# Air travel with a stoma (ileostomy or colostomy)

A stoma is a surgically inserted hole in your stomach through which urine and faeces can exit your body. It's part of the operation where your bladder or colon gets removed. There are approximately 102,000 such people in the UK alone. If you Google for 'stoma', don't look at the images (if you do, remember that I told you so).

When you have a stoma you use an appliance (bag) to catch and collect the urine or faeces; it is glued to your stomach and you change it usually once a day or more often.

Issue. Sometimes the appliances leak, worse, sometimes they fall off completely. The result is that BAM your body and clothes are soaked in urine and/or faeces. If it's a bad leak, your chair and possibly your neighbours are included in the mess. Air pressure, temperature, humidity, even the seat belt cutting in to the flange area all can cause a leak.

Here's two videos of young women who (bravely!) relate stories about their stoma leaks. Here and here These ladies were not on air planes and their videos are charming (and read the comments), and they were small leaks. But generally... it's a nightmare.

Lots of people do not fly because of this, some worry about the change in pressure causing the appliance to explode, but for most it's embarrassment. On the other hand some people must fly because of work or because they want to maintain family relationships.

The immediate remedy is to wear a level 3 stoma belt with a protector, but these are horrendously expensive and do not last for a long time (despite manufacturer's claims). And even the level 3 belt does not prevent the appliance from falling off when conditions are right.

Those with airline training or those travellers with a stoma (or have close relations with a stoma person), or simply those with some good ideas are asked: What are your travel tips for this situation?

And p.s., thanks to those brave ladies! Especially the one who got it on her boyfriend in HIS bed! And (heaven help us) ruined the carpet!

• To clarify, a stoma is not a hole in the stomach. It is either the small intestine or the large intestine where the stoma is formed by the surgeon looping the organ out of the abdomen and making an opening in it. It can also be formed for the bladder. The collection pouch is then adhered over the protruding bowel. Perhaps the writer meant 'abdomen'. – Eric Feb 7 at 6:01

# General Tips and Tricks

There are various guides on the web focusing specifically on how to travel with a stoma. Most of which are written by authoritative associations, such as the UK Colostomy Association, Ostomy Lifestyle, and Securicare Medical just to mention a few. For a complete, portable tips-and-tricks guide, here is a Travel Advice PDF by the UK Colostomy Association. I will summarise some of the advice present in these documents below.

# Flying with a Stoma

## 0. Leaks Happen

From your question I gather that your main concern are bag leaks and the trouble, let alone the embarrassment, they might cause on a plane. My first piece of advice would be: keep in mind that the appliance might leak. Irrespective of where you are (land, sea, air), and what you're doing (walking, swimming, waiting for your meal), bags of any kind can be subject to leaks. Having said this, there are some preventive measures we can take.

First thing I would say is to make sure that you pack your stoma gear (pouches, accessories, baby wipes, etc.) in your cabin luggage. If you want to go the extra mile, store that carry-on underneath the seat in front of you. This combination will ensure you quick and easy access to it. Moreover, having your gear in your carry-on will make sure that none of it is lost/mishandled during airplane transfers.

You can then decide if to split the gear between checked-in and carry-on luggage, or to pack it all in your carry-on. The important thing is to make sure that your carry-on pack renders you autonomous for a long stretch of time should, part of your be lost in a checked-in luggage mishandling.

## 2. Ask for a Seat Next to a Lavatory

Before boarding, contact the airline staff, mention your needs, and ask for a seat next to a lavatory. Very much like in the case of air-sickness as advised here by @MeNoTalk, you want to make sure that staff knows about you, so to avoid problems should you need to run to the bathroom during turbulences/fasten-seat-belt-conditions. Moreover the closer you are to the bathroom the faster you can get there.

## 3. Bring the Right Amount of Gear

Take twice as much gear as you think you might need. A general rule of thumb when packing stoma gear, be it disposable or not, is to make a rough estimate of your needs and then multiply that by two. It's always better to have some spares when returning home rather than running out of them on your way to the Taj Mahal.

Luggage weight restrictions may be a problem. The Uk Colostomy Association Travel Advice booklet mentions contacting the Airport Security Manager asking to extend your baggage allowance on medical grounds. You will probably need a doctor's notice to back this request up.

Another, more expensive, solution would be to fly in business/first class as these often offer more lenient hand-luggage allowances.

## 4. Bring the Right Gear

Your carry-on gear should include the following (this list is not exclusive, of course):

• Stoma bag kits
• Baby wipes
• Sanitizing hand gel (travel size, of course)
• Spare plastic bags
• Spare shirt and underwear (a complete change of clothes won't hurt, should you have space to pack it)
• Deodorant or perfume to cover-up any odour in the bathroom (wastebin or environmental)
• Small torch
• Piece of heavy-duty plastic film large enough to kneel on (useful should you need to kneel down in a bathroom without dirtying your clothes, as suggested here)

## 5. Wear the Right Clothing

You should wear loose-fitting comfortable clothes, to avoid any excess pressure/squashing on the bag when sitting down, as this is what you'll be mostly doing on a plane. Of course you should consider taking a walk every so often.

# Some Scientific Considerations

The common fear of flying with a stoma comes from the fear of it expanding due to cabin pressurisation, causing it to leak or burst. I could not find authoritative statistics on the matter. All I could gather are citations from various scientific journal publications which all mention the possibility of the bag leaking due to the increase in volume of the air inside both the body and the bag itself.

## Quoting Vagueness

Here are some quotes in chronological order. From Richards, P. R. (1968). Modern air transport and invalids. The Journal of the Royal College of General Practitioners, 15(5), 336.:

Pathological conditions that are at risk to reduced barometric pressure are as follows:

[...]

Colostomy and ileostomy may discharge flatus and faeces copiously.

Those with ileostomies or colostomies may need to vent the increased volume of gastrointestinal gas and should be warned to take extra bags and dressings in their hand luggage.

Gas in colostomy and ileostomy bags at ground level will also expand with altitude, and removing the bag in flight can result in faecal overflow. Stoma outputs of gas and faecal material will likely increase as gas expands in the intestinal tract. Changing the bag before departure and venting before removal may prevent problems in transit.

In all these quotes the emphasis is mine. Hence note the vagueness of the claims which themselves are not backed-up by numbers. Rather they seem to be based on logical reasoning and knowledge of Boyle's law alone. Moreover technology must have improved since the last of these articles was published (2003).

Modern day stoma bags should be fit with an escape filter, whose purpose is exactly to let the air out, be it due to flatulence or pressure differentials. So make sure the filter is not covered and permeable before travelling.

All in all I think the hard part of flying with a stoma is taking the first step to win over the fear of embarrassment. Quoting from the boy scouts, all you need is to be prepared to whatever might happen and you'll know how to handle every situation.