Intestinal stoma

A stoma is an opening in the intestine formed surgically after the removal of all or part of the intestine, or bladder, brought to the anterior abdominal wall, designed to divert the contents of the intestine or urine.

Cabinet of Ministers of Rehabilitation of stomatological Patients

The office of rehabilitation of stoma patients is a structural subdivision of the clinical and diagnostic department of the Moscow Clinical Research and Practice Center and is intended for conducting diagnostic, therapeutic, preventive and rehabilitative measures for patients with intestinal stomas.

What is a stoma?
The term "stoma" (ostomy, Greek) refers to a surgically created opening that connects the lumen of an internal organ with the surface of the body. There are different types of stomas, which are named after the organs on which they are applied.

A stoma is an opening in the intestine formed surgically after the removal of all or part of the intestine, or bladder, brought to the anterior abdominal wall, designed to divert the contents of the intestine or urine.
The stoma does not have a closure device, so the stoma patients do not feel the urge and can not control the emptying process. The stoma is also devoid of painful nerve endings, so the pain is not felt. The resulting pain, burning or itching may be associated with irritation of the skin around the stoma or with increased peristalsis (work) of the intestine.
The need for a stoma occurs when the intestines or bladder are unable to function. The cause of this may be a birth defect, illness, or injury.
The intestinal stoma is often called an unnatural anus, since the bowel emptying is not carried out through the natural anus, but through an opening formed on the anterior abdominal wall.
Stomas can be classified according to the following parameters:
At the place where the stoma is applied:

* ILEOSTOMY - if a section of the small intestine is removed

* COLOSTOMY - if the colon is removed

* UROSTOMA - if the ureter is removed 

According to the shape of the removed intestine:
* convex;
* flat
* retracted

By the number of barrels:
• single-barrel
• double-barreled

According to the prognosis in terms of surgical rehabilitation:
* permanent
* temporary

The stoma can be temporary or permanent. A temporary stoma can be applied if it is not possible to achieve good preparation of the intestine for surgery (in case of violation of intestinal patency due to a tumor or adhesions). Also, the imposition of a temporary stoma may be required to limit the passage of intestinal contents through the intestine – so that the place of surgical exposure is not injured by fecal masses. Usually, after the closure of temporary stomas, the functioning of the intestine returns to its previous level.

The stoma can be permanent or temporary. Permanent stoma can not be eliminated in the course of further treatment of the patient, because there is no or irreversible damage to the intestinal locking apparatus, or there is no way to quickly restore the continuity of the intestinal course.

Stomas can be single-barrelled (that is, through an opening on the anterior abdominal wall, one intestinal trunk is removed) and double-barrelled. Moreover, the latter are divided into loop (that is, two trunks are in close proximity to each other and are withdrawn into one hole) and separate double-barrel stomas, when there are two holes on the anterior abdominal wall at some distance from each other. In this case, when using stoma care products, the colostomy bags should not overlap each other (even if the distance between the stomas is very small). With such stomas, one trunk is active, through which the bowel is emptied. A colostomy bag is glued to the active trunk. Another trunk may be needed for mucus removal or medical procedures. It can be covered with a mini-cap (closed bag of minimal capacity) or a gauze napkin.
Depending on the part of the intestine that is removed to the anterior abdominal wall, the following types of intestinal stomas are distinguished: colostomy (when removing the large intestine) and ileostomy (when removing the small intestine).

Several types of colostomy can be distinguished by the place of superposition: cecostoma, ascendostoma, transversostoma, descendostoma, sigmostoma. With colostomy, bowel emptying usually occurs 2-3 times a day, the stool is formed (with sigmostoma) or semi-formed (with other types of stomas).

With ileostomy, bowel emptying occurs very often, almost constantly, the stool is liquid and acrid. A common problem with ileostomy is diarrhea, which can lead to dehydration and loss of electrolytes, minerals and vitamins. Therefore, it is very important to consume a lot of liquid.

Urostoma is formed when the bladder needs to be removed. Urine is diverted through a dedicated section of the intestine, to the upper end of which the ureters are sewn, and the lower end is removed to the anterior abdominal wall. Urinary excretion is constant and uncontrolled. With urostoma, there is a constant outflow of urine through the stoma.

How the stoma changes
The size and shape of the stoma may vary. After surgery, the stoma is usually swollen, bleeds a little and has a bright red color. Over time, the postoperative wound heals, the swelling subsides, the size of the stoma decreases, and its color becomes red-pink.
After 4-6 weeks, the stoma will fully form. Do not be alarmed if you notice that the stoma is slightly increased, then decreased. This occurs as a result of the contraction or expansion of the wall of the removed intestine.
However, you should regularly monitor the size of the stoma. During the first 6-8 weeks after surgery, the size of the stoma should be determined weekly, and then monthly for the first year. In the future, it is recommended to determine the size of the stoma every six months.
Measurement of the stoma is necessary for the correct selection of feces/uropriemniki.

Stoma complications and their prevention
Sometimes stoma patients have to deal with various types of complications associated with the presence and functioning of an intestinal or ureteral stoma on the abdominal wall. These complications become a cause of serious concern for patients, so we will focus on them in more detail.

Irritation of the skin in the area of the superimposition of the stoma (parotid dermatitis)
Dermatitis is observed quite often, it is the result of mechanical irritation (frequent change of colostomy bags, careless skin treatment), or chemical exposure to intestinal discharge or urine (leakage under the plate, poorly selected, leaky colostomy bag). Its manifestations: redness, blisters, cracks, wet, oozing sores on the skin near the stoma. Skin irritation causes itching, burning, and sometimes severe pain.
Possible allergic reaction of the skin to devices and products for the care of the stoma, if it is very pronounced, you should for some time abandon the use of glued bags. In such cases, the question of choosing the type of colostomy bag should be decided by the doctor.
Often, the cause of skin complications is simply insufficient skin care in the area of the superimposition of the stoma. In case of irritation of the skin around the stoma, you need to consult a proctologist, stomatotherapist and dermatologist.

Bleeding from the stoma
In most cases, it is caused by damage to the intestinal mucosa due to careless care of the stoma or the use of coarse materials. The edge of a tight hole in the plate, the rigid flange of the colostomy bag can also injure the intestine and cause bleeding. Bleeding usually stops spontaneously. But if it is prolonged and plentiful, you should consult a doctor.

Narrowing (stenosis)
The stoma should be passable, freely pass the index finger. Narrowing is usually caused by inflammation in the area of the stoma in the early postoperative period. If the narrowing reaches a degree that interferes with the emptying of the intestine, it is necessary to perform an operation to expand the opening. If the stoma is narrowed, do not take laxatives without consulting a surgeon!

Retraction of the stoma (retraction)
This is a retraction of the intestinal wall below the level of the skin, circular or partial. The presence of a funnel-shaped depression significantly complicates the care of the stoma and requires the use of special two-component colostomy bags with a convex (concave) plate and additional care products (special pastes for leveling the skin surface and protecting it). In case of ineffectiveness of these measures, surgical treatment is undertaken.

Prolapse of the stoma (prolapse)
A small (3-4 cm) mucosal prolapse is quite common, but, as a rule, is not accompanied by a violation of the patient's condition and the function of the stoma. Complete loss of all layers of the intestinal wall disrupts the function of emptying, makes it difficult to care for the stoma, and can lead to intestinal obstruction. The loss increases in the standing position, when coughing, during physical exertion. In the supine position, it is sometimes set; the fallen intestine in most cases can be set back by hand. In case of repeated or permanent loss, you should consult a doctor, and in case of infringement — immediately!

Hypergranulation in the stoma area
Sometimes on the border between the skin and the mucous membrane, polypoid outgrowths are formed, which easily bleed. They are usually small, with a diameter of several millimeters. The appearance of whitish, bleeding vesicles on the mucous membrane is possible. In all such cases, you should consult a doctor. Problems, complications and their prevention in patients with urinary tract stomas (urostomas) are similar to those faced by patients with intestinal stomas.

Hernia in the area of the superimposition of the stoma
A hernia in the area of the superposition of the stoma (parastomal hernia) is a protrusion of internal organs around the stoma due to the weakness of the muscle layer of the abdominal wall at the site of removal of the stoma. This is a common complication in colostomy; it is less common in ileostomy. The risk of a hernia increases with obesity, as well as a slow cough. Patients with even small hernias may experience pain, constipation, and difficulty using colostomy bags.

Parastomal hernia
it may be infringed, in such cases, treatment is only surgical. As a prevention of this complication in the first time after surgery (2-3 months), patients wear a specially selected elastic bandage. The bandage is used for parastomal hernia and intestinal prolapse in case of impossibility of surgical treatment due to concomitant diseases.

Rules for using the bandage:
1. The bandage is worn in the prone position.
2. The bandage is put on top of the colostomy bag.
3. Cutting holes in the bandage in the projection of the stoma is absolutely unacceptable.

In our center, an office for the rehabilitation of stomatological patientsis opened , an appointment is made at the KDO at the address Moscow, Entuziastov Highway, 86 GBUZ MOSCOW CLINICAL RESEARCH CENTER DZM of MOSCOW

Within the framework of the office for stomatological patients, the following services are provided::

1.      Conducting outpatient treatment of stomatological patients.

2.      Consultation of stomatological patients in surgical departments before and after stomatological operations.

3.      Training of patients and (or) their relatives in the rules of stoma care.

4.      Carrying out complex measures for the medical rehabilitation of stoma patients: selection for inpatient treatment of patients for surgical correction of complicated stoma and for operations to restore the continuity of the intestinal tract.

5.      Conservative treatment of patients with complicated stoma.

6.      Provision of stoma care products for stoma patients during their stay in the hospital with mandatory consideration of the use of products; selection of stoma care products for permanent use.

7.      Sanitary and educational work (instructions and brochures on stoma care, publications and speeches in the media).

It is advisable to visit the office for stoma patients for all stoma patients to receive individual recommendations from the coloproctologist on the selection of technical means of rehabilitation (colostomy bags and skin care products around the stoma) before passing the medical and social examination

Not only residents of Moscow, but also residents of other cities can get advice from a coloproctologist in the office for stomatological patients.

The office for the reception of stoma patients of the MCSC is located at:
Moscow, Shosse Entuziastov str., 86

GBUZ Moscow Clinical Scientific Center named after Loginov MHD