A stoma is a surgically-created, artificial opening in the abdomen, which allows waste (faeces or urine) to be diverted into a collection bag (Cancer Council 2021).
Stomas are identifiable through their prefix:
(Coloplast 2020; Cancer Council 2021)
The faecal matter collected by a stoma will vary depending on where in the intestines the stoma was created. 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 to 800 mL 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).
The waste that passes through the stoma is collected in a stoma bag - a pouch made from soft, waterproof material (CliniMed 2011).
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 2011).
(Australian Council of Stoma Associations Inc 2020)
A stoma can be permanent or temporary. A permanent stoma is generally required after a colectomy has been performed - most commonly 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).
A stoma can be life-changing for an individual. Not only are they forced to come to terms with the loss of control over their elimination of faeces or urine, but they may also experience other consequences such as changes to body image or sexual function, social isolation, stigma, embarrassment and decreased mood (Liao & Qin 2014).
A study by Jayarajah et al. (2016) found that 16 to 26% of patients will experience negative psychological symptoms postoperatively following a stoma creation. These symptoms are commonly anxiety and depression, but may also include suicidal ideation. Alarmingly, a year following their stoma creation, roughly the same percentage of people were still experiencing negative psychological symptoms.
The services of a stomal therapist may be useful in helping to prepare the individual and their family for stomal surgery, and also provide needed support and education following the operation (Koutoukidis et al. 2016).
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 2021).
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 2021).
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 2021).
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. The person should be trained in the hospital of how to manage the bag and look after the skin around it (Coloplast 2021).
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 2021).
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 these 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 2021).
Approximately 50,000 Australians are living with a stoma (DoHAC 2022). Remind the person they are not alone. It will likely help them to talk to someone about what they are going through.
It is very important for healthcare professionals caring for a patient with a newly-formed stoma to provide them with adequate information and education. This education can help facilitate emotional adjustment to the stoma 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.
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Approximately how many Australians are living with a stoma?
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