A stoma, or ostomy, is a surgically created opening on the abdomen that allows waste to exit the body into a pouching system. Adjusting to a stoma involves many lifestyle changes, and regaining comfortable sleep is a significant concern for many people. Finding a resting position that avoids placing pressure on the stoma and the attached appliance is a common challenge. The desire to return to a preferred sleeping position, such as lying on the stomach, often raises questions about safety and appliance integrity.
The Immediate Answer: Safety and Timing
Whether you can lie on your stomach with a stoma depends on your stage of recovery. In the initial post-operative period, typically the first six to eight weeks, sleeping in the prone position is discouraged. This restriction is due to the need for surgical incision sites and abdominal muscles to heal completely. Direct pressure on the abdomen can interfere with the healing process and cause strain.
Once surgical sites have fully healed, which usually takes a few months, most ostomates are safe to try sleeping on their stomachs. The stoma itself, which is a piece of bowel, is resilient tissue and is not easily damaged by gentle contact. The primary concern shifts from physical injury to the integrity of the appliance seal. Before attempting to lie prone, consult with a Wound, Ostomy, and Continence (WOC) nurse or your surgeon for medical clearance.
The prone position should be introduced gradually and only after a medical professional confirms the abdominal wall is strong enough to handle pressure. Rushing this stage risks complications like a hernia near the stoma site or separation of the appliance from the skin. Healing properly ensures the long-term safety and comfort of returning to a natural sleeping position.
Practical Techniques for Prone Positioning
Once cleared to attempt a prone position, the focus shifts to preventing direct pressure on the stoma and pouching system. One effective technique is using pillows or rolled towels to create a protective space around the appliance. Placing a thin, rolled towel or a small cushion on either side of the stoma helps distribute body weight away from the appliance. This ensures the mattress supports your body rather than compressing the stoma against it.
A specialized approach involves using a semi-prone position, which is a slight variation of lying on your stomach. This is achieved by bending the leg on the same side as the stoma and rotating your body slightly toward the opposite side. This maneuver creates a natural dip in the abdominal area, relieving pressure and allowing the pouch to hang more freely. Experimenting with different pillow arrangements, such as using a body pillow, can help maintain this angled position throughout the night.
Another strategy is to use a travel pillow or a foam ring with a central cutout placed around the stoma site. This creates a dedicated void where the appliance can rest without being flattened. The goal is to avoid sustained, direct force on the wafer or skin barrier, which could compromise the seal. Slowly transitioning into the position and checking for comfort determines a sustainable method for a full night’s sleep.
Addressing Potential Issues: Pressure and Leakage
The primary risks of sleeping on your stomach relate to appliance integrity and output management. Constant pressure on the pouching system can lead to the seal separating from the skin, resulting in leakage. This risk increases as the pouch fills up overnight, causing the output volume to push against the barrier. To mitigate this, the pouch should be emptied completely right before lying down for the night.
Another common issue is “pancaking,” which is the accumulation of thick, sticky stool at the top of the pouch near the stoma. When lying prone, pressure can flatten the pouch, preventing output from sliding down and creating a vacuum effect. This trapped output can then seep under the adhesive barrier, leading to skin irritation and potential leaks.
Solutions for pancaking include ensuring a small puff of air is inside the pouch before bed, which helps keep the internal layers separated. Some people find success by placing a drop of lubricating deodorant or vegetable oil inside the pouch to help the output slide down. If pancaking or leakage remains a persistent problem, a stoma care nurse may recommend a different appliance. This might include one with a more rigid or convex barrier to encourage the stoma to protrude slightly and direct output away from the skin seal.