Your Stoma

What is a Stoma and What Does It Look Like?

A stoma is the end of the small intestine that is connected to the abdominal wall. Urine will leave your body at the stoma. You won’t be able to control urine from leaving your stoma. This is why the stoma bag is necessary. Stomas are different in size and shape. They stick out a little (less than an inch), and may look like a rosebud. Stomas are typically red and moist (like the inside of your mouth) Stomas have no feeling. You will not feel pain touching your stoma or cleaning the skin around it. After surgery your stoma will be swollen, but it will shrink to a stable size in a few weeks. You will need to make adjustments to the opening of the stoma pouch or the skin barrier as it shrinks over time.

Video: Urinary diversions for bladder cancer patients

• Stoma Information
• Stoma Training

Common Stoma-Related Problems

Leaky Pouches

Ostomy leaks can be extremely distressing, cause anxiety and contribute to a poor quality of life. To prevent leaks, it is critical that you understand why your pouch leaks, as well as how to fix the source problem. Maintaining a well-fitted pouching system will ensure you have the opportunity to resume your life style. Here are five of the most common reasons your urostomy pouch may leak:

1. Poorly Fitting Pouch
2. Improper Pouch Application
3. Wrong Pouch
4. Body Changes (e.g. creases, wrinkles, hernias)
5. Peristomal Skin Lesions

Contact your WOC nurse immediately if your pouch is leaking.

When to Contact Your Healthcare Provider About Problems with Your Stoma

Contact your doctor about your stoma if you experience any of the following problems:

• If your stoma bleeds and won’t stop bleeding
• If you notice a change in color of your stoma
• If you notice a change in the general appearance of your stoma

Know Your Ostomy Checklist©

• Open Checklist PDF

Tips for a Successful Recovery after Ostomy Surgery from a WOC Nurse

• Tips from a WOC Nurse

Ostomy myths still persist. Facts can help ease fears and misinformation about surgery:

• Ostomy Facts

Advice and Stories from Patients and Survivors

Female, Ileal Conduit 1

Female, Ileal Conduit 2

Male, Ileal Conduit

NFL Legend Rolf Benirschke - UOAA

Your Stoma

What is a Colostomy and What Does It Look Like?

The colon is part of the body’s digestive system. Your digestive system processes nutrients from food and help pass waste material out of our body. The colon is the first part of the large intestine. The last part of the large intestine is the rectum and anal canal.

A colostomy is an opening that is created surgically in the colon, which is also known as the large intestine. This opening is brought through the abdominal wall to create a stoma. Intestinal waste exits the stoma into a pouching system. The waste is mostly solid because most of the colon remains. Common reasons for colostomy include colorectal cancer, Crohn’s disease or anal cancer. Birth defects or a nonfunctioning colon could also result in a colostomy.

Colostomy Procedure

A colostomy is a type of surgery in which a surgeon brings a part of your colon (large bowel) to the surface of your abdomen. To do this, the surgeon takes a short segment of the intestine and places it at an opening in the skin he/she has made on the surface of the abdomen to create a stoma. The intestine, which normally carry bowel to the anus, is then attached to the other end of the segment of intestine inside the abdomen. The bowel now travels from the intestine, passing through to the stoma and out into a collecting pouch known as a colostomy pouch. This pouch is worn outside the body around the stoma 24 hours a day. Because the nerves and blood supply are preserved, the new conduit is able to propel the bowel out of the body and into the pouch constantly. The pictures above show the change in the digestive tract after colostomy procedure.

• Stoma Information
• Stoma Training

Common Stoma-Related Problems

Bowel is not coming out of the stoma

Contact your physician immediately if waste stops coming out of your stoma. This might be a sign of blockage or internal changes that needs immediate medical attention.

Change in Diet

There are temporary dietary restrictions following the surgery. For the first weeks, you often times follow a low residue diet with foods that are easily digested and excludes raw fruits and vegetables. The first foods you will receive as you are recovering may be clear liquids i.e. tea, jello, and broths. Gradually you will advance to soft foods that are generally easy to chew. After healing is completed and the ostomy is functioning normally, you can return to a normal diet (about six weeks after surgery). You can ask your doctor about a diet that will work with both that problem and your colostomy.

Eat regularly and at a leisurely pace. Chew all foods thoroughly. It may take several weeks to have a normal diet like before. The key to going back into a normal diet is to experiment. Add new food you haven't eaten since the surgery one at a time. This way, you can be sure if eating the same food would bother you or not. Eat small portions at first, and then gradually increase the amount. If a small serving gives you cramps or diarrhea, stop eating that food temporarily but try it again in a few weeks.

Your diet may increase intestinal gas, depending on what you intake. Foods, such as dried beans, onions, cabbage family, eggs, fish, asparagus, melons, beer, carbonated drinks and very fatty foods, can cause more gas than other foods. It is also important to drink plenty of water (a recommended minimum of 5-6 ounce glass of water per day).

UOAA Food Reference chart

• Ostomy Nutrition Guide

It is essential that ostomates are properly educated on diet and hydration after surgery. For more information, please refer to the UOAA's Ostomy Nutrition Guide

• Ostomy Nutrition Guide

Ostomates need to be properly educated on diet and hydration issues after surgery. Patients can find out more:

• UOAA Diet + Nutrition

Changes in Your Ability to Have Sex (Men)

Sexual functions in a man may be affected if the rectum and anus are removed because the nerves controlling the erection can be a part of the removed parts. However, the nerves in the rectum and the anus are not the same nerves that control the feeling of the penis or the feeling of an orgasm.

For some men, erections can recover within time, but if it doesn’t return, you should contact the physician and discuss treatments such as oral medicine with PDE5 inhibitors Viagra, Levitra or Cialis, Vacuum Erection Devices, Intracavernosal Injections or Penile Implants.

Note: Resuming sexual activity should be taken slowly, gradually and in a non-pressured way. It is important that you and your partner have an open relationship and communicate honestly about any sexuality concerns.

The United Ostomy Associations of America has helpful sexuality resources including the Intimacy After Surgery Guide

• Intimacy After Surgery Guide

Changes in Your Ability to Have Sex (Women)

Women’s sexual functions are not medically impaired by the surgery although they might experience pain during intercourse. You may want to consider using a lubricant as many women note they do not have sufficient physiologic lubricant. You should discuss with your physician your chances of having sexual problems after surgery and possible solutions for these problems.

Women typically should have no problem conceiving and bearing children.

Note: Resuming sexual activity should be taken slowly, gradually and in a non-pressured way. It is important that you and your partner have an open relationship and communicate honestly about any sexuality concerns.

The United Ostomy Associations of America has helpful sexuality resources including the Intimacy After Surgery Guide

• Intimacy After Surgery Guide

Diarrhea/Constipation

Sometimes antibiotics may upset the bowel causing diarrhea. Constipation can also be caused by lack of adequate fluids, adequate fiber, sedentary life style, some medications (especially pain medication), and certain types of chemotherapy.

Always check with your physician before using laxatives or stool softeners.

Infection

It is normal if your skin around the stoma looks red after surgery. If your skin continues to look red, if you have pain in the area around your stoma or if your skin is tender, itchy, or bumpy, you might have an infection. 

Contact your physician immediately if you notice these symptoms.

Leaky Pouches

Ostomy leaks can be extremely distressing, cause anxiety and contribute to a poor quality of life. To prevent leaks, it is critical that you understand why your pouch leaks, as well as how to fix the source problem. Maintaining a well-fitted pouching system will ensure you have the opportunity to resume your life style. Here are five of the most common reasons your colostomy pouch may leak:

1. Poorly Fitting Pouch
2. Improper Pouch Application
3. Wrong Pouch
4. Body Changes (e.g. creases, wrinkles, hernias)
5. Peristomal Skin Lesions

Contact your WOC nurse immediately if your pouch is leaking.

Occasional flecks of blood on your stoma

You may see blood spots on your stoma because the stoma has good blood supply. You may also see blood spots when you are cleaning or changing the stoma bag.

Contact your WOC nurse or physician immediately if you see blood in your pouch or if the bleeding continues.

Odor

You may experience this because of diet and medication. All foods may cause gas. Some foods, when consumed in large volumes, i.e., dried beans, onions, cabbage family, eggs, fish, asparagus, melons, beer, carbonated drinks and very fatty foods may cause more gas than others. Some medications and vitamin supplements are responsible for a strong odor. If you suspect this is the case and the odor is bothersome, consult your physician. He or she may be able to change the prescription. Modern colostomy pouches are made from odor resistant materials which allow you to enjoy foods that may produce odor without the fear of it affecting the people around you.

However, if you still want to reduce odor, options for odor management include oral products such as bismuth subgallate, chlorophyll and charcoal products. Deodorant drops, or Odor Eliminating drops, are another way to manage odor; these are scentless drops that are put into the drainable ostomy bag after emptying it to prevent and eliminate odor. Sometimes just rinsing the pouch with mild suds is helpful.

Skin Irritability

The skin around your stoma can become irritated and red when it comes in contact with bowel from your stoma. This is normal.

To avoid skin irritation, you will need to adjust the opening of the wafer (skin barrier) to the size of your stoma. It is also recommended that you change the skin barrier every 3 or 5 days to avoid skin irritation if you are using a two-piece pouching system. You will also need to examine the skin barrier every now and then to look for exposed skin and leaking under the barrier.

If you notice exposed skin or any leaking, you will need to change your bag. You may also need to use skin barrier past to fill any gaps between the barrier and the skin.

Refer to the UOAA's guide on Ostomy Skin Care for additional information on skin problems faced by ostomy patients

• UOAA's guide on Ostomy Skin Care

When to Contact Your Doctor About Problems with Your Stoma

Contact your doctor about your stoma if you experience any of the following problems:

• If your stoma bleeds and won't stop bleeding
• If you notice a change in color of your stoma
• If you notice a change in the general appearance of your stoma

Tips for a Successful Recovery after Ostomy Surgery from a WOC Nurse

• Tips from a WOC Nurse

Ostomy myths still persist. Facts can help ease fears and misinformation about surgery:

• Ostomy Facts

Video: What is a Colostomy?

Advice and Stories from Patients and Survivors

NFL Legend Rolf Benirschke - UOAA

Your Stoma

What Is an Ileostomy and What Does It Look Like?

An ileostomy is a surgically created opening in the abdomen in which a piece of the ileum (lowest part of the small intestine) is brought outside the abdominal wall to create a stoma through which digested food passes into an external pouching system.

Ileostomy Procedure

During your ileostomy procedure, your surgeon will make an incision in your abdominal wall, creating a small opening, or stoma (ostomy), that is approximately an inch in diameter and typically on the lower right side of the abdomen. Then, the ileostomy is created by bringing the ileum, the lower part of your intestine, to the opening where it is then attached. This is where your stoma bag will be attached externally.

• Stoma Information
• Stoma Training

Common Stoma-Related Problems

Skin Irritability

The skin around your stoma can become irritated and red when it comes in contact with bowel from your stoma. This is normal.

To avoid skin irritation, you will need to adjust the opening of the wafer (skin barrier) to the size of your stoma. It is also recommended that you change the skin barrier every 3 or 5 days to avoid skin irritation if you are using a two-piece pouching system. You will also need to examine the skin barrier every now and then to look for exposed skin and leaking under the barrier.

If you notice exposed skin or any leaking, you will need to change your bag. You may also need to use skin barrier past to fill any gaps between the barrier and the skin.

Refer to the UOAA's guide on Ostomy Skin Care for additional information on skin problems faced by ostomy patients

• UOAA's guide on Ostomy Skin Care

Change in Diet

There are temporary dietary restrictions following the surgery. For the first weeks, you often times follow a low residue diet with foods that are easily digested and excludes raw fruits and vegetables. The first foods you will receive as you are recovering may be clear liquids i.e. tea, jello, and broths. Gradually you will advance to soft foods that are generally easy to chew. After healing is completed and the ostomy is functioning normally, you can return to a normal diet (about six weeks after surgery). You can ask your doctor about a diet that will work with both that problem and your colostomy.

Eat regularly and at a leisurely pace. Chew all foods thoroughly. It may take several weeks to have a normal diet like before. The key to going back into a normal diet is to experiment. Add new food you haven't eaten since the surgery one at a time. This way, you can be sure if eating the same food would bother you or not. Eat small portions at first, and then gradually increase the amount. If a small serving gives you cramps or diarrhea, stop eating that food temporarily but try it again in a few weeks.

Your diet may increase intestinal gas, depending on what you intake. Foods, such as dried beans, onions, cabbage family, eggs, fish, asparagus, melons, beer, carbonated drinks and very fatty foods, can cause more gas than other foods. It is also important to drink plenty of water (a recommended minimum of 5-6 ounce glass of water per day).

UOAA Food Reference chart

• Ostomy Nutrition Guide

It is essential that ostomates are properly educated on diet and hydration after surgery. For more information, please refer to the UOAA's Ostomy Nutrition Guide

• Ostomy Nutrition Guide

Ostomates need to be properly educated on diet and hydration issues after surgery. Patients can find out more:

• UOAA Diet + Nutrition

Changes in Your Ability to Have Sex (Men)

Sexual functions in a man may be affected if the rectum and anus are removed because the nerves controlling the erection can be a part of the removed parts. However, the nerves in the rectum and the anus are not the same nerves that control the feeling of the penis or the feeling of an orgasm.

For some men, erections can recover within time, but if it doesn’t return, you should contact the physician and discuss treatments such as oral medicine with PDE5 inhibitors Viagra, Levitra or Cialis, Vacuum Erection Devices, Intracavernosal Injections or Penile Implants.

Note: Resuming sexual activity should be taken slowly, gradually and in a non-pressured way. It is important that you and your partner have an open relationship and communicate honestly about any sexuality concerns.

The United Ostomy Associations of America has helpful sexuality resources including the Intimacy After Surgery Guide

• Intimacy After Surgery Guide

Changes in Your Ability to Have Sex (Women)

Women’s sexual functions are not medically impaired by the surgery although they might experience pain during intercourse. You may want to consider using a lubricant as many women note they do not have sufficient physiologic lubricant. You should discuss with your physician your chances of having sexual problems after surgery and possible solutions for these problems.

Women typically should have no problem conceiving and bearing children.

Note: Resuming sexual activity should be taken slowly, gradually and in a non-pressured way. It is important that you and your partner have an open relationship and communicate honestly about any sexuality concerns.

The United Ostomy Associations of America has helpful sexuality resources including the Intimacy After Surgery Guide

• Intimacy After Surgery Guide

Diarrhea/Constipation

Sometimes antibiotics may upset the bowel causing diarrhea. Constipation can also be caused by lack of adequate fluids, adequate fiber, sedentary life style, some medications (especially pain medication), and certain types of chemotherapy.

Always check with your physician before using laxatives or stool softeners.

Tips for a Successful Recovery after Ostomy Surgery from a WOC Nurse

• Tips from a WOC Nurse

Ostomy myths still persist. Facts can help ease fears and misinformation about surgery:

• Ostomy Facts

Video: What is an Ileostomy?

Advice and Stories from Patients and Survivors

NFL Legend Rolf Benirschke - UOAA

Types of Surgical Procedures for Patients to Consider

Ileal Conduit

An ileal conduit is a type of urinary diversion which a surgeon creates using a piece of small intestine after removing the bladder. This is commonly referred to as a urostomy.To do this, the surgeon takes a short segment of the small intestine and places it at an opening in the skin made on the surface of the abdomen to create a stoma (ostomy). The ureters, which normally carry urine from the kidneys to the bladder, are then attached to the other end of the segment of intestine inside the abdomen. The urine now travels from the kidneys, passing through the ureters and the newly formed ileal conduit, to the stoma and out into a collecting pouch known as a stoma pouch or ostomy pouch. This pouch is worn outside the body around the stoma 24 hours a day. Because the nerves and blood supply are preserved, the new conduit is able to propel the urine out of the body and into the pouch constantly.The pictures below show the change in the urinary tract after ileal conduit procedure.

Front View of Urinary Tract:

Urinary Tract After Ileal Conduit:

Continent Reservoir (Indiana Pouch)

Continent Reservoir (sometimes referred to as Indiana Pouch) is an internal system of urinary storage which a surgeon creates using parts of the small and large intestine after surgical removal of the bladder. This pouch, which is connected to the skin by a small stoma, is drained periodically by inserting a thin tube or catheter into the stoma. After the pouch is emptied, the catheter is removed. No external pouch is needed to collect urine. The creation of a continent urinary reservoir, or pouch, will mean several things to you in terms of care and what to expect after surgery. It is important to know and understand that it will take several weeks, perhaps even months, before your pouch is functioning in a predictable fashion.

Orthotopic Neobladder

To replace your bladder, the surgeon will create an internal pouch that sits inside your body made from a piece of your intestine. This internal pouch is called neobladder. The surgeon connects the neobladder to the ureters so that urine can flow from the ureters and can be stored in the neobladder. The surgeon also connects the neobladder to your urethra. The urethra is the tube empties urine from the bladder and carries urine out of your body. Because the neobladder is joined to your urethra, you will be able to empty the neobladder much as you emptied your bladder before the surgery through the urethra.

Neobladder:

Unlike other surgical procedures for bladder cancer patients, the orthotopic neobladder procedure does not create a ostomy, stoma or external opening for the patient.

United Ostomy Associations of America (UOAA) Guide for Continent Diversions for the Bladder

• What You Need to Know from UOAA Guide

Bladder Cancer Advocacy Network (BCAN) Resources for Patients and Caregivers

• Bladder Cancer basics
• What is a cystectomy
• Tips for caregivers

New Ostomy Patient Guide

• New Ostomy Patient Guide

Types of Surgical Procedures for Patients to Consider

Ascending Colostomy

The ascending colostomy is located on the right side of the abdomen. The discharge is very liquid. A drainable pouch is worn for colostomies of this type. This type of stoma is rarely used since an ileostomy is a better stoma when the discharge is liquid. When a colostomy is located in the right half of the colon, only a short portion of colon remains. Caring for an ascending colostomy is similar to caring for a transverse colostomy.

Transverse Colostomy

The transverse colostomy is in the upper abdomen, either in the middle or  toward the right side of the body. Diverticulitis, inflammatory bowel disease, cancer, obstruction, injury or birth defects can lead to a transverse colostomy. This type of colostomy allows stool to exit the colon before it reaches the descending colon.

When conditions such as those listed are present in the lower colon, it may be necessary to give the affected portion of the colon a rest. A transverse colostomy  may be created for a period of time to prevent stool from passing through the area of the colon that is inflamed, infected, diseased or newly operated on, thus allowing healing to occur. Such a colostomy is usually temporary. Depending on the healing process, the colostomy may be necessary for a few weeks, months, or even years.

Eventually, given your good health, the colostomy is likely to be closed and normal bowel continuity restored.

A permanent transverse colostomy is made when the lower portion of the colon must be removed or permanently rested. This may also be the case if other health problems make it unwise for the patient to have further surgery. Such a colostomy provides a permanent exit for stool and it will not be closed at any time in the future.

Generally, a transverse colostomy will be placed higher on the abdomen so concealing the pouch may be more of a challenge.

Descending or Sigmoid Colostomy

The sigmoid colostomy is probably the most frequently performed  of all the colostomies. Located on the lower left side of the abdomen. Generally, the discharge is firm and can be regulated naturally and predictably.

New Ostomy Patient Guide

• New Ostomy Patient Guide

Types of Surgical Procedures for Patients to Consider

Ileoanal Reservoir (J-Pouch)

A procedure in which the colon and most of the rectum are surgically removed and an internal pouch is formed out of the terminal portion of the small intestine (ileum). An opening at the bottom of this pouch is attached to the anus in a way that the existing anal sphincter muscles can be used for continence. This procedure most often is performed on patients with ulcerative colitis or familial polyposis who have not previously lost their anal sphincters. In addition to the “J” pouch, there are “S” and “W” pouch geometric variants. It is also called ileoanal anastomosis, endorectal pull-through, pelvic pouch and, ileal pouch anal anastomosis (IPAA).

Continent Ileostomy (Abdominal Pouch)

An ileostomy that drains into a surgically created pouch or reservoir located in the abdomen that is created from loops of the small intestine (ileum). Involuntary discharge of intestinal contents is prevented by a nipple valve created from the ileum. This method eliminates the need for the patient to wear an external pouch over the stoma. The stoma is catheterized throughout the day to empty the reservoir.

Brooke Ileostomy

The Brooke ileostomy is the second most common type of ileostomy surgery. The terminal ileum is pulled through the abdominal wall and a segment is turned back and attached to the skin, leaving a smooth, rounded ileum as the end of the ileostomy. The stoma is usually placed in the right lower quadrant whenever possible and located on a flat surface sufficiently free from irregularities. The fecal output is incontinent (not controlled) and will require wearing a collection pouch.

New Ostomy Patient Guide

• New Ostomy Patient Guide