Life with a stoma

Many patients forced to live with a hole in the anterior abdominal wall lose their quality of life and suffer from an internal psychological condition. But it’s not all that bad. Excessive worrying slows the process of adapting to new realities. It is important to calm down as soon as possible and give yourself a chance to adjust. Today we will take a detailed look at the stoma, its types, and the rules for caring for it and the skin. 

What is a stoma?

A stoma is an opening in the abdominal cavity that is formed during surgery. It is needed to remove urine or intestinal contents when it is necessary to prevent them from entering the bladder or lower sections of the gastrointestinal tract. The formation of an opening is performed when part of an organ or the entire bowel/bladder section needs to be removed and for some types of pathology treatment. 

To form a stoma, the surgeon pulls a piece of the large or small intestine outward through the opening and sews it to the adjacent tissues. The ureters are taken along with the intestine to remove the urine.  

Due to the absence of a muscular closure apparatus in the opening, the urge cannot be controlled. The patient cannot feel a clear desire to empty. Therefore, special systems (uroprinters and colostomy bags) have been created to facilitate the collection of urine and feces. 

In addition, the stoma is completely disconnected from nerve endings, so there will be no pain during urination. Discomfort appears only when the skin around the hole is affected and peristalsis is intensified.

Stoma formation is necessary if the bladder or bowel section does not perform its function. This is possible with trauma, some pathological conditions, and due to a congenital defect. The most common causes are bladder cancer, colon cancer, diverticulitis, Crohn’s disease, intestinal obstruction, ulcerative colitis, and urinary tract obstruction. 

Types of intestinal stomas

Intestinal stomas are subdivided into:

Temporary – formed for therapy in the lower GI tract;

Permanent stoma – when irreversible lesions of the organs are made;

single-barrel stoma – when only one intestinal trunk is brought to the orifice; 

double-barrel stoma – when two intestinal trunks are connected to the orifice at once.

A double-barrel stoma is subdivided into a loop stoma when both bowel trunks are led only to one orifice, and a split stoma, when two bowel trunks have their orifices. When the latter type is installed, emptying is still done through only one trunk. A colostomy bag or urinal is installed on it. The second trunk is needed to drain mucus or perform therapeutic manipulations. 

Stomas are also subdivided into urostomas, colostomas, and ileostomas.

Urostomy

A urostomy is the formation of an opening for urination. It is most often performed after removal of the bladder and for the treatment of cancer. The stoma is formed from the small intestine, one section of which is inserted into the opening, and the other is sutured to the stomach. The ureters, separated from the bladder, are also led to them. 

Colostomy

Colostomy – a section of the large intestine is brought to the opening. Due to the lengthy process of digestion, the colon is emptied in regular feces up to 3 times a day. 

Ileostomy

Ileostomy – a section of the small intestine that is brought to the opening. It is accompanied by frequent defecation, which severely damages the skin. Feces do not have time to form, so the stool is often unformed, which can lead to dehydration and loss of important vitamins, and micro and macronutrients for the body. 

Peculiarities of stoma change

Immediately after formation, the stoma has a scarlet hue and swelling. A small amount of blood or blood may ooze from the orifice. 

A few days after the swelling disappears, the stoma decreases and takes on a pink hue. Only after a month, it takes on its final appearance.

Due to the periodic contraction of the internal muscles of the intestine, the excreted appendix may periodically increase and decrease in size.

To choose the right colostomy bag or urine bag, it is necessary to measure the size of the stoma at all times. In the first year after its formation, measurements should be taken every month, then every six months.

Stoma care

In each case, stoma care will be individual. It depends on the type, purpose, and place of its formation, as well as the condition of the skin, frequency of emptying, and personal feelings of the patient.

There are 2 types of receiver systems – one-piece and two-piece. Each requires a different type of care.

Single component systems

One-piece receivers are bags with an adhesive backing. They come in non-drainable – closed, drainable – open (to allow emptying), and uroprimers – to collect urine.

Non-drainable systems are replaced every 2 days or more frequently as needed. Drainable receivers need to be emptied constantly and replaced at least once a day. 

It is recommended that the collection tanks be changed every day and emptied at all times.

Dual component systems

Two-piece receivers have two separate structures – a plate and a reservoir. They are bonded together by a flange that helps secure the system to the patient’s body.

The non-drainable systems’ plate should be replaced every 3 days, while the bag should be replaced twice a day. Thanks to the built-in automatic filter, no odor escapes and air enters freely. For the drainable colostomy and uroprimary systems, the plate should also be changed every 3 days and the bag every day provided it is emptied at all times. 

Rules of care

To take good care of the stoma the following rules should be followed:

When changing a urinal in the supine position, be sure to lay a waterproof diaper on the bed.

Replace the system while standing or sitting.

Prepare all necessary supplies before beginning any manipulation of the stoma.

Replace the uroprimer/stool in front of a mirror.

Wash hands thoroughly with soap and water before changing the stoma. 

Do not change the system immediately after eating.

The best time to change the stool is in the morning immediately after bedtime and in the evening before bedtime.

Do not throw the used system or parts of it down the toilet.

Do not be afraid to touch the stoma with your hands, it is vital to observe the rules of personal hygiene. 

Use special products and ordinary running water for cleaning.

Thoroughly clean the skin around the stoma.

Do not use cotton, its fibers may remain on the stoma and irritate. 

Do not use soaps or antiseptics – they dry out the skin.

Gently dry your skin with a clean, soft towel.

If you have hair near the stoma, cut it off with scissors or carefully shave it off with a loom. 

If there is any hair around the stoma, cut it off with scissors or shave it off with a machine. Systems without drains do not need to be emptied before disposal.

Care of the skin around the stoma 

It is very important to pay special attention to the skin around the stoma. Their condition will depend on therapy, diet, type of stoma, amount of defecation, and individual characteristics. 

It is important to make sure that the skin around the stoma remains dry, without rashes or lesions. It should be constantly monitored and simple rules should be followed to keep it healthy:

Choose a urinal and colostomy bag correctly according to your doctor’s recommendations.

Make an incision under the stoma that fully fits the diameter of the stoma itself.

Empty the open colostomy bag and urinal as soon as contents appear in it.

Ensure that the plates fit tightly against the body. This is important to prevent the contents of the bag from leaking.

Maintain healthy skin around the stoma with the products recommended by the specialist.

If there is a deformation of the skin around the stoma – apply a special paste. 

If redness, irritation, itching, ulcers, pimples, or burning occurs – be sure to consult a doctor.

Improper sizing of the bag will cause some of the excrement to come out and affect the skin.

Frequently Asked Questions

• How long will it take me to get used to a stoma?

This process is individual. Some people get used to it in the first few weeks, others take much longer. The main thing is to have the support of your loved ones and to follow the doctor’s recommendations at all times.

• Will people around me notice that I am wearing a colostomy bag or a ufo primer?

No, the new systems are completely invisible. They are flat, don’t let odor in, and don’t make any noise when you walk. The only rule is that you should not wear clothes that are too tight. It will not hide the system and will bring discomfort because of the pressure on the stoma. 

• Can I go back to work?

Going back to work is an opportunity to adapt even more quickly to the appearance of the stoma. But only if the work does not involve heavy physical activity. 

• Can I play sports?

Yes, you can participate in all sports, except power sports. Before you start training, you need to consult a doctor.

• Can I bathe in the bathtub and swim in the pool?

You can take a bath, shower and swim in the pool and sea. The main thing is to close the filter of the receiver if there is one. When visiting the beach and swimming pool, it is recommended to wear close-fitting swimming trunks. You should not go to the sauna or bathhouse.