What is a stoma

If you are facing stoma surgery, you are probably going through a well of emotions. What does it mean to have a stoma? How will life change? How do I share the news with my family and friends? The idea of having a stoma may take some getting used to and it's only natural to be looking for information and advice as you are preparing yourself for life with a stoma. In this article, we address all the common questions about stomas, how it connects to your digestive system and what happens after your surgery.

Knowing what a stoma is and how it is created is an important first step in understanding how it may affect daily life.

A stoma is a small opening in your abdominal wall that allows waste to pass from your small intestine (ileum) or large intestine (colon). The small or large intestine is brought out to the skin in the abdomen during surgery and is meant to remove disease and relieve symptoms and pain. A pouch, called a stoma bag, is attached to the stoma to collect feces or urine from the opening.

Do you need a permanent or temporary stoma?

Your stoma can be temporary or permanent, depending on your condition. A temporary stoma can give your bowel the necessary rest and restitution to recover from a damaging condition or critical illness. When stoma surgery is a temporary measure to relieve pain, you will most likely have a new surgery scheduled 3-12 months later to rejoin the bowel. A permanent stoma is necessary when part of the colon has been removed and the bowel cannot be rejoined.

Who needs a stoma?

The following diseases and conditions can cause the need for an ostomy operation:

• Inflammatory bowel disease
• Crohn's disease
• Colorectal cancer
• Bowel cancer
• Rectal cancer
• Ulcerative colitis
• Trauma or RTAs (Road Traffic Accidents)
• Familial Adenomatous Polyposis (FAP)
• Bowel Obstruction
• Typhoid perforation
• Tuberculosis perforation
• Congenital defects

The need for an ostomy procedure can occur at any age and does not lower life expectancy. An ostomy doesn't require medicine or other pain relief after you have recovered from surgery. Most often, stoma surgery will be planned in advance, so you have time to prepare for the procedure, and can talk everything through with your doctor or surgeon. However, in fewer cases, it will be an emergency surgery if your condition is critical and ostomy surgery can be a life-saving procedure.

How does a stoma look and feel?

A stoma is usually moist and pinkish-red because it is a mucous membrane, just like the mucous membrane inside your mouth. After surgery, your stoma may be dark red and quite swollen to begin with but will reduce in size over time – usually after six to eight weeks. The stoma usually sits on the left side of your abdomen, below your waist. However, it will depend on the section of your colon that's been removed. Prior to your surgery, you will have a consultation with a stoma nurse or your surgeon during which you can discuss the placement of your stoma.

There is no sensation in the stoma so it is not painful to touch. The stoma can bleed a little when you clean it, especially in the beginning, but this is quite normal, and should stop shortly afterwards.

Understanding your digestive system and your urinary system

If you are preparing for a stoma surgery, it's good have basic knowledge on your digestive system and urinary system. Understanding how food and liquid is digested in your intestines can help you understand how your stoma works. A colostomy and ileostomy work within your digestive system, while a urostomy works within your urinary system.

Your digestive system

The stomach

When you eat, the food travels down a long, narrow tube called the food pipe into your stomach. Here, the food is churned into smaller pieces and your digestive juices turn it into liquid.

The small bowel

The journey continues as the contents of your stomach move into the small bowel (ileum), where digestion finishes. Your body absorbs the nutrients it needs for energy, growth and building new cells and channels these into the bloodstream.

The large bowel

When all nutrition has been absorbed, the remains move into the large bowel (colon), where your body absorbs more fluid to make the waste more solid. The muscles in your colon wall then push any waste forward into your rectum, where it passes out of your body through your anus, with the aid of the sphincter muscles, as stool.

Your urinary system

Urine is made by your kidneys and travels down two tubes called the ureters to your bladder. Urine is produced all the time, but it is stored in your bladder until you get a sense that you need to urinate. The urine then passes out of your body through the urethra.

If you have an ostomy, you can try our BodyCheck tool to ensure optimal fit between your body and your pouch system.

What are the different types of colostotomy, ileostomy and urostomy?

There are three different types of ostomy procedures: Colostomy, ileostomy and urostomy. The type of colostomy and ileostomy that is relevant for each patient, depends on their condition. The different types of ostomy surgery are:

• Loop colostomy
• End colostomy
• Loop ileostomy
• End ileostomy
• Urostomy

Learn more about the different types of ostomy procedures to understand how they are carried out, and what kind of bag and products are suitable for each ostomy.

What can I expect after stoma surgery?

The first few weeks after your stoma surgery can be challenging and we know that it takes time to adjust to having a stoma and you may struggle with a different body image. However, most stoma users are able to lead completely normal lives and resume to normal activities after having settled with their new routines.

You are never alone

After your operation, you will stay in the hospital for a few days, allowing your body to recover and heal. A stoma care nurse will help you become confident in taking care of your stoma. Having a spouse or relative with you at this time can be helpful, and they can make sure that you continue with your new routines once you're home. You can also discuss with your nurse when you'll be able to resume to normal activities.

Your nurse will help you with:

• Learning how to care for your stoma, including any possible complications to watch out for
• Re-ordering stoma pouches and accessories
• Your rights regarding reimbursement and other economic support relating to your stoma
• Other practical and social aspects of living with a stoma, e.g. what food and drinks is good to eat and what should be avoided, your social life and how to talk to your family and friends about your stoma, travelling and your intimate relationships
• Who to contact when you have questions
• Ostomy association support groups in your area

Discover our article on stoma surgery/colostomy to learn more about the different types of stoma surgery including urostomy, loop ileostomy, loop colostomy, end ostomy/end colostomy and end ileostomy. We also answer your questions on permanent or temporary stomas, guide you on how to prepare for stoma surgery and give helpful advice on how to tackle challenges post surgery.

Overcoming challenges: We're here to help

Once you are home, you may experience some challenges caring for your stoma. But remember that your WOC nurse, as well as a dedicated Coloplast Care Advisor, will be more than happy to help you with any issues.

Our care programme, Coloplast Care was created to help make living with an ostomy easier. We send you tailored emails with lifestyle advice, Our dedicated advisors and helpful health and lifestyle education can help you find a "new normal." To get in touch with a Care Advisor, call 1800-102-0550 (toll-free from all service providers).

How do I care for my stoma?

In the beginning, your stoma may need extra care and attention to heal properly. It will be swollen, but slowly shrink to its normal size over the next 6-8 weeks. The best way of caring for your stoma is watching what and when you eat and drink, and taking good care of the skin around your stoma.

Caring for your skin

• Always wash the skin around your stoma with warm water, and let it dry completely before you attach your baseplate and pouch
• Use special skincare products for the skin around your stoma to nourish the skin and prevent skin irritation. Avoid any products that contain alcohol and can dry out your skin. Avoid products that contain oil, which can make it harder to attach the baseplate and pouch.

Would you like more advice and tips on how to care for your stoma? Explore our full article on stoma care to learn more about diet and nutrition and healthy habits to care for your stoma.

What is the best ostomy product solution for you?

It may take some time before you find a product that fits you perfectly and the pouch you are using when discharged from the hospital will most likely not be your permanent solution.

Some stoma users can experience sore skin around the stoma, skin irritation and leakage. Usually, this would be a sign that you need to care differently for your stoma or more likely, that your current bag doesn't fit you as it should. Your stoma bag should always fit snugly around your stoma. However, a stoma can change over time, especially if your body shape changes. After a stoma operation, your body may change for a number of reasons. These include:

• Weight gain or loss as you recover from the illness that caused the operation
• Folds or scar tissue in the skin surrounding your stoma
• Parastomal hernia connected to your stoma opening

If your body profile changes, it’s important that you make sure your pouch still fits snugly. Make sure that you assess the fit of your pouch at least once a month, and even more frequently in the first couple of months after your surgery. Always check in with your doctor, if you are experiencing serious skin complications or leakage.

Take the test: What product is right for you?

If you experience ostomy leakage or sore skin around your stoma, try one of our Ostomy Self-Assessment Tools. We have 3 self-assessment tools designed to help guide you in finding the ostomy solution that is best for you and your body.

Coloplast offers a wide variety of ostomy products to suit every kind of stoma and body shape. Our products are designed to give you a custom fit and prevent leakage. We also offer a wide range of accessory product such as skin barriers and sealants, which can help reduce skin irritation and ensure a better fit.

Visit Coloplast India’s official online store to explore our range of ostomy products.

Join Coloplast® Care

If you'd like to learn more about living with a stoma, the Coloplast® Care program can help. We offer advice, personalized support and inspiration whenever you need it. We'll pair you with a dedicated care advisor to help answer any questions you might have along the way. Sign up for Coloplast® Care here!

After surgery, your stoma may be quite swollen to begin with, but will reduce in size over time – usually after six to eight weeks.

No sensation, no pain

A stoma is red in colour. This is because it is a mucous membrane, just like the mucous membrane inside your mouth. There is no sensation in the stoma, so it is not at all painful to touch.  The stoma can bleed a little when being cleaned, especially in the beginning, but this is quite normal, and should stop shortly afterwards.

The digestive system

The stomach
When you eat, the food travels down a long, narrow tube called the food pipe into your stomach. Here, the food is churned into smaller pieces and your digestive juices turn it into liquid.

The small bowels
The journey continues as the contents of your stomach move into the small bowel (ileum), where digestion finishes. Your body absorbs the nutrients it needs for energy, growth and building new cells and channels these into the bloodstream.

The large bowel
When all nutrition has been absorbed, the remains move into the large bowel (colon), where your body absorbs more fluid to make the waste more solid. The muscles in your colon wall then push any waste forward into your rectum, where it passes out of your body through your anus, with the aid of the sphincter muscles, as stool.

The urinary system

Urine is made by your kidneys and travels down two tubes called the ureters to your bladder. Urine is produced all the time, but it is stored in your bladder until you get a sense that you need to urinate. The urine then passes out of your body through the urethra.

The three types of stoma are: Colostomy, Ileostomy and Urostomy

Colostomy

In a colostomy operation, part of your colon is brought to the surface of your abdomen to form the stoma. A colostomy is usually created on the left-hand side of your abdomen. Stools in this part of the intestine are solid and, because a stoma has no muscle to control defecation, will need to be collected using a stoma pouch.

There are two different types of colostomy surgery: End colostomy and loop colostomy.

End colostomy
If parts of your large bowel (colon) or rectum have been removed, the remaining large bowel is brought to the surface of the abdomen to form a stoma. An end colostomy can be temporary or permanent. The temporary solution is relevant in situations where the diseased part of the bowel has been removed and the remaining part of the bowel needs to rest before the ends are joined together. The permanent solution is chosen in situations where it is too risky or not possible to re-join the two parts of the intestine.

Loop colostomy
In a loop colostomy, your bowel is lifted above skin level and held in place with a stoma rod. A cut is made on the exposed bowel loop, and the ends are then rolled down and sewn onto the skin. In this way, a loop stoma actually consists of two stomas (double-barrelled stoma) that are joined together. The loop colostomy is typically a temporary measure performed in acute situations. It can also be carried out to protect a surgical join in the bowel.

Ileostomy

In an ileostomy operation, a part of your small bowel called the ileum is brought to the surface of your abdomen to form the stoma. An ileostomy is typically made in cases where the end part of the small bowel is diseased, and is usually made on the right-hand side of your abdomen.

Stools in this part of the intestine are generally fluid and, because a stoma has no muscle to control defecation, will need to be collected in a pouch.

There are two different types of ileostomy surgery:

End ileostomy
An end ileostomy is made when part of your large bowel (colon) is removed (or simply needs to rest) and the end of your small bowel is brought to the surface of the abdomen to form a stoma. An end ileostomy can be temporary or permanent.

The temporary solution is relevant in situations where the diseased part of the bowel has been removed and the remaining part needs to rest before the ends are joined together. The permanent solution is chosen in situations where it is too risky or not possible to re-join the two parts of the intestine.

Loop ileostomy
In a loop ileostomy, a loop of the small bowel is lifted above skin level and held in place with a stoma rod. A cut is made on the exposed bowel loop, and the ends are then rolled down and sewn onto the skin. In this way, a loop ileostomy actually consists of two stomas that are joined together.

The loop ileostomy is typically temporary and performed to protect a surgical join in the bowel. If temporary, it will be closed or reversed in a later operation.

Urostomy

If your bladder or urinary system is damaged or diseased and you are unable to pass urine normally, you will need a urinary diversion. This is called a urostomy, an ileal conduit or a Bricker bladder.

An isolated part of the intestine is brought onto the surface of the right-hand side of your abdomen and the other end is sewn up. The ureters are detached from the bladder and reattached to the isolated section of the intestine. Because this section of the intestine is too small to function as a reservoir, and there is no muscle or valve to control urination, you will need a urostomy pouch to collect the urine.

After your stoma operation you will need some time to recover. This is perfectly normal, and the time needed will vary from person to person. Your stoma will change in the first weeks following surgery, in terms of both size and output. Also, you might lose or gain weight in these weeks.

Get started with a pouch
Having a stoma means you have no control over when you defecate or, in the case of a urostomy, when you urinate. This means that you always need to wear a bag to collect your output.

Healthy skin
In order for your bag to adhere properly, it is very important to keep the skin around your stoma healthy. When the bag is attached correctly, there is no risk of smell from your stoma and less risk of skin irritation. Before you leave hospital, you will be trained in how to choose and manage your stoma bag and how to take care of your skin.

What about food and drink?
In general you can eat and drink as normal. Try to see how your stoma reacts to different foods. Your stoma care nurse, surgeon or physician will advise if you need to take special precautions.

In general, your stoma is no hindrance to working, socializing, playing sports, travelling or other hobbies. Your general state of health – physically as well as mentally – will play a big role in determining your quality of life as you move forward.

Talk about it
Nothing is more helpful than someone who really understands what you are going through. You are certainly not alone – the number of people with a stoma worldwide is 1.9 million. Your local patient organization is one way of meeting peers to get handy tips, inspiration and personal support.

No matter what type of ostomy you have, all the output from the stoma must be collected in a secure and convenient way. That’s where your ostomy bag comes in. Your bag is designed to stick to the skin on your abdomen around your stoma and collect the output.

Secure and discreet

The type of ostomy bag you select will depend on whether you have a colostomy, ileostomy or urostomy. Your Stomal Therapy Nurse will show you which one is right for you, but the overwhelming majority of bags are secure and discreet. Nobody will know you’re wearing one unless you decide to tell them.

Although it can be difficult at first to accept the fact that you will have to wear an ostomy bag on your stomach, you should soon start to realize that it’s possible to live much as you did before.

Changing your pouch

How often you change or empty your bag depends on the type of stoma you have:

• Colostomy: The bag needs to be changed between one and three times a day, depending on the amount of output.
• Ileostomy: The bag needs to be drained several times a day.
• Urostomy: The bag needs to be drained several times a day. At night, a urostomy bag or a smaller, "micro-bag" version can be attached to a night bag so you don’t need to get up to drain your bag.

When you have a stoma, urine and stools exit directly into the bag on your abdomen. To avoid leaks, skin irritation or social embarrassment, it is very important that you learn how to seal the ostomy bag securely to the skin.

A snug fit is key
The guiding principle is that the adhesive part of the appliance is stuck to the area around the stoma and that the hole in the adhesive fits snugly around the stoma.

Your stomal therapy nurse will help you choose the best product for you and show you how to apply and remove the pouch in the right way. You might also find these instructional videos helpful.