What is a stoma and why is it needed?
A stoma is the visible, mouth-like part of an ostomy, which is a surgical procedure creating an opening on the outside of your body that connects to an internal organ. It's a vital medical solution for individuals whose digestive or urinary systems are no longer functioning correctly due to various health conditions. The stoma is created by bringing a portion of the intestine (small or large) or urinary tract to the surface of the abdominal wall and stitching it in place. This provides a new pathway for waste—whether stool or urine—to leave the body, as the normal route is blocked, damaged, or has been removed.
The need for a stoma can arise from several serious medical conditions:
- Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis can cause severe damage to the intestines, necessitating their removal or a period of rest.
- Bowel or Colorectal Cancer: If a tumor blocks or necessitates the removal of a section of the bowel, a stoma is required to reroute waste.
- Birth Defects: Some congenital defects of the anus or intestine may require an ostomy.
- Trauma or Injury: Severe injury to the abdomen, perhaps from an accident, can damage the bowels, requiring surgical intervention.
- Diverticular Disease: Severe inflammation or infection can damage parts of the large intestine.
- Bladder Malfunction or Cancer: Conditions requiring the removal of the bladder or affecting its function will necessitate a urostomy.
Types of ostomies: A comparison
There are three main types of ostomies, named for the part of the body involved. The type of ostomy and stoma created depends on the specific medical condition and which part of the tract needs to be diverted.
| Feature | Colostomy | Ileostomy | Urostomy |
|---|---|---|---|
| Surgical Connection | Large intestine (colon) to the abdominal wall | Small intestine (ileum) to the abdominal wall | Ureters diverted via a piece of ileum to the abdominal wall |
| Location | Typically on the left side of the abdomen | Often on the right side of the abdomen | Usually on the right side of the abdomen, depending on the patient |
| Output | Thicker, more formed stool as more water has been absorbed | Liquid or pasty stool, as it hasn't passed through the large bowel | Urine drains continuously |
| Common Cause | Colon cancer, diverticulitis, intestinal obstruction | Crohn's disease, ulcerative colitis, removal of large intestine | Bladder cancer, chronic infections, nerve damage |
How a stoma works and looks
An abdominal stoma is formed by bringing a section of the bowel or ureter through the abdominal wall and suturing it to the skin's surface. Because the stoma is made from the moist, pinkish-red mucous membrane lining the inside of your body, it resembles the inside of your mouth. The stoma has no nerve endings, so it is not sensitive to touch and does not cause pain. Immediately after surgery, it may be swollen, but it will shrink over a few weeks.
Since there are no sphincter muscles at the stoma, a person has no voluntary control over the passage of waste. For this reason, a secure, odor-proof pouching system—also known as an ostomy bag—is worn over the stoma to collect the waste. This system consists of an adhesive baseplate (or barrier) that sticks to the skin around the stoma and a pouch that attaches to the baseplate. Modern systems are discreet and reliable, allowing most individuals to resume a normal lifestyle.
Temporary vs. permanent stomas
A stoma can be either temporary or permanent, depending on the reason for the surgery.
- Temporary Stoma: This is often created to allow a portion of the bowel to rest and heal after surgery or a serious infection. After the healing period, a second surgery can be performed to reverse the ostomy and reconnect the bowel.
- Permanent Stoma: A permanent stoma is necessary when a large portion of the bowel or the rectum and anus have been removed, making it impossible to reconnect the digestive tract. This is more common with certain cancers or severe inflammatory diseases.
Life with a stoma
Adapting to life with a stoma is a process that requires time and support. Initially, it can be a significant emotional and physical adjustment, but most individuals learn to manage their stoma care and return to the activities they enjoyed before surgery, including sports and travel.
Key aspects of adapting include:
- Stoma Care Education: A specialized stoma nurse (Wound, Ostomy, and Continence nurse) provides comprehensive education on how to care for the stoma, including changing the pouching system and managing skin health.
- Dietary Adjustments: Some dietary changes may be necessary to manage output and avoid blockages, particularly with an ileostomy. A healthcare provider can offer guidance.
- Physical Activity: Most physical activities are possible after healing, with proper protection for the stoma.
- Emotional Support: Connecting with support groups, such as the United Ostomy Associations of America, can provide a vital network of peers who understand the journey.
Conclusion
A stoma is a life-altering but often life-saving medical necessity for those with damaged digestive or urinary systems. While requiring an adjustment period and learning new routines for waste management, individuals with a stoma can go on to live full, active lives. With proper care and support, having a stoma is not a barrier to enjoying one's life. Understanding what is a stoma and the care involved is the first step toward a successful adaptation and positive outlook.
For more in-depth information and resources on living with an ostomy, you can visit the United Ostomy Associations of America.
