Stoma

An ostomy is a surgically made opening from the inside of an organ to the outside.

Stoma is the Greek for mouth or opening. The stoma is the part of the ostomy attached to the skin. A stoma bag is then attached to the opening, in the case of colostomies, ileostomies and urostomies, so that either faeces or urine drain into this bag. There are various types of ostomies – for example:

  • Colostomy – opening from the large intestine to the abdominal wall so faeces bypass the anal canal.
  • Ileostomy – opening from the small intestine to the abdominal wall so faeces bypass the large intestine and the anal canal.
  • Urostomy – connection between the urinary tract and abdominal wall leading to a ‘urinary conduit’ so urine passes straight into a stoma bag and thus bypasses the urethra.
  • Gastrostomy and jejunostomy – openings between the stomach and jejunum respectively and the abdominal wall, used predominantly for enteral feeding tubes.

Reasons for stomas

  • Gastrointestinal stomas are used in various disorders – eg, inflammatory bowel disease, neoplasia and diverticular disease.
  • Urostomies are more rare and are usually used following invasive neoplasia of the bladder or prostate.
  • Stomas may be temporary or permanent. Temporary stomas are usually reversed at a later date, usually allowing the blind loop of intestine to recover.

Patient preparation

  • Once a decision is made for a stoma, patients will be introduced to the stoma nurse specialist. The role of the nurse specialist should not be underestimated. They can provide counselling as well as information on the following:
    • The stoma procedure.
    • Practical aspects – eg, types of stoma bags and various equipment available.
    • Reassurance that life can continue as normal – including bathing, showering and swimming (adhesive is waterproof).
    • How to change bags.
    • How to detect and manage the most common problems – eg, bleeding on changing bags.
  • A really important part of planning patients for stomas is to ensure the site is appropriate. Poor siting leads to a stoma which the patient has difficulty in changing and cleaning. This leads to increased risk of skin, and other, complications.
  • Once patients are discharged they are usually supported within the community by their GP and district nurses, especially in the initial period of adjustment.
  • Bags must not be restricted by clothing or waistlines.
  • Faeces and urine are usually flushed down the toilet – but the bags must not be discarded by flushing. Ileostomies and urostomies usually have features which allow the contents to be drained.

Stomas and travelling

Wind can become worse for patients when they travel in aircraft. The change in pressure within the cabin can lead to large amounts of wind being passed. This can be exacerbated by drinking fizzy drinks and beer.

Stomas and sports

Caps are available that will block off the stoma for patients during sporting activities.

Medicines that might need to be prescribed for patients with stomas

Most patients will eventually self-manage their stomas. They can usually alter any output-related problems by changing their diet. However, sometimes medication will be needed to relieve problems. These include medication:

  • For relief of diarrhoea – eg, loperamide, opiates, codeine phosphate.
  • For relief of constipation – eg, magnesium hydroxide, ispaghula husk (not for patients with ileostomies, as it increases salt and water loss).