KUALA LUMPUR, March 27 — For many, the term stoma (derived from the Greek word for mouth) may evoke fear and doom which is often fuelled by misunderstanding and myth about its impact on daily life.
If the term stoma is new to you, let’s delve deeper into what they are and the common misunderstanding and myths surrounding them.
What is a stoma and its functions?
According to Subang Jaya Medical Centre consultant colorectal and general surgeon Dr Khong Tak Loon, stoma is an opening through the abdomen which allows part of the digestive or urinary system to be exteriorised through the abdominal wall and skin.
Individuals who undergo surgical procedures to remove part of their intestines would normally have their intestines reconnected once the diseased portion has been removed.
However in selected patients, stoma formation may be necessary as part of their surgical treatment to allow an alternate way of excreting bodily waste.
Patients who have a colostomy would pass motion out of the exteriorised bowel into a specially designed removable pouch.
The purpose of the stoma is therefore to allow excreted waste to be collected into a specially designed pouching system to allow patients to resume their daily lives with minimal disruption and consequence.
So what are the different types of stomas?
According to Dr Khong, there are three primary types of stomas:
Colostomy: Created from the colon to facilitate bowel movements and divert stool from the colon to an external pouch that sits on the belly.
Ileostomy: Formed using the small intestine and is often used when the colon needs rest and healing after a surgical procedure.
Urostomy: Created to divert urine in patients who have had surgical procedures to remove the urinary bladder.
Subang Jaya Medical Centre consultant colorectal and general surgeon Dr Khong Tak Loon talks about the importance of stoma in a patient’s life. — Picture by Choo Choy May
Who needs a colostomy?
According to Dr Khong, a colostomy may be necessary for patients undergoing treatment for various conditions which affect the large intestines such as colorectal cancer, benign conditions such as inflammatory bowel disease and diverticular disease, or in emergencies with bowel obstruction and bowel perforation.
Will a patient with a stoma require it for life?
Colostomies may be permanent or temporary depending on their indication.
Permanent colostomies are typically required after radical surgical procedures where the anal sphincter has been removed.
Such patients would be incontinent as they lack the fine control offered by the sphincters, thus a colostomy is formed to offer them a better quality of life.
Temporary colostomies may be formed as part of a course of treatment, typically to temporarily divert waste material.
Specifically, colostomies can be formed to “short circuit” the continuity of the bowel, for example to prevent intestinal obstruction due to large downstream tumours, or to allow healing to take place at the part of the bowel which has been joined together following surgery.
Once the temporary stoma is no longer required, the stoma can be reversed by joining the two ends of the bowel together.
How can the stoma be of assistance in managing colorectal cancer?
Citing a recent case, Dr Khong said he has a patient in her 70s who suffered with a rectovaginal fistula (a channel between the rectum and vagina) due to advanced rectal cancer.
She had to endure severe pelvic and anal pain daily due to spontaneous passage of stools through the vagina.
We had to divert the stools away by creating stoma. The patient was however unable to come to terms with it.” he added.
Reluctant at first to have a stoma, the patient spent a month in pain before finally making up her mind to go for the procedure.
She was initially unwilling to proceed with surgery due to the taboos surrounding stoma, but after having had time to consider her options, and with the support from her family, she decided to proceed with surgery to create a colostomy.
She had the procedure three months ago and she is currently back to resuming her social activities as before” said Dr Khong.
How can the stoma be of assistance in managing colorectal cancer?
Citing a recent case, Dr Khong said he has a patient in her 70s who suffered with a rectovaginal fistula (a channel between the rectum and vagina) due to advanced rectal cancer.
She had to endure severe pelvic and anal pain daily due to spontaneous passage of stools through the vagina.
“We had to divert the stools away by creating a stoma. The patient was however unable to come to terms with it.” he added.
Reluctant at first to have a stoma, the patient spent a month in pain before finally making up her mind to go for the procedure.
“She was initially unwilling to proceed with surgery due to the taboos surrounding stoma, but after having had time to consider her options, and with the support from her family, she decided to proceed with surgery to create a colostomy.
“She had the procedure three months ago and she is currently back to resuming her social activities as before,” said Dr Khong.
Common myths surrounding stoma
One of the pertinent steps taken by a surgeon prior to surgery is to counsel the patient thoroughly for joint decision-making and informed consent for stoma formation.
During these counselling sessions, it is common to encounter misconceptions about stomas that are widely held by both patients and the public.
Here are some of the common myths about stomas that Dr Khong often hears from his patients who resist using them.
- Myth: Stomas will inevitably disrupt and prevent me from living my life. Reality: Many patients living with a stoma are able to continue living an active life going about their usual everyday activities.
- Myth: It can be smelly and aesthetically unpleasant. Reality: Most stomas are air-tight and are designed to be discreet.
- Myth: Stomas are unhygienic. Reality: Modern stomas make it easy to manage hygiene effectively and come with washable bags.
Living with a stoma
According to Dr Khong, living with a stoma does require some lifestyle adjustments, but with the right support and knowledge, most people can continue enjoying a full and active life.
Some key adjustments to consider are:
- Good stoma care is essential to keep the stoma clean and leak-free in order to protect the surrounding skin.
- Diet and hydration: Most foods are safe, but eating smaller and frequent meals and avoiding certain foods will help to reduce gas bloating and blockages.
- A dietician is typically involved to provide the necessary support and advice.
- Care has to be taken to drink the correct amount to avoid dehydration, whilst conversely avoiding excessive fluid intake to limit fluid losses through the stoma
- Clothing: No special clothing is required – just wear one’s usual everyday comfortable clothing as the stoma appliance can be easily concealed.
- Exercise: Most activities, including swimming and sports, are possible as long as certain precautions are taken.
- Support groups and counseling will help to boost confidence and facilitate adjustment to living with a stoma.
Similar to learning any new life skill, managing a stoma becomes easier with time.
With practice, living with a stoma becomes another part of an individual’s daily routine, allowing them to live and pursue an active and healthy lifestyle.
Don’t be surprised if the next person that you meet for the first time and sat next to may have a stoma and you may not even be aware of it.
He, however, noted that with practice, living with a stoma becomes just another part of the patient’s daily routine, allowing them to live active, healthy lives.