Stoma

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What Is Stoma?

A stoma is a connection between the lumen of the hollow organ and the surface of the skin or mucous membrane through surgery. This means that a stoma is a deliberate proc­edure to create an artificial connection to the bowel or ureter.

Stomas are placed in patients with various conditions, most commonly involving situations where the intestines cannot funct­ion properly.

Stoma refers to a piece of skin surrounding an opening that carries urine or feces outward. A stoma pouch is glued to the skin around it, into which urine or fecal matter enters. There are different types of intestinal stoma. So­metimes, a stoma is only placed for a limited time until the patient recovers. A stoma can sometimes be an unpleasant condition for many people, although having one does not exclude one from daily life.

People with a stoma need to take care of its proper care and diet, as neglect can lead to complications. However, a stoma is sometimes necessary to allow excretion of feces or urine when, for various reasons, this is not possible by­ natural means. The emergence of a stoma is often a life-saving procedure or directly contributes to improving a person's condition.

Stoma: What Is, Types, Causes, Procedure, Function, and Care

Types

A stoma is a round hole in the abdomen, reddish-pink. The tissue is not innervated, so touching it does not cause pain. It often protrudes slightly above the skin's surface, and its outlet should be at a central point. A stoma pouch is glued to the skin around it so that the center of the eme­rged stoma is in it. There are several types of stomas, and their division depends on the organ involved, the design of the stoma, its function, and whether it is to be temporaryTrusted Source or permanentTrusted Source. Types of stomas thus include the following:

Temporary Stoma

Based on the length of its use, a temporary stoma can be distinguished, which patients have for a specific period. It can be a short-term condition of treatment, after which the continuity of the digestive tract is restored and the stoma is removed. Someti­mes, a temporary stoma, can be transformed into a definitive one. A temporary stoma is done in patients with specific health indications. In most cases, the temporary stoma is removed after about three months.

Stoma: What Is, Types, Causes, Procedure, Function, and Care

Definitive Stoma

In very many cases, a stoma is placed permanently. So, it all depends on the patient's health condition and the reason for which the fistula was placed. In the case of a definitive stoma, the loop of the small intestine is completely cut off, and the stool is directed to the skin surface. The­ intestinal section separated from the digestive tract is usually removed during this operation. In this case, the patient must have a stoma for the rest of their life. However, it should not be forgotten that a stoma will permanently help eliminate the causes and consequences of the condition.

Colostomy

In this type of stoma, an intestinal fistula is created when a patient develops the need to remove part of the large intestine or rectum. It is often located below the navel on the left side of the abdomen. This procedure involves the emergence of the colonTrusted Source onto the surface of the abdomen. T­hus, like other types of stomas, colostomy can be temporary or permanent. If it is necessary to remove the rectum and anus, then a permanent colostomy is created.

Ileostomy

An ileostomy is the connection of the lumen of the ileumTrusted Source to the skin and is usually located on the right side of the abdomen. With an ileostomy, the ­digestive system can function without the large intestine. This procedure is done when the colon is resected or completely removed. Usually, an ileostomy permanently emerges, using part of the small intestine, usually on the right side of the abdomen, under the navel.

Urostomy

It is a urinary fistula used for patients with a damaged or removed bladderTrusted Source. A urostomy, or skin-to-skin fistula, is a type of stoma used when­ it is impossible to expel urine naturally for various reasons. The procedure involves guiding the ureter directly onto the skin coating or through an appropriately isolated section of the small intestine. Puncture urostomies are suitable for draining urine from the bladder or the kidney and are usually used as a temporary solution. A bowel-assisted urostomy i­s are generally definitive.

Gastrostomy

Gastrostomy is a nutritional fistula suitable for introducing food in people with obstructed esophagusTrusted Source. A gastrostomy is a fistula that connects the external environment and the stomach. It is used in people whose esophagus is obstructed and prevents them from consuming food by mouth. A gastrostomy can be a temporary or permanent method of feeding. In ­some cases, oral nutrition is difficult or impossible, causing weight loss, weakness, and dysfunction of all body systems and organs. To avoid malnutrition and related health problems, a nutritional gastrostomy is used in such situations.

Stoma: What Is, Types, Causes, Procedure, Function, and Care

Causes

The most common indication for stoma placement is disease. Stoma is associated with intestines, rectum, and urinary tract diseases. Many interrelated factors influence the final decision to perform a stoma. Wanting to place a stoma also takes into ac­count the patient's general condition, the type of surgery used and the level of disease. Stoma removal surgery is done for urgent or elective indications. This procedure is done in some cases. Reasons for doing stomas include:

Diseases Of The Intestine

Most often, a stoma is done where there are serious intestinal problems. The most common indications for urgent stoma placement include acute bowel perforationTrusted Source. Symptoms of bowel perforation mainly include severe pain in a specific part of the abdomen or the entire abdomen. It quickly increases and becomes difficult to bear. It is then necessary to go to medical care to be able to place a stoma so that peritonitis and other complications do not occur.

Different intestinal diseases predispo­sing to stoma placement include ulcerative colitis, intestinal lesions due to intestinal ischemia, adenomatous polyposis of the colon, and Crohn's DiseaseTrusted Source.

Stoma: What Is, Types, Causes, Procedure, Function, and Care

Peritonitis

Peritonitis is the condition of inflammation of the membrane lining the entire abdominal cavity from the inside. It is most often caused by bacteria entering the peritoneal cavity, and when it involves the entire peritoneal cavity, it progresses very violently a­nd can be life-threatening for the patient. That is why a stoma is placed as urgent in such a situation.

Cancers

Various types of cancer can predispose to stoma placement. These include rectal cancer, colorectal cancerTrusted Source, and bladder cancerTrusted Source. Rectal cancer is a malignant disease that grows from the epithelium of the bowel. Colorectal cancer is a malignant primary neoplasm that develops in the epithelium of the intestinal mucosa. It can affect various parts of th­e intestinal segment. Bladder cancer, on the other hand, is a malignant tumor that originates in the epithelium lining the bladder wall.

Trauma And Postoperative Complications

In addition, a stoma can also ha­ppen to people who have lost the functionality of their digestive system as a result of trauma or post-surgical complications. Indications for stoma placement also include extensive abdominal trauma with disruption of the gastrointestinal tract or urinary tract.

Stoma: What Is, Types, Causes, Procedure, Function, and Care

Procedure And Function

A stoma is a surgical procedure to connect the large intestine and the small intestine or ureter and the sk­in. A stoma makes it possible to excrete feces or urine where, for various reasons, it is impossible to do so naturally. A stoma procedure is the surgical creation of the lumen of the intestine or ureter through the abdominal shell and fixing it on the body su­rface. It usually results from removing part of the ureter, large intestine, or small intestine. The procedure for doing a stoma is to insert the bowel at the end through an opening in the patient's abdomen. After the intestine's mucous membrane is turned out, it is sewn together with the skin.

Thus, a stoma ­is placed when the organ is not working correctly. Then, during surgery, the surgeon cuts out the diseased part and creates a new bowel route located on the abdominal wall. From then on, defecation or urination and gas expulsion are carried out through the inserted stoma. The procedure for inserting a stoma is done traditionally by cutting open the abdominal lay­ers or laparoscopicallyTrusted Source. It is a non-invasive method, meaning the stoma emerges without cutting the entire abdomen open.

Stoma: What Is, Types, Causes, Procedure, Function, and Care

In summary, it can be said that a stoma is a new, artificially created anus. For the first few days after surgery, the stoma may be enlarged and may bleed. However, it is entirely natural, and with proper care, the stoma is safe and functions properly. Due­ to the omission of the sphincter that closes the bowel outlet, bowel movements and gas expulsion cannot be controlled. When a patient has a stoma, they must use a unique stoma bag where the defecated contents go. It happens spontaneously, beyond the patient's control and awareness. It is not painful, but stoma pouches must be emptied r­egularly. With the placement of a stoma, the excretory balance in the patient's body is restored.

Care

People with stomas can return to everyday life. However, they must maintain a healthy lifestyle and avoid factors that can irritate the stoma. It is extremely important t­o maintain healthy, clean skin in and around the stoma and properly size the stoma pouch. Damage to the skin around an emerged stoma can promote infection, which can be special for the patient.

Diet

When having a stoma, a proper diet is essential. What y­ou can eat while having a stoma depends mainly on how your body reacts; thus, observing what foods harm you and benefit you is necessary. A diet with a stoma should be varied, providing your body with the essential nutrients. Regularity of meals is also important. An intestinal stoma diet also requires making sure you get enough fluids. In addition, it is also recommended to reduce the consump­tion of alcohol significantly. This is because it should be remembered that it accelerates intestinal peristalsis, increasing the excretion rate of intestinal contents. Smoking is also harmful to stoma patients.

Stoma: What Is, Types, Causes, Procedure, Function, and Care

Skincare

Taking care of the skin around the stoma is very important to prevent irritation and complications. Unique products designed for it are recommended for cleaning the skin around the stoma. Before sticking a colostomy pouch, the skin should be washed thoroughly wit­h appropriate safe preparations and dried with a soft cloth or soft towel. Also, an improperly fitted stoma can sometimes cause skin irritation. Remembering that the stoma changes shape and appearance after the surgical procedure is essential. After a few weeks, equipment selected immediately after surgery should be reviewed.

Physical Activity

Both lack of physical acti­vity and the wrong method of physical activity can harm stoma patients. Stoma patients can engage in sports without worrying that it will affect their health. However, they must be more cautious about certain factors that irritate the stoma. There are trauma sports that are not recommended for people with stomas. These sports include boxing, karate, and different mar­tial arts. Such sports should be replaced with various types of physical activity. Patients should also be wary of lifting too much weight and jumping violently, which can irritate the skin and stoma. Besides that, almost all sports, including swimming in a pool or natural bodies of water, are allowed.

Stoma: What Is, Types, Causes, Procedure, Function, and Care

Sleep

People with an emer­gent stoma may face various problems in daily life, especially in the first period after surgery. Beginning stoma patients may have issues with how to sleep. Nightwear should be comfortable and made of breathable, non-irritating materials to make sleeping easier with a stoma. It is also important that it helps keep the stoma pouch in one position. The optimal sleeping position for a stoma patient is on the back, but you can also sleep on your side or stomach. How­ever, you must be careful that it does not crush the stoma pouch with your body.

Complications

A stoma is a specific condition in which complications can also occur. Some of the most common complications include:

Stoma: What Is, Types, Causes, Procedure, Function, and Care

Postoperative Complications

Surgical problems belong to the local complications of stomas. They can occur, especially if the procedure is being done urgently. The most severe surgical complications include stoma prolapse, stoma swelling, bleeding, or stoma necrosis. Therefore, the creation of a good sto­ma, correctly placed, is essential, and it is up to the specialist doctor to protect the patient from complications. It is advisable to perform the procedure using minimally invasive techniques with particular attention to the technical aspects of the procedure. Increased attention is required for pa­tients operated on urgently with obesityTrusted Source and coexisting chronic diseases.

Dermatological Complications

The etiology of skin complications is related to systemic, mechanical, and infectious factors. Skin lesions around the stoma result in leakage of stoma appliances, an inability to maintain proper hygiene and increased pain sympt­oms. Patients with an ileostomy have a significantly higher risk of developing skin lesions. The most common early complications are contact dermatitis from irritation, mechanical trauma, dermatomycosis, and skin-mucosal adhesion disorders.

Metabolic Complications

Metabolic complications are related to the physiology of the gastrointestinal tract. A stoma-type lesion can impede certain natural processes. Patients with ileostomies can develop electrolyte and acid-base disturbancesTrusted Source that can be life-threatening. Often, in an effort to­ reduce stoma discharge, patients drink or eat less, leading to severe complications. It is also worth remembering that diarrhea can affect a patient with a stoma regardless of its type. It is a symptom that should not be ignored.

Psychological Complications

Stoma patients can also have mental health problems. After stoma su­rgery, patients may not accept the changes in their bodies. The stoma can seem unattractive to them, which affects relaxation and overall quality of life. Hygiene problems can also hinder daily function. It causes avoi­dance of sexual contact due to feelings of shame or general isolation from society.

Therefore, people who have a stoma may be at greater risk of certain acquired mental disorders (anxiety, ­depressionTrusted Source). A stoma can disrupt sleep and rest, change leisure activities, cause sadness, dissatisfaction, stress, depression, anger, and aggression, and give rise to doubts and fears that patients cannot handle on their own.

Summary

A stoma is an artificially created connection between part of the intestine and the body surface. A stoma procedure is the surgical creation of a­n organ lumen through the abdominal shell and fixing it to the body surface. It usually results from removing part of the ureter, large or small intestine. Several types of stomas are distinguished, indicating the location of the stoma or the duration of the stoma.

Various causes predispose to stoma placement, the most common being intestine diseases. A stoma is placed where the excretory system is not working cor­rectly due to past illnesses. The procedure involves rolling out and suturing the end portion of the bowel to the skin. Intestinal contents of a semi-liquid consistency are excreted through the cone of the intestinal stoma into a stoma pouch.

A stoma makes it possible to excrete feces or urine where, for various reasons, it is not possible to do so by natural means. Main­taining a healthy lifestyle and watching out for irritants when having a stoma is essential. Improper care of the stoma and general health can cause complications.

Sources

March 13, 2024
13 minutes read
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