Collecting one’s faeces in a bag sounds unpleasant to most people. However, to thousands of people, it is a part of their daily lives.
In this article, we explore the ins and outs of the stoma.
What is a stoma?
A stoma is a surgically made opening in the intestine attached to the abdomen’s skin surface.
Based on the type of organ being connected to the skin, a stoma is categorised into:
- Ileostomy – a stoma of the small intestine
- Colostomy – a stoma of the large intestine
There is also a stoma of the urinary system called a urostomy. However, in this article, we will be focusing on the intestinal stoma.
A stoma can be temporary or permanent at times. This decision depends on the reason why the stoma is needed.
Why is a stoma needed?
The primary purpose of a stoma is to redirect waste products out of one’s body. A stoma bag is attached at the opening to collect the stools and gases. We would manually change and empty these bags for hygienic purposes.
There are many reasons why we would need to redirect these waste products. Commonly, we would need to surgically remove a part of the intestine when there is a disease. These diseases are such as:
- Inflammatory bowel disease (IBD)
- Intestinal cancer
- Obstruction of the intestine
- Trauma to the intestine
After removing the affected part of the intestine, reattaching the two ends may not be as simple. In many cases, it may be safer to create a stoma instead of immediately reattaching the two ends.
Another indication of a stoma creation is in unfortunate patients who are born without an anus. A stoma is created for these patients to allow clearance of waste products.
Will my stoma be permanent?
The short answer to this is that it depends. A stoma can be temporary or sometimes permanent. Patients with an incurable or severe disease may require a permanent stoma.
In other conditions, we would usually create a stoma temporarily. The aim is to give the intestines a rest and time to heal before reattaching the two ends back together.
Doctors base the appropriate choice of a permanent versus a temporary stoma on a case-to-case basis. Before that, the doctor should discuss the situation with the patient. The doctor would then provide the various treatment options with the pros and cons of each option.
Fun facts
- The word ‘stoma’ originates from the Greek word translating to ‘mouth’.
- The term for people living with a stoma is ‘ostomates’.
- The stoma itself does not have any nerve endings. Therefore, patients would not feel it when they touch their stoma.
Will it restrict my daily life?
In public, a person with a stoma is practically indistinguishable from a person without one. After initially adjusting to the change, a stoma would generally not affect a person’s daily activities. Below are some tweaks that people with stomas might need to make in their daily lives.
Travel
Holidays with a stoma should not be a problem. Patients must bring their cleaning supplies and spare stoma bags to care for their stoma.
Air pressure changes in flights can fill a stoma bag with air. We advise patients to simply expel the air from the stoma bag in a restroom.
Physical activities
During the initial recovery process, patients should avoid strenuous activities. The stoma creation causes an area of weakness in the wall of the abdomen.
To prevent complications, we advise patients to increase their physical activity slowly. We would also teach patients gentle exercises to strengthen their abdominal muscles.
Once healed, patients can resume most physical activities with no issues.
Swimming
Stoma bags these days are waterproof if applied securely. Patients with stoma bags can usually swim with no problems.
Sexual activities
While some positions may be uncomfortable, patients can make little adjustments to prevent discomfort during intimate moments.
Emptying the stoma bag before intimate activities and ensuring a secure seal can help prevent any hiccups.
Issues regarding a patient’s sexual life are usually due to the impact on their body image. Patients may use many commercially available covers and custom undergarments to feel more comfortable.
Clothes
Stoma bags are lightweight and discreet. There are some adjustments that patients can make to ensure their comfort and decrease visibility.
- Avoid crop tops and tight-fitting clothes
- Positioning the stoma bag below or above the waistband
- Opting for specialised garments that are made for people with a stoma
Common stoma issues and dietary changes
Below are some common issues and recommended diet changes a patient with a stoma can make.
Gas
To reduce excess gas production, patients should eat regular meals. Having small, frequent meals also helps. We also advise patients to avoid drinking from straws and talking with food in their mouths.
Patients may also reduce their intake of certain foods, such as:
- Alcohol
- Carbonated drinks
- Beans and soy
- Dairy products
- Broccoli, cauliflower, cabbage, cucumber
- Onions
Odour
Some of the measures to reduce excessive odour are:
- Ensuring secure sealing of stoma bags
- Using odour-resistant and filtered stoma bags
- Using special deodorants in the stoma bag
- Frequent emptying of the stoma bag
To avoid excessive odour, patients can also reduce the intake of these foods:
- Beans
- Eggs
- Asparagus, broccoli, cauliflower, cabbage
- Onions and garlic
- Fish
Diarrhoea
In contrast to a colostomy which produces semi-solid, an ileostomy produces watery stools – this phenomenon is normal.
Some dietary changes to reduce excessively loose stools are:
- Eating fibre-rich vegetables in moderation
- Reduce coffee and alcohol intake
Dehydration
Linked to diarrhoea, patients with an ileostomy and those who experience excessively watery stools have a risk of dehydration.
We emphasise that such patients should stay hydrated with at least 1.5-2 Litres of water intake daily.
Constipation and blockage
To avoid food blockage, we advise patients to chew their food thoroughly and eat slowly. Drinking fluids with meals will also help.
Patients should also avoid heavy consumption of foods with indigestible parts and fibres. These are such as:
- Sweetcorn and popcorn
- Fruits with unpeeled skin (apples, pears, etc.)
- Fruit peels and dried fruit
- Food with seeds and pits
- Nuts
- Coconut
- Stringy vegetables
Patients with an ileostomy are likelier to experience a blockage due to the narrower passage.
If you are experiencing some blockages, please do not take over-the-counter laxatives.
Will it affect my nutritional absorption?
Nutritional absorption in patients with ileostomies is more likely to be affected than in colostomies. Patients must comply with their regular follow-ups to identify any nutritional issues.
Living with a stoma
Undoubtedly, a stoma would impact a person’s mental health. Body image issues are common and justifiable.
Other than speaking to your doctor about your issues, various support groups are available to help.
How do I care for my stoma?
A healthy stoma is a shiny pink doughnut-shaped hole on the tummy. Initially, it can be tedious to care for the stoma. However, after adapting to it, caring for it becomes part of a patient’s daily routine.
As a rule of thumb, we should empty the stoma bag when it’s one-third filled. Patients should carry their cleaning supplies and spare stoma bags wherever they go.
We replace the stoma bags once or twice weekly. However, it depends on the type of stoma bag used.
There are various stoma bag options, each with specific instructions. The healthcare provider will help patients select the most suitable choice based on their lifestyle, preferences and budget.
How do I clean my stoma?
Specific cleaning instructions vary based on the type of stoma bag. These are some general tips when cleaning the stoma:
- Check the stoma and skin surrounding the stoma each time the bag is changed.
- When cleaning around the surrounding skin, use lukewarm water or a wet towel. Soap is not required. Some soaps and wet wipes can interfere with the adhesive and irritate the skin.
- The skin should be pat dried before sticking on the new stoma bag. Avoid using creams or lotions which can interfere with the adhesive.
- The stoma itself does not require washing. Wiping any excess stools from the area is enough.
- Be gentle when handling the stoma. Injuries to the stoma may go unnoticed as the patient would not feel pain at the stoma.
- A hand mirror can be helpful if it is hard to visualise the stoma while cleaning.
Skin irritation around the stoma
Irritation of the skin surrounding the stoma is a widespread occurrence. Here are some tips to reduce this irritation.
- Be gentle when removing the stoma bag from the skin. Aggressive removal can irritate the skin.
- Use an appropriately sized stoma bag. Using a larger ring base is usually the problem. The faecal matter will cause irritation when it comes in contact with the skin.
- Severe irritation and rashes are causes of concern. Consult your healthcare provider if this occurs.
What complications should I look out for?
There are some potential complications of a stoma. These are some signs that patients should look out for.
- Abnormal bulges around the stoma
- Unusual changes in the colour and size of the stoma
- Excessive bleeding from the stoma
- Severe pain/cramps at the stoma site or abdomen
- Persistent excessively watery stools
- Ongoing lack of stoma output
Complying with regular follow-up visits when having a stoma is crucial. The stoma will be monitored over these visits to identify any complications.
Conclusion
Having a stoma may seem like a daunting experience. However, most patients can adapt to the lifestyle of having a stoma with no issues.