use any support, and developed a hernia (part of it was lack of knowledge, part of it was me thinking it won't happen to me, part of it was lack of education/communication from my care team). Also, I had rectal cancer, so I had to go through 6 months of chemo after my surgery, so I wasn't rushing back into physical activity. I did what I could when I had the energy to do so. Once chemo was completed, I gradually reintroduced my activities and went on with my life. I did develop a hernia, and started wearing an abdominal binder at that point. Now I wear it all of the time.
Lived with it for about 6 years without any issues. Had it repaired, but it only lasted a few years. Had a second repair with a re-siting of the stoma. After the second repair, my wife was diagnosed with a brain tumor. She eventually lost function of the left side of her body, and I being a therapist was doing a lot of her transfers from seat to seat. The hernia blew out at that time...worse this time. So now, I'm in the process of losing weight so that I can get this volleyball sized hernia repaired.

So, to answer your questions, I returned to physical activity as my body allowed...you'll just know. Wait as long as your body is telling you to...again, this is going to be unique to your situation. Start slow, build up as you go.

I didn't really take precautions, and I've paid the price ever since, but you are correct, you're darned if you do, darned if you don't work on core activities. As noted, I wear an abdominal binder now. I have a colostomy, so I irrigate daily and don't have output until I irrigate again the next morning, so a complete binder works well for me. Obviously with an ileostomy, this is not ideal. NuHopes belts are probably the best for support, in my opinion. In addition to my binder or when using the NuHope belt, I wear under armor compression shirts. They do a nice job of keeping everything close to my core. And, they are flexible enough to allow for output without causing pancaking issues. I bought a Stealthbelt, and it works fine, but as you noted, they don't provide the support needed to prevent or manage a hernia. They are spandex, and simply don't provide that type of support.

As I've mentioned, yes I ended up with a hernia, but a stoma is the actual definition of a hernia, so you already have one!! Again a lot of factors play into hernia causation and management afterward. My hernias have not caused any pain or blockages, so I've been lucky in that respect, but finding clothes to accommodate it now can be challenging.

As far as doing anything different.... Yeah, I probably would have been more proactive with finding a good support belt sooner. But, I'm not upset that I kept on going with my life. I've tried for over 15 year now to not let this ostomy have too great of an impact on how I live my life. Does it produce challenges and some extra planning? Sure, but I've never let it limit me in anything that I wanted to accomplish.

Hope some of that helps.

David

[Richie]

Thank you so much Dave for this advice and sharing your experience! So appreciated in all the detail, reflection, and honesty.

[GeorgeS]

I irrigate daily and don't have output until I irrigate again the next morning, so a complete binder works well for me. Obviously with an ileostomy, this is not ideal.

Dave, do how long does this process take you daily? I've heard from a coworker that her grandmother takes 2 hours but not sure if this is daily or every other day. And her being in her 90's, I'm thinking it could be harder and longer to do.

Thanks for your prospective on parastomal hernias. I too have one forming but with little issues other than self-image and trying to hide it more. I have a hernia belt with a pouch hole that feels fine to wear. I just cannot wear it 24/7. I'm also using Metamucil before each meal to keep the stool softer. At some point I need to try improving my core too. Belly fat seems to run in the family, or drinking beer, that is probably the biggest contributor.

[ot dave]

Hey George.
Irrigation usually takes me about 45 minutes to complete. I do irrigate daily, but there are others who can go 2 or 3 days between sessions. With diet and immodium, I've reliably been able to go 48 hours between sessions. I irrigate in the morning, so I typically get up about 2 hours before I need to leave the house, unless I'm going out to hunt in the morning during the fall/winter. I use the extra time to allow for any late returns, and to check this board, check email, etc., before I get up to get a shower and dressed. Again, this is only an option for colostomates. It's not effective for folks with an ileostomy.
If you're interested in trying it out, check out the irrigation forum. Lots of infromation and irrigators that can point you in the right directions. I've been irrigating since 2010, it's the one thing that allows me some control over my bowels these days. Hope that helps.

David