A stoma is an artificially created connection between a hollow organ and the body surface. Typical examples of a stoma are the artificial bowel outlet and the artificial bladder outlet. The stoma system can either be a temporary solution or permanently necessary. Read all about the different stomas, when they are used and the risks they entail.
What is a stoma?
A stoma is an artificial connection between a hollow organ and the surface of the body, i.e. a body orifice. Examples of this are:
the gastrostoma (stomach stoma) for artificial nutrition
the enterostoma (artificial bowel outlet) for stool excretion
the urostoma (artificial bladder outlet) for urination
The procedure in which the doctor applies the stoma is called gastrostomy, enterostomy or urostomy, depending on the organ involved.
Depending on the underlying disease and previous operations, stoma care can be terminated after some time; then the doctor can also perform a stoma repositioning. In many cases, however, the permanent, i.e. lifelong creation of a stoma is necessary.
When do you put in an ostomy?
The main purpose of an ostomy is to support the patient when they are admitted or discharged, if this is no longer possible in a natural way.
A gastrostoma is created when the patient requires artificial nutrition, for example in cases of nerve damage leading to swallowing disorders, diseases of the oesophagus or injuries to the neck and face.
The artificial bladder outlet supports the patient in excreting urine. The doctor creates the urostoma if the bladder had to be removed due to an underlying disease (such as bladder cancer) or if there is a functional disorder of the urinary tract.
An enterostomy, i.e. an artificial bowel outlet, is used when the patient is no longer able to empty his bowel naturally, especially in cases of surgical removal of the rectum, for example as a result of inflammatory bowel disease or cancer.
What does one do when applying a stoma?
Before the stoma is set up, the patient is given a general anaesthetic. As a result, he feels no pain during the procedure and spends the operation asleep. The surgeon now carefully cleans the patient’s skin with a disinfectant solution. He then covers it with sterile surgical drapes, leaving the operating area uncovered.
Percutaneous endoscopic gastrostomy is normally used for the medium and long-term artificial feeding of a patient through a stoma. Here, the procedure is accompanied and controlled by an endoscope. First, the endoscope is inserted into the stomach via the oesophagus. With the help of the equipment, the stomach is inflated and a spot on the front wall of the stomach is selected. There the patient is punctured and a feeding tube is inserted. This is attached to the inside and outside of the stomach.
The surgeon gains access to the abdominal cavity either through an abdominal incision (laparotomy) or via a probe. The further surgical procedure depends on whether the patient is to be treated by a terminal stoma or a double stoma:
There are various procedures available for urostomy: After removal of the bladder, patients are mainly treated with an ileum conduit or a ureteral fistula. If the bladder can be preserved, a so-called Mitrofanoff stoma is created.
What are the risks of a stoma?
Creating a stoma is not a complicated procedure and is performed frequently. However, there are some risks associated with stoma care, despite careful adherence to current standards. In principle, the risk of complications increases with the length of time the stoma is worn.
Risks of gastrostoma
The following problems can occur when treating a gastrostoma:
Clogging of the gastric tube
Internal or external pressure injuries leading to tissue death
accumulation of air in the abdominal cavity or abdominal wall
Excessive formation of new tissue that may need to be removed with laser therapy or surgery
What do I have to consider with a stoma?
Daily and careful stoma care helps to prevent infections and hygiene problems. Empty the bag daily to avoid hygiene problems! Specially trained stoma therapists can show you in hospital how to change your stoma bag and what you need to be aware of. If you are no longer able to perform stoma care on your own due to your underlying disease, you will be supported by the nursing staff or nursing service.
You can continue to engage in sporting activities with the ostomy as long as your basic condition allows this. For this purpose, it is recommended that you wear an individually adapted stoma bandage, which generates counter pressure when the abdominal cavity is strained. For water sports there are also water protection belts that can be put on.
Self help groups
For many patients with a stoma, sharing their experiences with other patients with a stoma is helpful in getting used to a life with an artificial bowel or bladder outlet. There are numerous self-help groups for patients with a stoma, for example from the Fachgesellschaft Stoma Kontinenz und Würde e.V. or the Deutsche Solidargemeinschaft von Stomatträgern (German Solidarity Association of Stoma Carriers) and of people with colorectal cancer and their relatives.
On the road with stoma
For travel, it may be useful for stoma owners to obtain a special travel certificate. This is drafted by the self-help association of European ostomy carriers and must be signed by a doctor. This certificate is used to inform foreign authorities, especially airport staff, about the ostomy. This prevents the stoma bag from being removed during a trip during an inspection without the presence of a doctor.