What is a stoma?
The purpose of this information is to provide pre-op and recently post-op patients, as well as family members with information about how the digestive and urinary systems work, how stomas are formed and some of the lifestyle factors that you may have questions about after stoma surgery.
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When you swallow food and drink it travels from your mouth, down your oesophagus (or gullet) towards your stomach. Your stomach contains digestive juices which break the food down into a paste that then moves into your small intestine. Your small intestine is a long structure that plays a very important role in your digestive system. It is here that the nutrients from our food that we require for survival are absorbed. The small intestine consists of the duodenum, the jejunum and the ileum. Once the food has moved through the small intestine most of the nutrients and liquid have been absorbed and what is left now gets passed into the large intestine (also known as the colon). You may like to think of the large intestine as a tumble dryer. As your food waste moves through your large intestine, the moisture is absorbed and the waste becomes drier and more formed so that by the time it reaches your rectum it is a well formed stool. It is at this point that you get the sensation of needing to empty your bowels and, when you are ready, your stool will exit your rectum via the natural opening in your bottom, which is your anus.
The water that your digestive system has extracted from your food and drink passes into your blood stream for your body to use. This blood passes through your kidneys for cleaning and the kidneys remove any waste. Waste products, along with water, become urine, which travels from the kidneys down to the urinary bladder via the ureters. It is stored in the bladder until you are ready to urinate and then it travels from the bladder, along the urethra to the outside world.
A stoma (or ostomy, these 2 words mean the same thing) is a surgically created opening on the abdomen which allows stool or urine to exit the body. There are 3 main types of stoma – colostomy, ileostomy and urostomy. You should ask your medical team which type of stoma you have/are going to have as there are some differences between them.
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 doesn’t look like the ones in this leaflet.
Colostomy is the term used to describe 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.
Usually, you will need to wear a bag over the colostomy to collect your stool as there is no way to control when the stool will be released. Wind will also be collected in the bag but the bag will have a filter that allows this wind to be passed without allowing odour to escape. The bag will be closed across the bottom and will need to be changed after each bowel motion. The amount of times you need to change the bag can vary but is normally between 1 and 3 times a day. It is possible that you will change your bag more than this in the early post-operative period, but it will reduce as your system recovers and settles down.
Ileostomy is the term used to describe an opening from the small intestine, specifically the ileum. The surgeon will bring a part of the small bowel from inside your body to the surface where it will be stitched down to secure it. Normally this will be on the right hand side of your abdomen.
An ileostomy works almost continuously and you won’t have any control over this, although some people find there are times of the day when their stoma is less active. You will wear a drainable bag over your ileostomy to collect your output. The drain at the bottom of the bag is secured with either a clip or Velcro. The bag will have a filter that allows flatus to be passed without allowing odour to escape. The number of times people empty their ileostomy bags varies greatly and may be anywhere between 4-12 times per day. As with a colostomy, it is likely that your stoma will produce more output in the first few weeks and months after surgery, but this will decrease as things settle down.
Types of colostomy and ileostomy
There are two main types of colostomy and ileostomy – loop and end. Either type of stoma may be temporary or permanent. Your medical team will be able to tell you which kind you have. To create a loop stoma, a loop of intestine is brought through the abdominal wall (and supported by a temporary rod, Fig 1). This loop is partially opened to form a stoma with two openings (Fig 2), although you may only be able to see one.
One opening is still connected to the functioning part of your digestive system and is where your output will come through. The other opening leads down to the lower part of your digestive system and may discharge a small amount of mucus, but will otherwise be inactive.
An end stoma is made by bringing one end of the intestine out through the abdominal wall. There is only one opening from an end stoma and this is where your output will come through.
Urostomy (also known as an ileal conduit) is the term used to describe an opening for your urine. A urostomy is made by taking a piece of your small intestine and attaching it to your ureters to create a channel for urine to pass through. One end of the tube is brought out through the abdomen to create a urostomy. Depending on your operation sometimes the bladder is removed, but this will be discussed with you prior to your operation. Urostomies are normally on the right hand side of your abdomen and will have a little spout to allow the urine to exit the body.
After the operation there will be stents in the urostomy and these usually come out after 7 days. The stents are used to protect the join between the ureters and the piece of bowel. A urostomy does not have any muscles therefore you have no control over the flow of urine. You will wear a urostomy bag over your stoma to collect your urine. Urostomy bags feature a non-return valve which stops urine flowing back over the stoma and a tap at the bottom of the bag to empty the contents.
The answers to these questions are derived from feedback and suggestions from people with stomas and nurse specialists.
- Will it smell?
It is perfectly normal for our waste products to smell. Stoma bags are designed to contain this smell while you are wearing them so the only time you should notice the smell is when you are emptying and changing your bag. Remember, other people leave a smell in the bathroom too!
- Will it make a noise?
It is normal for our digestive system to make noises as it processes our food, and this is the same after stoma surgery. You may be quite conscious of the noise your stoma makes but it is unlikely that other people will notice, they will probably assume you just have a gurgly tummy!
- Will I still be able to eat normal food?
The vast majority of people report being able to enjoy a normal diet after stoma surgery, although everyone is different and foods affect us all in different ways. Many people find that there is a period of trial and error during their recovery as they figure out how their new stoma responds to different food and drink in terms of level of output and wind production. Your stoma care nurse will tell you more about how food and drink might affect your particular type of stoma and our ‘Healthy Eating’ leaflet may also be of use.
- Will I still be able to exercise?
Once you have recovered from your operation there is no reason why having a stoma should prevent you from enjoying a full range of physical activities, including walking, running, swimming, cycling, football, the list is endless! The key is to build up gradually and listen to your body to prevent injury. You should take particular care of your core abdominal muscles, which are weakened by the surgery. There is a risk of developing a hernia around your stoma so you may like to discuss appropriate exercises and support garments with your stoma care nurse. Our ‘Fitness & Exercise’ leaflet may also be of use.
- Will I still be able to wear normal clothes?
The majority of people report that they continue to wear the clothes they wore before their stoma operation. Depending on the position of your stoma you may find the waistband of some clothing is awkward, so shop around for what feels comfortable if this is the case. Some people prefer to wear their bag inside their underwear while others have the bag over their underwear, it is simply a matter of choice, so do whatever feels most comfortable to you.
- Will I still be able to bath and shower as usual?
Bathing and showering as normal are fine, whether you choose to keep your bag on or not. Many people say bathing without a bag on allows them to clean thoroughly around their stoma, but you should not use soaps on the skin near your stoma, warm water is enough. You may like to choose a time when your stoma is less active to do this. Alternatively some people prefer to keep their bag on when bathing, this is also fine and won’t affect the adhesiveness of your bag. You may like to change your bag afterwards for a dry one, or simply towel it dry.
- Will I still be able to work?
Once you have recovered from your operation it is likely that you will be able to return to work, although this may depend a little on the nature of your work and the reason for your operation. Some people find a phased return to work helpful as part of their recovery, so you should speak to your doctors and employers about this.
- Will I still be able to go on holiday?
Having a stoma should not prevent you from travelling, whether you choose to holiday in the UK or fly off further afield. Planning ahead to ensure you take adequate supplies with you is important, as is making sure you have appropriate travel insurance. There is more about travel in our ‘Travel’ leaflet.
- Will I still be able to have sex?
Yes, there is no reason why you can’t enjoy a satisfying sex life after stoma surgery. You may like to give yourself time to recover from your operation first, but many people report enjoying sex more than before, especially if you had been suffering from a serious illness before your operation. In practical terms people often suggest emptying or changing your bag beforehand and you may find some positions more comfortable than others, so experiment to see what works best for you and your partner.
- Will anyone be able to tell I have a stoma?
Stoma bags are very discreet and it is very difficult for other people to tell that you are wearing one. It is highly likely you have met someone with a stoma before and not known it. In most cases people will only know about your stoma if you have told them.
- Should I tell anybody that I have a stoma?
This is a personal decision, and you should do whatever you feel most comfortable with. Some people like others in their life to know so that they be can more understanding of the situation, while some like to maintain their privacy. The majority of people with a stoma report that reactions from others are mostly a combination of interest, support and compassion.
A full list of the sources used to produce this document may be obtained by contacting Ostomy Lifestyle.
Date of issue: November 2013
Planned review date: November 2016
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