Ostomy: everyday life with an artificial anus

Contents of the article at a glance:

12 common anal diseases and their causes

What is a stoma?

Stoma is the Greek word meaning “mouth, opening” and describes the surgical connection between the hollow organ and the surface of the body. If this connection is between the intestine and the abdominal wall, it is called an enterostomy (also called an artificial anus or anus). The term “ostomy” became established as a short form.

Depending on which part of the intestine is attached to the abdominal wall, experts differentiate between two types of ostomy:

There are also gastrostomy (artificial opening of the stomach) and urostomy (artificial opening of the bladder).

In Germany, about 150,000 people live with an artificial anus. They are called greats.

What does the stoma look like and how is it taken care of?

In the case of an ostomy, a small piece of intestine protrudes from the body. Because it is the mucous membrane of the intestine, the stoma is red and moist and does not feel pain. Ideally, it should be slightly above skin level so that stool can pass into the attached bag without irritating the surrounding skin.

Since the artificial anus does not have a sphincter, stool passes uncontrollably through the artificially created opening. They are collected in a special odor-resistant bag that is fixed to the skin using an adhesive surface (base plate) and should be emptied or changed regularly. The hospital has specially trained staff who train affected people on how to handle the stoma and care for the stoma after the operation.

Create a stoma

The process of creating an artificial anus is called creating a stoma. During an ostomy, a small piece of intestine is pulled through a 2- to 3-centimeter incision in the abdominal wall and sutured to the surrounding skin (so that it does not slip back into the abdominal cavity). Depending on whether the stoma is created permanently or temporarily, different forms of artificial anus are created:

• Terminal stoma: The intestine is completely cut out. The upper end is taken out through the skin, and the lower end is closed and remains in the abdominal cavity or is removed completely. A terminal stoma is usually created because the underlying part of the intestine is so severely diseased that it needs to be removed or permanently protected.

• Double-barreled stoma: It is placed temporarily to protect the main part of the intestine (eg after surgery) by draining stool through the abdominal wall. A loop of intestine is pulled through the abdominal wall, incised in front, and sutured to the abdominal wall. This creates a stoma with two holes that can be reconnected after some time and returned to the abdomen.

When and why is a stoma created?

The most common reason for having an artificial bowel outlet is colon cancer. If the last section of the colon, the rectum, is affected, the tumor often grows into the sphincter. Then the sphincter must also be removed as part of the removal of the tumor, so stool excretion can no longer be controlled.

Even in cases of severe inflammatory bowel disease (Crohn’s disease, ulcerative colitis or diverticulitis), creating a stoma is sometimes necessary. An artificial anus is created, for example, if

• A certain part of the intestine is so severely inflamed that it must be given rest to heal. In this case, a stoma is created over the relevant section of intestine to direct stool through the inflamed areas.

• The severely inflamed portion of the intestine must be surgically removed. A stoma is then created over the surgical site so that the intestinal sutures can heal without stool flowing through the critical area and the sutures potentially becoming leaky.

• The suffering increases due to pain and diarrhea to the point that large parts of the colon or even the entire colon are removed and a permanent stoma is created.

In rare cases, an anal fistula can also make it necessary to create a stoma. Anal fistulas are abnormal passages that form between the anal canal and the surface of the skin and are often accompanied by purulent abscesses in the anal area. If these fistulas are removed surgically, an artificial bowel outlet may sometimes be necessary during the healing phase.

Possible complications of the stoma

Caring for the stoma and choosing appropriate ostomy bags requires great care – otherwise mechanical irritation of the skin, allergic reactions to the bag material or fungal infection may occur. Sometimes there is a tear in the abdominal wall next to the stoma (parastomal hernia), which may require further surgery.

Stoma prolapse or stoma stenosis is also possible: in prolapse, the intestine pushes out through the stoma, and in stenosis, the stoma narrows to the point of closure. People with an ileostomy are at risk of dehydration because they lose a lot of fluid through stool.

Laxative foods: These foods help in the digestion process

Diet with ostomy

Most people with ostomy are able to eat and drink normally. In the weeks following the operation, the intestines are often a little sensitive at first, but this disappears after a while. Depending on whether your stool is too thick or too thin, you can counteract this by eating constipating foods or laxatives.

Because the stoma makes uncontrollable sounds when releasing air, many stoma wearers do without foods that cause gas. To prevent stoma blockage, it is recommended to avoid foods that contain a lot of fiber (such as asparagus); In general, you should always chew your food well.

People with an ileostomy should pay special attention to their fluid balance: since their large intestine is dysfunctional (which removes fluid from the stool), they often have very thin stools – there is a risk of dehydration.

Everyday life with an ostomy

With good stoma care, it is possible to live an almost carefree life, and there are also different aids such as bags, hats or skin protection for care. Many patients with chronic inflammatory bowel disease find it very comforting to not be constantly restricted by severe diarrhea after having an ostomy. Thanks to stoma bags that are invisible under clothes, they can work, travel and play sports again. Only lifting heavy objects and putting too much pressure on the abdominal muscles should be avoided so as not to lead to a hernia of the abdominal wall.

You can also shower, swim and take a sauna using ostomy bags, as they are attached to the skin in a way that is waterproof and odor-resistant. It is even possible to become pregnant through an artificial colostomy, but it is considered a high-risk pregnancy and you should definitely get good medical care.