Nurses and health care staff will come across patients with a stoma during some point in their career. They may work in a variety of clinical settings, including the nursing home, and so it’s important that both nurses and care staff know how to manage a stoma, and that they are able to offer advice and support. Ongoing health care training and support must be given to all staff to ensure that this happens.
What exactly is a stoma?
The word ‘stoma’ actually comes from the Greek word meaning opening. A stoma is when a surgeon has made an opening from the abdominal wall, allowing part of the bowel to be pulled through. Here faeces can exit the body, as opposed via the rectum. A stoma is pink or red in colour and is wet to the touch, somewhat like the inside of your mouth. Although a stoma may look painful, it isn’t because there are no nerve endings. However, this also has its downsides as it can be difficult for the individual to know if any damage has occurred. This is why the from a needs to be observed regularly during bag changes.
Why do people need a stoma?
So, why do people need a stoma? There are so many medical reasons why a person may need to have a stoma. Reasons include those of cancer of the bowel, inflammatory bowel disease (IBD) and diverticular disease, in which parts of the bowel ‘die’.
There are also three different types of stoma, and the type and placement of the stoma on the abdominal wall very much depend upon the primary disease, and if the stoma is to be permanent or temporary. A temporary stoma will later be reversed, allowing normal function of the bowel.
Stoma pouches and other appliances
The stoma pouch collects the faces as it exits the stoma. The individual has no control over when the stoma is emptied. Another word for the pouch is the stoma bag. This pouch has a hole that can be cut to the correct size to fit snugly around the stoma. Every stoma is different, so one size bag does not fit all. The bag has a sticky circle that is applied to the skin around the stoma, with the bag attached. When the pouch becomes full, it is removed by gently unsticking this circle and a new bag is applied. The skin around the stoma is known as peristomal, and needs to be kept clean to avoid any irritation or infection. It’s also important that the stoma bag is a snug fit as any faeces that makes contact with this delicate skin can cause irritation and skin breaks over a period of time.
Individuals also have access to a wide range of accessories that can help with their daily stoma care. These include adhesives to help the bag be more secure, and to prevent any embarrassing leakage. Other products help to protect the skin by providing a barrier. You can also buy wipes, and powders to help manage the skin around the stoma.
In most cases stoma accessories are not needed. It is usually the stoma nurse who will suggest and then prescribe any of these items, to help protect the skin.
There are three types of stoma
The three types of stoma, the urostomy, colostomy and ileostomy. They can be permanent or temporary. A surgical incision is made in the abdominal wall and the bowel pulled through. A stoma can be an ‘end’ or a ‘loop’ stoma. An end stoma is when the end of the bowel is pulled through the abdominal wall and secured in place via dissoluble stitches. This type of stoma is usually permanent. A loop stoma is as the name suggests, as it’s a loop of bowel that is pulled through the abdominal wall, with each end sutured to the skin. One end will pass the faeces, while the other end passes nothing or mucous. This type of stoma is usually reversible, as the two ends can be reattached.
A colostomy is formed from the colon (large bowl) and it can be from the descending or sigmoid colon. The faeces that are emptied will tend to be of a soft consistency and flatus (wind) will also be passed. A colostomy bag should be changed when three thirds full to prevent the bag from ripping. The bag should only be removed when absolutely necessary, as frequent changes can damage the skin.
An ileostomy is when a stoma is formed from the ileum (small bowel). Usually the end of the ileum is used, and this type of stoma is referred to as a terminal ileostomy. The ileum passes faeces that is much looser than the colostomy. This is because the faeces has not yet passed through the colon, which removes excess water. This collection of fluid faeces means that the ileostomy needs to be emptied four to six times a day. The bag usually has a Velcro fastening, allowing the bag to be easily opened and emptied straight into the toilet.
A urostomy is formed to allow urine to exit the stoma, as opposed to faeces. A urostomy is formed when a small part of the ileum is used to form a link to the ureters, enabling urine to pass through. Sometimes the colon can also be used, but this is fairly uncommon. A urostomy is usually indicated when there is cancer of the bladder. A urostomy bag collects the urine, which is then emptied via a tap. The urostomy will pass the same amount of urine as the individual did pre urostomy. Most individuals change their urostomy every two to three days.
Caring for Care provides stoma health care training. The course covers topics such as infection control, applying and removing a stoma pouch, why a stoma may be needed and privacy and dignity. To learn more about our health care stoma training, then please do contact us here at Caring for Care today.