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Stoma careWhat is a stoma? A stoma is an artificial opening to or from the intestine (which is also known as the gut or bowel) on the abdominal wall usually created by a surgeon. Occasionally, it is an artificial opening in the urinary tract, called a urostomy. When is a stoma required? A stoma is necessary when parts of the normal intestine must be bypassed, for example when bowel surgery has removed important lengths of the intestine, or when food cannot be taken in by mouth. The main different types of stoma depend on the part of the intestine that forms the opening:
Another type of stoma, called a urostomy, is an artificial connection between the urinary tract (the kidneys, bladder and tubes that connect them) and the abdominal wall, sometimes referred to as a 'urinary conduit'. Stomas may be temporary (to allow another part of the intestine to heal), or permanent. If they are temporary another operation is required to close them. Stomas are carefully sited on the abdominal wall so that they can be hidden and yet still function. With a colostomy or ileostomy, a special bag is attached to the site that collects the faeces. The opening on the abdominal wall must be well cared for because bowel contents can irritate the skin, which results in ulceration and infection. Unlike at the anus, no mechanisms are in place to regulate the flow of faeces. The use of appliances such as a bag-and-seal over and around the stoma can, in turn, cause damage to the skin from their frequent removal, and from allergy to the materials used. What necessitates a stoma and who is at risk? Stomas are commonly necessary in sufferers of inflammatory bowel disease, including Crohn's disease and ulcerative colitis. They are also formed during operations for bowel cancer, diverticular disease and after accidental damage to the bowel wall. Urostomies are not common and are performed if there is a problem that prevents urine produced by the kidneys from reaching the outside of the body. Such problems can arise because of cancer, or pelvic or abdominal surgery. What are the common symptoms and complications of having a stoma? The problems of a stoma can often be psychological, and you may be initially shocked by the appearance of your stoma. You may experience a 'phantom rectum' with the urge to defecate (empty the bowels) for several days or weeks after formation of the stoma. Your body image may be affected, and you will need the support and understanding of your family and friends, and the professionals that care for you, to help you through this time and to minimise any effects on your quality of life. Once the initial decision to form a stoma has been reached, you will be introduced to a specialist stoma nurse who can explain the implications for everyday life. The nurse can show you the different type of appliances available, how they should be used and how to acquire them. A stoma nurse can also put you in contact with support groups and other people who have stomas, for reassurance and help. After you return home, the stoma nurse works in conjunction with the GP and district nurses to ensure you are confident managing the stoma. 
 Stoma patients often have problems with the consistency and volume of their faeces. The output from an ileostomy peaks three to four hours after a main meal, often in the evenings. With a colostomy, the main output occurs in the morning after breakfast. Patients often find that they must restrict or change their diet to avoid excess wind, odour or loose stool. Eggs and fish often cause problems with bad smells, and fizzy drinks and beer produce excess wind and runny motions. In general, you should try to eat a broad range of foods and use trial and error to find out which ones cause problems. It is important not to avoid dining out, because this is an important part of rehabilitation after stoma formation. Wind is a particular problem to stoma patients who travel by air because the change in pressure in an aircraft cabin can cause large amounts of wind to be passed, which can even cause the stoma bag to come off. To prevent this, you must avoid fizzy drinks before and during flights, and make sure you use a stoma bag with a gas filter. Another very important aspect of stoma care that will be discussed by the stoma nurse is skin care. The skin around your stoma can become sore and broken if it is not cared for meticulously. If you have an ileostomy you will need to take in more water and salt than normal, because these are no longer being reabsorbed in the large bowel. About an extra litre of water each day, and more in warm weather, is needed. How can I manage a stoma? Self-care action plan A range of bags and seals are available that protect the skin surrounding the stoma site and discretely allow for collection and disposal of faeces. Appliances today use hypoallergenic protective skin barriers and creams, and soft, smell-proof bags to help your mobility. The bags and seal appliances come in either one piece, which incorporate a protective skin barrier, or two pieces, with a separate protective barrier that remains on the skin between bag changes and needs to be changed every few days. The bags may be drainable (used especially with an ileostomy), or closed (used especially with a colostomy). Although their contents can be flushed down the toilet, the bags themselves cannot be disposed of this way. Special filters are available for wind, special lotions and cleansing wipes for the skin around the stoma, cotton covers for the bag to improve the comfort of wearing it, and caps that block off the stoma for use in sports when patients have a regular stoma action. Other useful aids include travel mirrors and opaque disposal bags. Medicines Most patients with a stoma can control its output by changing their diet and do not need medication, but from time to time a little extra help may be required. The following drugs are sometimes used by patients with stomas:
What is the outcome of a stoma? You can expect to lead a normal, complication-free life after you have fully recovered from the stoma operation. Indeed, many people become much more active afterwards as their symptoms have been relieved. However, you should have an occasional medical check up with your doctor to ensure the stoma remains in good condition. Occasionally, an ileostomy or colostomy can prolapse (protrude) or become narrowed, so blocking the passage of faeces. Both of these problems can be corrected surgically.
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