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
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 anastomosis) whilst
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 very 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
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.
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 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.
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
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, sprouts
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 ˝ teaspoon
This should be made up to 1 litre with tap water, kept in the fridge
and drunk as required. It is often more palatable to add small
quantities of squash or juice.
Reversing a temporary stoma
This is a relatively short operation lasting 30-60 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 will lead to looser more frequent
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 they will improve given time and there
are a number of strategies to 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
sudocreme) after every visit will also reduce contact of irritating
stool and the sensitive skin around the anal canal.