A stoma, or ostomy, is an opening in the abdomen created surgically, to enable waste products to exit the body after surgical removal of the normal organs designed for this task. A urostomy enables urine to pass from the body after the bladder has been removed, or if it is not functioning properly; a colostomy allows faeces (poo) to leave the body when part of the colon has been removed, or to enable it to rest because of disease or injury, and an ileostomy is the opening created when the end of the ileum (small intestine) is brought to the surface, when the colon has been removed. Stomas can be temporary or permanent. If the problem can be resolved, a reversal can be performed, to enable the body to function in the normal way again.
Why do people need stomas? The usual reason is disease. IBD (inflammatory bowel disease) is a common reason for a colostomy or ileostomy. Diseases falling into this category are ulcerative colitis and Crohn's disease. Ulcerative colitis affects only the colon (and possibly the rectum) but Crohn's disease can affect the whole alimentary canal from mouth to anus. The symptoms of IBD can be mild or severe, and usually include diarrhoea and possibly bloody stools, and abdominal cramping. Anaemia and malnutrition can result, and these diseases can have a profound effect on the daily lives of sufferers. It is often a relief to have surgery to remove the diseased bowel and to live with a stoma.
Another reason for stomas is cancer. Large bowel and rectal cancer are very common cancers, and fortunately they are fairly easy to diagnose and treat, especially if they are diagnosed early. Sometimes a temporary stoma is created to enable the tumour to be shrunk sufficiently, by radiotherapy and/or chemotherapy, in order for it to be surgically removed, and depending on the size of the area involved, and its location, the stoma may be temporary.
Stomas can also be necessary because of damage caused by injury, or problems in adjacent areas which might give rise to fistulas or incontinence.
Sometimes babies are born with parts of their anatomy missing, and until reconstructive surgery can be performed, a stoma may be created. In these cases the stoma is usually reversable.
The lower down the bowel the stoma is created, the more normal the poo is. People with a colostomy may produce fairly normal, well-formed poo - this may cause problems because it does not enter the pouch very easily, causing "pancaking" - and remedies such as fibre-rich food or medication may help this problem. For someone with an ileostomy, the output has not had the benefit of the water-absorbing colon and as a result it is more liquid; it also still contains digestive enzymes and can cause skin excoriation if the pouch is not firmly attached around the stoma. Because the output does not pass through the colon, where the water is absorbed back into the body, there is a danger of dehydration, so people have to drink large quantities of water every day, and also make sure their electrolyte levels remain stable. This can be achieved by using rehydration solutions such as Dioralyte or St. Mark's Solution.
Stomas have no control mechanism over the release of the output, so a bag or pouch has to be worn to collect it. Some bags are closed, and are simply removed and disposed of, and a new one applied. This is normally for people with a colostomy, but for people with an ileostomy which produces more liquid outpout, drainable bags are available which can be opened at the bottom, and emptied, and these bags do not need to be changed every time they are emptied; they can be worn for several days. I change mine twice a week, always on the same days so I remember. There are many different kinds of pouch available, and in the UK, each person is assigned a specialist stoma nurse who will advise them on what is best for them while they are still in hospital, and they can call their nurse any time for help or advice. Many pouch manufacturers will supply free samples; everybody is different, and what suits one may not suit another. They also provide ancillary supplies for managing the pouching system, for example adhesive remover, wipes, lubricants and deodorants, disposal bags, and skin preparations. Here in the UK, all this is available free on the NHS with a prescription from one's GP, and a delivery service is set up so that the supplies arrive direct at one's own home. The pouches are very discreet, and nobody need be aware that you are wearing one, although some people prefer to wear them with pride - after all, to survive the disease that has brought them to this point is a great achievement - many ostomates have been to hell and back with their disease, and to come out the other side is something to be proud of, not to be ashamed of or embarrassed about. Stoma awareness is a good thing, because it reduces ignorance and promotes understanding and compassion. Bag people are more common than you might think!!
After surgery, the body needs to heal, and post-operative swelling to be reduced, and during this early stage, a very bland, low fibre diet, known as the low residue diet, is required for a period of 6-8 weeks. The stoma itself will reduce in size during this time, too. After this, normal foods can be introduced in small quantities, one by one, and a food diary kept, to see the effect of each food. For someone with a colostomy, they can usually eventually eat any kind of food but someone with an ileostomy may have to avoid fruit skins and seeds and nuts, and very fibrous fruit and vegetable because of the danger of blockage; however, many people report that they are eventually able to eat virtually anything that they used to eat before. I am fortunate enough to fall into this latter category. The main advice for people with both kinds of stoma is "chew, chew, chew" - the mouth is the first stage of digestion, where the food is mechanically broken down and mixed with saliva which begins the digestive process before being swallowed. This is good advice for non-ostomates too - people tend to eat their food much too quickly, and chewing thoroughly aids digestion. Eating more slowly also helps people keep their weight down because it releases hormones which produce a sensation of being full more quickly.
Having a stoma is a major lifestyle change to start with, and can involve an emotional upheaval as one adjusts to one's new situation and learns a new skill, with problems and accidents aplenty at the beginning, and also adjusting to a new body image, and maybe dealing with some grief over the loss of the body one had before. However, for many, it is a huge relief because it signals the end of many years' suffering, incontinence, and inability to leave the house. It is different for everybody. There is no right or wrong.
There is a great deal of support available, through the professionals (specialist stoma nurses etc.), local self-help groups, and of course, the Internet - with forums and websites, and numerous Youtube videos too. Today is a good time to be alive with a stoma as there is so much help available, and so much more knowledge, and much better products, and one need never feel isolated and alone. There is always someone willing to help, who has trodden the same path before.
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