A stoma (the Greek word for "mouth") is a surgically created opening in the abdomen wall. The procedure that creates the stoma is called an ostomy. It involves making an incision in the abdomen and pulling a section of the digestive tract through the opening (stoma). A small bag is then securely fastened over the stoma to take the body's waste products. The bag is emptied as needed. Some stomas are temporary, others are permanent.
Ostomies are often recommended when people lose the normal function of their bladder or bowel because of injury or diseases, such as cancer, inflammatory bowel disease, Crohn's disease, ulcerative colitis, and diverticular disease.
Different types of ostomies
There are different types of ostomies, depending on what portion of the digestive tract is brought to the surface. The most common ostomies are the Ileostomies and colostomies, which bypass the ileum (part of the small intestine) and the colon (large intestine), respectively, and allow stool to be eliminated from the body and into a bag. When the urinary tract is affected, an urostomy redirects urine to the surface of the abdomen. Recovery from any such ostomy can take from 6 to 8 weeks.
The consistency and frequency of discharge after an ostomy depends first on its location and then on the type and amounts of foods eaten. Your doctor will explain what kind of discharge you can expect.
Caring for a stoma
When you first come home following surgery, your stoma will probably be large and swollen. Don't worry; it should shrink within 5 to 6 weeks. A healthy stoma is shiny, wet, and a pinkish/red colour - never black, blue, or purple. Since the stoma has no nerve endings, it should not hurt when touched.
When caring for your stoma, follow the instructions given to you at the hospital. Keep in mind the following:
- Every day, clean the skin around the stoma with warm water only. (If you see a small amount of blood when cleaning, don't worry; the stoma is rich with blood vessels and the blood should stop spontaneously.)
- Gently pat the skin dry or allow it to air dry.
- Apply protective skin barriers, borders, or pastes to the skin surrounding the stoma before attaching the bag.
- Empty the bag when it becomes one-third full.
- Change the bag before there is leakage, usually every 5 to 7 days.
There are a variety of soft, smell-proof stoma bags and seals or wafers, as well as hypoallergenic protective skin creams, pastes, and cleansing wipes available at your local drugstore. Most stoma bags now come with gas filters. Some bags can be drained (e.g., those used after an ileostomy) and some are closed (e.g., those used after a colostomy). The bags cannot be flushed down the toilet.
If you had an ileostomy, you must drink more water and take more salt than before, because these are no longer being reabsorbed in the large bowel. Most doctors recommend drinking about an extra litre of water each day, and more in warm weather. Your main output will occur 3 to 4 hours after your main meal (often in the evenings). If you had a colostomy, you must also drink more water and your output will peak in the morning after breakfast.
Digestion and absorption of medications may be affected after an ostomy. If you are taking medication in pill form, be sure to check your bag regularly for intact pills, indicating that they have not been digested properly. Review all over-the-counter or prescription drugs with your pharmacist. (Over-the-counter medications include antacids, antidiarrheal, anti-inflammatory agents, aspirin, laxatives, salt substitutes, sugar substitutes, and vitamins.) When possible, your pharmacist may be able to recommend rapid-dissolving formulations (such as chewable pills or liquids) or ones that bypass the gastro-intestinal tract completely (such as intra-nasal or trans dermal medications (i.e., patches)).
Diet after an ostomy
People with healthy eating habits don't usually need to change their diet after an ostomy. Continue eating well-balanced meals and, if you had a colostomy, be sure to eat at fixed hours so you can maintain regularity. Don't hesitate to dine out. You'll soon learn by trial and error if certain foods cause you problems and then you can modify your eating habits accordingly.
Odour: Some people find that after a colostomy, certain foods - such as asparagus, baked beans, onions, vegetables from the cabbage family, cheese, eggs, and fish - cause bad smells. Similarly, after an urostomy, be aware that asparagus, onions, fish, or garlic will give your urine an unusual smell.
Gas: Carbonated drinks and beer sometimes produce excess wind and runny motions, as may vegetables from the cabbage family, asparagus, corn, cucumbers, mushrooms, peas, and spinach. Also, skipping meals increases gas, as does swallowing air. Eat slowly, avoid chewing gum, and don't drink through a straw.
Exceptions: If you have watery stool, you may be losing 2 important minerals: sodium and potassium. Consult a nutritionist about recommending a special diet that replenishes your supply.
In general you'll find you can control your output by modifying your diet slightly. If you need a little help, your doctor may suggest a medication to speed things up or slow things down. Don't hesitate to talk to your pharmacist about any concerns you may have about the effects - or side effects - of any medication.
Occasionally a person with a stoma will develop a food blockage when undigested parts of food clog the bowel, causing decreased output, cramping, and pain. Foods that may cause blockage include peanuts, popcorn, coconut, mushrooms, celery, and dried fruits. Tips for avoiding food blockage include:
- do not eat high fibre foods until about a month or so after surgery (check with your doctor first).
- add high fibre foods to your diet gradually and in small amounts.
- chew foods well.
- drink plenty of fluids.
Contact your doctor if you think you have developed a food blockage.
Life after an ostomy
It is important to resume a normal life as soon as possible after an ostomy. At first, some people have difficulties. Those who have had a colostomy, for instance, may briefly experience a "phantom rectum" and feel the urge to have a bowel movement. Some people are disgusted by the appearance of their stoma and experience a dramatic shift in their self-image. Other people become very self-conscious, thinking that everyone can tell what's hidden under their clothing, just by looking. Remember that the ostomy was carried out to improve, even save, your life and that in time you will get used to the stoma. Discuss the surgery openly with your spouse and loved ones. Remember that there are people around to help you deal with the changes and minimize any negative effects on your quality of life.
Bathing with a stoma: You can take showers or baths with the bag attached or not, as you wish. If you shower with it off, use an oil- and residue-free soap that won't interfere with the adhesion of the wafer.
What to wear with a stoma: If your stoma is at or near the waistline, avoid tight-waisted pants or skirts, or belts. Soft and stretchy girdles or panty girdles can be worn, as can athletic supporters, although one size larger than before will likely be more comfortable.
Exercise with a stoma: You can resume playing most sports after surgery. Ones to avoid are those involving extremely rough contact or very heavy lifting. Discuss your exercise program with your doctor.
Sex with a stoma: Sexual activity will not hurt your stoma. Many people go on to have a satisfying sex life after an ostomy. Two points to keep in mind: Change your bag before sex and choose positions that won't put pressure on the stoma.
Talk to your doctor if you have any questions about conception or pregnancy following an ostomy. In general, a stoma should not stand in the way of a woman conceiving and bearing a child, nor of a man becoming a father.