Getting to grips with stoma anatomy can really help those who are facing or recovering from their stoma surgery, or even those who are supporting a loved one. Knowing the facts can really help understand what to expect from having a stoma, alleviating any anxiety. After all, knowledge is power.
Read our blog for useful information on stoma anatomy explained.
Types of stomas
A stoma is an opening on the stomach that can be connected to either your digestive or urinary system to allow faeces or urine to be diverted away from your body. A stoma pouch is worn on the stomach to collect the output, these can be closed or drainable pouches depending on the type of stoma you have.
There are three main types of stoma; colostomy, ileostomy and urostomy.
To learn more specifically about the different types of stomas and why they are needed, check out our dedicated blogs for each – What is a colostomy?, What is an ileostomy? and What is a urostomy?
Key features of a stoma
A stoma is usually round or oval in shape, and is positioned on the stomach. The area very much depends on the type of stoma you have, and the surgery required. An ileostomy is usually in the lower right-hand side of the abdomen, and a colostomy is usually located on the lower-left side, but it depends on what section of your colon is operated on.
Stomas are pink or red in colour, feels moist to the touch and appear slightly shiny. They look the same as the inside of your mouth. Stoma sizes can vary but are usually between 25 – 45mm in diameter approximately.
When the stoma is first constructed it will be swollen and over a couple of weeks will shrink down in size as the swelling subsides.
Ideally a stoma should protrude slightly from the skin, but on occasions stomas can become flush to the skin or even retracted, especially during the recovery phase.
Stomas are very delicate and have no nerve endings, so care should be taken as you won’t feel if it is cut or scraped.
How does a stoma work?
When the bowel moves, wind and faeces are re-routed and come out through the colostomy or ileostomy (stoma) rather than the anus. For a urostomy, the urine flows from your kidneys through the ureters and the piece of bowel, and out of your body through the urostomy (stoma) bypassing the bladder.
There aren’t any muscles in a stoma to be able to control it, so any output will happen involuntarily, however may tend to be more active after having a meal. Therefore, a pouching system called a stoma pouch/bag attaches to the stomach covering the stoma, to collect waste product.
These stoma pouches have a skin friendly adhesive on the back to help firmly attach securely to the skin and avoid leaks.
Differences in stoma outputs
Stoma output does vary quite significantly from person to person, and what’s normal for one person, won’t be for another. After stoma surgery it can take a while for things to calm down, but once it does you will soon be able to see what is normal for you.
With colostomy surgery, part of your colon (large intestine) is brought to the surface to form the stoma. As stools in this part of the large bowel are solid, emptying your colostomy bag regularly is important. You may find you need to do this once or perhaps several times a day. It is a good idea to empty the stoma bag when it is half full or less, otherwise it becomes heavy and may start to leak.
With a urostomy, its recommended to empty your pouch often, usually when it is one third to one half full. A urostomy pouch will hold the same amount of urine as the bladder did, so you will only need to empty it the same number of times you used to urinate before your illness or surgery.
Ileostomists must take care not to get dehydrated during episodes of diarrhoea. It is advisable to have rehydration fluid during this time.
As a general rule, if your output is over 1litre in 24 hours, then it is considered to be high. If you have any concerns, or notice a sudden change, you should contact your healthcare professional or stoma nurse to make sure everything is okay.
Foods that will help thicken an output include apple sauce, cheese, crackers, ripe bananas, boiled rice, white pasta, arrowroot, marshmallows and white bread.
If your output seems to be low, you may be constipated and should consider increasing your fluid intake and perhaps some gentle abdomen massage. If you have low or no stoma output for more than 12 hours, let a healthcare professional know, especially if you have abdominal pain, as it may be a sign of a blockage.
Stoma care tips:
Once you have a stoma it is important to understand how to care for it.
Looking after the skin:
learning how to look after the skin around your stoma (peristomal skin) is the first step in stoma care. If the contents of your stoma bag come into contact with your skin, it quickly can become very sore, inflamed and uncomfortable. This is due to the digestive enzymes that are harsh on your skin.
The size of your stoma will reduce in the first 6-8 weeks after stoma surgery, so it is important it is re-sized by your stoma nurse at this time, so your stoma bag creates a secure seal to prevent any issues such as leaks or sore skin.
Keep monitoring the size of your stoma each time you change your pouch, to check the template is fitting correctly and it is not too large or too tight. Stomas can change shape and size if you lose or gain weight.
Changing your stoma bag:
Knowing how to change and care for both your stoma and peristomal skin is another important factor.
- Start by getting all your equipment ready: Such as the adhesive remover spray, warm water, dry wipes, disposable bag and your clean stoma pouch (already cut to the size you need).
- If you are using a drainable stoma bag, empty the contents down the toilet first.
- Start by gently lifting the edge of the skin barrier, then spray a little adhesive remover spray onto the skin and let it trickle down into the skin barrier.
- Slowly lift off the skin barrier, from top to bottom (so no contents can spill) and dispose of it into the small bag, seal the bag and pop it into the outside bin (do not dispose of the bag or wipes down the toilet).
- Clean your stoma and peristomal skin with the moistened dry wipes.
- Warm water is sufficient and avoid using soaps which can dry the skin making it itchy.
- Dry the skin well and guide your fresh pouch over your stoma and onto the skin.
- Run your fingers around the edges to check it is wrinkle free and hold a hand gently over the whole pouch for a minute to keep it secure.
If your skin does become sore, reach out to your Stoma Care Nurse who can advise you what products are safe to use on your skin to soothe and heal the area, and learn more about skin irritation in this blog.
Care and complications related to stoma anatomy
Occasionally, some ostomates may have a stoma with an uneven shape, unusual size, or other irregularity. There are different types of bags available to these ostomates, but ones with soft convexity are the most well tolerated.
Unlike most stoma bag flanges which have a flat adhesive back to them, soft convex products have a circular outward shape built into it. This applies a gentle ring of pressure on the skin around the stoma, creating a more effective seal to provide maximum leakage protection.
They are designed with a shallow profile to minimise pressure, conforming well to the body making it more comfortable to wear.
It is important to note that convexity must be used with some caution as it can cause damage to your skin and stoma if they are not used appropriately.
Learn more about the benefits of soft convex products here.
Living with a stoma
Living with a stoma can seem overwhelming and some adaptions may have to be made. But don’t feel alone, there are plenty of other ostomates out there and many are happy to share their story to help support others. Lean on loved ones who are there to support you.
There is plenty of support out there which will enable you to continue living your life to the full. With the right support and advise most people manage their stoma on a daily basis as part of their usual hygiene routine. Some adaptions may have to be made with diet but often these are not limiting. Most ostomates return to their activities and exercise routines after the recovery phase of stoma surgery.
Reach out to others, join local support groups or online groups to hear other people’s stories. There is so much information available in the form of blogs and social media. Your Stoma Care Nurse is there for you with any practical tips or concerns with your stoma.
