Stoma surgery for IBD

A stoma is an opening in your abdomen which is surgically created. It diverts faeces (or urine) into a bag attached to the opening.

There are different types of stomas which may be created in people with inflammatory bowel disease (IBD) depending on what part of your digestive tract is diverted to the surface of your body. These include:

• Colostomy - made from the colon
  
• Ileostomy - made from the ileum (part of the small intestine)
  
• Mucous fistula - second stoma made from either colon or small intestine
  
• Gastrostomy - made from the stomach
  
• Esophagostomy - made from the esophagus
• Feeding tubes (enteral feeding) for people who aren't able to the get the calories and nutrients they need form eating or drinking in the usual way. These openings can be created directly into the stomach, duodenum or jejunum (both parts of the small intestine)
  

Stomas can be temporary or permanent. If you are given a permanent stoma then it will not be possible to reconnect your gastrointestinal tract at a later date. A temporary stoma is given when it is likely that a reversal will take place at a later date. This is where the GI tract is reconnected so you can go to the toilet in the usual way.

What forms of IBD is stoma surgery used to treat?

Stomas can be created for all types of Crohn’s disease and ulcerative colitis.

Why is stoma surgery needed for IBD?

A stoma is formed when it is not possible to reconnect your digestive system if you have had parts of it removed due to damage from your inflammatory bowel disease (IBD). The stoma allows waste to leave the body and be collected in a bag.

‘Feeding’ stomas are created when a person has severally damaged parts of their intestinal tract which prevents them from getting the food and drink they need.

How is stoma surgery done?

How your stoma surgery is performed depends on what part of your gastrointestinal (GI) tract is being used to create it.

In general, though, once any diseased sections have been removed in surgery a healthy part of your GI tract is brought to the the surface of your body where an opening has been created. This is then stitched to the skin.

Before your surgery you will likely be introduced to a specialist stoma nurse who can explain about the stoma you will be getting, the equipment you will need to use afterwards and discuss with you the position of your stoma.

Recovering from stoma surgery

Having a stoma may seem very daunting and it will take you a bit of time to adjust to it. In the days after your surgery you will remain in hospital and specialist nurses will help to care for your stoma and teach you how to care for it yourself.

Your stoma will look moist, pinkish/red and seem quite large. This is perfectly normal following surgery and as it heals you will find that the size of your stoma reduces by around two thirds. This usually takes around 6-8 weeks. Everyone’s stoma is a different size.

It will take a few days for the stoma to start to work and at first the output may be quite watery with a strong smell. Again, as your body heals the consistency will become thicker and the odour will reduce.

You may also find that your stoma produces some noisy gas. This will settle.

While you are recovering you may be given a diet to follow to allow your body to heal and start to work again properly.

Once you are well enough, and you feel confident managing your stoma, you will be able to return home. This could be after 3-10 days.

Possible complications of stoma surgery

Early complications

• Bleeding - a small amount of bleeding when the stoma is cleaned is normal, but if it becomes heavy or persistent you should seek medical advice
• Ischemia/necrosis - caused by deficient blood flow to the stoma. This is usually caused during surgery and symptoms occur in the days immediately after surgery
• Mucocutaneous separation - the stoma separates from the skin it has been attached to
• Fistula - a channel develops in the skin alongside the stoma
• Ulcers - these can occur from friction, often when the stoma rubs on the inside of the bag or if the opening is too tight

Later complications

• Stoma retraction - the stoma retracts below the skin surface
• Hernia - bowel or organs surrounding the stoma may push through the weak muscle around the stoma
• Stoma prolapse - when the stoma is displaced from its position and appears to push out through the opening, causing the stoma to increase in length and size
• Stenosis (stricture) - narrowing or constriction of the stoma
• Granulomas - tender red areas around the stoma which look at bit like cauliflower
• Stoma trauma - the stoma becomes injured, usually from the bag appliance or clothing
• Obstruction - a blockage in the bowel can be caused by undigested food, a narrowing or twist in the bowel. This will cause the stoma to stop working

In this video Thaila Skye talks about her ostomy surgery

Things to know about stoma surgery