stoma

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A stoma in surgery is the artificial mouth formed when the faecal or urinary stream is diverted onto the anterior abdominal wall.

Different stomas are named according to the part of the bowel or urinary tract that opens onto the abdominal wall:

  • an ileostomy is formed when the ileum opens onto the abdominal wall; it is usually on the right
  • a colostomy is formed when the colon opens onto the abdominal wall; it is usually on the left
  • a ureterostomy is formed when the ureter passes to the abdominal wall

The likelihood that a stoma is required rises with increasing distance along the bowel. The number of stomas fashioned each year is decreasing as alternative treatments are improved.

Examples of pathologies which may require formation of a stoma are colorectal cancer treatment, inflammatory bowel disease and diverticular disease.

  • approximately 100000 people in the UK have an intestinal stoma, which are most commonly formed after surgery for cancer or inflammatory bowel disease (IBD) (1).

Key points with respect to stoma management (1):

  • type of stoma may indicate the likelihood of a particular complication
  • consider incomplete obstruction in patients with high output stomas
  • when a patient is at risk of dehydration from high output, advise drinking oral rehydration solutions instead of plain water, which can compound the problem
  • avoid modified release medications if patients are experiencing high stoma output. Some capsules can be opened, some tablets may be crushed to allow for faster absorption - consult a pharmacist for assistance
  • prolapsed stomas can be safely reduced in primary care settings and rarely need urgent referral
  • removal of the stoma bag is essential to complete examination. Ask the patient to do this to reduce discomfort and always make sure they have a replacement bag
Reference:
  • Strong C et al. Common intestinal stoma complaints. BMJ 2021;374:n2310

Last edited 09/2021 and last reviewed 09/2021

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