What is a stoma? Colostomy, ileostomy and urostomy explained

What a stoma is

A stoma is an opening made on the abdomen during surgery, so that waste can leave the body into a pouch instead of through the usual route. The visible part is the end of the bowel or the urinary tract brought to the surface of the skin.

A healthy stoma is red or pink, moist, and slightly raised above the skin. It has no nerve endings, so touching it does not hurt. It can bleed a little when cleaned, which is normal because it has a rich blood supply.

A stoma has no muscle to control it, so output cannot be held in the way it could before surgery. This is why a pouch is worn at all times.

The three main types

• Colostomy: made from the large bowel (colon). Output is usually thicker and less frequent.
• Ileostomy: made from the small bowel (ileum). Output is looser and more constant, and contains digestive enzymes that irritate skin quickly.
• Urostomy: made to divert urine when the bladder is removed or bypassed. Output is urine, and it flows continuously.

Why surgery is needed

Reasons include bowel or bladder cancer, injury from an accident, severe infection, birth defects in children, and damage from poisoning or disease. Some stomas are temporary and reversed later; others are permanent.

Whether a stoma can be reversed is a decision for the surgical team, and depends on why it was created and how much healthy tissue remains.

What changes and what does not

Most people return to work, school, worship, farming and family life. Diet is usually adjusted rather than restricted for life. Many ostomates go back to sport and to swimming.

What does change is the daily routine of caring for the stoma and having a reliable supply of pouches. That supply is the single greatest difficulty facing ostomates in Zimbabwe, and it is the reason ZOST exists.

When to seek help

• The stoma turns dark purple, black or grey
• There is heavy bleeding from the stoma itself, not just the skin edge
• No output at all for several hours together with pain, swelling or vomiting
• The skin around the stoma is broken, weeping or increasingly painful
• The stoma becomes much larger, pulls inwards, or a bulge appears around it