What is a Stoma?

According to Colostomy UK, around one in every 335 people in the United Kingdom have a stoma. Each year, around 21,000 new stomas are formed. Stomas are given for a variety of different medical reasons. In this article, we’ll explore the ins and outs of stomas, what the different types are and why they’re needed.

What is a stoma?

A stoma is an opening in the abdomen that connects to either urinary or digestive tissue to divert waste (faeces or urine) out of the body. When you have a stoma, it looks like a pink, circular and small piece of flesh. Some people’s stomas lie flat to their bodies, while others will protrude outwards. The stoma will be enclosed in a pouch or bag. This will have an opening or be entirely enclosed depending on the type. As there are no nerve endings on the stoma flesh, it won’t ever hurt.

The most common reasons for a stoma happening are in the cases of colorectal cancer, ulcerative colitis, bladder cancer, accidental injury and Chron’s disease.

The word itself comes from the Greek stoma, which means ‘mouth’.

What are the types of stoma?

There are three types of stoma surgery. These are ileostomy, colostomy and urostomy.

Within these types, there are further sub-categories:

Colostomy

A colostomy describes when some of the colon (large bowel) forms a stoma through an incision in the abdomen. There are two colostomy types.

End colostomy

An end colostomy is when the end of the colon comes through the abdomen and is sewn in place. This can be either temporary or permanent. The part of the bowel that is diseased is either allowed to heal or removed before the re-joining occurs (if possible).

Loop colostomy

This is when a loop of colon is pulled through an incision in the abdomen. It is sewn to keep it above surface level. This type of procedure is usually temporary and is performed as an emergency that can be reversed further down the line.

Ileostomy

This describes when part of the small bowel (the ileum) is made into a stoma through an incision in the abdomen. There are two ileostomy types.

End ileostomy

Like the end colostomy, this is when the end of the ileum is made into a stoma and sewn to the abdomen. It can be temporary or permanent and the diseased bowel is either given time to heal or removed.

Loop ileostomy

This is when the ileum is pulled to make a loop through the abdomen, usually on a temporary basis. These are typically removed after a few weeks or months.

Urostomy

A urostomy is a procedure that’s performed when a person’s bladder needs to be removed. This is usually due to a disease like cancer.

To make a urostomy, doctors pull a small piece of the bowel through the abdomen to form a stoma. The ureters (tubes that carry urine from the kidneys to the bladder) will then be detached and reattached to the bowel piece, allowing urine to flow out of the abdomen.

Why may a stoma be needed?

There are lots of reasons why stomas are needed. The most common reasons are bladder cancer, bowel cancer, inflammatory bowel disease (ulcerative colitis or Crohn’s disease), diverticulitis, and a bladder or bowel obstruction. Depending on the reasons why a stoma has been created, it can be temporary or permanent.

Reasons why people have ileostomies

One of the most frequent causes of ileostomies is because of ulcerative colitis. This is a disease that causes inflammation in the colon. People often have a history of diarrhoea, pain and frequent bathroom visits. Medication is often issued to control the disease, but if it doesn’t work the bowel needs to be removed.

Another reason is because of Crohn’s disease. Crohn’s is very similar to ulcerative colitis. Some people with this condition only need a stoma temporarily and surgeons try to only remove the diseased bowel and then join it back up again. The stoma allows it time to heal.

Cancer is another reason why people need ileostomies. This might be permanent or temporary.

Reasons why people have colostomies

The most common reason why people have a colostomy is down to cancer. This could be because the tumour is low in the bowel. It would depend on the tumour’s position as to whether the stoma is temporary or permanent.

Diverticular disease is another cause of colostomies. The colon has little pockets inside that can get infected and inflamed. This condition can be either acute or chronic and comes on as a severe pain in the abdomen.

Reasons why people have urostomies

This is the least well-known type of stoma and there aren’t as many people with this type. The primary cause of a urostomy is bladder cancer. However, cancer in other organs (like cervical cancer) that has spread to the bladder might also mean a urostomy is needed. Another reason could be a genetic condition or radiotherapy damage.

How does a stoma work?

When a person’s bowel moves, waste matter and wind are pushed out through the opening in the abdomen – the stoma. There is no sphincter like the anus so the movements are uncontrolled. For this reason, a small bag is attached to the body to collect waste.

Stoma bags are attached to the body with a secure sticky patch. They’re designed to be odour and leak-proof. A filter will let out wind (but not odour) and this will stop the bag from inflating. You typically won’t be able to see the bag under your clothing.

There are two types of bags, closed ones or drainable ones. Usually, those with an ileostomy will wear a drainable bag due to the looser consistency of the waste matter.

Stoma bags are fitted individually according to your body shape and your stoma. The emptying of the bag will depend on what you eat and drink.

When you have a drainable bag, you can empty it straight into the toilet when it is one-third full. A closed bag needs to be disposed of and can’t be flushed down a toilet.

Depending on the amount of bowel removed, a colostomy bag might need emptying between one and three times a day. An ileostomy, on the other hand, might need emptying between four and six times a day due to the waste being looser.

Some people have a colostomy in their descending colon, which means they have the option of not having to wear a bag. Instead, they can give themselves a colostomy irrigation – a type of enema – to remove faeces each day or two.

What problems could you have with a stoma?

Though stomas give many people a new lease of life after disease, they’re not without a few problems.

Most of the common side effects can be prevented or helped so it’s not all bad news if these things happen.

Here are some of the common problems:

Odour

Some people worry about smells coming from their bags. People are much more conscious of their own smells than other people are. If you are worried about odour, there are things you can do.

Some people find foods like green vegetables, cheese, onions, asparagus, eggs, fish, beans and cucumber cause odour. Avoiding these might improve things.

Other people find a deodorant spray helps them feel more confident.

Wind

Everybody has wind, stoma or not. Some people find that their stoma is more vocal than others.

You can try to reduce the wind produced by doing the following:

• Don’t talk when you eat.
• Chew food properly to avoid swallowing air.
• Avoid fizzy drinks.
• Avoid mealtimes that are irregular.
• Avoid certain foods known to cause wind like eggs, beans, sweetcorn, onions, peas, nuts, fruit and green vegetables.

Stoma diarrhoea

Loose output or diarrhoea can be caused by particular foods, including chocolate, prunes, spinach, beans, peas and spicy foods. It can also be caused by stress, emotional upset and alcohol as well as a side effect of medication.

Leakage

A huge concern for those with a stoma is leakage. Leakage tends to happen when the bag hasn’t been securely attached to the skin.

Ballooning

Another common problem is ballooning. This is when the bag fills with wind. This can happen when the bag’s filter is blocked with stoma output or water. Ballooning can cause the bag to push away from the body.

Pancaking

This describes when the inside stoma bag layers stick together and cause a vacuum. This results in the bag’s contents not dropping to the bottom of the bag, which can block the filter or force the bag off the body.

Sore skin

Often an ill-fitting stoma bag can cause the skin around the stoma to become sore due to contact with waste. This is easily prevented and treated.

Ill-fitting stoma bags usually happen due to weight gain or weight loss, so people need to check their stoma fit regularly.

Some people also get sore skin if they are sensitive to stoma bag adhesives. This will start as a mild irritation that will progress if not treated.

Another skin problem is folliculitis. This occurs when the hair follicles in the skin become inflamed. Folliculitis looks like little pimples but it can be sore too.

Sore skin can also be caused by output changes. If someone has a closed bag and loose stools, they might find a drainable bag more suitable to avoid so many bag changes.

Bleeding can also occur due to the fact that the bowel has a good supply of blood – hence the stoma being red/pink in colour.

Hernia

A hernia can happen when the muscle wall is weak. Around the stoma this is called a parastomal hernia and it means that a part of the bowel has pushed through the muscles in the abdomen to cause swelling under the skin. This can cause pain and discomfort.

Living with a stoma

Stomas are either temporary or permanent.

When living with a stoma, people often have to make changes to what they eat to prevent digestive issues.

To avoid wind, people should avoid:

• Lentils, beans and pulses.
• Cabbage.
• Cauliflower.
• Chewing gum.
• Fizzy drinks.
• Leafy green vegetables.
• Onions.
• Spicy foods.
• Sprouts.

Blockages

Foods that swell in the bowel can also cause blockages for those who have an ileostomy. Symptoms of a blockage include a decrease in output and lots of watery fluid, pain, nausea, vomiting, a swollen abdomen, a swollen stoma, and no wind or reduced wind.

To avoid blockages people are encouraged to chew their food extremely well. It’s also wise to avoid things like celery, mushrooms, nuts, coconut, sweetcorn, fruit skin, bamboo shoots, bean sprouts, popcorn, pips and pith, and dried fruit like raisins and currants.

Constipation

There are various reasons that cause constipation including diet, poor mobility, poor fluid intake and medication.

To reduce constipation, stoma patients are encouraged to eat more vegetables and fruits, eat wholegrain products, drink at least two litres of fluids per day (and avoid caffeine), try and do gentle exercise, have prune or fruit juice, and take a mild laxative.

Dehydration

People who have a stoma are at greater risk of dehydration. This can occur when the body is losing more water than it’s taking in. Severe dehydration can be fatal. Stoma patients are at risk of dehydration if they have a loose output.

To avoid this, they should consume at least 8 glasses of water a day, eat salted foods like Marmite, Bovril and crisps, try full sugar fizzy drinks like Lucozade (leave to go flat), and drink isotonic sports drinks.

Final thoughts

Many people falsely believe that only older people have stomas, but this isn’t true. There are many younger people with stomas and it isn’t as rare as you might think. There are lots of different reasons why stomas are given to patients and they can be either temporary or permanent solutions. Most stomas are used to remove faecal matter from the body but there are some patients who have a stoma for removing urine. Provided that a patient knows how to look after their stoma properly, there is no reason why they can’t lead a healthy and fulfilling life.