Intestinal stoma. When does a stoma emerge? Does it allow you to function normally? [WE EXPLAIN]

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The intestinal stoma is used in the surgical treatment of serious diseases of the gastrointestinal tract. Having a stoma can save the lives of patients with obstruction or after surgery to remove sections of the intestine. What exactly is a stoma and when is it made? What complications may occur after the procedure?

What is an intestinal stoma?

The intestinal stoma is an artificially created, i.e. surgical, connection of the intestine with the surface of the skin or mucosa. This means that an opening is created in the abdominal wall through which a fragment of the intestine protrudes above the surface of the skin. In this way, the intestine is allowed to continue working in diseases that prevent the patient from functioning normally, including cancer and inflammatory bowel diseases.

An intestinal stoma is sometimes also referred to as a stoma intestinal fistula. It should be noted here, however, that there is a stoma artificial fistula, selected for medicinal purposes. The body may develop a fistula spontaneously, which is a pathological phenomenon resulting from disease processes. In this sense, a fistula means a connection between two organs, more rarely between more than one (internal fistulas), or between a specific organ and the skin (external fistulas).

There must be specific medical indications for the stoma to be performed. While surgery may be scheduled as a follow-up treatment, it is sometimes performed as an emergency procedure. This happens especially with intestinal obstruction or perforation of the intestinal wall. Depending on the medical recommendations, the stoma is either final or temporary.

Check: Anal fistula – causes, symptoms and diagnosis

When is stoma surgery performed?

Having a stoma is a procedure that affects the patient’s quality of life in the long term – it requires compliance with the rules of hygiene, but also affects the psyche. For this reason, the operation is performed for clear medical reasons, sometimes to save the patient’s life.

Main indications for an intestinal stoma appear in the following diseases:

1. colorectal cancer – this disease is the most common indication for intestinal stoma surgery, although the choice of treatment method depends on the stage of the disease (whether surgical excision of the intestine is necessary), therefore it is crucial to detect this cancer as early as possible;
2. Crohn’s disease – it is an inflammation that most often develops within the ileum / large intestine, which is usually diagnosed in young people; can lead to the formation of abscesses, fistulas or obstruction, with some complications leading to the creation of a stoma;
3. ulcerative colitis – complications caused by the disease (similar to Crohn’s disease) may be an indication for the creation of an intestinal stoma;
4. Ogilvi’s syndrome (pseudo-obstruction of the large intestine) – if surgical intervention is indicated in the treatment of the disease, if possible, percutaneous endoscopy is performed cecostomywhich consists in creating the caecal anus; if the situation requires it
5. multiple familial polyposis – one of the varieties of the disease is Gardner’s syndrome, requires monitoring of polyps appearing in the intestines;
6. severe and complicated diverticular disease of the colon;
7. intestinal ischemia with complications;
8. acute intestinal obstruction;
9. abdominal injuries;
10. disruption of the intestine (perforation) – may be one of the complications of intestinal diseases or arise as a result of mechanical factors, i.e. injuries.

Stoma – possible complications

While having an intestinal stoma can be a life-saving procedure, it is still a surgical procedure that may have complications. Bleeding, swelling, ischemia, infection, necrosis or periostomy fistula. There is a risk over a longer period of time periostomy hernia, the formation of strictures, mucosal implants or recurrence of the disease. Some postoperative complications may be related to incorrect positioning of the stoma.

The intestinal stoma is associated not only with local and surgery-related complications, but also some negative systemic effects. These can include:

1. metabolic and water-electrolyte problems;
2. vitamin and mineral deficiencies, especially potassium and magnesium; if the ileum is removed, vitamin B12 deficiency is possible, leading to the development of megaloblastic anemia in the long term;
3. fatty diarrhea in patients after partial or complete resection (removal) of the small or large intestine;
4. increased risk of nephrolithiasis or gallstones in patients with an ileostomy;
5. psychosocial problems, including lowered self-esteem, sense of mutilation, conscious limitation of interpersonal contacts;
6. disorders affecting the sexual sphere, e.g. decreased libido, avoidance of sexual contact.

Types of intestinal stoma

There are the following types of bowel stoma:

1. colostomy – colon extraction is performed when the rectum is removed, but also in other situations when it is impossible to defecate by natural means; in the case of a colostomy, the excreted stool is unchanged;
2. transwersostomia – Double-barrel (loop) colostomy performed on the right side of the transverse colon has two entrances and is temporary;
3. ileostomy – the emergence of the small intestine is usually carried out in young people suffering from inflammatory bowel diseases; this type of stoma is typically located on the right side of the small intestine and the resulting intestinal contents are semi-fluid.

A stoma is produced not only for diseases of the intestine. Appropriate treatments are also used in the case of diseases affecting other systems. In addition to the types of stoma mentioned above, treatment in the form of an artificial fistula may also apply to the urinary tract (urostomia) or bile ducts (hepatojejunostomia).

What is life like with a stoma?

Patients with a stoma require special medical and therapeutic care, in which various specialized medical staff should be involved. The situation of the patient is slightly different before the surgery, in the intraoperative phase, and after the stoma is selected. For this reason, both the surgeon responsible for the procedure and the nurse, physiotherapist, dietitian and psychotherapist play an important role.

Read more: Living with a stoma. What awaits the patient after surgery?

At the stage of preparation for surgery, the patient can get all the necessary information about everyday functioning with a stoma, about the necessary equipment and hygiene rules. This makes it easier to later adapt to changes in the appearance of the body. People who had to undergo emergency surgery and had the opportunity to mentally prepare for the effects of this procedure are in a more difficult situation.

Special preparations can be used for stoma hygiene, e.g. a medical device – Anusir anal and stoma cleansing foam.

In practice, a patient with a stoma has to learn to function in a new situation, to look after the stoma on their own, or possibly to seek the care of other people. It is important to follow the recommendations regarding diet, physical activity and work. Acceptance of the new situation is one of the key factors influencing the patient’s quality of life.

After having a stoma, some patients may feel anxious, fearful, hurt or depressed, and even experience depressive symptoms or suicidal thoughts. In such a situation, it is worth seeking help from a psychotherapist. The process of adapting and building a positive outlook on life after surgery may take less time for some people and more time for others. Achieving this level and learning the practical activities related to self-care, however, allow you to gain self-confidence, as well as trouble-free functioning on a mental and physical level.

Read also:

1. A stoma. This “something” saved my life
2. Psycho-oncology – what is it and what is its role?
3. Bowel diseases – how to recognize them and how to treat them?

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