Sometimes, during surgery, it may be necessary for the surgeon to form a 'stoma' on the wall of your abdomen. The stoma may be temporary (to allow the bowel time to heal) or permanent.
What is a stoma?
A stoma (from the Greek word for 'mouth') is where an opening is made on your abdomen which allows waste to pass out of the body. There are different types of stoma and, if you need one, the type you have depends on the location of your tumour and the type of surgery you need.
An ileostomy is a stoma formed by bringing the end or a loop of the small bowel (ileum) out on to the surface of your abdomen. The food waste passes out of the ileostomy and is collected in an external pouch (generally known as an ileostomy bag). Ileostomies are often formed during rectal cancer surgery to allow the area to rest and heal after surgery. The waste produced is usually liquid rather than solid. In due course, the ileostomy may be reversed with another, smaller operation, and you go back to using your bowels in the usual way. Please see our 'Stoma Reserval' factsheet for more information.
A colostomy is a stoma formed by bringing part of your colon (large bowel) out on to the surface of your abdomen. The waste from a colostomy is usually more formed than from an ileostomy as it has had some of the water removed on its way around the bowel. The waste passes out of the colostomy and is collected in an external pouch (generally known as a colostomy bag). A temporary colostomy can sometimes be formed to divert the waste away from the section of the colon which has been operated on, in which case a second operation is later carried out to reverse the stoma and allow the patient to resume a more normal bowel function. Permanent colostomies however need to be formed for some patients if the surgeon is unable to join the remaining ends of the bowel, or if your anus has been removed due to the location of the tumour.
Your surgeon will tell you before your operation if you might need a stoma. It's not always possible to know 100% either way as the decision can sometimes only be made during the surgery. If a stoma is a possibility, you should also meet with the stoma care specialist nurse before your operation. He / she will discuss with you where the stoma will be on your abdomen and answer any questions or concerns you may have. They will also introduce you to the special bags and equipment you will need to manage the stoma afterwards.
Before your planned operation, the stoma care specialist nurse or the surgeon will carefully examine you and mark the exact site of the stoma on your abdomen with a marker pen, to make sure it is in the right position for you to manage easily.
Managing your stoma after surgery
You will meet with the stoma care nurse again after your operation. He / she understands it can be very daunting at first and that learning to manage your stoma will take time and practice. No-one expects you to be an expert overnight. For the first few days, the stoma care nurse and the nurses on the ward will help you with your stoma.
As soon as you are well enough, the stoma care nurse will show you how to clean your stoma and how to change the bag. He/she will give you hints and tips on how to manage the stoma yourself at home. Simple, common sense advice will quickly help you to build your confidence, including how to be thoroughly prepared before you start changing the bag and have everything you need to hand in the bathroom.
The stoma nurse will also talk to you about the different types of appliances (bags) that are available as you become more accustomed to managing your stoma, as there are very many different types available, and it can take some trial and error to find which one might be best for you. You might wish to have a relative or friend with you while you are learning about your stoma, in case you need help or support when you get home.
You may find it useful to talk to one (or more!) of our Patient Voices who have a stoma to hear their practical and personal experiences and how they have got used to living with their stoma. They may also have diet hints and tips which may be of help to you too - many of them can be found in our booklet 'Living with bowel cancer - Eating Well'.
Louisa, our nurse answers your question "I have got a new stoma but I am passing mucus and feeling like I need to go to the toilet. Is that normal?"
Managing your stoma at home
When you are able to manage your stoma independently, and the specialist team are happy with you, you will be able to go home - with a plentiful supply of stoma bags. Once home, you will be able to order new supplies from your chemist, dispensing GP or a home delivery company. All stoma products are free, but require a prescription from your GP. You should also make sure you have the contact details of your stoma nurse and local district nurse in case you have any concerns or queries.
If it is appropriate, the nurse may also talk to you about irrigation as a method of managing your stoma (colostomies only) or other new techniques that may be useful.
There is no doubt that having a stoma whether it be temporary or permanent will require time and perseverence to adjust to, but there is no reason why the stoma patient can't live a full and active life.
For further information and support:
Louisa, our nurse, answers your question "The skin around my stoma (or on my bottom) is getting very red and sore. What can I do to make it better?"