Stomas

Question 1

What is stoma?

Answer 1

A stoma is an opening in the front of the abdomen.

It is surgically created. It is created either from the bowel or bladder. This opening essentially enables elimination of contents from the bowel or bladder.

Question 2

Why may a patient need a stoma?

Answer 2

Diseases such as Inflammatory bowel diseases (IBD), diverticular disease, cancer of the large intestine etc, may predispose patients for a stoma.

These also require need for a stoma:
- Volvulus (twisted bowel)
- Perforation of colon (hole)
- Toxic megacolon
- Colonic polyps (growth of excess tissue)

Question 3

What are the different types of stomas available?

Answer 3

1. Colostomy (most common)
   - Stoma which is surgically inserted within the colon or the large intestine.

At the end of colostomy:
- At the descending portion of the large intestine is where more firmer stools are eliminated

• Ascending or transverse colostomy, as the contents have been in the large intestine for a shorter period of time, hence less opportunity for bowel to reabsorb hence more fluid stool
• Colostomy can be temporary or permanent deepening on the condition. They may have had surgery hence the GI system needs time to recover etc. Or more permanent in cancer patients

2. Ileostomy
   - Stoma which is surgically inserted at the ileum, which is the final portion of the small intestine

• In these cases the patient would have had the large intestine removed. The large intestine is heavily involved in the reabsorption of the GI contents hence patients who have had an ileostomy, the contents of the stoma would be largely fluid due to the lack of reabsorption of excess content.

3. Urostomy
   - Where urine is removed from the body. The ureters are directed away from the bladder and instead they’re directed towards a stoma, which is at the site of the ileum.

• Urostomy is created following bladder removal. So the patient would’ve had their bladder surgically removed probably due to cancer.

Ileal Conduit Urinary Diversion:
- A small piece of the bowel is connected to the ureters
- This then acts as a channel for urine

• It is NOT a reversible procedure
• Does lead to continuous flow so patient would have urostomy bag fitted

Question 4

What are the different types of colostomy bags?

Answer 4

Generally people would have a closed bag and that’s disposable.
- They would essentially need to change this once or twice a day depending on the output through the stoma.

Usually opaque/beige so they’re more discrete for patients.

There is one or two piece system:

1. One-piece system:
   - The pouch or stoma bag itself is already attached to the base plate. The base plate is the contact point for the bag to the skin.
   - This is changed once or twice a day depending on the output.
2. Two-piece system:
   - The base plate is separated from the actual stoma pouch.
   - The base plate itself is attached to the skin and the stomas pouch is attached to the base plate.
   - The base plate can stay on the skin for up to 3-7 days
   - The pouch itself can be changed as necessary

Question 5

What are the different types of ileostomy bags?

Answer 5

Generally drainable bags used. (Reusable)
- They can be changed every 3-5 days

Available as one or two piece systems.

There are 2 different types:
1. With an Integrated clip
- The patient has the ability to close off the system after emptying the contents
- Hence they’re drainable so reusable

2. No closure system
   - Would need to be changed on a much more frequent basis

Question 6

What are the different types of urostomy bags?

Answer 6

Available as one or two piece systems.

Includes a tap outlets, hence the patients would be able to empty the contents of the bag.

Tap outlet bag needs changing every 1-3 days

Night drainage bags can be used at home:
- There is a tube that would be connected to the tap of the bag.

Question 7

What other items are available relating to stomas?

Answer 7

1. Adhesives
   - Helps the base plate to adhere to the stoma site
2. Adhesive removers
   - As some adhesives can irritate the skin or difficult to remove the appliance
   - Helpful in cleaning the area in preparation for application of the new stoma
3. Deodorants
   - They can be inserted into the contents bag in order to reduce the odour that the bag will present
4. Skin fillers and protectives
   - If the area os the skin is uneven, skin fillers can be used to smoothen the edges and makes it easier to attack the base plate
5. Stoma caps
   - Smaller volume
   - They may use this for when they’re doing something for a short period of time for example swimming etc.

Question 8

What psychosocial dimensions would need to be considered for patients using stomas? (lifestyle)

Answer 8

1. Diet
   - Fluid intake
   - Fibre-rich food
   - Dispelling gas food
   - Reducing odour
2. Clothes
   - Discrete
   - Special designs to accommodate the use of a stoma
3. Travel
   - Forwards planning
   - Plenty of supplies
   - ORS and anti-diarrhoea medicines
4. Personal life
   - Most resume normal sex life
   - Smaller bag or stoma cap
5. Swimming/sports
   - Stoma caps can be helpful, perfect for stable patients who need to use a smaller capacity bag for a short time.