Stoma


What is a stoma?

A stoma is an artificial opening to or from the intestine (which is also known as the gut or bowel) on the abdominal wall usually created by a surgeon. Occasionally, it is an artificial opening in the urinary tract, called a urostomy.

The right amount of nutritions can greatly affect the outcomes of stoma.

When is a stoma required?

A stoma is necessary when parts of the normal intestine must be bypassed, for example when bowel surgery has removed important lengths of the intestine, or when food cannot be taken in by mouth.

The main different types of stoma depend on the part of the intestine that forms the opening:

Gastrostomy is an opening from the skin directly into the stomach, to allow feeding.

Jejunostom is an opening from the first part of the small bowel, also used for feeding,

Ileostomy is an opening from the small bowel, to allow faeces to leave the body without passing through the large bowel,

Colostomy is an opening from the large bowel, to allow faeces to bypass the anus.

Another type of stoma, called a Urostomy, is an artificial connection between the urinary tract (the kidneys, bladder and tubes that connect them) and the abdominal wall, sometimes referred to as a 'urinary conduit'.

Stomas may be temporary (to allow another part of the intestine to heal), or permanent. If they are temporary another operation is required to close them.

Stomas are carefully sited on the abdominal wall so that they can be hidden and yet still function. With a colostomy or ileostomy, a special bag is attached to the site that collects the faeces. The opening on the abdominal wall must be well cared for because bowel contents can irritate the skin, which results in ulceration and infection. Unlike at the anus, no mechanisms are in place to regulate the flow of faeces. The use of appliances such as a bag-and-seal over and around the stoma can, in turn, cause damage to the skin from their frequent removal, and from allergy to the materials used.

What necessitates a stoma and who is at risk?

Stomas are commonly necessary in sufferers of inflammatory bowel disease, including Crohn's disease and ulcerative colitis. They are also formed during operations for bowel cancer, diverticular disease and after accidental damage to the bowel wall.

Urostomies are not common and are performed if there is a problem that prevents urine produced by the kidneys from reaching the outside of the body. Such problems can arise because of cancer, or pelvic or abdominal surgery.

What are the common symptoms and complications of having a stoma?

The problems of a stoma can often be psychological, and you may be initially shocked by the appearance of your stoma. You may experience a 'phantom rectum' with the urge to defecate (empty the bowels) for several days or weeks after formation of the stoma. Your body image may be affected, and you will need the support and understanding of your family and friends, and the professionals that care for you, to help you through this time and to minimize any effects on your quality of life.

Once the initial decision to form a stoma has been reached, you will be introduced to a specialist stoma nurse who can explain the implications for everyday life. The nurse can show you the different type of appliances available, how they should be used and how to acquire them. A stoma nurse can also put you in contact with support groups and other people who have stomas, for reassurance and help.

After you return home, the stoma nurse works in conjunction with the GP and district nurses to ensure you are confident managing the stoma.