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WHAT IS STOMA SURGERY? - STOMA EXPLAINED

Mersad Alimoradi 27 Oct 2021
WHAT IS STOMA SURGERY? - STOMA EXPLAINED

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Every year, hundreds to thousands of people undergo stoma surgery. Statistics estimate over half a million people have some type of ostomy in the United States alone.

A stoma is a vital surgical procedure for medical conditions that affect your digestive and urinary tract. Injury, infection, or disease can alter your normal control of bowel movement. A stoma serves as an alternative passage to eliminate wastes when your bowels and bladder no longer function correctly.

Whether temporary or permanent, a stoma can take some getting used to. With time and support, a stoma can improve your overall health and give you a better quality of life.

What Is A Stoma?

The word “stoma” and “ostomy” are often interchanged, but they actually have different meanings.

An ostomy refers to an opening created in your abdomen. The stoma is usually the part of your digestive or urinary tract connected to the ostomy. It looks like a circular, pink flesh-like material sewn to your body. 

Stoma surgery, also known as ostomy surgery, is a life-saving procedure to reroute your bodily fluid in cases of a malfunctioning digestive or urinary tract. It allows urine or feces to successfully pass out of your body through alternative exits.

There are three common types of ostomy surgery:

  1. Colostomy: Your surgeon pulls your colon or large intestine through the incision created on your abdomen to form a stoma.
  2. Ileostomy: Your ileum, the lowest part of your small intestine, is pulled and sewn onto the opening in your abdomen, creating a stoma.
  3. Urostomy: Your surgeon creates a passageway for urine to pass out through the ostomy. A urostomy may involve the removal of a diseased bladder - usually after bladder cancer. Your surgeon might use part of the small bowel to create a pouch to collect urine (called “neobladder”).

On top of your stoma, a pouch or ostomy bag is attached. This stoma pouch is where your bodily waste will pass into.

A stoma may be necessary for severe conditions. It isn’t painful since there are no nerve endings in the viscera.

Who Needs A Stoma?

A stoma is needed in several medical conditions affecting your bladder or bowel. Surgeons usually recommend stoma surgery when a part of your bowel is injured, missing, or deceased. A stoma can be used in cases of colon injury, bowel obstruction, or cancer.

Here are a few conditions that often require a stoma:

Inflammatory Bowel Disease

Crohn’s disease and ulcerative colitis are a group of diseases called inflammatory bowel diseases (IBD). IBD causes chronic bowel inflammation and ulceration in the digestive system. Ulcerative colitis usually affects the innermost layer of your colon and bowel.

The symptoms for this condition include abdominal pain and cramping, rectal pain, rectal bleeding, inability to pass out stool, weight loss, fatigue, and others.

Stoma surgery (colostomy or ileostomy) may be indicated in inflammatory bowel disease when:

  • Medical treatment fails
  • The symptoms are unbearable and significantly affect your quality of life
  • Bowel perforation
  • Bowel obstruction
  • Persistent bowel bleeding

Colorectal Cancer

Colorectal cancer is one of the most common cancers around the world. A colon tumor can grow anywhere along your large intestines. It can cause abdominal pain, bleeding, or bowel obstruction.

Partial or total colectomy (colon removal surgery) are usually indicated to treat colon cancer. When a large portion of your colon is removed, your surgeon will have to permanently re-route the stool through an ileostomy.

With partial colectomy (when only part of the colon is removed) there’s a possibility to reattach the two ends of the colon again. However, sometimes, a temporary ‘protective’ ileostomy or colostomy is created to allow your colon to heal. The ostomy is usually closed after 2-3 months, and you can usually go back to defecating normally.

Colonic polyps

Colonic polyps are abnormal non-malignant growths that occur inside your colon’s lumen. Most times, these growths are harmless. But there is a slight risk of some of these polyps becoming malignant. Sometimes, polyps can cause bowel obstruction or they may be very numerous and distributed all over your colon. In such cases, colon removal (partial or total colectomy) may be indicated. Your surgeon will redirect the stool through a colostomy or ileostomy.

Diverticulitis

Diverticula are small pouches that occur most often in the lower digestive tract. They usually occur anywhere in the digestive tract, but most often occur in the lower digestive tract. In severe cases of diverticulitis, you may require bowel surgery. Your surgeon might create a permanent or temporary stoma to redirect feces.

Urinary Tract Diseases

Bladder cancer, bladder polyps, ureteral cancer, and other diseases of the urinary tract may require urostomy surgery. Stoma for urine is created when the bladder is removed or when the ureters cannot reach it anymore.

Urostomy usually involves creating a neobladder, which is a flesh pouch in the abdomen to collect urine instead of the defunct bladder. It is connected to the ostomy to drain urine out.

Birth Defects

Some babies are born with congenital defects that disrupt their digestive system and urinary system. Spina bifida is a condition that affects the development of your spine. It can cause a neurogenic bladder that changes urination and the way your bladder normally works.

Hirschsprung disease is characterized by missing nerves in your large intestine, affecting the way you pass stool. Stoma surgery is required for many babies with these congenital disorders. Although it may be permanent or temporary, depending on the cause.

How Does A Stoma Work?

When your bladder or bowel is not functioning correctly, a stoma serves as a passage to divert your bodily wastes outside so they can be eliminated.

In a colostomy, ileostomy, or urostomy, stoma surgery follows the same principle.

Your surgeon removes all damaged or diseased parts of the organ affected. In creating a stoma, they take a portion of your bowels, either large or small intestine, depending on the type of surgery, and stitch it into the incision in your abdomen. Your stoma may lie flat on your body or protrude like a spout.

An ostomy bag or pouch is attached to your stoma where your waste will be collected. There are two types of stoma bags based on the number of components: a one-piece and a two-piece variation.

  • One-Piece Ostomy Bag

A one-piece bag is combined with a wafer that secures the bag and protects your skin. It’s attached with an adhesive and fits around your stoma. Replacing it with a fresh stoma bag usually requires total removal of the entire system. Some designs allow for easy toilet disposal through flushable liners.

  • Two-Piece Ostomy Bag

The two-piece variation has two separate components; a base plate or wafer and a bag. The base plate is attached to the stoma and the stoma bag is then connected to the base plate. You can replace the base plate every 2 to 3 days and the stoma bag as often as needed.

How Is Life With A Stoma?

Reports reveal that about 120,000 ostomy surgeries are carried out annually and over 500,000 Americans have some type of stoma.

Ostomy surgery can occur at any age and does not lower life expectancy at all. The purpose of a stoma is to give you a healthy life. Yes, it seems daunting and may take some time to become comfortable with this “new normal”, but once you’ve learned to maintain your stoma, managing it can be very easy.

Food

You are free to return to a regular diet after your stoma surgery. As long as it’s healthy and balanced, that is. If you’ve noticed some discomfort when eating after a colostomy or ileostomy, try building up your eating habits slowly and gradually.

Just like before your surgery, some foods are likely to cause gas, constipation, or diarrhea. Don’t worry, this is completely normal. If you’re unsure which foods will affect you, try experimenting at home.

You can also consider talking to your doctor or surgeon. They can advise you on certain food to avoid and give you the OK on what you can eat regularly.

Traveling And Flights

Having a stoma doesn’t limit your ability to travel. It just needs a bit more planning than usual. Be prepared. Make sure you have your ostomy supplies on hand and bring extras for longer journeys.

If you're traveling to unfamiliar places, drink from a bottle of water and stick to eating food that you know won’t cause any unwanted bowel movement.

Traveling soon after your ostomy surgery, however, may make you susceptible to blood clots (deep venous thrombosis). You may need to get medical advice before taking long-distance trips immediately after your surgery.

Body Image

You may think the ostomy bag is completely obvious. Every noise it makes, the lump under your clothes; it’s enough to cause severe anxiety. Find support in your family and friends to help you cope and become more comfortable.

Not everyone will have to know. You can choose to tell, or not to tell, anyone you want about your stoma. You can even hide your ostomy by choosing an ostomy bag that suits you, emptying it before it gets full, and applying pouch deodorants.

There may even be times when you don't have to wear a stoma bag. However, health practitioners don’t recommend this because of accidental leakages.

Is A Stoma Permanent Or Reversible?

A stoma can be permanent or reversible, depending on your health condition.

If a large portion of your bowels is removed, this usually warrants a permanent stoma. Same thing applies to urostomy after urinary bladder removal.

Surgeons recommend a temporary stoma or loop stoma if they plan to reconnect your bowel later on, after your disease subsides. Your surgeon makes an incision on the side of your bowel and stitches this into the incision on your abdomen.

Temporary stomas are reversed by simply detaching the bowel from the abdominal wall and restoring the connection to re-establish the normal flow of waste.

Can You Still Poop If You Have A Stoma Bag?

The short answer is: it depends on the type of ostomy you have.

If you have a temporary ‘loop’ ileostomy, yes, you can still poop[3] . With a loop ileostomy, the bowles are reconnected after removing the diseased area, so their continuity is restored. However, the loop ileostomy just gives the bowels an extra opening to decompress them as they heal. In this case, you can still poop[4] through your anus even if you have a stoma. 

With other types of ostomy surgery, you cannot defecate through the anus. The bowels are cut and closed, so they are not continuous. The stoma opening is the only opening through which feces can come out.

FAQs

How do you clean a stoma? Use warm water and a dry wipe to clean the area around the stoma. Do not rub the stoma, instead use gentle pats when you’re cleaning. Once you’ve dried the area thoroughly, dispose of the used wipes and the used pouch in a disposable bag. Don’t forget to wash your hands before and after.

How do you sleep with a colostomy bag? You can sleep on either your back or side. When sleeping on the side opposite your pouch, place your pouch on a pillow to prevent it from weighing down and shifting your abdomen.

How many times per day should a stoma bag be changed? Your healthcare provider, usually your ostomy nurses or doctors, will explain when you should change your stoma bags. You can replace drainable stoma bags once in 2 or 3 days. If you’re using a closed bag, you need frequent changes between 1 to 3 times per day.

Is having a colostomy considered a disability? Having a colostomy is by no means a disability. The various ostomies do not make a person disabled, whether permanent or temporary. Stomas give you a healthier, better quality life in the context of your condition.

Is it safe to fly with a stoma bag? Yes, you can fly with a stoma bag. Stoma products are categorized as essential medical products and can be taken through airport securities with no stress.

Does having a stoma make you tired? Stoma procedures are associated with making you feel “under-hydrated,” with symptoms of fatigue, having a headache, and feeling groggy. Stay hydrated and consult your healthcare provider if you experience these symptoms.

Can I eat ice cream with a stoma? Your doctor may suggest avoiding foods high in fat and protein after stoma surgery. Avoiding such foods can help you keep a healthy gut and improve digestive tract health. Low-fat ice cream might be a better option for ostomy patients.

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About the Author:
Mersad is a medical doctor, author, and editor based in Germany. He's managed to publish several research papers early in his career. He is passionate about spreading medical knowledge. Thus, he spends a big portion of his time writing educational articles for everyone to learn.

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