AN OVERVIEW OF INTESTINAL STOMA

Introduction

 

Intestinal Stomas Classification

Intestinal stomas can be classified into several types based on their location and surgical technique. Here are the common classifications:

1. Temporary vs. Permanent Stomas: Stomas can be created either temporarily or permanently, depending on the underlying medical condition. Temporary stomas are created when there is a need to divert intestinal contents temporarily, allowing the affected area to heal. Once the healing process is complete, the stoma is reversed, and normal bowel function is restored. Permanent stomas, on the other hand, are created when it is not feasible or safe to restore normal bowel continuity.
2. Colostomy: A colostomy involves bringing a part of the colon (large intestine) to the abdominal wall to create a stoma. The location of the colostomy may vary, such as sigmoid colostomy, descending colostomy, transverse colostomy, or ascending colostomy. The specific site of the colostomy depends on the medical condition and the surgeon’s preference.
3. Ileostomy: An ileostomy involves bringing the end of the small intestine (ileum) to the abdominal wall to create a stoma. This type of stoma is typically located in the right lower quadrant of the abdomen. It bypasses the entire colon and is commonly performed in cases where the colon needs to be bypassed or removed, such as in certain types of inflammatory bowel disease or colon cancer.
4. Loop Stoma: A loop stoma is a temporary stoma formed by bringing a loop of bowel to the abdominal wall. A section of the loop is then opened, creating both an entrance and an exit for the stool. Loop stomas are often created in emergency situations or when a temporary diversion is required. They are usually reversed once the underlying condition improves.
5. Double-Barrel Stoma: A double-barrel stoma involves dividing a segment of the bowel, creating two separate stomas on the abdominal wall. One stoma is used as a functional stoma for the elimination of feces, while the other stoma acts as a mucous fistula for the passage of mucus from the distal part of the bowel. Double-barrel stomas are typically created in situations where there is a need to preserve the distal bowel or when a temporary diversion is required.

It’s important to note that the classification of intestinal stomas may vary based on individual patient circumstances and surgical preferences. The specific type of stoma chosen is determined by the underlying condition, the surgical goals, and the patient’s overall health.

 

Stoma Formation Principles

 

Stoma Formation Indications

The following are common indications for stoma formation:

1. Bowel Obstruction: Stoma formation may be necessary if there is a blockage in the intestine that cannot be resolved with conservative measures or requires immediate intervention.
2. Inflammatory Bowel Disease (IBD): People with severe forms of IBD, such as Crohn’s disease or ulcerative colitis, may require a stoma if medical treatments fail to control symptoms or if complications like fistulas, abscesses, or strictures develop.
3. Cancer: Certain types of cancer, particularly colorectal cancer or bladder cancer, may necessitate a stoma when surgical removal of a portion of the affected organ is required. The stoma allows for the diversion of waste while the remaining healthy tissue is connected or reconstructed.
4. Diverticulitis: Recurrent or severe diverticulitis, which is the inflammation or infection of small pouches in the wall of the colon, can lead to complications such as abscesses, fistulas, or bowel perforation, requiring the formation of a stoma.
5. Trauma or Injury: Severe abdominal trauma or injury that affects the intestines, bladder, or urinary tract may necessitate the creation of a stoma to bypass damaged or non-functional areas.
6. Birth Defects: In some cases, individuals are born with congenital conditions affecting the digestive or urinary systems, such as Hirschsprung’s disease or bladder exstrophy, which may require stoma formation early in life.
7. Neurological Disorders: Certain neurological conditions, such as spinal cord injuries or spina bifida, can result in loss of bowel or bladder control, requiring the creation of a stoma to manage waste elimination.
8. Functional Disorders: Some individuals with chronic constipation or fecal incontinence that doesn’t respond to conservative measures may opt for a stoma to improve their quality of life and manage symptoms effectively.

It’s important to note that stoma formation is a complex decision that is made on an individual basis, taking into account the patient’s overall health, medical condition, and specific circumstances. A thorough evaluation and consultation with healthcare professionals, including surgeons and stoma care nurses, are essential in determining the appropriateness of stoma formation.

 

Stoma Appliance Attachment

The attachment of a stoma appliance, also known as an ostomy appliance or stoma bag, involves the process of securely connecting the appliance to the stoma to collect waste from the body. Here’s a general description of how the attachment is typically done:

1. Preparation: Before attaching the stoma appliance, it’s essential to ensure that the stoma and the surrounding skin are clean and dry. Gently clean the stoma with warm water and a mild soap or a specialized stoma cleanser, if recommended by a healthcare professional. Pat the area around the stoma dry with a soft towel or a clean cloth.
2. Choosing the right appliance: There are different types and sizes of stoma appliances available, and it’s important to select the one that fits properly and comfortably. The type of appliance may depend on the type of ostomy (colostomy, ileostomy, urostomy) and individual preferences. Consult with a healthcare professional or a stoma nurse for guidance in choosing the right appliance for your specific needs.
3. Adhesive application: Stoma appliances typically have a flange or a baseplate with an adhesive backing that adheres to the skin around the stoma. Remove the protective backing from the adhesive and position the appliance correctly over the stoma. Gently press the adhesive onto the skin, starting from the center and working your way outward to ensure a secure attachment.
4. Creating a seal: After attaching the appliance, it’s important to create a seal around the stoma to prevent leakage. Some appliances have built-in barriers or convexity rings that can help create a better seal, especially if the skin around the stoma is uneven or retracting. Gently apply pressure around the edges of the appliance to ensure a tight seal.
5. Securing the appliance: Depending on the type of appliance, there may be additional features to secure it in place. Some appliances have clips, belts, or adhesive strips that help keep the appliance secure and prevent it from moving or shifting during daily activities.
6. Checking for comfort and fit: Once the appliance is attached, it’s crucial to check for comfort and proper fit. Ensure that the appliance does not feel too tight or too loose. The adhesive should adhere firmly to the skin without causing any discomfort or irritation. If there are any signs of leakage, skin irritation, or discomfort, consult with a healthcare professional for adjustments or guidance.

It’s important to note that the process of attaching a stoma appliance may vary depending on individual circumstances, stoma type, and personal preferences. It is recommended to consult with a healthcare professional or a stoma nurse who can provide personalized guidance and support throughout the process.

 

Complications of intestinal stomas

 

Ostomy Dietary Guidelines

As an ostomate, it’s important to maintain a healthy and balanced diet to support your overall well-being and manage your condition effectively. Here are some dietary recommendations for ostomates:

1. Stay hydrated: Drink plenty of fluids throughout the day to prevent dehydration. Water is generally the best choice, but you can also include other fluids like herbal teas, clear broths, and electrolyte drinks.
2. Eat a high-fiber diet (if suitable): While some ostomates may need to avoid or limit high-fiber foods depending on their specific condition and ostomy type, others may benefit from including fiber in their diet. Fiber can help regulate bowel movements and prevent constipation. Consult with your healthcare provider or an ostomy nurse to determine the right level of fiber for you.
3. Gradually reintroduce foods: After ostomy surgery, it’s common to start with a low-residue diet and gradually reintroduce different foods to assess their impact on your digestion. This process helps identify any foods that may cause discomfort, blockages, or excessive gas.
4. Chew food thoroughly: Take the time to chew your food thoroughly to aid digestion and prevent potential issues. Chewing well helps break down the food into smaller pieces, making it easier to pass through the digestive system.
5. Manage gas-producing foods: Certain foods can lead to increased gas production, which can cause discomfort for some ostomates. Common culprits include beans, lentils, cabbage, onions, carbonated drinks, and chewing gum. You may need to limit or avoid these foods if they cause excessive gas or bloating.
6. Monitor output consistency: Pay attention to the consistency of your stool output and adjust your diet accordingly. If your output is consistently too loose or too firm, you can make adjustments by adding or reducing certain foods like bananas, rice, applesauce, or yogurt. Again, consult with your healthcare provider for personalized recommendations.
7. Be mindful of hydration and electrolyte balance: Depending on the type of ostomy and your individual needs, you may need to be mindful of your electrolyte balance. In some cases, you may require additional electrolytes or certain restrictions. Discuss this aspect with your healthcare provider to ensure you maintain proper hydration and electrolyte levels.

Remember, it’s essential to consult with your healthcare provider or an ostomy nurse who can provide personalized dietary advice based on your specific ostomy type, medical condition, and individual needs. They will guide you on managing your diet while taking into consideration any particular restrictions or recommendations for your situation.