Stoma – what types of stoma are there?
A stoma is a surgically created connection between the inside of the body and the skin. Stomas take a lot of getting used to at first, but for many those affected they lead to lasting freedom from symptoms and sometimes also to an improvement in the quality of life.
What is an ostomy?
A stoma is an artificially created body opening to the outside, which connects an organ – whether it be the windpipe (tracheostomy), urinary bladder (urostomy), stomach (gastrostomy) or intestine (ileostomy, colostomy) – to the body surface. There are various reasons for the surgical creation of a stoma – what they all have in common is that without a stoma the state of health of the person concerned would often deteriorate dramatically.
Types of stoma: What types of stoma are there?
The construction of a stoma is always necessary when the trachea, the urinary bladder or the intestine is blocked by some process and air, urine or stool cannot be transported naturally. Accordingly, a distinction is made between different types of stoma.
Tracheostoma
The tracheostoma is a permanent connection between the upper section of the trachea and the skin. It is placed below the larynx, and there are various methods for cutting the trachea, the so-called tracheotomy . The connection between the trachea and the skin is usually maintained via a rigid plastic tube, the tube. If the tube is removed, the opening between the trachea and the skin gradually closes.
Only when the larynx is removed is a permanent connection created between the skin and the trachea, for which the end of the trachea is sewn into the skin – breathing is then only possible through this opening. A tracheostomy is created either when the larynx is so narrowed by inflammation or a tumor that not enough breathing air can reach the lungs, or when a patient has to be ventilated over a longer period of time due to a serious illness.
For short-term ventilation, a ventilation tube can be placed over the mouth or nose past the vocal folds and ventilation can take place in this way. With continuous ventilation, however, the ventilation tube leads to irritation of the vocal folds and the mucous membrane of the larynx, so that a tracheostomy is required.
Urostoma
With the urostomy , an artificial connection is created between the bladder and the body surface. There are also different methods for this. The ureters are rarely sewn directly into the skin both (uretero-cutaneous stoma) or one behind the other with an opening (TUUC, trans-uretero-uretero-cutaneous stoma) , usually a piece of the small (ileum conduit) or large intestine (colon conduit) removed from the intestinal structure during an operation and interposed.
The advantage of the conduit procedures is that they can still be performed well on patients who are very upset by their illness. As a further variant, a kind of replacement bladder (Mainz-Pouch I) can be made from a piece of intestine , the opening of this system is usually hidden in the navel and continent – every 4 to 6 hours the bladder is emptied with a thin catheter.
A urostomy is an obstruction in the bladder or urethra. It is usually extensive bladder or prostate carcinomas that lead to a complete obstruction of the urinary tract.
Ileostoma und Kolostoma
The ileostomy and the colostomy are also called artificial anus or anus praeter(naturalis) . Here, too, there are different forms: A connection between the small intestine (ileum) and the body surface is an ileostomy, between the large intestine and the skin is a colostomy.
Depending on the location of the colostomy, a distinction is made between a cecostomy (stoma in the area of the appendix), a transverse ostomy ( the middle section of the large intestine is used for the stoma) or – the most common form – a sigmoid ostomy in the area of the ileum. In addition, there are terminal and double-barreled stoma systems: In the double-barreled form, the section of intestine coming from the stomach and that leading to the anus are sewn into the skin, with the terminal form, the section of intestine leading downwards is either surgically removed or closed and only the section of intestine coming from the stomach is sewn into sewn into the skin.
The creation of an ileostomy or colostomy is common. There are currently around 100,000 ostomy wearers living in Germany. An ileostomy is usually created either after an intestinal injury, for example as part of a serious traffic accident, or after the complete removal of the large intestine, which is sometimes necessary after a long-term course of chronic inflammatory bowel disease. After an injury, a double-barreled ileostomy is often created, which can be moved back again after some time.
A colostomy is created either to relieve the pressure on the intestines in the case of an intestinal tumor (usually terminal sigmoidostoma) and an intestinal obstruction (usually double-barreled cecal or transverse ostomy) or in the case of congenital malformations of the anus (as a terminal sigmoidostoma).
PEG (percutaneous endoscopic gastrostomy)
The percutaneous-endoscopic gastrostomy, PEG for short , is a special form and is often applied to old patients who, due to their illnesses, for example after a severe stroke or in the case of pronounced dementia , are no longer able to eat and drink independently. Food and liquid are then supplied via the PEG. Patients often find it less disturbing than a gastric tube placed over the mouth or nose. With PEG , a thin tube connects the stomach to the abdominal skin.
What do you have to consider as a stoma wearer?
Many of those affected react spontaneously defensively when they are first confronted with the therapy option “stoma installation”, because a tracheostomy inevitably attracts attention with its exposed position, a uro- or colostomy is automatically associated with the risk of “leaking” and ” smell”.
The creation of a permanent stoma is usually also associated with a serious underlying disease – be it cancer or a chronic bowel disease – which has sometimes led to a reduction in the quality of life for years. The chronic intestinal diseases Crohn’s disease and ulcerative colitis lead to recurring bleeding, narrowing of the intestines, massive colic and an increased risk of cancer. The ostomy often leads to an improvement in the quality of life in patients with intestinal inflammation, in cancer patients the stoma is an additional problem in addition to the cancer diagnosis.
Many questions relating to dealing with the stoma can be clarified in advance. Each hospital works with trained ostomy therapists who can work with the individual to select the best possible stoma care and allay many concerns. Of course, wearing a stoma often requires a rethink: Some types of sports or jobs are only possible to a limited extent with a stoma, and the partner also has to cope with the new situation.
Stoma restrictions
With a tracheostomy , smelling and tasting will only be possible to a very limited extent, since the air we breathe can no longer bypass the olfactory cells. Speaking is usually only possible with a speech cannula, because some air has to flow through the larynx for the speech process and cause the vocal cords to vibrate.
When it comes to urostomy and colostomy , the most important thing is the individually fitting bag system. There are one-piece and two-piece systems: With the two-piece system, a tightly adhering plastic ring is glued around the stoma and the transparent, white or natural colored ostomy bag is attached to it, the filter insert of which ensures that no unpleasant odor can escape.
With a one-piece system, the adhesive ring and bag are combined. The advantage of the two-part system is that the adhesive ring can remain on the skin for 24 to 48 hours.
Complications with stomas
The tracheostoma bypasses the upper respiratory tract, in which the breathing air is normally cleaned and moistened – the result is a susceptibility to infections in the bronchi. With all stomas, the hollow organ inside the body can pull back (retraction), which can lead to the narrowing of the stoma opening (stenosis) and sometimes has to be repaired surgically.
The stoma therapist can help if the area around the stoma is inflamed or if you have an allergic reaction to components of the adhesive ring. Leaking or “smelling” bag systems are usually due to incorrect operation – several surveys by the German ILCO eV have shown that these problems are rarely reported by those affected.
Serious problems are the psychological stress caused by a urostomy and colostomy with the fear of loud bowel noises and the sexual dysfunction associated with the stoma, which are mentioned by almost half of those affected. Sometimes sharing in a self-help group can be helpful.