What is a stoma?
The word stoma is from the Greek word meaning ‘opening’ or ‘mouth’.
In this post we are going to be discussing Colostomy, Ileostomy and Urostomy.
The stoma is a surgical opening bringing the bowel to the surface of the abdomen, this allows for the elimination of either urine or faeces.
Why might someone require a stoma?
Stoma formation occurs for a variety of reasons. Some are temporary and some are permanent.
Some of the reasons for stoma formation are:
- Bowel cancer
- Crohns disease
- Diverticular disease
- Ulcerative colitis
- Faecal incontinence
- Bladder cancer
- Pelvic cancers
Types of Stoma
A colostomy may be temporary or permanent.
A colostomy involves taking a section of the colon and bringing it to the surface of the skin to form an opening.
Colostomies are usually sited to the left of the abdomen, although assumptions should be avoided and staff should always ensure that they find out from the patient’s medical notes.
If the colostomy is to be temporary then usually a loop colostomy will be performed.
In a loop colostomy, a loop of colon is pulled out through an incision in the abdomen. The loop is opened up and stitched to the skin to form an opening called a stoma.
The stoma has two openings that are close together. One is connected to the functioning part of the bowel, where waste leaves your body after the operation. The other opening is connected to the ‘inactive’ part of the bowel, leading to the rectum.
With an end colostomy, one end of the colon is used to form the stoma. End colostomies are usually permanent, however, there are times when they are created in an emergency. This is typically to treat bowel obstructions, cancer or traumatic injuries. These are sometimes reversible.
Ileostomies prevent waste from passing through the full length of the small intestine to the colon.
Ileostomies are typically sited on the right side of the abdomen.
Again, there are different types of ileostomy.
In a loop ileostomy, a loop of the small intestine is pulled out through an incision in the abdomen and stitched to form a stoma.
This type of ileostomy is reversible. It is performed to rest the bowel in people with Crohn’s disease or ulcerative colitis. It is also performed to allow healing of the small intestine or colon following bowel cancer treatment.
An end ileostomy is usually more permanent and is formed by separating the ileum from the colon and creating a stoma.
It is also possible to create an internal pouch to the anus, this means there is no need for a stoma and stools are passed in a similar way to normal. An ileo-anal pouch is usually permanent.
A urostomy bypasses the bladder, due to conditions such as bladder cancer or a traumatic injury. Bladder dysfunction caused by neurological conditions such as Multiple sclerosis or cerebral palsy is another reason why a urostomy may be necessary.
A urostomy will drain urine but it is important to remember that, as the piece of bowel has been used to form the stoma the usual bowel mucus will still be produced.
This means that the urine will have a cloudy colour with some jelly like sediment.
People with stomas may experience possible complications.
The skin around the stoma can become irritated and sore. Contacting the stoma care nurse may be required.
There are devices that can be used to stop the faeces from touching the skin and also barrier sprays and protective rings to protect the skin and promote healing. Most bag adhesives are hydrocolloids and promote skin healing.
It is a myth that the bags should not be attached to red and sore skin. In many cases the adhesive can help to heal the excoriation. Cutting a bag to a larger size to avoid this can actually make excoriation worse as it is increasing the corrosive faeces contact with the skin.
This is when a small channel or hole develops in the skin alongside the stoma. Depending on the position of the fistula, appropriate bags and good skin management may be all that is needed to treat this problem.
When the stoma sinks below the level of the skin after the initial swelling reduces. This can lead to leakages because the colostomy bag does not form a good seal.
Different types of pouches and bags can help, although further surgery may be required.
When the stoma comes out too far above the level of the skin; using a different type of colostomy bag can sometime help if the prolapse is small.
There is a high chance of re occurrence. Therefore the patient will often be required to manage the prolapse, as surgery may not be recommended.
Where the stoma becomes scarred and narrowed. Surgery will occur where there is a blockage risk.
A stomal ischaemia is a result of blood supply to the stoma being reduced after surgery. Further surgery is sometimes required.
If a patient presents with necrosis to their stoma it is important to obtain input from the stoma nurse or GP. They must ascertain whether it is affecting only the tip or whether the necrosis is travelling through to the bowel.
Patient’s with a colostomy may still have their rectum and anus intact, in these instances mucus discharge will continue to be produced by the bowel.
The mucus may have a sticky consistency and can either leak out or build up and cause an uncomfortable feeling in the bottom. The amount produced varies between people but is generally less if less of the bowel remains after surgery. It can vary from several episodes per day to every few weeks.
It is advised that people sit down on the toilet daily and push down to expel the discharge and prevent it from building up.
Since a stoma passes through the abdomen, it can compromise the strength of the muscular abdomen wall. These weakened muscles can come away from the stoma, weakening its integrity and causing the intestine to bulge.
Surgery is required for large hernias in some cases. For smaller hernias, patients can try a hernia belt to support the stoma.
A Parastomal hernia is not painful but it may be more difficult to hold the appliances in place and changing them can be more difficult.
Stomas can become blocked due to a build up of food.
Signs of a blockage include:
Not passing stools, bloating, swelling and cramps in the abdomen, nausea and vomiting as well as a swollen stoma.
Taking extra fluids to relieve the blockage. Seek medical advice if this does not relieve the blockage.
There is a risk of bowel perforation if the blockage remains.
Encourage patients to chew their food thoroughly, drink lots of fluids and avoid foods that trigger blockages such as corn, celery, nuts etc.
Reactions to food are so varied so patients are not told to avoid any particular food. Some people are very sensitive and some can continue to eat and drink all that they did before without any problems.
Flatulence and Wind
Again, there are no rules on food and drinks to avoid. However some may increase wind and flatulence. For example, spicy food such as curry as well as beer.
Patients need to work out their own triggers and manage them accordingly. Modern stoma bags use filters to avoid bags becoming full of air, coupled with an odour neutraliser to dispel any odours.
Next week we will discuss dietary advice as well as appliances designed for Ostomies.