Managing Difficult Thoughts & Feelings
Worry can take up a lot of attention when you are living with a stoma. You may find yourself predicting problems, checking repeatedly or being hard on yourself for feeling anxious. These tools offer ways to understand those patterns without dismissing genuine practical concerns. They complement, rather than replace, advice from your healthcare team.
Five tools to explore:
- Understand your worries:
Notice how a situation, a thought, a feeling and a response connect. For example, an invitation may bring the thought “My pouch will leak”, followed by anxiety and the urge to stay home. Write down what happened, what you predicted and what you did next. This can help distinguish a practical care question from a prediction about something that has not happened. - Question unhelpful predictions:
When you notice “Everyone will notice”, ask: “What evidence do I have? Am I treating a possibility as a certainty? How might I manage if someone asked?” A balanced response might be: “I don’t know what others will notice, and I can choose how much to explain.” The aim is a fairer perspective, not a promise that nothing difficult will happen. - Notice avoidance and choose a manageable step:
If worry is stopping you from an activity that your treating team considers appropriate, break it into smaller steps. A brief visit to a familiar place may be a starting point before a longer outing. Keep necessary care and precautions in place, and seek professional support if taking a step feels overwhelming. See Getting Back to Everyday Life for an example. - Distinguish necessary care from anxiety-driven checking:
Checking your pouch and asking for advice can be important parts of stoma care. If you repeatedly check or seek the same reassurance despite having addressed the practical issue, talk with your stomal therapy nurse about what care is appropriate for you. A psychologist can help you explore any remaining anxiety pattern. Do not delay necessary checks, ignore symptoms or change your care routine on the basis of this page. - Be kinder to yourself:
Notice self-critical thoughts such as “I should be coping better.” Ask what you would say to someone you cared about in the same situation. You might try: “This is a significant adjustment. I can find it difficult and still take one small step.” You do not have to earn support by managing everything on your own. If worry or low mood is affecting daily life, explore Getting Support or speak with your healthcare team.
The free Bladder and Bowel Anxiety Program explores these ideas in more depth, including threat beliefs and catastrophic thinking (Module 2), hypervigilance and body monitoring (Module 3), and shame, self-compassion and acceptance (Module 5).