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What is a stoma?


There are about 1,3 million people with a stoma worldwide. In The Netherlands there are around 30,000 stoma wearers and Belgium has around 12,000. In the Netherlands approximately 6000 to 9000 people are annually confronted with the construction of a stoma of the intestine or urinary tract. Because many stomas are temporary, stomas are replaced for example with a pouch, and also because unfortunately people die, the number of stoma wearers in our country remains roughly the same. But what actually is a stoma?


According to the medical dictionary, a stoma is an unnatural artificial opening that binds a body cavity with the outside world, and is the result of illness or an operation. You can therefore imagine that there are many sorts of stomas. On this page we are only dealing with the ileostomy and the colostomy (for faeces) and the urostomy (for urine).


Picture source: Convatec


For the intestines a stoma is also called AP (anus praetor naturalis) and for the urine UP (urethra praetor naturalis). Some people also call a stoma “rosebud”. Or so Jan Wolkers named a book “A rose of flesh”. A stoma is constructed of the intestines or the urethras when the faeces or urine cannot leave the body in the natural way. For example with birth defects, intestinal inflammation, polyps and tumours but also if the intestines are damaged in such a way after sexual abuse or an accident.


The word “stoma” comes from the Greek and means opening or mouth. And this is what a stoma looks like: a red mouth. Quite simply, a stoma is a hole in your stomach made of intestinal tissues to allow the passage of faeces or urine which are then collected in a bag.



Source picture below: Dansac


As a rule, a stoma protrudes some 2 to 3 cm from the stomach, although there are, of course, a number of different possibilities. There are stomas that lie so deep that they can cause problems with leaks and there are also “long spouts” as I have heard them called by a fellow forum member. Interested in how varied a stoma can look? Then look at the Stomaatje wall!!



Source picture below: The stolen colon.blogspot.com


A stoma is red and moist and feels like the inside of your cheek. There is little sensation since there are no nerve endings in your intestine. It has a number of small blood vessels so that it can easily bleed while being cleaned or if it is not handled gently. This is quite normal! It may sound a little strange but you can actually stick your finger in your stoma and you will feel nothing.


Below you can se a cross-section of a stoma. An operation creates an opening in the stomach wall and a piece of intestine is pulled through and folded over on itself.


A stoma is, of course, not an illness in itself, but a change in the physical functioning of the body with the aim of alleviating the symptoms of an illness. (I called it a detour myself). If you are ill and there is no prospect of getting better, then the formation of a stoma can be a relief since many problems will diminish or even disappear altogether. Consequently, I do not consider a stoma to be a physical disfigurement, as people frequently think, but as a way in which it is possible to live life to the full again instead of simply surviving. It’s great that they have come up with this (stop-gap) solution.


A colostomy (also known as a large intestine stoma) = an artificial opening of the large intestine (colon). A colostomy is formed when part of the large intestine (or possibly the rectum) has been removed. The end of the remaining piece of intestine is then pulled through and stitched to the abdomen. A colostomy is usually situated on the left hand side under the navel.





Source of image below: UW medicine ostomy care


An ileostomy (also known as a small intestine stoma)= an artificial opening of the small intestine (ileum). An ileostomy is formed when the large intestine (and possibly the rectum) no longer function or have been removed. The lower end of the small intestine is then pulled through and stitched to the abdomen. An ileostomy is usually situated on the right hand side of the abdomen under the navel.



Source of image below: UW medicine ostomy care


A urostomy (also known as a urine stoma) = an artificial opening of the urinary tract. A urostomy is formed when urine can no longer leave the body naturally. In a urostomy the bladder is removed and the 2 ureters are stitched to the abdomen by using a piece of the small intestine.



Source of image below: UW medicine ostomy care


A stoma can be either temporary or permanent, depending on why it was necessary in the first place. In the case of a permanent stoma the operation has meant that the natural opening, the anus or the bladder, can no longer be used. A permanent stoma usually has only 1 opening, known as a single loop or independent stoma.


© Healthwise


Source of image on the left: Coloplast, in the middle: thanks to cock!


Source of image: kinderchirurgie


A temporary stoma is formed when it is going to be reversed at some later date. This kind of stoma may be formed on the large intestine or on the small intestine. The reasons for a temporary stoma can vary: to give part of the intestine a chance to recover, after an operation for example or in the case of chronic inflammation. A temporary stoma has 2 openings and is also known as a double loop stoma. One opening produces the faeces and the other mucous, (the latter is the opening which leads to the rectum). A temporary stoma cannot always be reversed; if, for example, the seriousness of the problem does not allow this or if the person in question wishes to keep the stoma.


 Picture source: Healthline



Picture source: kinderchirurgie



Another type of temporary stoma is a colostomy with mucous fistula. This is the same principle as a colostomy, but the anus and rectum remain intact and a piece of the intestine is pulled through the abdominal wall. This gives rise to a separate opening out of which only mucous is excreted, the so-called mucous fistula. Also in this case, the stoma can sometimes be reversed by joining the 2 ends together again.



Source of image below: kinderchirurgie


Whatever sort of stoma you are given, the stoma nurse will see where the best place for it is. This is because every stomach is unique. In principle, a stoma can be formed anywhere on the abdomen. But there are a number of preferred places:

* (double loop) ileostomy ~ on the right at the bottom

* Colostomy ~ on the left at the bottom

* Double loop colostomy ~ on the left at the bottom or at the top

* Urostomy ~ on the right at the bottom

Exceptionally, an ileostomy or colostomy can be place above the navel. This is not possible with a urostomy due to the anatomical placement of the kidneys, ureters and the bladder. For example, Muslims consider a stoma below the navel to be unclean and this has to do with cultural background. For a stout person or a wheelchair user then the stoma is better sitting slightly higher up the stomach.


In order ensure that after your operation your stoma bag sits well and is in the right place while you are standing, sitting or moving around, the surgeon and the stoma nurse carefully choose with you the best place for the stoma; this depends on the shape and folds of your stomach. It is quite important that the stoma is in the ‘right’ place, otherwise you can later have problems with leaks. They take into consideration protruding bones, like your hip bone and ilium and also your navel, any scars and the contours of your body. Often the stoma is placed at the top of the “fat roll” at the height of the navel. They also consider your clothing, as it is important to know where the waistband is. And finally, is it is of course very important that you yourself can see your stoma and can move and bend easily. It is advisable to walk around for a while as a test before the operation with a stoma bag placed on your stomach, so that you can feel if it is a good place. In some hospitals you are loaned a fake stoma that you can place on your stomach. All these considerations can only serve as a guide, since ultimately the surgeon is naturally limited by what the situation is in the stomach. In an emergency the positioning of the stoma can be particularly problematic.


What about the faeces and urine that comes out of your stoma? With a stoma you have no control over your faeces or urine, essentially you are incontinent. That is why you need a bag. The consistency of the faeces which comes out of the stoma is dependant on where in the intestines the stoma is made.


* Colostomy ~ the longer the piece of large intestine, the thicker the excrement. In the case of a colostomy where a large part of the large intestine has been removed then the consistency is much looser. There is a missing link in the digestive process – in fact the large intestine which usually extracts moisture from the faeces.

* Ileostomy ~ The whole large intestine is missing whereby the faeces are no longer thickened; it is often porridgy in appearance. The faeces comes out all day and also night from the stoma, often in a liquid form (watery) but the thickness can also be altered during the day by your food intake for example.

* Urostomy ~ urine dribbles continuously out of the stoma and is a clear light yellow colour. There are also white floccules in it which come from the small intestine where the urostomy is sited.



It is also possible that someone may have a second stoma formed; therefore two bags on one stomach.




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