If you’re heading to the gym for the first time since your stoma surgery (or for the first time ever or since lockdown) you may be feeling nervous and excited.
The idea of getting your life and body back on track feels amazing, especially after going through so much, but equally you may be feeling confused about various exercises and things you can and can’t do, especially when it comes to core and abdominal exercises.
Ultimately*, there’s nothing you can’t do when you have a stoma. You can lift weights, you can run, cycle, swim, jump about in dance classes. You can do press ups and pull ups. Nothing is really off the table. There may be some modifications and adaptations, but generally (once fit and strong enough) you can do anything you want.
(note I use the world *ultimately… this is stuff to BUILD UP TO.. these things are not a starting point. And there are some people who may always need to modify various exercises).
'This gallery shows some of the advanced exercises we have in Pilates. But these took me years to build up to'.
From my experience, most people with stomas are confused about what they can and can’t do in the gym and whether or not they can do abdominal exercises… can you do them? Should you do them? What sorts of things are safe? Some people are advised to strengthen their core.. others are told not to.
There’s not much consensus and most people haven’t been given much information by their medical team.
However, the answer is that YES you CAN and you SHOULD do core exercises, but there is a world of difference between a plank and a pelvic tilt.
And you need to learn what’s appropriate for your level of recovery, fitness and ability and build up SUPER slowly.
So in a nutshell.. it’s not quite as simple as ‘Have surgery – recover – go back to the gym’.
In order to lift, run, swim, cycle, jump about and press and pull, you need to have good core function and control.
This is slightly different to ‘core strength’. Function comes before strength.
Your DEEP INNER CORE (namely your pelvic floor, transverse abdominis, and diaphragm) needs to be functional and working well (it’s an integrated unit that works together as one), so that you’re able to tolerate the load of the exercises and manage intra-abdominal pressure).
And this needs to happen first, before anything else. You need to put the foundations back in place.
When we have surgery this ‘function’ is often disrupted, and we need to retrain it before we do much else.
Imagine that you have a cannister deep inside of you with a top, sides and bottom. This is your ‘DEEP INNER CORE’. It’s your internal support garment.
Fixing this will ensure that you feel strong and functional and able to do the exercises you want to do.
You’ll know when your deep inner core is working properly again, you’ll feel more ‘connected’, less vulnerable. You’ll feel stronger and that it sort of ‘kicks in’ when you go to lift something or push, pull or even sneeze or cough.
It will reduce your risk of hernia, as you’ll be able to tolerate the pressure and load created by lifting/exercising/sneezing etc. You’ll be able to do stuff with better form and will have the ability to lift and move with confidence.
Think of this like building your own INTERNAL support garment, which moves with you and is functional and supportive.
So before you pick up the dumb bells or hop onto the treadmill, spend some time tuning into your deep core, pelvic floor and abdominal muscle function.
If - at the gym - anyone asks you to do a plank at your first session to ‘strengthen your core’, please don’t. That needs to wait. Most fitness trainers haven’t come across many clients with stomas, and it’s not part of their training, so unfortunately it’s unlikely that your gym instructor will know much about it or be able to advise you (not a criticism at all, just not something they ever get training on).
So… first things first.
You need to restore ‘core function’ before strength. US based physio and pelvic health guru Diane Lee describes it beautifully in this post.
Time spent on this now will pay huge dividends in the future. You’ll feel stronger, less vulnerable and you’ll be tuned into your body so you’ll know what feels right and safe.
You’ll be able to tolerate load and pressure of exercise, you’ll reduce your risk of hernia and you’ll be moving and exercising with quality technique and movement quality. You’ll just FEEL that it feels better and less vulnerable.
It’s a step-by-step process where you build from the INSIDE out.
So.. how do you do it?
Regardless of when your surgery was (and I’ve worked with people who had their surgery 40 years ago and have never done this process), before you get start gym sessions or fitness classes you need to do a phased programme of rehab exercises for your deep inner core. Don’t think because you’re otherwise ‘fit’ or you’re surgery was years ago that your core is functioning properly.
So we start with physio-based/clinical Pilates rehab movements, deep core connection exercises and diaphragm breathing.
I know, I know.. it sounds dull and you’re desperate to get to the sexy stuff.. but just wait and get this bit right first. Please!
This rehab stuff is all in the me+recovery programme that I developed for ConvaTec, and also in my book The Bowel Cancer Recovery Toolkit.
This video also shows the absolute basics of breathing and core connection.
Once you’ve got that nailed, you can progress onto specific rehab Pilates classes.
Note – this is not just any old Pilates. Even beginner classic Pilates is likely to be too tough.
You need physio led/clinical rehab Pilates. Luckily for you, I have just the answer.
Last year during the pandemic in 2020, I got my act together and launched The Ostomy Studio for this exact purpose. I have put together a range of 12 progressive videos on my website ‘The Ostomy Studio’ and also teach 3 LIVE classes each week. You can join from anywhere in the world.
The Ostomy Studio is just for people who have had stoma surgery, abdominal surgery or ostomy reversal. Essentially, it’s Clinical Pilates, rehab and confidence building for people after stoma surgery. It's fun, I give loads of coaching and most importantly, people feel safe.
Classes involve a mix of floor-based exercises, as well as standing, side lying and include balance, abdominal work, hip and glute work and help to rebuild confidence in movement. They work on everything from your shoulders to your toes.
It is an awesome way to give people confidence again. My clients feel more confident than they have in years. They tell me that they wish they have found it years ago, and why did their doctor never tell them to do this? I know... right.
Firstly we work on balance, shoulder/rib placement, ankle stability and breathing.. which will mean better posture, better technique and less risk of injury or hernia.
Then you’re ready to get to all those things on the ‘ultimately’ list – lifting weights, doing more traditional core exercises, pull ups, press ups and all that sexy gym fitness stuff.
So if you’re raring to get back to the gym for the first time, just take it slow and make sure you’re READY.
And when I say ‘READY’ I mean feeling strong and functional in that deep core.
Come and join me for a live class, watch one of my on-demand videos or book a 1:1 online session and I’ll teach you how to exercise in a ‘stoma friendly way’ and restore that deep core 😊.
Sarah Russell MSc
Clinical Pilates Teacher, Clinical Exercise Specialist, Cancer Rehab Trainer, Author and Educator. Lived with an ostomy since 2010. www.sarah-russell.co.uk www.theostomystudio.co.uk
