Stomal Therapy | Illawarra Shoalhaven Local Health District (ISLHD)

A Stomal Therapy Nurse (STN) specialises in the care of people who have to wear a bag attached to their skin to collect their waste (urine and/or faeces). They also provide:

Expert care and advice to patients, carers, nurses and other health professionals.
Advice on bowel health
Draining wounds
Fistulae (a communication between the bowel and the skin)
Advice on skin care
Information on ordering medical supplies
Information about peer-to-peer support and your local support group.

What is a stoma?

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What is a stoma?

A stoma is a stoma is a small, surgically created opening on the surface of the body. It's made to help waste or bodily fluids leave the body when the usual routes are blocked or not working properly.

A stoma might be needed because of medical conditions or surgeries that affect the normal function of the intestines or bladder. A stoma can be temporary or permanent.

There are different types of stomas:

Colostomy: An opening made in the colon (large intestine) to allow stool to exit the body into a colostomy bag.

Ileostomy: An opening made in the ileum (the last part of the small intestine) for stool to exit into a bag.

Urostomy: An opening made to divert urine away from the bladder, usually when the bladder has been removed or is not functioning properly.

What does a stoma look like?

A stoma looks like a small, red, and moist opening on the surface of the abdomen where waste exits the body through an artificial opening.

A stoma is typically round or oval and protrudes about 1 to 2 inches (2.5 to 5 cm) but can vary in size.

A stoma is a pinkish-red colour, similar to the inside of the mouth, due to its rich blood supply. The surface of the stoma is generally smooth and moist, with a slightly shiny appearance.

Stoma Nurse

A stoma nurse provides personalised advice and education on what is normal for your stoma and how to manage it effectively.

You will have the support of a stoma nurse before your operation, during your hospital stay and afterwards when you go home.

Before your surgery

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Before your surgery

Before stoma surgery, education and support are crucial to ensure that you are well-prepared for the procedure and can manage the changes to your daily life effectively. Here's a general outline of what you might expect:

Preoperative Education

Understanding the Procedure:

You will discuss your operation and understand the type of stoma (e.g., colostomy, ileostomy, urostomy) and how this will impact your body.

Preoperative Counselling:

Discuss with your stoma nurse what to expect in terms of recovery, changes in body image, and emotional adjustments.

Practical Training:

Your stoma nurse will provide practical demonstrations and allow you to practice changing a stoma bag.

Stoma Site Marking:

Location: The stoma nurse will mark the best location for the stoma on your abdomen to ensure it’s in an area that will be comfortable.
Considerations: Factors like clothing, mobility, and body contours will be considered to ensure your stoma bag fits well.

Lifestyle changes

Dietary Changes: Understand any dietary adjustments you might need to make before and after surgery.
Activity Level: Get guidance on physical activities and what modifications might be necessary.

Educational Materials:

Receive written materials or online resources about stoma care and management.
Your stoma nurse can advise you on instructional videos and online information to visualize the care process.

After your surgery

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After your surgery

Looking after your stoma

Stoma education will be provided by the stoma nurse and ward nurses to give you the practical skills to help you manage your stoma.

Stoma Care Routine:

Changing the Bag: Learn how to change and manage your stoma bag, including when and how to empty it.
Skin Care: Follow guidelines for cleaning and caring for the skin around your stoma to prevent irritation. Tap water and a soft cloth are all that is required.
Stoma Characteristics: Learn about the normal appearance and function of your stoma.
Output Expectations: Understand what type of output (stool or urine) to expect and its normal characteristics.

Stoma supplies

You will be supplied with bags to take home. While you are in your hospital your stoma nurse will organise the first month of supplies. You will be shown how to continue ordering supplies during your follow-up appointment at the clinic.

Diet and Hydration:

Dietary Guidelines: Follow any dietary recommendations provided by your healthcare team. Gradually introduce different foods to see how they affect your stoma output.
Hydration: Drink plenty of fluids to stay hydrated, especially if you have an ileostomy. You will receive information from your stoma nurse about this.

Activity and Mobility:

Gradual Return: Start with light activities and gradually increase as you feel comfortable. Avoid heavy lifting or strenuous activities initially.
Walking: Gentle walking can aid recovery and prevent complications.

Going home

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Going Home

Follow-Up and Support

Follow-Up Appointments: You will be given an appointment to see the stoma nurse in a clinic after you have gone home.

Support Groups:

Peer Support: Connecting with others who have undergone similar procedures can provide valuable insights and encouragement. Ask your stoma nurse about the Illawarra Ostomy Information Group.
Online Forums: You can join online communities for advice and support from people with firsthand experience.

Emotional and Psychological Adjustment and Support:

Adjustment Period: Coping with the emotional impact of having a stoma can be difficult. You can talk to your stoma nurse about this adjustment.
Counselling: Consider speaking with a counsellor or therapist to help with emotional adjustments. See your GP for access to counselling or mental health professionals.

Peer Support: Engage with others who have similar experiences for encouragement and practical advice. Ask your stoma nurse about this.

Social and Daily Life:

Gradually resume social activities and daily routines and communicate openly about your needs with those around you.

Stoma Reversal

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Stoma reversal

Stoma reversal, also known as stoma closure or takedown, is a surgical procedure to remove a previously created stoma and restore normal bowel or urinary function. This procedure is typically considered when the underlying condition that necessitated the stoma has resolved or improved, and the stoma is no longer needed.

When is Stoma Reversal Considered?

Indications:

Disease Resolution: The original condition that required the stoma, such as certain types of cancer, inflammatory bowel disease, or diverticulitis, has improved or been successfully treated.
Functional Improvement: The person’s overall health and bowel or urinary function are deemed suitable for the reversal.
Temporary Stoma: The stoma was initially intended to be temporary, such as after certain surgeries where it was meant to allow healing or diversion of waste temporarily.

Preoperative Considerations

Assessment:

Medical Evaluation: Your healthcare team will assess your overall health and suitability for the procedure through physical exams, imaging studies, and sometimes endoscopy.

Preparation:

Education: You will receive information about the procedure, including what to expect during recovery and potential risks.

The Procedure

Anaesthesia: The procedure is performed under general anaesthesia.
Surgical Steps: The surgeon will carefully remove the stoma and rejoin the ends of the intestine. This involves closing the opening created for the stoma.
Recovery Time: The length of surgery can vary depending on the complexity and individual factors.

After your surgery

Monitoring: You will be monitored for any complications, including infection or issues with the newly reconnected bowel or urinary tract.
Pain Management: Pain relief will be managed with medications.
Wound Care: Follow instructions for caring for your surgical site
Diet: Reintroduce foods gradually and follow dietary advice to support recovery.
Activity: Begin with light activities and gradually return to normal activities as advised by your healthcare team.

Functional Changes:

Bowel or Urinary Function: You may experience changes in bowel or urinary function as your body adjusts. Report any significant issues or concerns to your surgeon. You can also contact your stoma nurse for advice.

Overall, stoma reversal is a significant procedure that requires careful consideration and preparation. With appropriate planning and support, many individuals successfully transition back to normal bowel or urinary function and adapt well to life after the reversal.