A stoma – what it is, its types and what problems it can cause

Proven content

A stoma is a rescue for many people, in whom the digestive system and the work of organs do not function properly and require surgical intervention. What is a stoma and what are the different types of stoma? When is it necessary to have a stoma? What is the need for a surgical stoma?

The human digestive system begins in the mouth and ends in the rectum, through which the undigested contents are excreted. The entire process of digestion and absorption of nutrients and the elimination of residues is supported by digestive juices in the stomach, and then by digestive enzymes produced by the liver and pancreas. Nutrients from the digested content are absorbed in the small intestine into the bloodstream, while the remainder passes to the large intestine, where it forms and is excreted as feces through the rectum. This abbreviated digestive system shows the path that food consumed each day must travel.

What is a stoma?

The word “stoma” comes from the Greek στόμα and means a mouth or an opening. In the literature, this term is used interchangeably with other names such as: fistula, abdominal anus or artificial anus. A stoma is designed to support the functioning of the digestive and urinary systems in the event of organ malfunction. The use of a stoma solution in the absence of natural urination or defecation is a health-saving procedure and in some cases even life.

So what is a stoma? A stoma is a surgically fabricated jointlocated between the lumen of the digestive tract (small intestine, large intestine, bile ducts or ureter) and the body surface, i.e. the skin. Simply put, a stoma involves creating an opening during a surgical procedure that runs through the abdominal wall, connecting a malfunctioning organ of the digestive or urinary system with the external surface of the body, leading outside the body, among others: undigested food residues, urine or feces, into a removable bag, attached to the outside of the stoma.

When should a stool test be performed? Check: Why is it worth examining feces?

A brief history of the stoma

According to many records, the history of the stoma goes back to around 1000 BC, when Ehud killed the King of Moab Eglon by stabbing him with a dagger, which allowed all “impurities” to be released from his abdomen.

Further references to the origins of a stoma date back to ancient Greece. One of the most outstanding precursors of modern medicine, Hippocrates of Kos, thanks to the ongoing wars, noticed that wounds inflicted in the abdomen with a spear or a sword gave the chance of survival to soldiers with a damaged colon.

The surgeon of Emperor Marcus Aurelius-Galen also observed that in the event of damage to the large intestine, it was possible to save the patient by moving part of the damaged large intestine outside the abdominal cavity.

The above examples, in which the first references that can be compared to a stoma are searched for, were related to accidental injuries resulting from puncturing the abdomen with a knife or a sword. However, the first scheduled operations were aimed at emergence of a stoma, were carried out around the sixteenth century. These treatments were initially used to treat malformations of the colon, intestinal obstruction, or as a consequence of abdominal trauma.

The first description of the planned stoma surgery comes from 1710. The procedure was performed by Mr. Alexis de Littre, saving the health of a newborn with an overgrown anus. The stoma surgery, despite the fact that nowadays it is a rescue for many patients in the world, until the end of World War I was approached with great reserve and caution. This procedure was considered very dangerous and often fatal, therefore it was performed as rarely as possible.

The development of knowledge about the selection of a stoma was very difficult, because doctors were afraid to perform procedures that would allow them to broaden their knowledge, which significantly delayed research into the legitimacy of this procedure. The breakthrough came thanks to Professor Jan Mikulicz, who was the author of the concept of a two-stage colorectal surgery, which solved the problem of perioperative patient mortality.

When looking at the history of the stoma, it cannot be overlooked ostomy equipment. First ostomy bags were not created until the mid-twentieth century. In earlier years, intestinal secretions were collected with sponges and bandages. It was only thanks to surgeon Daniel Pring that the idea developed stomatotherapy. The first metal and glass bowls began to be used at the beginning of the 1954th century, and only before World War II did plastic materials begin to be used, which were easier to handle and lighter. Interestingly, it was only in XNUMX that disposable plastic bags began to be used, which significantly influenced the comfort and safety. stoma.

With what diseases of the anus do we most often report to a proctologist? Check: Embarrassing diseases of the anus

When is a stoma performed?

A stoma is a procedure that often saves lives, and certainly allows you to improve human functioning. Stoma induction surgery it can be urgent or planned depending on many factors. The decision to choose a stoma depends, among other things, on from the diagnosis of the underlying disease and its location, from the onset and advancement of peritonitis, and from the degree of colon filling with faeces.

A stoma can be permanent or temporary, depending on the type of disease or wound in the abdomen. The first reason that needs to be done stoma in the intestine, there is a problem with the excretion of debris of digested food through the anus. This disease occurs as a result of colon cancer or in the case of injuries resulting from, for example, a traffic accident.

Another disease that requires stoma is inflammatory bowel diseases such as Crohn’s disease and postoperative complications in the abdomen. A stoma is also installed in the case of cancer of the urinary tract, colon or rectum, as a growing tumor may lead to blockage of the gastrointestinal or urinary tract.

Often a stoma is emerging when an advanced tumor requires the excision of an entire organ, such as the rectum with anus or the bladder. Another indication for the emergence of a stoma is severe and difficult to treat rectovaginal and rectovaginal fistulas. In summary, the most common causes of stoma surgery are:

1. cancer of the colon, bladder, rectum, prostate;
2. inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis;
3. penetrating injuries and wounds in the abdominal area;
4. the occurrence of hereditary diseases, e.g. glandular polyposis of the large intestine;
5. birth defects, spina bifida;
6. obstruction in the ureter, making it difficult to drain urine from the kidney. 

If you want to know what a proctologist does and how to prepare for an appointment at his office, read: Proctology – just no shame, please

What does a stoma look like?

A stoma is a piece of the large or small intestine that has been led to the outside of the abdomen and curled up through a hole that is formed in the lower abdomen on the left or right side of the abdomen. The location of the stoma it depends on the site of the wound or the site of the lesion.

The stoma can take many different sizes, designs and shapes. Stands out:

1. final stoma resulting from cutting the intestine and bringing its end to the surface of the abdomen;
2. double-barreled stomawhich results from the passage of both ends of the intestine to the surface of the abdomen;
3. loop stoma, resulting from the introduction of the bowel loop, which is temporarily supported by the stoma.

The color of the stoma resembles the oral mucosa, it is pink-red. The size of the stoma is about 2-5 mm in diameter and it comes out above the skin by several to several dozen millimeters. In addition, the stoma is not innervated, so that the patient usually does not feel pain even when touched. From the outer part of the stoma, which is located on the skin surface, the patient must have a so-called a stoma bag into which intestinal contents or urine are flowing.

What is life like for a patient after stoma surgery? Read: Living with a stoma

Types of stoma

Split into types and types of stoma it depends on the location, size, shape, structure and time criterion.

The first division important from the patient’s point of view is the time criterion, where we distinguish two types of stoma. The first is temporary stomawhich is only applied temporarily, e.g. because of the time it takes for the operated bowel or bladder to heal or to heal an infection and prevent postoperative complications. If it is not possible to restore the former functions of the excretory system, it is necessary to select a second type of stoma, i.e. a definitive stoma– constant that the patient is associated with for the rest of his life.

Another division concerns building a stoma and allows you to highlight single-barreled stoma (final) and double-barreled stoma (side). The first is characterized by the mouth of the gastrointestinal tract ending at the sheaths of the abdominal cavity, while the remaining part remains cut or sewn up. In case of double-barreled stoma one opening is the end section of the intestine and the other is the natural pathway of the anus.

The last division concerns the place where the stoma is drawn out. There are three main types of stoma: colostomy, ileostomy and urostomy.

1. Colostomy – is a type of stoma that comes out of the large intestine called the abdominal rectum. This type of stoma is created when part of the large intestine needs to be permanently removed and the remainder is pulled out to remove digested intestinal contents. This procedure can be performed in the ascending colon, which results in the colostomy being on the right side, in the descending or sigmoid colon. Then the stoma is on the left side. However, in the case of a transverse colon stoma, it will be located around the midline of the abdomen. In the case of a colostomy, it is characterized by a slightly elongated round shape, red or purple in color, protruding approximately 1,5 cm above the level of the abdominal skin. When the stool passes, it is most often formed and passes regularly.
2. Ileostomy– is a type of stoma emerging in the small intestine at the level of its final section, its name comes from the Latin term “ileum”, meaning the ileum. An ileostomy is the operative connection of a part of the small intestine to the front wall of the abdominal cavity. This type of stoma has a round red shape and protrudes approximately 3 to 4 cm above the skin surface. The content of this type of stoma is more abundant and more fluid, and can irritate the skin because it contains digestive enzymes.
3. Urostomia – this is the last type of stoma created in the urinary tract. The operation of this type of stoma is based on the removal of the urinary fistula by attaching both ureters to the inset of the small intestine, through which they are led directly outside the body. The use of a urostomy may reduce the storage capacity of urine and affect the uncontrolled release of its contents.

If you want to know more about urostomy read on: Urostomy – what is it?

Types of ostomy systems

The emerging stoma requires the proper adjustment of the ostomy equipment, which will allow for normal functioning and improve the quality of life. There are two types of ostomy bags in ostomy systems: one and two-piece. In the case of the former, the bag is glued directly to the abdomen, and the plate is permanently connected to the bag, whose task is to collect faeces and urine. With two-piece hardware, when changing the bag, there is no need to remove the plaque, only the bag, as the plaque remains stuck to the skin.

Ostomy systems are designed in such a way that you can easily hide them under your clothes and are practically invisible. In the case of urostomy bags, they are often equipped with a tap that allows urine to be drained directly from the bag into the toilet and have a system that prevents urine from flowing back into the urinary tract.

The stoma system is designed in such a way that it allows you to take a bath or shower without removing them, as they are 100% waterproof. In the case of colo- and ileostomy bags, they are equipped with filters that remove gases and prevent the bag from inflating. Each type of stoma allows you to return to a normal life after surgery thanks to the care accessories, appropriate stoma equipment, as well as hygiene and careful care for the stoma.

What bowel diseases are most often diagnosed? Read: Bowel diseases – how to recognize them and how to treat them?

How do I care for my stoma?

The emerging stoma, which takes over the function of excreting intestinal, bile or urinary contents, requires, in addition to appropriate equipment, above all, appropriate and thorough care. Adequate hygiene and keeping the stoma in good condition can help you return to an active and normal life faster.

Caring for each type of stoma is similar. After each stoma surgery, before leaving the hospital, each patient is trained in the principles of hygiene and how to replace the pouch. The best way to learn how to properly handle your stoma is to do the nursing activities under the supervision of a nurse or stoma clinic.

The most important rule in proper ostomy care First, the frequency of pouch changes at the stoma. If the stoma is closer to the anus, the pouch may be changed less frequently. It should be remembered that haste and a feeling of embarrassment is an obstacle in this activity, so it is worth taking care of a room where we will feel at ease and where we will have access to a washbasin with running water and a toilet.

Another important issue is the stock of ostomy equipment. We should not allow a situation where we are left without a bag and the medical shop is closed or the doctor giving the order is unavailable.

The last important step in stoma care is keeping your skin clean. When changing the bag, first wash the skin with soap and water, then dry it thoroughly. In the case of sensitive skin, you can use special preparations for ostomates, such as SaltAir Soap or WipeAway, which will protect the skin from irritation and prevent leakage of intestinal contents under the plate.

Medonet Market’s offer also includes Anusir anal and stoma cleansing foam.

An important issue in stoma care is not to use lotions, oils, creams on the skin around the stoma. The use of oily, oily products can reduce the adhesion of the ostomy pouch and reduce its seal. People with a stoma are advised to epilate where the bag is applied, as it increases the adhesion and better adherence to the skin.

Compliance with the above rules and doctor’s recommendations allows you to reduce the risk of complications and skin irritation, which affects the quality and improvement of the life of the stoma.

If you want to know what stoma atlases are, read about the “STOMAlife. Discover the stoma “: Ostomy atlas – help in patient education

Stoma – what are the complications and consequences?

Having a stoma is a necessary procedure to improve health, eliminate the disease, and it is often also needed to save the patient’s life. The decision to undergo the procedure is often very difficult and usually requires the support of not only a surgeon or a nurse, but also a psychologist, dietitian, physiotherapist and, above all, the closest family and friends.

As with any operation, the creation of a stoma can cause complications and undesirable consequences. The main complications that can occur after a stoma are made are those that are associated primarily with the disease that forced the stoma. It stands out among the complications early complications of a stomasuch as: stoma ischemia and necrosis, bleeding, infection, stenosis or retraction, and late stoma complicationsin which there are, for example, a parastomal hernia, obstruction or relapse of the disease.

In addition to complications related to the proper functioning of organs and the stoma, a very important aspect are systemic complications related to psychological, sexological or metabolic problems.

The first of the undesirable the consequences of a psychological nature is to lower one’s self-esteem, avoid interpersonal contacts, and marginalizing social roles. Stomics can be prone to many psychological disorders at this time, such as depression, feelings of rejection or a wave of high self-criticism. It is very important that a person undergoing stoma surgery is provided with the help of a psychologist and the support of their loved ones, whose role is primarily to create positive relationships, not to treat the stoma as a cripple or a defective person in connection with their disease.

Another negative consequence of having a stoma can be sexual dysfunction. A frequent effect of the emergence of a stoma is a decrease in libido and deliberate avoidance of intimate contacts by patients. Having a stoma does not entail any contraindications when it comes to sexual contact or the parental aspect. This problem is of a psychological and social nature, so it is very important to be accepted by the partner and build in the sick person a sense of acceptance for their own appearance and illness.

The final ramifications of having a stoma are metabolic disorders. Most often, this problem concerns patients who have had an ileostomy, because in this case the body also loses electrolytes along with the body fluids. An ileostomy, which bypasses the large intestine responsible for the absorption of water, electrolytes and the formation of stools, causes about 1000 ml of semi-liquid content to irritate the skin due to the presence of digestive enzymes in it. The above case may lead to a bacterial infection, which causes a rapid increase in the excreted content and, consequently, may lead to dehydration and electrolyte disturbances.

Although having a stoma may have some complications and consequences, it plays a huge role in improving the health and functionality of the human body. It should be remembered that the appropriate support of specialists, family, hygiene rules and a properly balanced diet allow the patient to avoid most of the complications that may occur after the emergence of a stoma.

What are the correlations between mental health and nutrition, sleep, physical activity, and interpersonal relationships? Check: Sanity

Dietary recommendation for a person with a stoma

A person with a stoma does not have to follow a specialized diet or follow strict dietary recommendations. However, an important point when it comes to a dietary recommendation is to avoid foods that can cause gas, constipation or diarrhea, and foods that cause excessive gas build-up.

With the passage of time and after observing the body’s own body, the stomic can properly choose the products that should be eliminated so that the digestive system works efficiently and does not cause unnecessary ailments.

The care of a dietitian is recommended immediately after the ostomy surgery. The diet should be properly adjusted depending on the length of the bowel resection and the site of the anastomosis.

An important issue in the diet in the initial phase is the introduction of products or dishes one at a time to make it easier for the stoma to notice allergic reactions or food intolerances. Meals should be eaten in small portions and should initially consist of a small amount of ingredients, which will make it easier to see how the body reacts to the different foods that make up the dish.

In the case of removing a part of the small intestine, it is necessary to remember when arranging the menu to remove or very limit the consumption of fatty foods and dishes, because the digestion of fats may be slightly disturbed, especially in the initial period after the emergence of the stoma. The first 3 days after stoma surgery are very important, so the patient should eat meals slowly and in small amounts and chew them thoroughly.

In addition, it is important that the meals are initially fresh, with no preservatives or artificial colors, and should not be processed artificially. The diet of people with an ostomy should be properly balanced, provide as many vitamins and minerals as possible.

Adequate hydration is also an important issue, a person with a stoma should drink about 2 liters of water a day. An important issue raised by nutritionists in the case of people with a stoma is to avoid products that cause gas and gas, and to enrich the diet with products that reduce these ailments, e.g. natural yoghurt, kefir or buttermilk.

Stoma menu It doesn’t have to be drastic, but it is recommended to avoid excess consumption of certain foods. These products include: carbonated drinks, excessive amounts of fruit and vegetables (e.g. peas, beans, cabbage, onions, broad beans), alcohol (especially beer), sweets (e.g. containing chocolate), spicy spices, fried foods and large amount of eggs.

If you want to learn the principles of a healthy diet, read: Healthy eating – the most important rules

Stomics card – what is it? Is it worth having it?

In some situations, the functioning of the stoma is quite difficult. Most of the problems that people with an ostomy may encounter are travel-related situations, i.e. border controls or airline checks.

The organizers of the STOMA-life campaign came out with the initiative of the so-called a stoma card, which is designed to facilitate the functioning of people with an ostomy. Thanks to its format, the ostomy card fits easily into a wallet. The card is accompanied by a medical certificate confirmed by the attending physician about the fact of having a stoma. The stoma card is translated into seven languages: English, German, French, Spanish, , Italian and Greek, making it an essential document to facilitate travel for people with an ostomy. The ostomy card allows you to avoid unpleasant situations during airline checks or border checks, or it can be desirable in the event of a sudden need to change the ostomy pouch, e.g. in the room intended for mother and child.

A big problem for people with an ostomy is the regulations regarding the transport of hand luggage, medicines and cleaning agents. These regulations do not regulate the issue of people who require appropriate ostomy appliances, i.e. bags, clips, clasps, sealing rings, which may contain metal elements, or products intended for the care of the stoma area, which can often be in the form of sprays. It seems important to have a stoma card, but most of all it is important to raise social awareness of having a stoma and difficulties in everyday life.

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