What is a stoma?
A stoma is an opening in your abdomen that allows waste to exit your body, rather than going through your digestive system. They’re used when part of your bowels or bladder either need to heal or be removed.
To create a stoma, your doctor will pull part of your small or large intestine onto the surface of your skin and sewn it onto an opening in your abdomen. The intestine end empties waste into an ostomy appliance, which is a pouch attached to your stoma. Stomas are usually round, red, and moist, and they measure about 1 or 2 inches wide.
Many people use the terms “ostomy” and “stoma” interchangeably, but they do have slightly different meanings:
- An ostomy refers to the actual opening in your abdomen.
- A stoma refers to the end of the intestine that’s sewn into the ostomy.
Ostomies can be permanent or temporary. If you have an organ that’s permanently damaged, you’ll likely need a permanent one. However, if part of your intestine just needs to heal for a while, you might have a temporary ostomy.
What are the different types?
There are several types of stoma, depending on the procedure used to create them:
- Colostomy. A stoma is created with part of your colon, also known as your large intestine, to bypass your rectum. In some cases, you might have the lower part of your colon removed, leading to a permanent stoma. A colostomy can also be temporary if your colon just needs to heal. You might need a colostomy if you have colon or rectal cancer, a colon injury, or a blockage in your colon.
- Urostomy. Your doctor will make a pouch using your small intestine. They’ll connect your ureters to this pouch so that urine can drain outside of your body without passing through your bladder. You might need a urostomy if your bladder is diseased or damaged.
- Ileostomy. A stoma is created using your small intestine so waste can bypass your colon and rectum. This is the most common type of temporary stoma, but they can also be permanent. You may need an ileostomy if you have Crohn’s disease, ulcerative colitis, or bowel cancer.
Regardless of the type of stoma you have, your doctor will likely use one of these two methods to create it:
- End ostomy. The cut end of your intestine is pulled through the ostomy and sewn to the opening.
- Loop ostomy. A loop of intestine is pulled through the opening. The loop is then cut and both ends are attached to the ostomy. One stoma opening is for mucus, while the other is for feces.
What to expect
Before ostomy surgery to create a stoma, you’ll be placed under general anesthesia. Your doctor will start by removing any diseased or damaged parts of your bowels before creating the stoma.
After surgery, you’ll be given instructions on how to care for your stoma and ostomy appliance. Once you leave the hospital, you’ll need to rest for a few days and avoid vigorous activities for a few weeks. Your doctor might also advise you to follow a low-fiber diet for the first few months while your body adjusts.
During the first few weeks after surgery, you might notice that you have a lot of gas, which is very normal. Your stoma might also shrink during the first few months, which is also normal and part of the healing process.
Most people can return to work about six to eight weeks following surgery.
What kind of care is involved?
Your ostomy appliance includes a pouch that your stoma drains into. Depending on the type of pouch you have, you’ll need to change it every three to seven days. When you change the pouch, clean the skin around your stoma with warm water and let it dry completely. You don’t need to use soap, but if you do, make sure it’s very mild and unscented, like this one. While the pouch is removed, look for any signs of irritation, blood, or changes in the size and color of your stoma. Call your doctor if you notice any of these. While some changes are normal as your stoma heals, it’s best to be safe and check with your doctor.
Aside from changing out the pouch every few days, you should also empty your pouch several times a day. Try to empty it when it’s about one-third full to avoid any leaks.
As you recover, you can start reintroducing different foods back into your diet. Try to do this slowly so you can note if you have a hard time digesting a certain food. Keep in mind that you may have trouble digesting some of the foods you used to eat. You can also monitor the consistency and amount of the waste in your pouch to check for signs of dehydration or other issues.
Make sure you fully understand how to care for your stoma before leaving the hospital. Your doctor should provide you with a full set of instructions that you can take home as well.
Is it reversible?
Depending on your underlying condition, your stoma can be either permanent or temporary. If your bowels or bladder aren’t permanently damaged and just need a break, your stoma might be reversible. Your doctor should be able to tell you before your surgery whether your stoma will be permanent. If your stoma is temporary, surgery to reverse it is usually done three months to a year after your original surgery. This gives your organs time to heal.
To reverse a stoma, there needs to be enough of the bowel left to reattach the ends to each other. During reversal surgery, your doctor will rejoin the ends of your intestine and sew the ostomy opening closed. It may take some time for your bowel to start functioning normally again.
Are there any complications?
Although stomas are a relatively common and safe surgery, there are some possible complications. These include:
- Skin irritation. This is a common problem that’s caused by the adhesive on your ostomy appliance. Try using a different appliance or changing the adhesive you use.
- Dehydration. Having a lot of waste exit through your stoma can lead to dehydration. In most cases, you can rehydrate yourself by drinking more fluids, but severe cases might require hospitalization. Avoiding foods high in sugar, salt, and fat can decrease your risk of dehydration.
- Leakage. If your stoma appliance doesn’t fit properly, it can leak. If this happens, you probably need a new appliance that fits better.
- Bowel obstruction. If your food isn’t chewed or properly digested, it can cause a blockage in your intestines. Symptoms of a blockage include cramps, stomach pain, and a sudden decrease in waste. Call your doctor if you notice any symptoms of a blockage. While it may clear up on its own, some blockages require additional treatment.
- Retraction. It’s possible for your stoma to move inward, usually due to weight gain, scar tissue, or improper placement. Retraction makes it hard to attach your appliance and can also cause irritation and leakage. Accessory products for your appliance can help, but a new stoma might be needed in severe cases.
- Parastomal hernia. This is a frequent complication that happens when your intestine starts to press outward through the opening. These are very common and often go away on their own. However, in some cases you may need surgery to repair it.
- Necrosis. Necrosis refers to tissue death, which happens when blood flow to your stoma is reduced or cut off. When this happens, it’s usually within the first few days after surgery.
Most complications associated with stomas are minor, but some, especially necrosis and dehydration, can turn into medical emergencies. Call your doctor immediately if:
- you’re vomiting and not seeing any waste in your pouch
- the skin around your stoma is turning blue, purple, or very dark red
- you’re dizzy, lightheaded, and always thirsty
Living with a stoma
Having a stoma can be a big life change. However, you should be able to resume almost all your normal activities once you recover from the procedure. For some inspiration, take a look back at some of the top ostomy blogs of 2017. Just remember to take proper care of your stoma, including draining and changing the pouch as often as necessary and monitoring any changes.
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