Bowel stomas

Bowel stomas are surgically-created connections between the intestines and the abdominal wall. A bowel stoma may be created as a permanent or temporary conduit to allow faeces to exit the body before it reaches the anus.

Types of Bowel Stomas

There are two types of bowel stomas:

• A colostomy refers to a surgically-created connection between a part of the large intestines and the abdominal wall.
• An ileostomy refers to a connection between the ileum (part of the small intestines) and the abdominal wall.

When is a Stoma Required?

A stoma may be used in the management of a number of medical conditions including severe anal disease and Crohn's disease, diverticulitis, cancer, severe infection or in individuals who are unable to control their bowel motions (faecal incontinence). A temporary colostomy/ileostomy may be used in people who have just had bowel surgery and need to rest their bowel to allow it to heal. When the stoma is no longer required, it may be reversed with a minor operation. A permanent stoma may be created for long term use in individuals who have permanent faecal incontinence, such as after injury to their spinal cord or after extensive surgery.

What is the Procedure?

Your doctor will discuss the specific details of your surgery prior to creating a colostomy or ileostomy. In general, you will be required to drink a liquid known as bowel preparation to empty the bowel before the operation. Education and pre-operative counselling will also be offered to help you prepare for the surgery.

The operation itself will be performed while you are under general anaesthetic. The surgeon will open the abdomen, perform your surgery and then create the stoma. The end of the stoma at the abdominal wall will be fitted with a small bag to allow the contents of the intestine to collect.

Immediately after the operation the stoma will be checked periodically in order to make sure it is functioning properly and not becoming infected. You may be asked not to eat or drink for two to five days after the surgery to allow the intestines to rest after the surgery. Usually, once the ileostomy/colostomy bag begins to collect material or fill with gas, the surgeon will allow you to recommence oral intake. A dietician may give you some advice on what sort of foods to eat in the time following your surgery. Usually, this will involve low-residue foods which are low fibre and easily digestible, avoiding fruit peels, nuts, vegetables. The dietician may also give you some advice regarding foods which will produce less gas and odour (avoiding cabbage, onion and soft drinks). Charcoal and anti-flatulence medications are also available and may be recommended by your doctor.

The amount of fluid collected by the bag may vary depending on the site of the bowel that has been used. The normal output ranges 500-1000mL per day. It is important that this be measured, as higher outputs may cause dehydration and lower outputs may indicate that there is something (for example narrowing of the bowel from scarring) causing an obstruction.

Possible complications of the surgery include:

• dehydration from excessive loss of fluid from the stoma
• bleeding
• infection
• narrowing of the stoma
• obstruction
• skin irritation around the stoma from the fluid contents of the bag leaking onto the surrounding skin
• the formation of a tract between the bowel and another part of the abdominal wall (called a fistula)
• a portion of the bowel protruding through the stoma (hernia)
• kidney stones and gallstones.

Stomal education is provided before and after the surgery to help you adjust. You will learn how to fit and change your appliance, how to care for it and what signs to look out for in case of infection. Some people may find it difficult to adjust to their new body image and this may impact on their sexual relationships. Additional counselling and stoma support services are available if this is the case.

Further Information

Queensland Stoma Association website (includes links to support groups)

Help and Assistance

If you have any problems with or concerns about your stoma please contact one of the nurses at 13 HEALTH by phoning 13 43 25 84.