A digestive stoma means an artificial opening surgically created in the abdomen to allow patients to pass their stools. This “opening”, often nicknamed “artificial anus” can be temporary or permanent. In which indications is a digestive stoma performed? What is she like ? How to maintain it every day ? Answers from Pr Michel Ducreux, head of the digestive oncology department at the Gustave Roussy Institute.
Definition: what is a digestive stoma?
A digestive stoma results from a surgical operation: it designates the joining of part of the intestine to the skin in the abdomen, to allow the evacuation of stools and gases. Concretely, surgeons create an “opening” in the skin (the stoma) by directly connecting part of the colon or the small intestine to the skin of the belly, explains the doctor. The stools are discharged through the stoma and collected in a specific pocket. This is why we often speak of “artificial anus”.
What are the different types of stoma?
There are two types of stomas:
- digestive stomasalso called intestinal, which consists of diverting part of the patient’s digestive tract by joining the abdominal wall;
- et urinary stomasalso called urostomies, which consist of diverting the urinary tract by joining the skin of the abdominal wall.
What are the differences between a colostomy and an ileostomy?
There are two types of digestive ostomies:
- colostomywhich involve part of the colon;
- et ileostomieswhich involve the last segment of the small intestine, the ileum.
Temporary or permanent digestive stoma?
Digestive stomas can be temporary or permanent.
- THE temporary stomas (sometimes called discharge or protection), consist, as their name suggests, in diverting the stool to facilitate the healing of an operated area or to avoid complications in the event of a leak. They are the subject of a second surgery following three to six months to restore digestive continuity, specifies Professor Ducreux.
- Definitive stomas, as their name suggests, consist of diverting stools and gases permanently. In this case, the medical team does not plan to restore digestive continuity and patients must manage their ostomy pouch for life.
Indications: when and why place a digestive stoma?
Digestive stomas can be linked to tumor lesions, inflammatory diseases or congenital intestinal anomalies such as hereditary adenomatous intestinal polyposis.
What causes an ileostomy?
Ileostomies can be done when part of the colon is damaged or has been removed due to cancer or injury.
They can also be carried out as part of the management of a crohn’s diseaseof a diverticulitisof a ulcerative colitis or of tumors obstructing the bowel.
A temporary ileostomy can also be performed following colon surgery to optimize healing.
What causes a colostomy?
Colostomies are most often necessary in case of cancers du rectum (more rarely of the colon) requiring the removal of part of the colon.
The crohn’s disease, certain lesionseven fecal incontinence may also indicate a colostomy.
A temporary colostomy may also be performed following colon surgery to optimize healing.
Note: some intestinal trauma (accident, assault, etc.) may also require a colostomy, especially in the event of perforation or occlusion.
Where is the stoma? What does it look like when laid down?
The seat of the stoma varies according to the segment concerned by the intervention (the ileum, the right colon, the transverse colon, the left colon or the sigmoid colon). The opening can therefore be more or less high, on the right or left of the abdomen.
“Depending on the colon segment concerned, the stools collected in the stoma pouch will not have the same consistency, since the colon absorbs the water contained in the stools”, specifies Professor Ducreux. In details :
- If the stoma is made on the left side of the colon, the stools are usually molded and solid ;
- If the stoma is made on the right side of the colon, the stools are rather semi-liquid or pasty ;
- And if the stoma is made at the level of the ileum, the stools are liquids and corrosives.
Note: most anal pouches are made up of carbon filters that limit unpleasant odors. Deo-lubricants or powders can also be placed in the pocket to absorb odors.
What does an “artificial anus” look like?
As noted above, the stoma takes the form of a small round bright red opening (between 2 and 4 cm in diameter).
After the intervention it is slightly swollen and comes out of the skin. It can sometimes bleed in case of friction, because it is very vascularized, but it is not painfulbecause the mucous membrane contains no nerves.
This “artificial anus” will only take on its final appearance following a few weeks. The surrounding skin, called peristomal skin, remains sensitive and must be monitored to prevent infections and other harmful irritations.
What is colonic irrigation?
“Unlike the anus, the stoma does not control the emission of stools. The latter are therefore evacuated untimely, which can be a major source of discomfort and encourage certain patients to social exclusion”, underlines Professor Ducreux.
In the event of a permanent digestive stoma, the surgeon can therefore suggest that the patient perform colonic irrigations. Concretely, this consists of completely emptying the colon every 48 hours. Thus, instead of the traditional ostomy pouch, patients can wear a mini ostomy pouch, a shutter pad or a simple bandage. “Patients are accompanied by a stomatherapist to learn how to inject the enema into their intestines and manage the evacuation of water and stool”, reassures Professor Ducreux.
What are the possible risks and complications?
Several so-called “early” complications can occur following the placement of a stoma:
Other complications may occur in the medium / long term (late complications)
- The stoma opening may narrow (stenosis) and complicate the evacuation of stools;
- part of the bowel can “pop out” through the stoma (prolapse) ;
- Finally, a peristomal eventration can also occur at the level of the stoma. It is manifested by the formation of a subcutaneous lump around the orifice. Patients feel no pain, but there is a risk of strangulation of the bowel in the eventration orifice. Not to mention that this unattractive lump can interfere with the fitting and promote leaks between the support and the skin.
How to take care of your stoma (change and clean your pouch)?
The stoma reaches its final size following three to six weeks. This potentially requires adapting one’s equipment, while adopting a strict care routine.
How to clean your stoma?
Nothing might be simpler: the stoma is generally cleaned with tap water, or in the shower, with neutral pH soap, taking care to rinse the “wound”. In case of irritation, however, soap is avoided.
To limit bleeding, avoid excessively brisk movements and compress the stoma with a water-soaked compress until the blood stops flowing. If they persist or appear regularly, do not hesitate to contact your doctor!
Before putting your pocket back on, make sure that the peristomal skin is completely dry. If the stoma remains a little moist, dab it gently with a compress. Moreover, the use of gels, creams, antiseptic products and other wipes is prohibitedat the risk of impacting the adhesion of the device and the bag.
Limit irritation around the stoma
Several “accessories” make it possible to protect the peristomal skin from irritation, in particular rings of different sizes or thicknesses, specific pastes with or without alcohol, etc. Your skin is therefore not directly in contact with the equipment. The stomatherapists are there to advise you.
How to live with an anal pocket on a daily basis?
“Some patients find it difficult to support their ostomy pouch: their physical integrity and their self-esteem are alteredthey fear the gaze of others”, notes Professor Ducreux. However, once freed from their fears, patients can lead an almost “normal” life!
The first step obviously begins with becoming familiar with the equipment. With the help of the medical team, the patients gradually gain self-assured and independent. Care only becomes a daily formality and they go on with their lives as they see fit.
Food, sport, work, sexuality… What are the constraints?
On a daily basis, wearing a stoma does not hinder movement. clothing side, you can afford anything, on the condition of avoiding clothing, underwear and accessories (belts) which risk compressing the pocket. And for the summer, if you are a fan of crop topknow that there are very aesthetic pocket covers!
As for food, each patient goes at their own pace. In theory, there is no specific diet to favor. But in practice, we sometimes limit foods that promote intestinal gas, such as cabbage, red beans, onions, etc. We put on antidiarrheal or anti-constipation foods as appropriate and we make sure to hydrate well! Good to know: there are sachets of powder to place in the pocket to gel the stool if these are too liquid.
The resumption of work is generally carried out without incident. However, it requires some logistical precautions : have access to sanitary facilities, provide a kit with the necessary equipment to change your pocket, etc. Moreover, doctors advise once morest carrying heavy loads and any activity that weakens the abdominal wall, which sometimes forces some patients to retrain.
The practice of physical activities generally remains possible, including water sports, because the pockets are waterproof (it is also possible to use a small pocket or a sealing pad). However, contact sports such as boxing, rugby, judo or wrestling are generally not recommended because they risk tearing the pocket stoma. For other sports, a protective belt specifically designed for ostomates can be helpful.
With regard to sexuality, no contraindications to report (if not too “violent” practices)! The difficulties encountered are not so much of a “technical” order, but rather of a psychological order: as Professor Ducreux points out, “the body image is very affected by this intervention and the patients often put time to get used to their new appearance”. And to assure that it is entirely possible to resume an active sex life by adopting small tips such as wearing a mini-pocket, wearing a suitable covering top, adopting sexual positions that limit the view of the pocket, etc.
To better understand all these aspects and overcome his fears, the doctor finally reminds you that you should never hesitate to (re)contact a stomatherapist. It also exists ostomy associations and support groups which allow you to discuss your experience and benefit from the advice of other patients. A psychological follow-up can also be beneficial for regaining self-confidence.