Ostomy: digestive, urinary, what role for the stool?

In medical parlance, a stoma is an opening in the body. There are Several types stoma. The stoma can be digestive or intestinal (in this case, the opening is created in the colon or small intestine to evacuate stool or remove a tumor for example), or it can be urinary to evacuate urine that cannot be evacuated by the natural route. What causes a stoma? How is a stoma performed? What are the risks ? Complications? What is the life expectancy with a stoma? Learn all about it with Dr Sophie Pitel, digestive and proctological surgeon at the Alleray-Labrouste clinic.

Definition: what is a stoma?

A stoma is a diversion of stool or urine to the skin via surgery. These operations are performed on people whose disorder, trauma or illness prevents them from meeting their needs naturally. The stoma can be temporary or permanent. About 16,000 stomas are performed in France each year.

What are the types of stoma?

There are two types of stoma:

• The digestive stoma or intestinal which corresponds to a deviation of the intestine (enterostomy) or the colon (colostomy)
• The urinary stoma (or ureterostomy) which corresponds to a deviation of the ureter.

What is a digestive stoma?

The digestive stoma corresponds to theabutment of a piece of digestive tract, whether the small intestine or the colon, to the skin. Most often, a colostomy is located in the left part of the abdomen and an enterostomy in the right part. This opening of the colon or ileum to the outside of the body is made to allow the evacuation of stools and gases. The digestive stoma can be temporary or permanent.

What is a urinary stoma?

The urinary stoma designates the connection of the urinary tract to the skin. This means that a new hole has been created in the skin to allow the evacuation of urine outside the body. The urinary stoma can be performed on the right or left of the lower abdomen, depending on the pathology being treated and the patient’s anatomy.

What diseases can cause a stoma?

A stoma can be made when part of the intestine needs to be removed or bypassed. These interventions can be performed as part of a treatment for the following diseases (non-exhaustive list):

• Colon Cancer
• rectal cancer
• anal cancer
• ulcerative colitis or Crohn’s disease
• familial adenomatous polyposis
• bowel obstruction (bowel obstruction)
• diverticulitis
• congenital anomalies of the intestine…

What does a blocked stoma mean?

“A clogged stoma doesn’t mean much, sometimes a blockage can form at the exit just under the skin and it is enough to introduce a gloved finger to remove the obstacle, it’s very rare. Signs of occlusion (vomiting, abdominal pain, impossible to obtain gas and stools in the pocket), must be consulted urgently and a scanner will look for the cause of the occlusion, probably not related to the stoma but rather with the disease that led to the placement of a stoma”says Dr. Sophie Pitel.

When should you (absolutely) consult?

A consultation is therefore necessary when there is no more gas coming out of the pocketthat the production of stools has ceased, that you vomit and that you can no longer eat. “The degree of urgency varies by type of stomabecause the stoma on the small intestine secretes continuously, while the stoma on the colon passes stool into the stoma pouch sometimes every other day, but not necessarily continuously”, specifies the digestive and proctologic surgeon.

“The blocked stoma is not not a phenomenon that occurs frequently. The diagnosis is made when the patient complains of pain and notices the cessation of gas and stool emissions. If it is indeed an obstruction, it is usually enough to put a finger in the stoma to remedy it“, indicates the specialist.

What treatment to cure a blocked stoma?

the processing is manual : it consists of inserting a finger into the stoma to remove the obstruction. When an anatomical problem is involved, for example if the skin has closed up, surgery is necessary.

What are the indications for an ostomy pouch?

The indications for stoma are numerous, the most common being:

► One acute abdominal pathology such as peritonitis : the digestive surgeon cannot make a digestive seam in the belly because it will not hold. It therefore connects the intestine to the skin while the stomach heals. A few weeks later, he will be able to perform a digestive seam to restore continuity in better conditions.

► Certain scheduled surgeries : for example, in case of cancer of the rectum, when an anastomosis between the colon and the anus is indicated, a stoma can be made on the small intestine while the seam between the colon and the anus heals.

► “There are also feeding stomas which consist of placing a tube in the patient so that he is fed. When we put the stomach to the skin, it is a gastrostomy, and when we put the jejunum, that is to say the first part of the small intestine, to the skin it is of a jejunostomy”, adds Dr. Sophie Pitel.

How long to wear a temporary stoma?

A stoma is temporary when it is reversible. Its wearing time depends on the healing time of the dysfunctional part of the intestine. On average, the stoma is worn for an estimated average duration of between 3 and 9 months.

What are the possible complications of an ostomy?

Complications of a digestive stoma include:

• A disturbed transit (diarrhea, constipation, abdominal pain, gas…)
• The prolapse (externalization of the intestine through the stoma)
• stenosis
• Disembowelment

Complications of a urinary stoma include:

• Displacement or obstruction of the probe
• The risk of urinary tract infections
• Lskin orifice infection

What is the life expectancy with a stoma?

“It is not the stoma that prevents life, but the pathology for which it was performed that can impact the vital prognosis“, notsay our expert. This intervention leads to a change in body image, people with a stoma are embarrassed to have gas noises that come out like that without being able to control them, odors. “But when patients are independent enough to manage their stoma, they can live completely normally. The base must be changed every three days and the pocket empties when it has filled up”, reassures our interlocutor.

Thanks to Dr Sophie Pitel, digestive and proctological surgeon at the Alleray-Labrouste clinic in Paris.