What is stoma?
An ostomy is an opening made on the abdomen to bring part of the bowel or urinary system to the surface to create a new exit route for excretion of stool and gas or urine. This new open end of the bowel or ureter is known as a stoma.
A urine-draining stoma is called a urostomy, and a stoma formed from the bowel is referred to as a colostomy or an ileostomy, depending on which part of the bowel it is connected to.
What does a stoma look like?
A stoma is a shiny, pink-red donut-shaped hole on the surface of the skin. They can vary in size; a colostomy should protrude a little and is about 1.5 to 2.5cm, while an ileostomy is around 2.5 to 3.5cm.
Why would someone need a stoma?
There are a number of bowel conditions that might mean someone needs a stoma, such as:
- Crohns, ulcerative colitis, diverticulitis, or other serious inflammatory bowel diseases.
- Ischaemic bowel – this is a condition where blood flow to part of the bowel is restricted, causing areas of tissue death.
- Cancer – cancers of the colon or rectum.
- Congenital bowel defects – these are bowel problems that are present from birth; some babies’ digestive systems don’t fully form and need surgery to correct this. They may need a permanent, or a reversible stoma.
Types of Stoma
An ileostomy drains stool from the ileum, or the small intestine. Stool in the ileum is liquid and high in digestive enzymes, so extra care must be taken to prevent the stool from damaging the skin around the stoma.
Colostomies are an opening to drain stool from the large intestine, or colon. There are various points along the colon where stomas might be created, depending on the reason that they’re needed. The large intestine is where most of the liquids are absorbed from the digestive system, and so the type of stool passed varies depending on where along the length of the colon the stoma is located. A stoma in the ascending colon, the first part of the large intestine, is usually very liquid, similar to the stool passed through an ileostomy. A stoma on the transverse colon will be slightly thicker and more formed. Stomas towards the end of the bowel, at the descending or sigmoid colon, should be formed and close to the consistency of the individual’s normal bowel movements.
A urostomy is created to drain urine when there is a permanent problem with the bladder or lower urinary tract. A urostomy is usually on the lower right abdomen, and a urostomy bag has a kind of tap at the bottom to drain urine.
A stoma may be permanent or temporary. A temporary stoma may be created when lower parts of the bowel need to ‘rest’ after bowel infections, trauma or surgery and will be reversed once healed.
A stoma that’s reversible can look like two stomas next to each other in a kind of figure ‘8’ pattern. One side will be the active stoma where stool passes through, while the other is the entrance to the lower part of the bowel. This may drain some mucous and the two ends can be rejoined at a later date.
What to Eat When You Have a Stoma
Most people can go back to having a normal healthy diet with a stoma, although this will be a gradual process after the surgery. Certain foods may affect the way your stoma works and reintroducing the foods you love gradually will help you work out which foods affect you.
Although the aim is to get back to a normal healthy diet, there are some foods that can be more problematic with a stoma. Practise caution when eating:
- Foods that have indigestible parts: For example, sweetcorn, peas, seeds, and the skins of some fruit like apples can cause blockages in stomas.
- High fibre foods: Choose lower fibre foods. For example, choose white bread instead of whole grain, white rice instead of brown.
- Vegetables that make you more flatulent: Some people find that they pass more gas when they have certain vegetables, such as broccoli and cabbage. Fizzy drinks are also a culprit.
It is also very important to stay hydrated, so drink plenty of fluids.
When you have a stoma, particularly higher in the digestive system, like an ileostomy, you may have some problems absorbing all the nutrients from your diet. If this is likely to be the case, you should be given specialist advice and may need regular check-ups with blood tests to ensure that any nutrient deficiencies are picked up and treated.
Stoma Care Tips
The skin around stomas, particularly ileostomies or colostomies which pass loose, liquid stool, can become very raw and broken when the stool is in contact with the skin. Carefully measuring the size of the stoma and cutting the hole in the flange of the stoma bag can prevent this kind of skin damage. The hole should fit over the stoma without restricting the stoma but with minimum skin exposure to the contents. Making sure that the skin is clean and dry before the stoma bag is replaced is important, and if the skin around the stoma is hairy, carefully clipping or shaving the area can ensure a good seal.
The stoma should be a pink-red colour, and the skin around the stoma should look healthy. It takes a little time for swelling to settle down after surgery, but once you’re used to your stoma, you’ll be able to notice if anything isn’t right; if the skin is breaking down, is red and hot around it, or if the stoma becomes very dark in colour, these can be a sign of a problem that needs urgent medical attention.
There are different brands, sizes and shapes of stoma bags and it may take a few tries to find one that suits you. Stoma bags usually have an open end that folds up with a clip or Velcro for emptying. Others are closed and need to be changed every time they’re full; this kind more commonly clips on to the adhesive part to avoid continuously removing strong adhesive from the skin. The adhesive section of the bag usually stays affixed for several days and leaving it in place when it’s well stuck and well fitting is a good way to protect your skin.
Sometimes the skin around a stoma can protrude or be sunken or lumpy. Some stoma bags are specially designed to fit well over these different areas and your stoma nurse can advise you on products that may be the best fit.
Common Concerns About Having A Stoma
It is natural to have mixed feelings about having a stoma. It can have an impact on your self-image and it takes time to get used to the changes. Although it will mean a bit of adjustment, there’s no reason you can’t continue to do all the things you did before your stoma. Once you and your body get to know what it’s like to live with a stoma, you might be able to anticipate the time of the day when your stoma is more or less active, and plan your activities around that. Here are some commonly asked questions about things you can or cannot do with a stoma:
A stoma doesn’t have to stop you from having a healthy sex life and you can do it whenever you feel ready after your operation. It may take a little adjustment; some positions may now be more comfortable than others, and it may take a little time to get used to the changes in your body. Flat stoma covers are available to wear for shorter periods, but there’s also no reason you can’t wear your usual stoma bag during times of intimacy.
You can absolutely continue to travel and holiday with a stoma. If you’re flying, make sure you have everything you might need for your stoma care on board, and take plenty of spares. If you’re going through security checks, letting the staff know you have a stoma means they can perform their checks in a discreet and sensitive way.
Some people find that the air pressure changes during a flight can cause their bag to fill with air so it might be helpful to use the facilities regularly to expel excess air.
You may not feel up to it for a while after surgery, but having a stoma should not stop you from swimming. A well-fitted stoma bag with a tight adhesive barrier should be enough to keep you secure during swimming. Extra adhesive tape can help if you’re concerned about the edges coming unstuck in the water. Specially designed swimming costumes are available, but many people find that choosing normal swimwear is fine.
Returning To Work
Once you’ve recovered from surgery and are used to life with a stoma, you may want – or need – to think about returning to work. How easy this will depend in part on the type of work you do; a job with a lot of heavy lifting, bending and stretching will naturally require more support and adjustments than a more sedentary job. Your employer should make reasonable adjustments to support you in returning to work, including ensuring you have enough time and an appropriate place for stoma care throughout the day.
Support Available for Individuals With A Stoma
There are lots of resources available, both online and locally, to support people living with stomas. Some people may need extra help and support with their stoma care, particularly during the recovery period after surgery. Long or short-term care solutions are available to support you throughout the transition period and beyond. Specialist nursing care for complex stomas and wounds can promote good healing and prevent complications, enabling you to continue living life to the fullest.
- Strong, S. A. (2016). The difficult stoma: challenges and strategies. Clinics in colon and rectal surgery, 29(2), 152. https://dx.doi.org/10.1055%2Fs-0036-1580628
- Bladder and Bowel Community (2020) What is a Stoma? bladderandbowel.org https://www.bladderandbowel.org/bowel/stoma/what-is-a-stoma/
- Burgess-Stocks, J. (2020) Eating with an Ostomy. United Ostomy Associations of America https://www.ostomy.org/wp-content/uploads/2020/07/Eating_with_an_Ostomy_2020-07.pdf
- Anaraki, F., Vafaie, M., Behboo, R., Maghsoodi, N., Esmaeilpour, S., & Safaee, A. (2012). Quality of life outcomes in patients living with stoma. Indian journal of palliative care, 18(3), 176. https://dx.doi.org/10.4103%2F0973-1075.105687