Colostomies and ileostomies
What is a stoma?
A stoma is a surgically created opening in the abdominal wall which allows intestinal contents to pass directly through and be collected in a bag which is attached to the skin by an adhesive. Because of this, the stool does not pass through the anus in the normal fashion. The most common stomas formed are an ileostomy (joining the small bowel and the skin) and a colostomy (connecting the colon to the skin). Stomas may be temporary or permanent: temporary stomas are created to prevent stool passing through a diseased area of bowel or to protect a surgical join in the bowel (an anastamosis). Permanent stomas are created when the rectum or anal canal is affected by a disease which means that it must be removed surgically or the muscles of the anal canal have been damaged leading to incontinence (an inability to control the stool). Although the idea of having a stoma is upsetting to most people, the reality is not as bad as imagined. A specialist nurse dedicated to the care of stomas will be available to answer all of your concerns before the operation and identify the best “site” for your stoma to be placed. They will also help in showing you how to manage the stoma after the operation, to change and empty the bag and will be available to help with any problems afterwards.
Will having a stoma impact on my life?
Whilst there may be some adjustment required to come to terms with having a stoma, the impact on your lifestyle will probably be far less than you think. Many people have a stoma without anyone else being aware of it, accidents are not common and there is seldom any odour. All of your regular activities such as sports including swimming may be resumed when you have recovered from the surgery. Most patients with stomas can resume their usual sexual activity. Some people worry that their partner will not find them attractive but this is seldom the case and support groups exist in most towns to help people through any difficulties. It is often helpful to talk to someone with a stoma and this may be arranged via your surgeon or stoma care nurse.
Are there foods that affect stoma function?
The function of some stomas (most commonly Ileostomies) may be affected by diet. Most people can eat their normal diet but the following is a brief guide which may help modify stoma function if necessary;
Foods that may increase output:
- Beans and peas
- Leafy green vegetables
- Spicy foods
- Citrus fruit and juice
- Wholemeal bread
Foods that may reduce output :
- Apple sauce
- Boiled rice
- Creamy peanut butter
- White bread
Foods that may increase wind:
- Fizzy drinks
- Dried peas and beans
- Cabbage, broccoli and sprouts
Can my stoma make me dehydrated?
To reduce stoma output patients often take a regular medicine such as loperimide which slows the bowel down. This is harmless and can be taken as often as required. Occasionally patients with an ileostomy may develop a high out put which can lead to dehydration particularly if the weather is very hot (an output of more than 1000 mls a day increases this risk). Drinking more water, juice, tea, coffee etc may actually make things worse and it is better to drink a specific rehydration solution such as dioryalyte or make up the following solution;
Sugar (6 teaspoons), Table salt (1 teaspoon), Bicarbonate of soda (½ teaspoon) in 1 litre of water.
This should kept in the fridge and drunk as required. It is often more palatable to add small quantities of squash or juice. If you have difficulties with the output of your stoma you shoud contact your stoma nurse or surgeon directly.
What happens when my stoma is reversed?
Reversal of a temporary stoma is a relatively short operation lasting arround 60 minutes. Patients tend to stay in hospital until their bowel has functioned, usually 3-4 days. After reversal of the stoma many people find that their bowels will have altered. This is particularly the case in patients who have undergone an anterior resection in which part or the whole rectum has been removed. The colon (or large bowel) absorbs up to 2 pints of water a day removing part of this may lead to looser more frequent stool. In addition the rectum acts as a reservoir for stool and sends important messages to the brain to tell it when to go to the toilet. When the bowel is “put back together” some patients experience frequency and fragmentation (needing to go to the toilet numerous times to pass small quantities of stool), urgency (when it is difficult to hold on to the stool) and occasionally incontinence. Although this may be troubling it should improve given time. The following strategies may help.
Avoiding food that is high in fibre (such as bran, brown bread, fruits and vegetables) is often recommended in the first few weeks after reversal of a stoma to reduce the activity of the gut. How diet affects bowel function is highly individual and foods can be slowly re-introduced or excluded depending on your response to them. Drinks with caffeine or alcohol in may make the bowel looser and moderating your usual intake of them may be of benefit. Fizzy drinks may produce more wind leading to “explosive” bowels and again it may help to moderate your intake.
Medications such as Imodium (loperamide) may be used to slow down the rate that food passes through the bowel and so allow more time for the water to be re-absorbed, your doctor should prescribe these and will advise you on the best way to take them. Fybogel may also be of help. Although this is often used for patients with constipation, fybogel contains fibre that will make the stool more bulky and may be of particular benefit in those who pass many small stools. Again your doctor will be able to help.
Patients who have frequent visits to the bathroom often develop soreness around the anus from irritation to the skin. Using moist toilet paper/wipes (found in most chemist shops) rather than paper will often reduce the trauma caused when cleaning after going to the toilet. Aloe vera also has a soothing effects and may be included in some toilet tissues. Applying a simple barrier cream (such as sudocrem) after every visit will also reduce contact of irritating stool and the sensitive skin around the anal canal.