Stoma Care

What is a Stoma?

Stoma comes from the Greek word meaning mouth/opening. It is a surgically created opening to dispel wastes out of the body.

What are the types of Stoma?

There are several types of stoma, depending on the procedure used to create them:
Colostomy: A stoma is created with part of your colon, also known as your large intestine, to bypass your rectum. In some cases, you might have the lower part of your colon removed, leading to a permanent stoma. A colostomy can also be temporary if your colon just needs to heal. You might need a colostomy if you have colon or rectal cancer, a colon injury, or a blockage in your colon.

Urostomy: Your doctor will make a pouch using your small intestine. They’ll connect your ureters to this pouch so that urine can drain outside of your body without passing through your bladder. You might need a urostomy if your bladder is diseased or damaged.

Ileostomy: A stoma is created using your small intestine so waste can bypass your colon and rectum. This is the most common type of temporary stoma, but they can also be permanent. You may need an ileostomy if you have Crohn’s disease, ulcerative colitis, or bowel cancer.

Is the stoma going to be permanent?

Depending on the nature of your disease, the doctor decides on your stoma. Usually in patients with rectal/anal cancer where it’s difficult preserve the sphincters a permanent stoma is required.

Why is a stoma procedure done?

Stoma procedure is usually done to divert the wastes so that lower anastomosis of intestine stays healthy.

Is a stoma procedure required for all patients?

Most of the rectal cancer patients require a stoma procedure. Majority of right colon cancer patients do not require a stoma.

Are there any complications?

Although stoma procedures are a relatively common and safe surgery, there may be some possible complications such as:
Skin irritation: This is a common problem that’s caused by the adhesive on your ostomy appliance. Try using a different appliance or changing the adhesive you use.

Dehydration: Having a lot of waste exit through your stoma can lead to dehydration. In most cases, you can rehydrate yourself by drinking more fluids, but severe cases might require hospitalization. Avoiding foods high in sugar, salt and fat can decrease your risk of dehydration.

Leakage: If your stoma appliance doesn’t fit properly, it can leak. If this happens, you probably need a new appliance that fits better.

Bowel obstruction: If your food isn’t chewed or properly digested, it can cause a blockage in your intestines. Symptoms of a blockage include cramps, stomach pain, and a sudden decrease in waste. Call your doctor if you notice any symptoms of a blockage. While it may clear up on its own, some blockages require additional treatment.

Retraction: It’s possible for your stoma to move inward, usually due to weight gain, scar tissue, or improper placement. Retraction makes it hard to attach your appliance and can also cause irritation and leakage. Accessory products for your appliance can help, but a new stoma might be needed in severe cases.

Parastomal hernia: This is a frequent complication that happens when your intestine starts to press outward through the opening. These are very common and often go away on their own. However, in some cases you may need surgery to repair it.

Necrosis: Necrosis refers to tissue death, which happens when blood flow to your stoma is reduced or cut off. When this happens, it’s usually within the first few days after surgery.

What is a stoma bag?

A Stoma bag is a pouch, which is attached to the abdomen by an adhesive, to collect the output from stoma.

How frequently do I need to empty the stoma bag?

There is no exact timeline for this and it depends on the output. Generally, output from urostomy > ileostomy > colostomy and hence frequency is also more respectively.

How frequently does the stoma bag need to be changed?

A Stoma bag needs to be changed every 5-7days.

Can I bathe with a stoma pouch?

You may bathe with or without your pouching system in place. If you wish to take a shower or bath with your pouch off, you can do so. Normal exposure to air or contact with soap and water will not harm the stoma, and water does not enter the opening. Choose a time for bathing when the bowel is less active. You can also leave your pouch on while bathing or use a bathing belt

What about my diet, should I be making changes?

There may be some modifications in your diet according to the type of ostomy surgery. People with colostomy and ileostomy surgery should return to their normal diet after a period of adjustment. Introduce foods back into your diet a little at a time and monitor the effect of each food on the ostomy function. Chew your food well and drink plenty of fluids. Some less digestible or high roughage foods are more likely to create potential for blockage problems (i.e., corn, coconut, mushrooms, nuts, raw fruits and vegetables).

There are no eating restrictions as a result of urostomy surgery. Urostomates should drink plenty of liquids each day following the doctor’s recommendations.

Will I be able to wear the same clothes as before?

Whatever you wore before surgery, you can wear afterward with very few exceptions. Many pouching systems are made today that are unnoticeable even when wearing the most stylish, form fitting clothing for men and women.

Depending on your stoma location you might find belts uncomfortable or restrictive. Some people choose to wear higher or loose waistbands on trousers. Cotton knit or stretch underpants may give the support and security you need. Some men find that jockey type shorts help support the pouch.

While swimming, women may want to choose a swimsuit that has a lining to provide a smoother profile. Stretch/Lycra undergarments help support and smooth out any bulges or outlines. Men may prefer to wear a sleeveless vest with trunks if the stoma is above the belt line.

What about sex and intimacy? Will I be able to get pregnant after surgery?

Sexual relationships and intimacy are important and fulfilling aspects of your life that should continue after ostomy surgery. Your attitude is a key factor in re-establishing sexual expression and intimacy. A period of adjustment after surgery is to be expected. Sexual function in women is usually not impaired, while sexual potency of men may sometimes be affected, usually only temporarily, unless the prostate is affected, in which case your doctor would give you the best possible advice.

In women, the ability to conceive does not change and pregnancy and delivery should be normal after ostomy surgery. However, if you are thinking about becoming pregnant, you should first check with your doctor about any other related/unrelated health problems.

Can I travel?

Travelling is no bar. In fact many people with ostomies travel extensively, from business/work related trips to camping trips to cruises to plane excursions around the world. Take along enough supplies to last the entire trip plus some extra, double what you think you may need. Checked luggage sometimes gets lost, carry an extra pouching system and other supplies on the plane with you. When traveling by car, keep your supplies in the coolest part, and avoid the boot. Seat belts, once adjusted comfortably will not harm the stoma.

When going overseas, apart from the obvious extra supplies, you may like to take referral lists for physicians and medical centres, and some medication to control any diarrhoea and stop the fluid and electrolyte loss. When going through customs or luggage inspection, a note from your doctor stating that you need to carry ostomy supplies and medications by hand may be helpful.

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