January 12, 2023
This blog will briefly detail what a stoma is, their purpose, and the common types of stomas and how they are brought up to the abdomen where an ostomy appliance is applied.
The word "stoma" is derived from the Greek word for mouth and refers to a bodily orifice that has been surgically made. There are three primary categories of stomas:
• Colostomy – a stoma formed in the colon (large intestine or bowel).
• Ileostomy – a stoma formed in the ileum (small intestine or bowel).
• Urostomy – a Urostomy is formed to divert the normal flow of urine away from the bladder.
Common conditions which may require a stoma include:
• Bowel or bladder cancer
• Diverticular disease
• Ulcerative colitis (inflammatory bowel disease (IBD))
• Crohn’s disease (inflammatory bowel disease (IBD))
• Surgical complications like anastomotic leak
• Birth abnormalities of the bowel or bladder in children
The above conditions can lead to damage of the intestine or bladder, which stops the organ from working properly and in turn makes you sick. Here are two examples:
A tumour may cause an obstruction in your intestine that stops the normal passage of waste. A surgeon resects and removes the diseased section and brings the healthy ends together.
Crohn’s disease may cause microscopic damage in random spots along your intestine that cause gastrointestinal issues like diarrhoea and stops the absorption of nutrients from the food you eat. A surgeon resects and removes the Crohn’s affected parts of your intestine and brings the healthy intestine back together.
The conditions listed above may not always lead to a stoma but if the damage is severe, then a stoma is formed, the most common reasons are:
To protect the new surgical join (distal to the stoma) and let it heal- For example, having a colorectal cancer tumour resected, a stoma is brought out earlier (proximal) to protect the healthy surgical join below.
Prevent possible complications - During surgery the surgeon may think there is a lot of swelling or signs of infection, so it is safer to form a stoma to prevent complications happening, like the surgical join breaking down (anastomotic leak).
In most situations a colostomy and/or an ileostomy will be carried out as a temporary measure and the stoma can be reversed later (months). Sometimes there are situations where the colostomy or ileostomy cannot be reversed, and the person has the stoma for life. An example of requiring a permanent colostomy is if the rectal tumour is too close to the nerves and sphincters that control your continence and if cut, you would have faecal incontinence. A urostomy is a permanent measure and looks like an end stoma. With all three types of stomas, the patient has no control over the output so will have to wear an ostomy appliance on their abdomen to collect the output.
An end stoma is when just the proximal end of the bowel is formed into a stoma.
This type of stoma is formed to divert content away from the surgical join below. The surgeon brings out a loop of bowel to the skin surface. The skin is then stitched to the opening edges. The stoma has two openings, one of which is functional (proximal loop) and the other of which is non-functional (distal loop). Sometimes a bridge or rod serves as a loop's initial support.
This type of stoma is formed when something has been resected in between and the surgeon is bringing up the healthy proximal end and the healthy distal end of the intestine. The two ends are stitched together on the skin surface.
Stomal Therapist and Clinical Educator
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