What Is a Stoma?

What Is a Stoma Bag and Why Do I Need One?

A stoma bag may be needed after surgery of the colon, rectum, or bladder.
A stoma bag may be needed after surgery of the colon, rectum, or bladder.

If you need surgery to remove part or all of your large intestine (colon) and rectum or your bladder, you might need a stoma. This is a surgical opening in your belly that allows poop or pee to leave your body and collect in a bag or pouch.

A stoma may be temporary if you only need it while your body heals from surgery or an injury. Or, it can be permanent.

It can take some time to adjust to a stoma. Your medical team will teach you how to use your pouch and help you get comfortable using it. Here is information you can use to help make the adjustment and understand why you need the stoma.

When Might a Stoma Be Necessary?

A stoma can be part of the treatment for:

Types of Stoma

There are three types of stoma: Colostomy, ileostomy, and urostomy.

Colostomy drains poop from your colon and out of your body. Normally, poop moves through your intestines to your rectum. It stays there until you're ready to go to the bathroom. When you push, the poop comes out your anus. If you have surgery to remove some of your colon, you might not be able to poop the normal way. That’s why you would need a colostomy.

During a colostomy, your surgeon pulls a piece of your colon through an opening in your belly and stitches it in place to create a stoma. Poop then drains from the stoma into a bag or pouch attached to your belly.

Ileostomy removes waste through your small intestine after surgery to remove your colon and rectum. The surgeon brings the bottom part of your small intestine (ileum) out through an opening in your belly and attaches it to your skin to form the stoma.

Urostomy is an opening in your belly where urine drains after surgery to remove or bypass your bladder. Normally, two tubes called ureters carry urine from your kidneys to your bladder. It stays there until you feel the urge to go. Then pee leaves your body through your urethra. A urostomy bypasses this route.

Doctors decide how to do the urostomy based on your diagnosis, your condition, and other individual factors. There are two ways to do it:

  • Ileal conduit: The surgeon uses a piece of your intestines to connect your ureters to your belly. After surgery, pee flows from your kidneys through your ureters and ileal conduit and out of your stoma.
  • Pouch (also called continent cutaneous reservoir): The surgeon makes a pouch from a small piece of your intestines to hold urine inside your body. You'll use a flexible tube called a catheter to drain urine from your stoma.

What to Expect During and After Stoma Surgery

You'll be asleep and pain-free during surgery to place your stoma. The surgeon will either make one large opening in your belly or a few small cuts. The opening for the stoma may be in the middle of your belly or on the right or left side. That depends on the type of stoma surgery you have.

You'll stay in the hospital for up to a week afterward. It will take a few days for your bowels to start working well enough for you to eat. And you might not have an appetite yet. Once you do eat again, you might need to start with soft foods in small portions.

Your stoma will be pink or red. That’s normal because it’s the lining of your intestine. It may be moist or release small amounts of mucus. The stoma will look a little swollen right after your surgery, but it should shrink within a couple of months.

Stoma Care

A nurse will teach you how to care for your stoma and pouch before you leave the hospital. The pouch should fit you well and not rub against your skin.

You'll need to empty the pouch regularly. How often you empty it depends on the type of stoma and how much poop or pee drains from it. Ask your nurse when to empty and change your pouch. Changing it often will keep the skin around your stoma from getting irritated.

To clean your stoma, wash it gently with warm water and a washcloth. Pat the skin dry.

Stoma Reversal

Some people have a stoma for the rest of their life. Others only need it while they recover from surgery or an injury. If your stoma is temporary, you'll have a second surgery to reverse it in about 3 to 6 months.

During reversal surgery, the surgeon will reconnect the ends of your intestines and close the opening in your belly or reconnect your ureters to your bladder.

If you’ve had a colostomy or ileostomy reversal, it can take a few months for your bowel movements to go back to normal. You might have trouble controlling when you go. You could also have diarrhea, constipation, and pain when you poop.

Stoma Complications and Risks

Stoma surgery has risks like these:

  • Bleeding from the stoma or intestines
  • Infection
  • Injury to nearby organs

Problems with the stoma can include:

  • Scars
  • Red and irritated skin
  • Reopening of the wound
  • Narrowing of the opening

Call your doctor if:

  • A bad smell comes from the stoma
  • The stoma gets redder or more swollen
  • There is a blockage in the stoma
  • The stoma opening bleeds a lot
  • Urine or poop leaks from the stoma
  • You feel nauseous or you throw up

Living With a Stoma Bag

It can take 2 months to fully recover after stoma surgery. You may have to watch what you eat while you heal.

After your surgery, stool or urine will drain from your stoma into a pouch or bag.

If you have a colostomy, at first you might not know when you are about to go. But, some people can eventually predict when they're ready to have a bowel movement. That way, they only put on the bag when they need it.

After colostomy or ileostomy, your poop may be looser than it was before your surgery. Adjusting your diet may help with diarrhea.

A stoma can change your life, but you should still be able to work and do all the activities you did before your surgery. New colostomy bags prevent odors and lie flat. That way other people can't see them. Ask your doctor or nurse if you have any questions or worries about your stoma and bag. Some people benefit from support groups to help them adjust to life with a stoma. United Ostomy Associations of America has an online support group finder.

References
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American Cancer Society: "What Is a Colostomy?" "What Is an Ileostomy?"

Cancer.Net: "Colostomy," "Ostomy," "Urostomy."

Cleveland Clinic: "Colostomy, Fecal Diversion: Recovery and Outlook."

JAMA: "Stomas."

KidsHealth.org: "Your Digestive System."

Johns Hopkins Medicine: "Colostomy."

Roswell Park Comprehensive Cancer Center: "For Colorectal Cancer Patients: What is Ostomy Reversal?"

United Ostomy Association of America: "Colostomy Facts," "Facts About Ostomy Reversals," "Urostomy Facts."

Wound Ostomy and Continence Nurses Society: "Basic Ostomy Skin Care: A Guide for Patients and Health Care Providers."
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