A stoma is the result of an operation that is meant to remove disease and relieve symptoms. It is an artificial opening that allows faeces or urine either from the intestine or from the urinary tract to pass.

The stoma is created of an end of the intestine, which is brought to the surface of your abdomen to form the stoma (opening). 

Download relevant stoma guides:

• Your guide to living with a colostomy (PDF)
• Your guide to living with a Ileostomy (PDF)
  
• Your guide to living with a urostomy (PDF)

After surgery, your stoma may be quite swollen to begin with, but will reduce in size over time – usually after six to eight weeks.

No sensation, no pain

A stoma is red in colour. This is because it is a mucous membrane, just like the mucous membrane inside your mouth. There is no sensation in the stoma, so it is not at all painful to touch.  The stoma can bleed a little when being cleaned, especially in the beginning, but this is quite normal, and should stop shortly afterwards.

The digestive system

The stomach
When you eat, the food travels down a long, narrow tube called the food pipe into your stomach. Here, the food is churned into smaller pieces and your digestive juices turn it into liquid.

The small bowels
The journey continues as the contents of your stomach move into the small bowel (ileum), where digestion finishes. Your body absorbs the nutrients it needs for energy, growth and building new cells and channels these into the bloodstream.

The large bowel
When all nutrition has been absorbed, the remains move into the large bowel (colon), where your body absorbs more fluid to make the waste more solid. The muscles in your colon wall then push any waste forward into your rectum, where it passes out of your body through your anus, with the aid of the sphincter muscles, as stool.

The urinary system

Urine is made by your kidneys and travels down two tubes called the ureters to your bladder. Urine is produced all the time, but it is stored in your bladder until you get a sense that you need to urinate. The urine then passes out of your body through the urethra.

The three types of stoma are: Colostomy, Ileostomy and Urostomy.

Colostomy

In a colostomy operation, part of your colon is brought to the surface of your abdomen to form the stoma. A colostomy is usually created on the left-hand side of your abdomen. Stools in this part of the intestine are solid and, because a stoma has no muscle to control defecation, will need to be collected using a stoma pouch.

There are two different types of colostomy surgery: End colostomy and loop colostomy.

End colostomy
If parts of your large bowel (colon) or rectum have been removed, the remaining large bowel is brought to the surface of the abdomen to form a stoma. An end colostomy can be temporary or permanent. The temporary solution is relevant in situations where the diseased part of the bowel has been removed and the remaining part of the bowel needs to rest before the ends are joined together. The permanent solution is chosen in situations where it is too risky or not possible to re-join the two parts of the intestine.

Loop colostomy
In a loop colostomy, your bowel is lifted above skin level and held in place with a stoma rod. A cut is made on the exposed bowel loop, and the ends are then rolled down and sewn onto the skin. In this way, a loop stoma actually consists of two stomas (double-barrelled stoma) that are joined together. The loop colostomy is typically a temporary measure performed in acute situations. It can also be carried out to protect a surgical join in the bowel.

Ileostomy

In an ileostomy operation, a part of your small bowel called the ileum is brought to the surface of your abdomen to form the stoma. An ileostomy is typically made in cases where the end part of the small bowel is diseased, and is usually made on the right-hand side of your abdomen.

Stools in this part of the intestine are generally fluid and, because a stoma has no muscle to control defecation, will need to be collected in a pouch.

There are two different types of ileostomy surgery:

End ileostomy
An end ileostomy is made when part of your large bowel (colon) is removed (or simply needs to rest) and the end of your small bowel is brought to the surface of the abdomen to form a stoma. An end ileostomy can be temporary or permanent.

The temporary solution is relevant in situations where the diseased part of the bowel has been removed and the remaining part needs to rest before the ends are joined together. The permanent solution is chosen in situations where it is too risky or not possible to re-join the two parts of the intestine.

Loop ileostomy
In a loop ileostomy, a loop of the small bowel is lifted above skin level and held in place with a stoma rod. A cut is made on the exposed bowel loop, and the ends are then rolled down and sewn onto the skin. In this way, a loop ileostomy actually consists of two stomas that are joined together.

The loop ileostomy is typically temporary and performed to protect a surgical join in the bowel. If temporary, it will be closed or reversed in a later operation.

Urostomy

If your bladder or urinary system is damaged or diseased and you are unable to pass urine normally, you will need a urinary diversion. This is called a urostomy, an ileal conduit or a Bricker bladder.

An isolated part of the intestine is brought onto the surface of the right-hand side of your abdomen and the other end is sewn up. The ureters are detached from the bladder and reattached to the isolated section of the intestine. Because this section of the intestine is too small to function as a reservoir, and there is no muscle or valve to control urination, you will need a urostomy pouch to collect the urine.

After your stoma operation you will need some time to recover. This is perfectly normal, and the time needed will vary from person to person. Your stoma will change in the first weeks following surgery, in terms of both size and output. Also, you might lose or gain weight in these weeks.

Get started with a pouch
Having a stoma means you have no control over when you defecate or, in the case of a urostomy, when you urinate. This means that you always need to wear a pouch to collect your output.

Healthy skin
In order for your pouch to adhere properly, it is very important to keep the skin around your stoma healthy. When the pouch is attached correctly, there is no risk of smell from your stoma and less risk of skin irritation. Before you leave hospital, you will be trained in how to choose and manage your stoma pouch and how to take care of your skin.

What about food and drink?
In general you can eat and drink as normal. Try to see how your stoma reacts to different foods. Your stoma care nurse, surgeon or physician will advise if you need to take special precautions.

In general, your stoma is no hindrance to working, socialising, playing sports, travelling or other hobbies. Your general state of health – physically as well as mentally – will play a big role in determining your quality of life as you move forward.

Talk about it
Nothing is more helpful than someone who really understands what you are going through. You are certainly not alone – the number of people with a stoma worldwide is 1.9 million. Your local Ostomy Association or patient organisation is one way of meeting peers to get handy tips, inspiration and personal support.

Following stoma surgery, it’s natural to have concerns about your body’s appearance. It can take time to get used to the physical changes and you may feel less attractive as a result. Although it can be challenge, it’s important to learn to accept it as a part of who you are.

What about intimacy?
Intimacy and a normal loving relationship following stoma surgery can be resumed. How and when depends on the nature of the operation you've had. However, impotence and/or discomfort can occur in cases where the rectum or bladder have been removed (women can also be affected by this).

It’s important to talk to your partner and try not to feel self-conscious because of the operation. It’s also important to talk to your stoma care nurse who is used to discussing the issues you’re experiencing and will be able to help in many ways. There are also several handy tips and tricks for overcoming everyday obstacles. For instance, adapting lace underwear so that it’s worn as a tube around your body covering the pouch, or using mini pouches for intimate situations.

Can I have children?
In a word, yes. Having a stoma does not prevent a woman from carrying a baby to term and having a normal delivery. As the belly grows, the stoma will typically just follow the changing shape of the abdomen. In the later stages of pregnancy, you might need to use a mirror when changing your pouch. Delivery usually takes place as normal.

Talk about it
Ultimately, nothing is more helpful than talking to someone who really understands what you are going through. Your local patient organisation is one way of meeting peers to get handy tips, inspiration and personal support.

No matter what type of ostomy you have, all the output from the stoma must be collected in a secure and convenient way. That’s where your ostomy pouch comes in. Your pouch is designed to stick to the skin on your abdomen around your stoma and collect the output.

Secure and discreet

The type of ostomy pouch you select will depend on whether you have a colostomy, ileostomy or urostomy. Your Stomal Therapy Nurse or surgeon will show you which one is right for you, but the overwhelming majority of pouches are secure and discreet. Nobody will know you’re wearing one unless you decide to tell them.

Although it can be difficult at first to accept the fact that you will have to wear an ostomy pouch on your stomach, you should soon start to realize that it’s possible to live much as you did before.

Changing your pouch

How often you change or empty your pouch depends on the type of stoma you have:

• Colostomy: The pouch needs to be changed between one and three times a day, depending on the amount of output.
• Ileostomy: The pouch needs to be drained several times a day.
• Urostomy: The pouch needs to be drained several times a day. At night, a urostomy pouch or a smaller, "micro-pouch" version can be attached to a night bag so you don’t need to get up to drain your bag.

For more  information on how to manage your specific pouch, visit the animated instructions for your specific ostomy type and pouching system.

When you have a stoma, urine and stools exit directly into the pouch on your abdomen. To avoid leaks, skin irritation or social embarrassment, it is very important that you learn how to seal the ostomy bag securely to the skin.

A snug fit is key
The guiding principle is that the adhesive part of the appliance is stuck to the area around the stoma and that the hole in the adhesive fits snugly around the stoma.

Your stoma care nurse will help you choose the best product for you and show you how to apply and remove the pouch in the right way. You might also find these instructional videos helpful.