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Stoma Introduction

A stoma is a surgically made opening in the abdominal wall, the intestine meets this opening and waste is then excreted into an ostomy appliance. Your reason for having a stoma can be due to an accident or illness and can be permanent or temporary. You may have a stoma for just a month or it may be two or three years.

A temporary stoma is often a loop or double barrel stoma which has two openings and any output will emerge from the larger one. A permanent stoma is constructed if it is unlikely that the portions of the digestive segments can be rejoined. Permanent stomas are usually end stomas (not loop) and only have one opening.

Types of Stoma

A stoma is a surgically created opening that connects a tube like vessel to the outside. It comes from the Greek word meaning mouth or opening. There are many types of stoma, but we will only concentrate on those for the bowel and urinary system.

Colostomy

A colostomy can be made at almost any point along the large bowel (colon). Where the colostomy is created will depend on the medical reason, but generally they are located on the lower left hand side of the abdomen. The output may be almost fully formed stool and wind is common.

Ileostomy

An ileostomy is made from the small intestine (ileum); usually it will be located on the lower right hand side of the abdomen. The output is generally liquid to paste-like stool and can often be corrosive due to the presence of digestive enzymes.

Urostomy

A urostomy is a diversion which drains urine and is made using the small bowel. It is generally located on the abdomen on the lower right hand side. The output is urine although you may find some mucous is secreted due to the nature of the surgical operation.

What should my stoma be like?

Your stoma should be red in colour similar to the inside of the mouth; this is due to the rich blood supply to the stoma. If the colour of the stoma changes, turns pale, dusky or dark then please contact your stoma nurse.

You may find that your stoma bleeds when wiped, this is normal and is again due to the rich blood supply very close to the surface.

Your stoma will have no feeling when you touch it as there are no nerves in the bowel tissue. Your stoma should also feel warm to the touch.

An ileostomy will usually be raised above the skin to form a spout and this allows the output to flow into the pouch more easily. A colostomy will usually be flush with the skin.


Stoma Hints and Tips

Try to change your pouch when your stoma is less active. It may take some time to get to know or recognise a pattern but it may help to make changing quicker and easier. Applying a pouch may be easier if the flange is warmed slightly, holding it between your hands for a short while will bring it to body temperature.

If you have wrinkles or folds in the skin around your stoma, try standing or changing position to stretch the skin, it will give you a better fit. Always check for nicks or faults before using a pouch. Your pouch must fit properly around your stoma to help prevent sore skin and reduce the possibility of leakage; use the backing from the flange to check the pouch has been cut to the right size for you. Some people  need thier pouches cut to size, perhaps because you find it difficult or you are short of time, which many suppliers can do for them.

Use the “up and over” technique to apply your pouch. Remove the backing paper, almost fold the flange forwards in half and starting at the bottom of the flange and stoma edge, stick the flange to the skin bringing it up and over the stoma. Once the pouch is in place run your fingers around the edge to check for any crease or folds. You can then place your hand over the pouch for 30 seconds and the heat from the hand helps the pouch adhere and conform to the body shape. This technique is easier to demonstrate and if in doubt contact your healthcare professional for guidance.

Hygiene

Bathing

If you bathe with a pouch, do not try to remove it immediately afterwards as this can lead to sore skin.  The adhesive is stronger when wet and becomes harder to remove.

You can bathe or shower without an appliance if you wish.  A good soak in the bath will give the skin around the stoma a chance to rest.  Be aware that your stoma might function while you are bathing or showering, especially if you are an ileostomist.

Do not use bubble bath or bath oils as they may stop the pouch sticking securely afterwards and can irritate your stoma.

If you have a power shower, the water jets can be very powerful and if directed onto your stoma, especially at close range, might cause problems.

Public Toilets

As an ostomist you can use disabled toilet facilities – these are often cleaner than other public toilets and have more space and surfaces to lay out your items.

You can obtain a RADAR key for many disabled toilets – either through the RADAR website (www.radar.org.uk) your nurse.

Put a couple of sheets of toilet paper in the bowl before emptying your pouch, it reduces the noise and splashing.

Flush the toilet immediately after emptying your pouch, it can help to reduce odour.

Always have paper or wipes with you for use in public toilets as they often run out. A bottle of water can also be handy when you need to clean up.

Use only plain lukewarm water and dry wipes for cleaning your stoma (if you must use wet wipes, then make sure they are lanolin and fragrance free as the skin around your stoma can be very sensitive).




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