2. The Stoma
Patient is able to state:
expected stoma function
expected stoma output
expected stoma appearance
The stoma can be either a loop (often temporary) or end (often permanent). A loop stoma will have two openings - a proximal opening, which passes stool and gas and a distal opening, which is generally seen at the base of the stoma and which will pass mucus. The loop is held in place with a rod, with or without sutures depending upon institution. If sutured, the rod is generally removed within five to seven days.
The stoma is red and moist, not unlike the lining of the mouth. Initially there will be swelling and it generally takes six weeks for all swelling to subside. It is important that measurement of the stoma take place for at least six weeks. At six weeks there should be no further need to measure the stoma and the appliances can be pre-cut at that point.
The stoma may appear delicate or inflamed to many patients largely due to the colour. Patients need to be reassured that red is health, that there are no nerve endings to the bowel and thus very little sensation. The blood supply to the bowel is rich and it would not be unusual to see some bleeding when caring for the stoma. There is nothing sterile about the bowel and a clean technique is used when caring for the stoma. Many patients will routinely wash their stoma and skin in the shower with their routine appliance change.
It generally takes 24-48 hours before an ileostomy will start to function. Prior to that there may be bloody effluent present in the pouch. With a return of bowel function, there will initially be bile, and flatus. Once food is introduced, the stool will change colour– yellowish-brown with the consistency of porridge. Most people with an ileostomy will empty their pouch 4-6 times during a 24-hour period.
It may take five to seven days for a sigmoid colostomy to function. Initially flatus will be passed followed by brown liquid drainage with gradual thickening to a soft or semi-formed consistency. The degree of thickness depends on the location of the stoma along the colon. Many people with a sigmoid colostomy tend to follow bowel patterns they had prior to surgery making the use of a closed-end disposable pouch quite convenient.
An ileal conduit or urostomy will start to function immediately for urine. The urine will have mucous shreads due to the fact that ileum is used to construct the conduit. Many people with a urostomy empty their pouches of urine 4-6 times during a 24-hour period. The kidneys will continue to function overnight which may necessitate the need for the pouch to be attached to bedside drainage for convenience.