Community nurses are well placed to provide information about travel to people living with a stoma. Although much of the advice seems like common sense, learning to live with a stoma and adapt the stoma into lifestyles can be difficult. Patients often want advice and reassurance that they can travel — be this on foot, by car, boat or aeroplane. There is a great deal of information on the internet from support groups, which is often reviewed by healthcare professionals and people living with a stoma to ensure accuracy. There is also information available from stoma appliance manufacturers and dispensers on their websites. Healthcare professionals need to advocate caution in using other sites that may be the opinion of just one person and may not offer a balanced view. However, in general, community nurses can encourage travelling as a safe and enjoyable way to live after stoma forming surgery. 

Stomas  

There are three main types of stoma, and they are all surgically formed for reasons such as colorectal cancer or inflammatory bowel disease. A colostomy and ileostomy will pass faeces and flatus, while a urostomy will pass urine. To collect and contain the output from a stoma requires the placement of an adhesive stoma appliance around the stoma on the abdominal wall (Burch and Black, 2017).  
 

Planning travel  

Having a stoma does not preclude travel, but planning travel does require consideration. This is where community nurses can be invaluable in advising patients in their plans. There is limited evidence to support travel advice when living with a stoma, so often common sense is needed. Alternatively, information has been passed between patients and nurses, with both learning from the other. The mode of travel needs to be taken into account as does what activities are undertaken, as well as eating and drinking when away. In the author’s clinical opinion, it can also be advisable to gradually increase the time spent travelling and the distance from home to gain confidence that it is possible to travel.  
 

On foot  

When walking, it can be useful for people living with a stoma to think about what they might need. Walking is an activity that is safe to do immediately after the stoma forming surgery (Gustafsson et al, 2019). Healthcare professionals can encourage people with a stoma to gradually increase the duration and distance walked each week, as strength and confidence increases.  
It can be useful to know toilet locations when out shopping to gain confidence that appliances can be emptied or changed if needed. However, it is unlikely that this will be necessary for short walks. It needs to be remembered that toileting facilities might not be available if out rambling in the countryside, for example. However, it can increase confidence to have a spare appliance and all the necessary equipment to undertake a change should it be necessary.  

In the author’s experience, it is helpful to provide individuals with specific information for different stoma types when they are planning to travel on foot. For people with a urostomy who are travelling a long way and without access to a toilet, it can be useful to use a leg bag so that they have added storage capacity for urine collection. People with an ileostomy who are travelling for a considerable time without toilet access, could take medication to thicken the faeces, which will also reduce volume of output. Caution must be exercised to ensure that use of medications, such as loperamide, do not cause problems. It is sensible to advise patients about effects and side-effects when starting a new medication, such as loperamide is useful to slow down the gut, but some people are more sensitive to loperamide than others, and to ensure that the faecal output from the ileostomy is not slowed too much that nothing comes out. For people with a colostomy, faecal output is less frequent than for people with an ileostomy and travel on foot will infrequently require any need to have concerns about the colostomy appliance.  
 

By road  

When travelling by road, there are usually many potential toilets on motorways and major roads. Coach trips often have an onboard toilet which can reduce the stress of finding a toilet. To remove the odour of faeces when emptying an appliance, a small air freshener can be used before the emptying process. Otherwise, the advice is the same as for travelling long distances on foot. 
 

By plane  

Travel by air can involve hours in an airport as well as time on the aeroplane. Air pressure changes can result in the stoma appliance ballooning with gas (Colostomy UK, 2024). This is particularly so for people with a colostomy but can also occur for people with an ileostomy. Gas can also occur with carbonated drinks and foods, such as beans. These therefore should be avoided before and during flights to reduce their effects when in the aeroplane. Although it is not necessary, some people prefer to request a seat by the toilet when travelling by air.  

It is also advised to take all stoma supplies in the hand luggage in case of issues with suitcases being lost. The airline might allow additional hand luggage if a request is made to allow for storage of medical devices such as stoma appliances. However, scissors are not allowed on aeroplanes and thus the aperture in the appliance needs to be pre-cut in advance; although many people no longer cut their own appliance once the initial period of adaptation occurs. 

It is also sensible to take twice as many appliances as is usual for the duration of the holiday or trip abroad, as things can be different in different climates. Hot weather can increase sweating, which can reduce the adhesion of the stoma appliance, meaning that it may require changing more often than would be usual at home. Being in the swimming pool may also mean that the stoma appliance needs to be changed more often than usual or to increase confidence. Confidence is necessary to ensure that there is no risk of a leaking appliance in the pool which may be obvious to other swimmers and result in pool closures while the pool is cleaned. When planning to go swimming, it is sensible to check that the appliance is secure and if it is a drainable appliance, such as an ileostomy or urostomy, it is emptied before going into the swimming pool. 
 

By train  

Train travel will usually involve trains with toilets, both in the station and on the train. Easy access to toileting facilities can reduce concerns about train travel.  
 

By water  

Travel by ferry or ship may involve eating foods and drinks that are different to normal, which may affect the function of the stoma. On cruises there are always medical staff available in case of passengers falling ill. However, it is important to bring more stoma equipment than would normally be used in case of needing to change the appliance more often than usual. As mentioned before, more frequent changes may be necessary if the climate is hotter than usual and more sweating is occurring, or in the case of swimming for example.  

Travel certificate  

When travelling abroad it is advised that all UK citizens gain a UK global health insurance card (UK GHIC), which is free to obtain via the NHS website. The UK GHIC enables people to have health care in the European Union or other stipulated countries (NHS, 2023). Health care may be free or the same payment as a local resident would pay for emergency treatment and can include pre-existing medical conditions. However, the UK GHIC does not cover all situations, such as being medically repatriated. Thus, it is essential to also have additional travel and medical insurance.  

Holiday insurance  

It is possible that having a stoma will increase the cost of holiday insurance compared to before stoma forming surgery. To keep costs down, it can be useful to compare several insurance company quotations. There are insurance companies that specialise in people with pre-existing medical conditions. The three main support groups (Table 1) for people living with a stoma might be able to offer information gained from members about holiday advice. Additionally, most stoma appliance manufacturers will have information on their website about travel advice which can be useful to read. 

Community nurses can suggest that their patients look up websites designed by their appliance manufacturer, details of which will be on their stoma products. Alternatively, if the patient uses a delivery or dispensing company, this is also likely to have information on their website for patients to view.  

Table 1. Stoma support groups

Stoma support group	Website
Colostomy UK	www.colostomyuk.org
Ileostomy and internal pouch association	www.iasupport.org
Urostomy Association	www.urostomy association.org.uk

Eating away from home  

When eating and drinking foods that are different to the norm, this can affect the output from the stoma (Young, 2016). Water can taste different and contain varying minerals in different places. It can be advisable for people with a stoma to drink bottled water when abroad. In addition, foods can be cooked differently when eating out. Fried foods, for example, can result in loose faeces. Healthcare professionals can provide dietary advice as well as information about the use of medication.  

For people with an ileostomy, it can be advantageous to take loperamide and to use it as needed to thicken faecal output. It is essential for healthcare professionals to advise about signs to look out for if the loperamide stops the faecal output, i.e. no faeces coming into the stoma appliance when they usually would, and that no further medication should be taken until the bowels have regained normal function. Subsequently, loperamide should be used with caution (NHS, 2024).  

Although being abroad will not affect the skin around the stoma (peristomal) per se, there is potential for skin damage to occur. This might happen if the appliance is changed more than usual due to sweating, for example. If an appliance is changed more frequently than usual, it is possible that the top layer of skin (epidermis) will be removed faster than usual, termed skin stripping. The epidermis contains no blood supply or pain receptors, so superficial damage might not be immediately obvious. To minimise skin stripping, patients should be advised to gently remove appliances and ensure that they carefully clean and dry the peristomal skin if they need to replace the appliance more than is usual for them.  

Colostomy UK have devised a travel certificate which is free to download and endorsed by the civil aviation authority. Also, you can advise patients that many appliance manufacturers will provide them with a travel card in multiple languages which can be useful for travel.  

Travel challenges  

There is limited evidence related to people living with a stoma and travel. All studies reported here were cross-sectional, looking only at a snapshot in time and most used questionnaires to gain results from large numbers of people living with a stoma. Some of the available research will be critiqued to help show how, or if having a stoma will affect travel. Although none of the studies were completed in the UK, it is likely that results would be similar if they were looking at people living in the UK with a stoma.  

Krouse et al (2009) in America reported on 246 people with a stoma, comparing them with 245 people who did not have a stoma. Both groups had previously had a colorectal cancer. To evaluate their life with a stoma, they were asked to complete several questionnaires. People living with a permanent stoma reported more challenges when travelling than people without one. However, both groups did not report that there were no challenges related to travel. These results suggest that adaptations are needed to be made to enable travel with a stoma.  

Dabirian et al (2010) in Iran interviewed 14 people living with a colostomy in relation to their quality of life. Of the 14 people interviewed, only one mentioned travel. In describing travel with a stoma, they were positive and explained how they knew what to do to manage their colostomy on long journeys. The participant stated:  

I travelled twice after having my colostomy for a long time, more than 20 hours. I know how to clean it before travelling and how to care for it during the trip.  

The results from this study suggest that once people know how to manage their stoma when travelling it does not hinder travel.  

Results from almost 700 questionnaires conducted with people living with a stoma for any reason in the Netherlands were collated and the types of concerns were ranked (Jansen et al, 2015). Travelling or being away from home was ranked in the top 10 list of concerns reported in this study group. This suggests that it is a concern to people living with a stoma to consider travelling. This highlights the need for community nurses to be able to support and advise people so that they feel confident to travel and leave their homes.  

In a systematic review undertaken to examine how a colostomy affected quality of life for people after colorectal cancer, Vonk-Klaassen et al (2016) described the results of 14 studies. The studies described within this review used a variety of different questionnaires to determine quality of life. The authors said that having a colostomy negatively affected quality of life and this included travel difficulties. The results of this study suggest that quality of life might be improved if concerns about difficulties when travelling could be reduced.  

In Norway, surveys were used to gain the opinions of over 150 people living with any type of stoma (Indrebø et al, 2016). The authors describe that people who negatively reported on the question about ‘being free to travel where I want despite my ostomy’, were more likely to have a poorer quality of life than people who were positive about travel with a stoma. This further supports the assumption that if people with a stoma feel confident about travel, they are likely to have a better quality of life. 

In Indonesia, interviews to explore opinions of 11 people living with a stoma after colorectal cancer showed positivity (Afiyanti et al, 2023). The interview participants reported that although they needed to make adjustments related to their stoma when they travelled, they were positive about the adjustments that were needed. One participant describes preparation for travel: ‘And if I want to travel, I always prepare him so he won’t make noise... (laughing)...for example, by not eating cabbage’. This also supports the assumption that confidence improves quality of life and that nurses are invaluable in providing support and guidance on travel. Confidence and ability to travel was not true of all participants, with one describing less ability to travel than before the stoma formation: ‘Now I can’t go out of town… I used to travel a lot outside the Java island. But now that I have a stoma, I have to accept and adapt to it. My health is my top priority now’. While these interviews were not undertaken in the UK, people in the UK are also at risk of concerns about leaving their homes or local environments. This indicates a potential role for community nurses to try and increase understanding about what is possible with a stoma.  

In Nigeria, Muhammad et al (2022) interviewed 15 people with a stoma to determine their lived experiences and coping strategies. Most (12 participants) reported making some change to their travel arrangements. This included changes to how they ate in the preparation for travel: ‘When I have to travel, I do not eat, I only take little snacks and I eat foods like rice because they make the faeces hard’. This insight shows that modifying diet can help to alter the consistency of faeces, which can make travel simpler.  

In the author’s clinical opinion, this research is likely to be representative of some of the people living in the UK with a stoma. If people living with a stoma want further information after discussions with their community nurse, it can be useful to advise them to contact their stoma specialist nurse. Alternatively, contact or look at the websites provided by stoma support groups for more advice (Table 1). 

Conclusion  

It is possible for people with a stoma to travel. Walking is encouraged in the immediate postoperative period. Other travel often requires a greater degree of recovery and a gradual increase in distance from home being travelled to boost confidence. Community nurses can facilitate this by providing advice and signposting to useful websites for additional advice, most of which is anecdotal.  

Originally published in Journal of Community Nursing: Burch J (2024) Travelling with a stoma: advice for patients. J Commun Nurs. 38(3):59–62. https://www.jcn.co.uk/journals/issue/062024/article/travelling-stoma-advice-patients