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A stoma is not terrible, you have to learn to live with it, and even make friends. Conversation with the drug. Med. Magdalena Derejska and the ostomy nurse Grażyna Majewska for the educational campaign “Shameful diseases. Let’s overcome the taboo ».
Doctor, what is a stoma and how many patients in Poland live with it?
play. with. Magdalena Derejska: A stoma is an outlet of the small or large intestine in the sheaths of the abdominal cavity so as to allow the stool to drain freely. It is estimated that there are more than 40 patients who have a stoma in Poland, this is quite a large number of people. A stoma can reveal either the small or large intestine. We can talk about a temporary stoma, i.e. it is selected only for a certain period of time with the intention of later restoring the continuity of the gastrointestinal tract, i.e. restoring the physiological passage of the intestinal contents. A stoma can also be definitive, so it is an intestine formed in the abdominal wall for the rest of life, without the possibility of restoring the physiological continuity of the gastrointestinal tract.
The development of medicine and innovations in the field of ostomy equipment make it possible to live a normal, active life with a stoma. Meanwhile, the fact of having a stoma is still a shameful topic for the patients and the society themselves. What it comes from?
MD: This is mainly due to the patients’ ignorance of what a stoma is and how it functions. It also results from the stereotypes on which the knowledge of the society is most often based. This is an embarrassing topic because the intestinal contents, secured with a suitable bag, are discharged onto the abdominal wall. Everyone associates it with the fact that the bag may peel off, it may emit an unpleasant smell and stain clothes. These are all stereotypes, but they are where fear comes from. Most patients do not know how the stoma works, how it is currently supplied, and that a properly developed stoma does not involve these types of situations.
How does the method of getting a stoma affect the quality of life of people with a stoma?
MD: The way in which the stoma is selected is crucial for the patient’s quality of life later on. The surgeon drawing up the stoma must carefully select the site of the skin so that it is not, for example, in a skin fold and that the patient has a clear view of the site. The operated patients are often elderly, overweight or even obese. The way the stoma emerges is especially important for them. Often this procedure is performed by young surgeons in training, due to the possibility of making mistakes that may significantly affect the functioning of patients in normal life, training and supervision should be performed by an experienced surgeon. The biggest problem appears when the stoma is badly sewn in, which causes difficulties in sticking the pouch, its frequent detachment and leakage of intestinal contents. These are very discomforting situations for the patient. Hence, the way the stoma is selected has a huge impact on the patient’s further life. Every patient is different, and the reasons for which the surgeon has to develop a stoma are also different. We are not always able to easily activate the gut and emerge anywhere on the skin of the abdomen. However, the manufacturers of ostomy equipment meet us. Special stoma bags allow the stoma to be properly secured in problematic situations, such as when the stoma is inserted, that is, under the skin of the abdomen. Thanks to them, the patient can function normally.
How does life change after having a stoma? Do patients have to give up their current activities?
MD: For many patients, a stoma saves lives. These are often seriously ill people, with inflammatory changes in the intestines (e.g. with Crohn’s disease), debilitated, in whom only surgical treatment, including the emergence of a stoma, can prevent life-threatening complications and even save them. Contrary to appearances, the comfort of life after the operation, which eliminates their basic problem, improves. Appropriate and proper training, equipment supply and knowledge of its operation will make it possible to function fully normally. Patients do not have to and should not give up physical activity, travel and everyday life. It is very important, apart from the method of selection, that the patient is properly trained by the stoma nurse. This is a great support that families should also participate in. A stoma is not terrible, you have to learn to live with it, and even make friends.
Can the life of a person with a stoma be comfortable and safe?
Grażyna Majewska: Indeed, today a patient with a stoma can feel a great sense of security in terms of access to ostomy appliances, as it is reimbursed by 100%. by the National Health Fund within certain amount limits depending on the type of stoma. And it is the ostomy appliance that plays a key role in providing patients with confidence and security. Currently, in Poland, we have access to the highest quality ostomy equipment. The most important part of a two-piece ostomy appliance is the plate. She decides to supply the stoma tightly. Particularly noteworthy are the convex tiles, the so-called convex, which enable the management of concave stomas. They ensure exceptional tightness of the stoma against leakage of contents. The accordion plate is also extremely interesting, as it allows the ostomy bag to be attached to the plate ring without the need to press against the abdominal surface. This is of particular importance in the early postoperative period when the abdomen is painful. A plastic plate is a unique version of the tile. Its great advantage is the possibility of manually modeling the appropriate hole for the stoma without the need for scissors. Manufacturers of ostomy appliances are paying more and more attention to the flexibility and flexibility of adhesives that physically active patients expect. Stoma accessories, reimbursed by the National Health Fund, are also very important. Without them, it would not be possible to effectively care for the stoma, protect the skin, and prevent leakage, especially in complicated stomas. The appearance of these products has significantly increased the comfort and quality of life of patients.
What is the daily operation and care of the stoma?
GM: Caring for a correctly identified stoma is not difficult. However, in order for stoma care to be effective, the patient should have individually adjusted stoma equipment depending on the type of stoma, the place of its emergence on the abdominal surface, the excreted content, the appearance of the mucosa and the condition of the skin around the stoma. Change of equipment should take place regularly, in a planned manner. Then it is easier to prevent possible complications. An important element in stoma care is the ongoing self-assessment of the appearance of the mucosa and skin.
Can the patient take care of the stoma on their own? When is specialist care needed?
GM: The patient should perform all the care activities at his / her stoma himself. Independence will allow him to rebuild faith in himself and in his abilities. Nobody manages their stoma as well as the patient himself. In order for the patient to gain independence, it is necessary to provide him with adequate education. This is the responsibility of the stoma nurse, whose task is to provide broadly understood care, psychological support, and education of patients and their families in the process of adjusting to the stoma.
Each stoma specialist should use a variety of additional sources of information.
GM: All stoma companies in Poland publish educational materials such as guides and brochures for people with a stoma. Quarterlies such as “Our concern” are published and are available free of charge. You can also use the free helpline with properly trained nurses who can provide you with all the necessary information and advice. There are also websites where the subject of the stoma is familiarized with in a very wide range. Finally, I will repeat the words of my patient – «Stoma? It is different. But I already know that it is mine, that I live thanks to it. »
Interviewer: Joanna Lewandowska
Bow. med. Magdalena Derejska, General Surgery Specialist, Department of Gastroenterological Surgery and Transplantology Central Clinical Hospital of the Ministry of Interior and Administration