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The decision: either surgery to remove part of the bowel and create a stoma, or the risk of further spreading of the lesions to the abdominal cavity. The first is associated with certain changes in the current life, the second with the risk of losing one’s life. Is the choice really that difficult?
The doctor, who gives the patient a not very optimistic diagnosis of his health, outlines the picture of the disease for him and presents possible consequences. However, he leaves the decision to the main stakeholder. Faced with the choice of treatment and its further functioning, the latter must weigh the pros and cons. In the case of a stoma, although the decision to operate and create an abdominal anus has been made, the vision of living with one’s own fecal sacs on the abdomen is frightening and seems too high a price to save a life.
Meanwhile, in Poland already 40 thousand. of people live with a stoma and lead a normal life so much that in their environment none of their co-workers and neighbors usually even knows what kind of surgery they have undergone and what has changed in their daily functioning as a consequence.
Gone are the pioneering times, when one of the first patients in Poland – stoma dentists, traveled for several years with prof. Roman Góral to lectures during which the audience was asked to guess who was in the room after the ostomy surgery. Of course, no one was able to recognize the right person.
Today, stoma surgery has become a standard in specific lesions, there are regular stoma clinics in 18 Polish cities, and patients – stomas live with dignity and fairly normally, using the amenities that appeared along with the modernization of the ostomy equipment.
After the surgery
An old proverb says that the first step is the hardest. The most important thing is that we accept the new state of affairs and not let ourselves be persuaded that the stoma is a disease. It is an anatomical change resulting from an operation, which in a large group of patients is reversible (the so-called temporary stoma), which means that after the rest of the operated intestines heal and the symptoms of the disease disappear – if only the anal sphincters are preserved – there is a chance of reconstructing a fragment of the duct digestive tract and restoration of normal bowel movements.
In the case of neoplastic lesions, when the entire intestine has been removed along with the anal sphincter, it is necessary to accept the presence of sacs with intestinal contents on the abdomen. The created stoma is then a life-saving procedure and is permanent.
Fortunately, the materials from which ostomy bags are made today are so durable that there is no risk of them breaking or leaking, and thanks to the built-in carbon inserts they are able to additionally absorb and regulate the rate of gas evolution. So they don’t swell on your stomach or splash under your clothes. Importantly, they are also waterproof, which allows stomics not only to bathe in the tub, but also to hide the pouches under a one-piece suit and use it in public places, such as in the sea or swimming pool. Finally, ostomy pouches are completely gas-tight, so fears that they will emit an unpleasant odor are unfounded.
Manufacturers of pouches and plates (in the so-called two-piece equipment, a special plate is attached to the stoma, and then the pouch to it) not only compete in the selection of materials in terms of quality, lightness, flexibility and flexibility, but even offer pouches in colors similar to the body color , which makes them almost invisible on the stomach, even if they accidentally peek out from under the clothes. Patients who have lived with a stoma for several years agree that thanks to the advancement and development of technology, the current materials are already so solid and durable that, with properly attached pouches, it is now possible to practice non-invasive sports without fear of losing or damaging them.
Ostomy patients are most concerned about their appearance and the feeling of losing their attractiveness. This is a completely unfounded fear. Many members of ostomy families say that they get used to seeing pouches in their loved ones, just like others, to baldness, and over time they simply stop noticing them. Therefore, almost all stomas – thanks to the cooperation of partners – return to sexual life, losing unnecessary inhibitions and fears that, for example, a pouch could break at the most unexpected moment, due to the weight of the body of a loved one. Rather unfounded (in the light of modern surgical techniques) are also fears of sexual indisposition in men, caused by damage during the procedure of emergence of the nerves controlling erection and ejaculation.
How to take care of yourself
Proper body hygiene requires certain activities that are carried out automatically. In addition to daily washing and moisturizing the skin, brushing the hair, there are other activities after the stoma surgery. If we are willing to learn how to perform them, they will quickly become a similar routine, such as brushing our teeth.
Therefore, we will first of all have to take care of:
• systematically washing the skin around the stoma with only water or with the addition of gray soap;
• checking the attachment of the ostomy plate to the skin, to which we attach the pouches (if necessary, the skin should be shaved of hair);
• frequent monitoring of the condition and degree of filling of the pouches themselves, which should be replaced in the case of colo- and ileostomy or urine emptied in the case of urostomy;
• checking the tightness of the stoma-plate-bag system and using sealing pastes if necessary, which fill the leaks without causing inflammation of the dermatitis around the stoma.
If we are colostomics, it is also worth asking the doctor if we can independently perform irrigation procedures, i.e. rinsing the colon with water, which will clean it of gases and stool. Thanks to this, it will be possible to gain control over the frequency of defecation, and in the most favorable cases, it will allow you to stop carrying pouches on the stomach and cover the opening of the stoma with only a small overlay called a stomakap. Unfortunately, if we have diarrhea or active Crohn’s disease, irrigation will be impossible.
To learn and familiarize yourself with the stoma equipment, it is a good idea to meet your stoma nurse first, who will help you choose the right bags and plates and advise you on which equipment is best for your type of stoma. We have a large selection of various types of equipment on the market, because the equipment is available in both a one-piece form (a bag with a plate glued directly to the skin) and a two-piece form (bags are then changed regardless of the plate that remains stuck to the skin). A universal solution seems to be the use of synergistic equipment, i.e. equipment intermediate between one-piece and two-piece equipment.
An important element of periostomy prophylaxis is taking care of a proper diet rich in fiber and drinking at least 2 liters of water a day (minimum 40 ml per 1 kg of body weight). After bowel removal surgery, the absorption of fluids, which is mainly the result of the colon, is lower, so it is better to drink little but often. It is very important to eat meals 3-5 times a day at regular intervals and at the same time of the day.
The type of food consumed also determines the frequency and form of excreted stools, so if you are a stoma, you should give up flatulent foods, such as: cabbage, beans and other legumes, and carbonated drinks containing a lot of carbon dioxide.
In patients with a colostomy, a greater (than in ileostomics) effect of the diet on the number of stools may be observed. Everyone, however, has a different organism, so you need to check in practice which dishes serve a given person best. Patients with a stoma on the small intestine secrete more intestinal fluid (up to 8 liters per day) and therefore have to change ostomy bags more often.
What to watch out for
If you have an ostomy, it should be regularly monitored so as not to “wait out” the complications that sometimes arise, such as the formation of a parastomal hernia, falling or falling out of the tip of the stoma or its necrosis.
In the case of a hernia around the stoma, the bulging appears over time, which causes problems with the alignment of the plate and bags. On the other hand, stoma necrosis occurs as a result of stoma ischemia and, like a hernia or prolapse of the tip of the stoma, requires another surgical correction.
In order to avoid dermatitis, which sometimes occurs around the stoma, it is necessary to regularly take care of the hygiene of this part of the body (frequent washing with water or special removers), and in the event of skin irritation, lubricate it with a special regenerating cream.
When going on a further journey, we must, of course, remember to bring an adequate supply of plates and ostomy bags. They should not be kept in a warm place (for example, on a sunny shelf in a car) as they may become unsealed.
Refund problem
By purchasing ostomy equipment, we can obtain a refund for the costs of purchasing bags from the National Health Fund, where an order written by the attending physician (preferably a surgeon) must be submitted. It is also necessary to present an insurance document and an ID card confirming the insurance status. Both in the case of colostomy, as well as ileo- and urostomy, each patient should be reimbursed for one set of bags per month (usually 90). Depending on the type of stoma you have, only the amount of co-financing will be different depending on the prices of individual bags (PLN 300 monthly refund for colostomic bags, PLN 400 for ileostomics and PLN 480 for urostomics).
Text: mgr farm. Rafał Jabłoński
Source: Let’s live longer
The stoma is not the end of the world, you can live comfortably with it. How? Read in health.TvoiLokony