Preparing for stoma surgery
It's natural to have a lot of questions before stoma surgery. Having an operation is hard physically and can be an emotional experience.
It is important to know that you are not alone and there is an abundance of help, advice and support available when you are ready to access it.
What is a stoma?
A stoma is a surgical opening that is created to allow faeces or urine to exit before it reaches the rectum or bladder and can either be permanent or temporary. For some the stoma is carried out as a temporary measure, to allow the gut a period of rest and recovery, whilst for others it may be permanent, having been carried out as a life-saving measure. Some of the most common conditions that might necessitate a stoma are:
- Imperforate anus: where there is no exit for the bowel or its contents
- Hirschsprungs disease: where nerves called the ganglion nerves are missing and waste matter cannot easily pass
- Inflammatory bowel disease: this includes Crohns Disease and Ulcerative Colitis, both inflammatory diseases of the intestines
- Neonatal necrotising enterocolitis: this occurs when a portion of the bowel is dead and cannot function and is most common in premature babies who weigh less than 3 pounds at birth. In this case a stoma can mean life to a baby
- Spina bifida: where part of the spine fails to develop properly and in more severe forms of the disease, the spinal nerves that control the muscles of the legs, bladder and bowels may be affected and a stoma needed
- Accident, injury and other causes: these include cancer and also injuries to the bowel or bladder caused by car accidents, etc.
After surgery, you will pass stool/urine through the stoma instead and will not be able to control when this occurs. To help with this a pouch is worn to collect the waste.
What does the stoma look like?
- It is common for the stoma and the area around it to be slightly swollen after surgery, but will reduce in size over time, usually after six to eight weeks.
- Stomas will be a pinkish red in colour, similar to the inside of your mouth, and will be soft and moist
- The stoma can bleed a little when being cleaned, especially in the beginning. This is entirely normal as stomas have a lot of blood vessels and the bleeding usually stops very quickly
- There is no sensation in a stoma, so it is not at all painful to touch
- Dependent on the type of stoma, it can be located on different parts of the body
- Stomas come in all different shapes and sizes, some are quite short and sit flat against the belly, while some protrude a little more.
Types of stoma
There are 3 types of stoma, colostomy, ileostomy and urostomy.
Due to the various locations of the colostomy, the faecal mass and liquid output will vary although output will generally be quite firm. Colostomies can be categorised into 2 main types:
An end colostomy is most commonly formed following rectal or anal cancer and can be temporary or permanent. It is formed when parts of the large bowel (colon), rectum and anus need to be bypassed and/or removed because of disease, cancer or severe injury. During your operation, part of your large bowel (colon) will be brought to the surface of your abdomen to form the opening, called a stoma. Temporary colostomies are performed to allow the intestine time to heal.
This is created by bringing a loop of the bowel through an incision in the abdominal wall. The loop is held in place outside the abdomen by a plastic rod, slipped beneath it. An incision is made in the bowel to allow the passage of faeces through the loop colostomy. The supporting rod is then removed approximately 7-10 days after surgery, when sufficient healing has occurred that will prevent the loop of bowel from retracting into the abdomen. So a loop colostomy actually consists of two stomas that are connected to one another. It is most often performed for creation of a temporary stoma to divert faeces away from an area of intestine that has been blocked or ruptured.
As there is no storage in the small intestine some of the food you will eat will drain into your pouch in 1-2 hours. Ileostomies can be categorised into 2 main types:
This is constructed when the colon has been removed usually due to inflammatory bowel disease such as Ulcerative Colitis or Crohns Disease. This type of stoma will act frequently, discharging a fluid/toothpaste consistency output.
A loop ileostomy is created when a loop of the small bowel (ileum) is brought out as a stoma but the colon and rectum are not removed. The procedure is usually only used as a temporary measure, when it is necessary to remove part of the colon. Once the remaining colon has healed, it can be reconnected to the small intestine, and the stoma can then be closed.
In a urostomy operation a passageway will be made for urine to pass from your kidneys to the outside of your abdomen. For some people the bladder may need to be removed due to damage or disease.
The most common type of urostomy is an ileal conduit which involves a piece of the small intestine or ileum being removed and separated from the gastrointestinal tract. One end of the ileum is closed while the other end becomes the stoma. The conduit acts only as a passageway and does not store urine and for this reason urine will constantly flow into the pouch.