Types of stoma
A stoma is a surgically created opening. For example in a procedure called colostomy an opening is created through the abdominal wall through which a section of the intestine is pulled out. Ostomyandstomaare general are often used interchangeably, but they do not mean exactly the same thing. Whereas an ostomy is the surgically created opening in the body for the discharge of body wastes, a stoma is the actual end of the ureter or colon that can be seen protruding through the abdominal wall. The other types of stoma are the neck stoma and smoking stoma.
A stoma can be either temporary (which can be reversed later) or permanent, depending on the type of operation that has been done and how much of the bowel or urinary tract has been removed. The size and shape of it will also depend on the type of operation the patient have had. It will always be moist and may bleed if the patient touches it. It may protrude a few centimetres from the abdomen.
A stoma in the abdomen collects faeces or urine. A pouch is placed over it to collect waste from the body that would normally pass through the colon to the rectum and anus. It is connected to the bowel (intestine) to collect faeces and to collect urine connects to the ureter (the tube that carries urine from the kidneys to the bladder). This means the patient will no longer use a toilet when the patient opens the bowels or urinate, as any waste products will pass into and be collected in a reservoir bag or pouch, on the outside of the body.
If the patient has a colostomy or ileostomy, the patient may notice that it sometimes moves, or ‘wiggles’ on its own. This is normal, and happens because it is attached to the bowel, which squeezes and relaxes to allow digested food to move through.
A neck stoma or breathing stoma is a hole or an opening made in the skin in front of the neck to allow the patient to breathe. The opening is at the base of the neck. Through this hole, air enters and leaves the windpipe (trachea) and lungs. The patient may need it if the mouth or oropharyngeal cancer is blocking the throat and it is too big to completely remove, or if the patient have swelling in and around the voice box after radiotherapy.
It is called smoking stoma because people who are diagnosed with developed throat cancer and despite surgery, they remain addicted and smoke through a hole in their neck. The hole allows people who are addicted to tobacco to continue smoking long after their body is naturally able to do so. The smoking stoma therefore is different from colostomy and ileostomy.
Stoma bags are very well designed. They cannot be seen through the clothes and should not smell or leak. If the patient does notice any smell or leakage, talk to the nurse. It may not fit perfectly and the nurse may recommend changes the patient can make, or they can give the patient a different type of bag.
Before the patient leave hospital, the nurse will make sure that the patient has a good supply of stoma bags. Make sure that the patient has plenty of bags and cleaning materials to hand before the patient start to change or empty the bag. It’s a good idea to keep everything the patient need in one place, so that the patient does not have to start searching for things at the last minute. Make sure that the patient allows plenty of time and privacy, so that the patient can work at the own pace without any interruptions.
A stoma therapist or nurse will show the patient how to care for it and the skin around it. A number of different protective pastes, membranes and powders are available. The therapist or nurse will show the patient how to use these and what to do if the skin becomes damaged or sore.
The surgery is a major operation that should not be underestimated. The first few weeks or even months may be a struggle as the patient gradually adjust. As long as the patient has no complications and the doctor has no objection, the patient can enjoy any kind of sporting activity at home or while the patient are travelling. Even contact sports, such as football, rugby, karate or kung fu, can be enjoyed by people with it. Even sports that involve a lot of bending, such as bowling and aerobics, are possible.
Try to change the pouch when it 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 the hands for a short while will bring it to body temperature.
The skin at the site of the it can become erythematous and fissured or can develop an allergic reaction to the materials used in stoma equipment. Various seals are available which cover and protect the opening. Similarly, hypoallergenic products are available for use, for example, lotions and cleansing wipes.
Sore skin can occur as a result of the aperture in the stoma flange being the wrong size. If it is too small, the flange tries to stick onto the “wet” stoma, which leads to a leaking appliance; if it is too large, faeces or urine can rest on the abdominal skin, causing the skin to break down. These problems can be resolved by remeasuring it and re-educating the patient on creating an appropriately sized aperture.
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