Living Well With a Stoma

What is a Stoma?

A stoma is a surgically-created artificial opening, where a section or piece of the bowel is brought through the abdomen. It doesn’t only apply to intestines but often when people think of stomas, they are thinking of intestinal stomas.

Common Types of Stomas

Stomas are identifiable through their prefix:

• A colostomy is a stoma created from the colon: an opening in the large bowel is made and faecal flow is diverted.
• An ileostomy is created from the ileum: an opening in the ileum (small bowel) is made and faecal flow is diverted.
• A urostomy is a surgically-created diversion of urine: a urostomy may be necessary if the bladder is removed and the person needs an alternative way to pass urine.

(Dansac n.d.)

When a stoma is created in different parts of the intestines, the faecal matter that it diverts will be different to the faecal matter found in another area. An ileostomy can be expected to produce loose stools because it is closer to the small intestine, while a colostomy will produce soft and formed stools with more flatulence because it is near the rectum.

The site also determines how active a stoma should be. Approximately 300-800mL of faecal matter is produced with an ileostomy, meaning the stoma appliance usually needs to be emptied four to six times a day, whereas a colostomy will generally be active daily (Koutoukidis et al. 2016).

What is a Stoma Bag?

The waste that passes through the stoma is collected in a stoma bag, a pouch made from soft, waterproof material (Clinimed n.d.).

This bag fits securely around the stoma and adheres to the abdomen using an attached or detachable flange, which is made from a breathable material and attaches to the skin using medical-grade adhesives. The type of bag needed will depend on the type of stoma (Clinimed n.d.).

Reasons for the Formation of a Stoma

• Trauma induced to the abdomen;
• Cancer in the bowel, bladder or pelvic organs;
• Diseases such as diverticulitis, Crohn's disease, or ulcerative colitis;
• Congenital abnormalities;
• Uncommon familial disorders;
• Neurological disorders where toileting is affected;
• Degenerative changes in the bowel’s blood supply in preterm babies or the older adult;
• After-effects of radiation therapy to the pelvis.

(Australian Council of Stoma Associations inc. n.d.)

How Long Does a Person Have a Stoma For?

A stoma can be permanent or temporary. A permanent stoma generally occurs after a colectomy has been performed, and most often occurs in cases of colorectal cancer. A temporary stoma can be made to give the bowel time to rest for individuals with conditions such as inflammatory bowel disease (Koutoukidis et al. 2016).

Psychological Impacts of Living with a Stoma

Having a stoma can be life-changing for an individual. As well as doctors and nursing being available to assist in this time, the services of a stomal therapist may be useful. They can help prepare the individual and their family for the surgery, and also provide needed support and education following the operation (Koutoukidis et al. 2016).

Having a stoma can potentially decrease an individual’s quality of life and therefore their emotional state must be regularly assessed throughout this time. The person may also benefit from a referral to a mental health professional. Not only does the person with the stoma have to cope with loss of control over their elimination of faeces, they may also experience changes to body image, sexual function, social isolation, stigma, embarrassment and decreased mood (Liao & Qin 2014).

Between 16-26% of patients will experience negative psychological symptoms following a stoma creation immediately postoperatively. These symptoms are commonly anxiety and depression, but can also include suicidal ideation. Alarmingly, a year following their stoma creation, roughly the same percentage of people were still experiencing negative psychological symptoms (Jayarajah et al. 2016; Kyung et al. 2014).

Optimism can be a predictor for lower psychological distress in patients, especially those with a diagnosis of cancer. They may experience hope, as the stoma is a way to potentially help them have a good outcome with their cancer treatment (Liao & Qin 2014).

Living Well With a Stoma

After a stoma operation a person will need time to recover. This is normal, and the time needed will vary. The stoma will also undergo change in the first couple of weeks after surgery, in terms of both size and output. A person may experience weight gain or loss during this time (Coloplast n.d.).

In general, a stoma should not prevent someone from working, socialising, exercising, travelling or other hobbies. A person’s physical and mental health will be important in determining their quality of life as they adjust to life with a stoma (Coloplast n.d.).

Getting used to a stoma bag

Having a stoma means that a person has no control over when they urinate or defecate. The stoma bag must always be worn to store the output (Coloplast n.d.)

Healthy skin

It’s important to keep the skin around the stoma clean and healthy so that the stoma bag is able to attach properly. When the bag is attached in the correct way, there is no risk of smell and reduced risk of skin irritation. A person should be trained in the hospital of how to manage the bag and look after the skin around it (Coloplast n.d.)

Food and drink

For the most part, a person is able to eat and drink as they would usually. A person should monitor how their stoma reacts to certain foods. They should be advised if their stoma requires them to avoid or limit particular foods (Coloplast n.d.)

Sex and intimacy

Following stoma surgery, it’s normal for a person to have concerns about the new appearance of their body. It can take time to get used to the physical changes and they may initially feel less attractive. Some discomfort may occur as a result of having part of the bladder or bowel removed. Advise patients to talk to their partner about ways they could feel more comfortable during this transition (Coloplast n.d.).

Talk about it

Approximately 1.9 million people are living with a stoma. Remind the person they are not alone. It will likely help them to talk to someone about what they are going through.

Conclusion

It is very important for healthcare professionals caring for a patient with a newly-formed stoma to provide them with adequate information and education. Emotional adjustment to the stoma can be facilitated by this information and help improve the confidence of the patient to independently manage their stoma (Farrell & Dempsey 2013).

This education can also have a positive effect on the person’s anxiety levels by teaching them how to independently care for their stoma while they are in a supportive environment.

If you’re in crisis and need support, call Lifeline on 13 11 14. Lifeline is open 24 hours a day, 7 days a week.

References

• Australian Council of Stoma Association Inc. n.d., What is a Stoma, Australian Council of Stoma Association Inc., viewed 13 February 2020, http://australianstoma.com.au/about-stoma/what-is-a-stoma/
• CliniMed n.d., Stoma Types, CliniMed, viewed 13 February 2020, https://www.clinimed.co.uk/stoma-care/stoma-types
• Coloplast n.d., What is a Stoma? Coloplast, viewed 13 February 2020, https://www.coloplast.com.au/ostomy/people-with-a-stoma/before-stoma-surgery/#section=Wondering-how-your-stoma-might-affect-daily-life_92644
• Dansac n.d., Facts About Your Stoma, Dansac, viewed 13 February 2020, https://www.dansac.co.uk/en-gb/livingwithastoma/factsaboutyourstoma
• Farrell, M & Dempsey, J (eds) 2013, Bare’s Textbook of Medical-Surgical Nursing, 3rd ed, Lippincott, Williams & Wilkins, Broadway
• Jayarajah, U, Samarasekera, AM & Samarasekera, DN 2016, ‘A Study of Postoperative Anxiety and Depression Among Patients with Intestinal Stomas’, The Sri Lanka Journal of Surgery, vol. 34, no. 2, pp. 6-10.
• Koutoukidis, G, Stainton, K & Hughson, J (eds) 2016, Tabbner’s Nursing Care Theory and Practice, 7th ed, Elsevier, Chatswood
• Kyung, SH, Bo-Young, O, Eui-Jung, K, Soon, SC, Kwang, HK & Ryung-Ah, L 2014, ‘Psychological Attitude to Self-appraisal of Stoma Patients: Prospective Observation of Stoma Duration Effect to Self-appraisal’, Annals of Surgical Treatment and Research, vol. 86, no. 3, pp. 152-160, viewed 26 April 2017, https://synapse.koreamed.org/DOIx.php?id=10.4174/astr.2014.86.3.152
• Liao, C & Qin, Y 2014, ‘Factors Associated with Stoma Quality of Life Among Stoma Patients’, International Journal of Nursing Sciences, vol. 1, no. 2, pp. 196-201, viewed 26 April 2017, http://www.sciencedirect.com/science/article/pii/S2352013214000428
• Vonk-Klaassen, SM, De Vocht, HD, Den Ouden, EM, Eddes, EH & Schuurmans, MJ 2015, ‘Ostomy-related Problems and Their Impact on Quality of Life of Colorectal Cancer Ostomates: A Systematic Review’, Quality of Life Research, vol. 25, no. 1, pp. 125-133, viewed 26 April 2017, https://link.springer.com/article/10.1007/s11136-015-1050-3