Complications of stoma

Written by amber keefer
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A surgeon creates a stoma, or small hole in the abdomen, by stitching the opening of the bowel or ureter to the skin of the abdomen. A bag can then be connected to the stoma to collect faeces or urine outside of the body. This additional surgery is needed when part of the bowel or urinary tract has been removed. The need for a stoma can be temporary or permanent depending on the extent of the surgery a patient has had. Some complications can occur.

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Types

There are three basic types of stomas. Urostomy is an opening from the ureters that allows urine to leave the body without passing through the bladder. This type of stoma may be located in the centre or in either the left or right side of the lower abdomen.

Ileostomy opens from the small bowel so that faeces can leave the body without passing through the large bowel. The stoma is usually placed in the lower right abdomen.

A colostomy is an opening from the large bowel, which allows waste to leave the body without passing through the anus. Most often the stoma is placed in the lower left abdomen.

Common Complications

Common stoma complications include retraction of the bowel back into the abdomen, prolapsed bowel or peristomal hernia. When a stoma retracts it pulls inward causing stool to leak from beneath. This can make the surrounding skin sore.

Prolapsed stomas protrude outward, increasing in length. While this can seem frightening to the patient, a stoma prolapse is not life threatening. This can be a later complication that is often associated with an emergency colostomy. Prolapse can be repaired with minor surgery. Weak abdominal muscles or poor healing following surgery can cause the area around the stoma site to bulge. In this case, peristomal hernia may be the cause of blockage or obstruction. Although not usually painful, the hernia can be uncomfortable and is often repaired under local anaesthesia.

Other Complications

Early complications that may follow surgery include bleeding, infection, fistula, vomiting, dehydration, or the more rare occurrences of stomal ischemia or wound dehiscence. Ischemia involves inadequate blood supply to the area whereas stomal dehiscence leads to contamination of the wound with fecal matter causing irritation and pain.

Later complications of a stoma may involve persistent infection, bowel obstruction, cancer, Crohn's disease or varicose veins around the location of the stoma. A patient is also at risk of developing skin disorders such as contact dermatitis, psoriasis, skin ulcers, cellulitis, impetigo, or a fungal or viral infection.

Stoma Care

The bag that connects to a stoma fits underneath clothing and is easy to change. Bags are designed to be leakproof and odour free. A stoma care nurse will show you how to empty the bag. Stoma patients need to drink plenty of fluids and eat regular meals in order to get into a toileting routine. In some cases, individuals can learn to time their bowel movements by flushing out the stoma with lukewarm water from the tap.

Include only small amounts of fibre in your diet for the first few months following surgery. After that, you can slowly increase the amount of fibre in your diet. Schedule routine medical check-ups with your doctor so that he can check the condition of the stoma site.

Side Effects

Sometimes the bowel can narrow or extend out of the stoma preventing faeces from passing through into the bag. These problems may need to be corrected with surgery. A stoma related to ileostomy or colostomy surgery can move on its own. If this happens there is usually no need to worry. Keep in mind that, in some cases, the stoma is attached to the bowel, which squeezes and contracts as digested food passes through it.

Diarrhoea is another common side effect, especially during the first few days following surgery. Until your system regulates, your doctor or stoma care nurse may advise you to drink and eat foods high in potassium and salt.

Prevention

Because your body is adapting to a shortened bowel or urinary tract, it is important to consume a diet that includes the necessary balance of nutrients. Avoid eating foods like nuts, corn, celery, mushrooms and coconut as these can cause blockages. This is especially important advice if you have had an ileostomy. The ileum is narrow and can become easily blocked.

Eat small mouthfuls of food and chew well. If you have had a colostomy, you should not eat cabbage, beans or broccoli. As with an ileostomy, eat slowly and do not talk as you eat so that you don't swallow too much air. With any type of stoma, you should drink plenty of fluids and eat foods high in fibre to avoid becoming constipated.

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