A stoma is an opening in your belly's wall that a surgeon makes in order for waste to leave your body if you can't have a bowel movement through your rectum.
You might get one if you have surgery to remove or bypass part of your large intestine (colon and rectum) and can't have bowel movements the usual way. The operation is called a colostomy. The surgeon will attach the end of your colon to the stoma. Bowel movements will leave your body through it and collect in a special pouch that you’ll empty out.
Your health care team will show you how to change your bag and take care of the stoma. Over time, you'll get used to this new routine.
When You Need Surgery to Get a Stoma
You might need this kind of operation because of:
- A bowel blockage or tear
- Crohn's disease or ulcerative colitis
- Birth defects
- Injury to the colon
- Pouches in the colon, called diverticulitis
Sometimes doctors do a colostomy to give a damaged section of bowel time to heal. In this case, the stoma is temporary. You'll have it for a few weeks or months.
Once the damage has healed, your surgeon can reverse the procedure and reattach the ends of the intestine. But if you had to have a large piece of the bowel removed, you may need the stoma for good.
What Happens in a Colostomy
Your surgeon will remove the damaged or diseased part of your colon. They'll pull out the healthy part of the colon and attach it to a small opening in your abdomen -- the stoma. Then you’ll get a plastic pouch over the stoma to collect wastes.
You'll stay in the hospital for a few days to a week after your surgery. Before you leave there, a doctor or nurse will teach you how to change the bag and keep the skin around your stoma clean.
How to Care for Your Stoma
You'll change it a few times a day. Try to do that when the pouch is only a third full to prevent leaks, which can irritate your skin.
To remove the pouch, carefully push down on your skin to separate it from the sticky part of the pouch. Empty its contents into the toilet before you throw it away, or wash it out to use again.
Gently clean the skin around your stoma with a wet washcloth or paper towel. Pat the area dry. Then put the pouch back on.
Skin irritation is one of the most common problems that can happen with a stoma. Wash and dry your skin well to help avoid redness and soreness.
The stoma will be dark red at first. The color should get lighter over time, although it will stay pink or red.
It will also get smaller in size. You may need to change the opening of your pouch so it's the right size for the stoma. If the opening is too big, stool can leak out.
Also ask your doctor about skin barriers and sealants you can put around the opening of the pouch to keep stool from leaking.
The stoma may bleed a little bit when you clean it. Call your doctor if the bleeding doesn't stop, or if you notice blood inside your pouch.
If you have a lot of gas, the bag can over-expand. You can take medicine to reduce gas. Or use a bag with a vent that releases it. Also, limit foods that make you gassy, like broccoli, cabbage, beans, and cauliflower.
Sometimes after a colostomy, stool can become very watery. To stay hydrated, drink lots of fluids. Include sports drinks, which also replace some of the sodium, potassium, and other electrolytes you've lost.
It’s rare, but sometimes a piece of the bowel can push out through the stoma. Doctors call this a prolapse. You may need surgery to fix it.
When to Call Your Doctor
Pick up the phone if you notice any of these problems:
- The skin around the stoma looks red, raw, or it leaks fluid.
- You have a fever of 101 degrees F or higher.
- You have nausea, vomiting, pain in your gut, severe constipation, or diarrhea.
- You're weak, have muscle cramps, or pee less than usual -- these are warning signs of dehydration.
Life With a Stoma
Most pouches are small and flat enough to hide under your clothes. They also trap odors, so no one should be able to tell that you're wearing one.
Try to think of your stoma and pouch as helpful accessories. They'll give you the freedom to go out and do all the things you want to do, without having to go to the bathroom as often. You'll still be able to work and exercise. You can shower, take baths, swim, and have sex.
If you're embarrassed or uncomfortable about your pouch, you may want to talk to a "stomal therapist" for tips. Your doctor can help you find one. You could also join a support group for people who've had a colostomy, know what it’s like, and want to share their questions, feelings, and tips.