Patient fact sheet – Stomas formed during Colorectal Surgery

By Dr Vikram Balakrishnan, General, Laparoscopic & Colorectal Surgeon

 

What is the digestive system?

Having a high-level understanding of the digestive system will help you to understand your stoma.

The stomach
When you eat, food passes down a long tube (oesophagus) into the stomach where the food is churned into smaller pieces by digestive juices.

The small intestine
The contents then move into the small intestine where nutrients are absorbed. The first part of the small intestine is called the jejunum and the second part is called ileum. In the small intestine the stool is usually liquid.

The large intestine (Colon)
The food residue then moves into the large intestine where further fluid is absorbed and the stool becomes solid. The muscles in the colonic wall contract to push the waste forwards through the rectum and out of the body through the anus.

What is a stoma?

A stoma is an artificial opening that is made in the small or large intestine which is then brought out to the skin in the abdomen during surgery. 

What is a Colostomy?

A stoma which is formed after removing the large intestine (colon) is known as a Colostomy. During surgery, part of the colon is brought to the surface of the abdomen to form a stoma. The opening is usually made on the left-hand side of the body and the stool from a colostomy is usually solid.

What is an Ileostomy?

Stomas made using the small intestine are normally formed from the end part, called the terminal ileum. Hence these stomas are called ‘Ileostomies’. The opening in the abdomen is normally made on the right-hand side and stool from an ileostomy is generally fluid.

What types of Colostomies and Ileostomies are there?

There are two main types:

End Colostomy and Ileostomy
When a segment of colon or ileum is removed and not joined back together, and the end of the intestine is sutured to the skin, this is called an end-colostomy or end-ileostomy. In this case, only one opening of bowel is visible.

Loop Colostomy
When a loop of colon or ileum is brought to the surface of the skin, this is called a loop colostomy or loop ileostomy. In this case, 2 openings of the intestine may be visible – a proximal portion where the stool comes out and a distal portion where stool does not pass through.

Why are stomas formed?

There are a variety of reasons why your Colorectal Surgeon will form a stoma. The main reasons are:

To protect a join (anastomosis) of two-ends of intestine
A segment of intestine may have been removed and the remaining segments joined back together. To protect this join from leaking (a complication called an anastomotic leak), your surgeon may form a temporary stoma proximal to this join, usually a loop ileostomy. This way, all the food you eat and subsequent stool content passes through the stoma, instead of through the join.

To avoid a join (anastomosis)
A segment of intestine that is removed may be too risky to join, in which case the Colorectal surgeon may not join the intestine at all and form an end-stoma. This could be permanent.

To divert stool for other reasons
There are a number of other reasons why an ileostomy or colostomy might be formed. For example, patients with severe Crohn’s disease causing peri-anal infections may require a diverting loop ileostomy to prevent stool contamination of the wounds.

How does a stoma work?

When the intestine contracts it moves wind and waste matter. Instead of passing through the rectum and anus, it will come out of the stoma. You will not be able to control when this happens, so therefore a small disposable bag is worn on the outside of the body which collects the stool. This is called a stoma bag or stomal appliance. Stoma bags have adhesive on the back, so they stick firmly to the skin and provide a leak-proof, odour-proof system. A filter lets out any wind (but not the odour), which should stop the wind inflating the bag. The bag usually cannot be seen under clothing.

What does a stoma look and feel like?

A stoma when newly formed will be quite swollen and will reduce in size over the first 6-8 weeks. It will be moist and pinkish-red in colour and may protrude slightly from the abdomen. The stoma has no sensation so it will not be painful to touch. 
A stoma will begin to work shortly after surgery, usually within a few days. At first the output will be watery liquid and will thicken.

What is it like to live with a stoma?

Having a stoma, even temporarily, is a big change in a person’s life and takes some getting used to. However, thousands of Australians have a stoma and most lead a relatively normal life.

The stoma may sometimes affect your travel plans, social life and sexual relationships, but these issues can be managed, especially with some planning. Unless your job or hobbies are particularly strenuous, you should still be able to participate in your usual activities.
A stomal therapist will work closely with you and will be an important point of contact to provide expert advice and solutions to assist with you everyday management of the stoma and stomal appliance.