LIVING WITH A STOMA

 

A stoma, or ostomy as it is also known, is an opening created on the abdomen in order to allow faeces or urine to exit the body. There are 3 different types of stoma – colostomy, ileostomy and urostomy. Your doctor will advise you which stoma will work best for you.

stoma_-__one_year_after_surgeryLiving with a stoma
The thought of a living with a colostomy can be daunting at first. Although it may be difficult to get used to, it does not mean you cannot lead a full and active lifestyle
Generally, your stoma will be pink and moist (like the inside of your mouth) and a little swollen after your operation. This will reduce over a period of between six to eight weeks. There are no nerves in your stoma so there will not be any sensation when you touch it. Everyone’s stoma is different in shape and size, so don’t worry if yours looks different to other pictures you may see.

Colostomy
A colostomy is an opening from the large intestine (colon). The surgeon will bring a part of the colon from inside your body, through the abdomen to the outside and stitch it down to secure it. Normally this will be on the left side of your abdomen.

How does it work?
After a colostomy is formed, the stoma, which is the opening in your stomach, will produce digestive waste such as faeces. The faeces will be collected in the colostomy pouch, and the consistency will depend mostly on which part of your colon is diverted, as well as your diet and fluid intake.

When the pouches are full, they should be removed and replaced, at least one to three times a day. Drainable pouches will only need to be replaced every one or two days may be used if you have particularly loose faeces. There is a wide range of colostomy appliances available, and you will be advised by your medical team about which is best for you.

The two types of pouches are:

  1. a one-piece pouch – the bag and flange (part that sticks to your skin) are joined together. The appliance is removed when full and disposed of.
  2. a two-piece pouch – the bag and flange are separate but can be connected; the flange can be left on your skin for several days and the bag removed and disposed of several times a day.

stoma (1)

Who needs an Ileostomy?
An ileostomy is needed when the colon (large intestine) is damaged, inflamed or loses its function. It is also used to treat some types of cancer, where it is necessary to remove part, or all of, the colon. Conditions often treated using an ileostomy are:

Crohn’s disease, also known as Crohn syndrome and regional enteritis, is a type of inflammatory bowel disease (IBD) that may affect any part of the gastrointestinal tract from mouth to anus, causing a wide variety of symptoms. It primarily causes abdominal pain, diarrhea (which may be bloody if inflammation is severe), vomiting, or weight loss, but may also cause complications outside the gastrointestinal tract such as anemia, skin rashes, arthritis, inflammation of the eye, tiredness, and lack of concentration. Crohn’s disease is caused by interactions between environmental, immunological and bacterial factors in genetically susceptible individuals
Ulcerative colitis is a form of inflammatory bowel disease. A disease of the colon which includes characteristics such as ulcers, or open sores. The main symptom of active disease is usually constant diarrhea mixed with blood, of gradual onset. IBD is often confused with irritable bowel syndrome
Bowel cancer: after chemotherapy or radiotherapy to shrink the cancer, it is usually fnecessary to remove the section of the bowel or rectum that contains the cancerous cells.

Ileostomies are often used to treat digestive conditions tend to be carried out in people aged between 15 and 30 years old. Ileostomies used to treat bowel cancer tend to be carried out in older people aged between 60 and 70 years old.
Less often, an ileostomy may be used to treat:
A bowel obstruction. It may be necessary to perform a temporary or permanent ileostomy depending on the underlying cause of the obstruction.
A significant injury to the colon. For example, if the colon becomes permanently damaged due to a puncture or an impact injury.
Familial adenomatous polyposis (FAP). This is a rare condition that affects one in every 10,000 people and triggers the growth of non-cancerous lumps of tissue inside the colon.

Types of ileostomy
There are three main types of ileostomy:
• Loop ileostomy
During a loop ileostomy, a loop of the small intestine is brought out through the stoma. The procedure is usually only used as a temporary measure when it is necessary to remove part of the rectum. Once the remaining colon has healed it can be reconnected to the small intestine and the stoma can be closed. Loop ileostomies are often used to treat bowel cancer.

• End ileostomy
During an end ileostomy the colon and rectum are removed and the end of the ileum is brought out through the stoma and attached to an external bag. An end ileostomy is usually permanent. An ileo-anal pouch (also known as a J pouch) is sometimes used as an alternative to an external bag. This is an internal pouch surgically constructed from the small intestine and connected to the sphincter muscle that surrounds the anus. It means bowel actions can be controlled in the normal way. Ileo-anal pouches are now preferred because they eliminate the external bag. However, they are not suitable for every patient. Disadvantages include having to go to the toilet frequently to empty the pouch.

Anal Stomas
Similar to a colostomy, an ileostomy is a surgical procedure, which is performed in order to link the end of the small intestine to an opening in the abdomen (stoma) or to an internal pouch, known as a J-pouch. The end of the small intestine is disconnected from the colon and re-routed through a hole made in the abdomen, which is known as a stoma. An external bag (stoma bag) is attached to the opening to collect waste products. Alternatively, an artificial pouch can be created inside the body, which can be regularly emptied when required.

Recovery
Like with any illness, recovering from an ileostomy can be difficult, and it is likely you may experience both physical and psychological problems shortly after the operation, such as:

• Skin irritation around the stoma
• Leakage from the stoma or bag
• Feelings of anxiety and self-consciousness

However, many people will receive help with their stoma from a designated stoma nurse. There are several ways you can help yourself following an ileostomy. There are also recommendations after an ileostomy that may help to treat or prevent some of the issues arising from the surgery. These include:
• Low-fibre diet to help digestion
• Add a little extra salt to diet
• Dealing with worries about smells or flatulence
• Taking medication
• Treating soreness due to an ileo-anal pouch.

 

Looking after a stoma
Getting used to living with a stoma will take time and patience, and you will not be expected to cope right from the start. Most hospitals have nurses who specialize in stoma care, and will therefore be able to help you through first using your colostomy pouch. It is a good idea to have a friend or relative with you, who will then be able to help you further when you return home.

Before your operation, the surgeon will show you where your stoma will be positioned, and as soon as you are well enough after the procedure, the nurses will help you with cleaning your colostomy bag.

Once you’re at home you can phone the stoma nurse if you have any problems. Your GP may also arrange for a district nurse to visit you for a few days when you first leave hospital. They can make sure you’re coping at home, and sort out any problems that you may have with your stoma.

While it may not be entirely necessary for you to wear the colostomy bag all the time, especially if your stool production is regular and predictable, leakages can still occur.
It is important to keep the area around the stoma clean. There are a number of different ways to do this in order to make living with a colostomy far easier, such as:

  • support belts and girdles
  • deodorisers that can be inserted into your appliance
  • protective skin wipes
  • adhesive remover sprays
  • protective stoma rings
  • specially designed underwear and swimwear

Common concerns about living with a stoma

Will it smell?
Colostomy bags are fitted with special air filters that will neutralize any smells, and although you may be able to recognise the smell from your stoma, no one else will.

What about my diet?
After your operation, you will be required to go on a low fibre diet in order to ensure you produce smaller stools. After eight weeks you will be able to go back to enjoying the foods you did before by slowly introducing them back into your diet.

Will I be allowed to exercise?
Following your surgery, the doctor will recommend you do some very gentle exercise to help with your own recovery. If you feel discomfort or pain during exercise then you should stop immediately. As colostomy bags are waterproof, you can still enjoy activities such as swimming.

Can I travel with a stoma?
There is no reason you can’t travel with a stoma. One essential item for people with a colostomy is a RADAR key. This provides you with access to public disabled toilets so that you can change your colostomy appliance when you need to.

Can I still have a sexual relationship?
The impact a stoma has varies depending on if you are a man or a woman. For example:
A woman who has had her rectum removed may find many positions uncomfortable, as the colon is no longer supporting the vagina.

For a man, the blood supply and nerve endings to their penis may be damaged. It is important to consult with your nurse about what might work best for you.

Support
It is common to feel embarrassed or self-conscious about your stoma, and may not be easy to deal with at first. Having a colostomy will impact many aspects of your life, but it is vital to remember that there is plenty of support available if you are struggling to cope.

These feelings are a natural part of coming to terms with the changes that a stoma causes, and usually decrease gradually over time.