by

Ms. Krisna Muthusamy

Stomas Stoma originate from Greek word meaning “MOUTH”

stoma is an opening, either natural or surgically created, which connects a portion of the body cavity to the outside environment.

The stoma is opened onto the surface of your abdomen.

It is normally formed as a small spout protruding

through the abdomen wall and is a healthy pinkish red in colour (similar to the inside of your mouth).

Straight after your operation the stoma may be a little swollen and you'll be able to see the stitches that hold it in place. These will eventually dissolve away and the stoma will shrink to form a neat spout The piece of bowel used to create the stoma

will secrete a thick white mucus,

although this will gradually diminish. The stoma has no nerve supply so it is

insensitive to pain. Because of this you

must be careful to avoid accidental injury

- so treat it gently

Stoma is not a disease but helps free symptoms obstruction and pain

The body waste is excreted through this stoma

Excretions cannot be controlled

You need to wear a bag or pouch to collect waste

The system should suit you and easy to handle

Reasons for ostomy surgeries Cancer

Inflammatory disease –crohns’s disease, ulcerative colitis

Familial polyposis syndrome

Trauma

Congenital disorder –hirchsprungs , imperforate anus

Bowel obstruction, diverticular disease etc

Reasons for ostomy surgeries Cancer

Inflammatory disease –crohns’s disease, ulcerative colitis

Familial polyposis syndrome

Trauma

Congenital disorder –hirchsprungs , imperforate anus

Bowel obstruction, diverticular disease etc

Examples of stomata Colostomy

Duodenostomy

Ileostomy

Jejunosstomy

Esophagostomy

gastrostomy

Tracheostomy

Urostomy

Nephrostomy

Ureterostomy

Colostomy

Loop colostomy

Urostomy

Managing the Colostomy Dependence on the type of surgery

Location of the stoma

Consistency of the stool

Stomal irregularities/ peristomal contours

Skin integrity

Patient comfort

Cost effectiveness

Ability to manage system

Sites of Stomas

Stool consistency

High volume

liquid stool

Drainable pouch

Liquid

Drainable

pouchfaecal fluid ,

strong odour

Loose to soft formed stool

Drainable pouch

Loose to

formed

stool

Drainable

Pouch

Normal

formed stool

Closed end

pouch

Managing Ileostomy Contain active digestive enzymes

Corrosive to skin

Loose enzyme, and fluid

Enzyme and extra fluid may be needed

Chew food well

Avoid high fibrous food eg

Popcorn, pineapple, celery, raw carrots corn nuts and dried fruit

Medication special caution

Measuring stoma

Drainage and irrigation

Diet After surgery, ostomates worry about their diet

there are very few restrictions as to what they can and cannot eat.

Dietary requirements are individual matter, and will depend on an ostomate’s own body.

Everyone is unique - different foods and drinks, may disagree with one person, but may have no effects on someone else

ostomate should eat a varied, well balanced diet with plenty of fruit and vegetables, and take regular exercise.

A stoma should not change your enjoyment of food.

The most important dietary concerns for ostomates are preventing blockage, and avoiding foods that produce unpleasant odours, gas or excess stool

.Controlling weight is always important, so it is beneficial not to overeat.

Eat at regular times in a relaxed atmosphere.

Eat small, sensible portions,

Eat little and often.

A stoma works best if three or four regular meals

It is always better to sit down to eat.

Never grab snacks, eat standing up or in a hurry.

Chew food thoroughly, especially if you have an ileostomy, as this will help to prevent any food blockage. Eat slowly and try not to gulp in air when eating.

● Drink plenty of fluids daily, (6-8 glasses/mugs), especially in hot weather,

Fluids may be lost more than normal through a stoma.

Take care when eating some foods, because they are not completely digestible and could cause a blockage.

eg celery, Chinese vegetables, coconut, coleslaw, mushrooms, nuts, peas, popcorn, raisins and other dried fruits, raw pineapple, relishes, salad greens, seeds and vegetable,

skins.

Avoid food that has been standing for a long period of time, especially when abroad on holiday in hot climates.

Natural yogurt can help to neutralise the bacteria in the gut, and therefore, reduce excessive wind.

Diarrhoea Beer, dark chocolate, citrus fruits, green vegetables, onions,

prunes, salad and spices are all foods that may bring on a bout of diarrhoea

Avoiding these foods for a few days, especially fruit and vegetables

white bread, jelly cubes, jelly sweets, pasta, potatoes and rice can also thicken the output.

diarrhoea may not necessarily be caused by diet - anxiety and emotional stress can often cause this condition.

Dehydration can happen as a result of diarrhoea

drink (non alcoholic) to replace what is being lost.

A rule of thumb is that if urine is a pale straw colour, an ostomate is well hydrated..

Also to replace the lost fluid, sugars and salts, rehydration powders can be useful.

Commercial isotonic sports drinks, which contain varying amounts of salts and sugars, could help with combating dehydration.

Anti-diarrhoea medication may also help generally.

If suffering from a prolonged bout of diarrhoea, it can be beneficial to switch to a drainable pouch,

if possible, and to use the largest size available.

If the problem persists, seek advice from a doctor.

CONSTIPATION Not drinking enough fluid or eating insufficient fibre.

Lack of exercise

Side effects of some medication

Boiled rice and eggs can cause motions to set hard.

Drink plenty of fluids and eat a high fibre diet.

drink 6-8 glasses/mugs (about 2 litres) of fluid a day, including tea, coffee and water.

Fruit juice also may help.

Increase the amount of fibre eaten.

Porridge is a perfect food for an ostomate.

Figs, grapes, papaya, pears, prunes and spinach.

Ensure that food is chewed properly

little gentle exercise.

If the stoma has not acted for 72 hours, laxatives may be required.

If the problem persists, seek advice from a doctor.

Wind Can be inconvenient or embarrassing,

No control over it..

To avoid wind problems, some ostomates find it helpful not to eat and drink at the same time, but to wait for a drink until they have finished eating.

When eating, avoid talking.

Swallowing too much air can cause excess wind.

Eat regularly.

Missing meals or rushed eating may be a cause.

Avoid chewing gum lot of air is swallowed,

Limit foods and drinks known to produce wind

alcohol, asparagus, baked beans, beer, broccoli, Brussels sprouts, cabbage, cauliflower, cheese, cucumber, eggs, fish, fizzy drinks, fruit, garlic, nuts, onions, peas and sweet corn

It will vary from person to person

There is no need to avoid these foods, just eat small amounts and chew them well.

A quick guide is that vegetables and salad produce, which are grown above the ground, normally produce more gas than those which are grown below the ground.

Use common sense------- do not have broccoli, cabbage and cauliflower in the same meal, and try to avoid a salad on the same day.

Fizzy drinks can cause excess wind. Pour into a glass/cup and leave to stand for ten minutes before drinking, i.e. let the carbonated fizz settle before having the drink.

Also, try to avoid fizzy drinks while eating and for about an hour after the meal.

Some ostomates find that taking pro-biotic yogurts can help.

For some stoma patients, adding peppermint essence to hot water and sipping slowly can reduce wind.

peppermint (cordial, mints or tea), fennel (as a vegetable, tablets or tea) or charcoal (biscuits or tablets) may help.

Alcohol should be consumed in moderation.

Gassy drinks such as lager and beer can cause wind, especially if drunk on an empty stomach.

keep a food diary. In this way, certain foods may be linked to an odour problem.

Problems retracted prolapsed necrotic

Allergy

Don’t tell I Coping with have a stoma multiple stomas

Stoma belt Stoma studs

Crotch less panties

Other stomas

Tracheostomy

Gastrostomy

Urinary system

Supra pubic catheter

Urostomy

Urostomy

Conduit stoma

Nephrostomy

Nephrostomy bag