Temporary stoma: colostomy, ileostomy and stoma reversal

A stoma is an opening in the front abdominal wall through which the surgeon brings out part of the bowel. The bowel contents then do not pass through the last part of the bowel and the anus, but come out through the stoma into a bag stuck to the skin. A stoma is pink or red, moist and usually not painful to touch, because the bowel does not have pain nerves like the skin.

A stoma is made when part of the bowel needs to be rested or protected, for example after surgery on the large bowel or rectum, when a new bowel join needs time to heal. Some stomas are temporary and some permanent. The surgeon explains which type is needed before the operation.

The difference is which part of the bowel is brought out onto the abdomen:

• A colostomy is made from the large bowel (colon). The stool is usually thicker, similar to normal.
• An ileostomy is made from the last part of the small bowel (ileum). The output is looser and more frequent, so drinking enough fluids is important.

A stoma can also be a loop stoma, when a loop of bowel with two openings is brought out onto the abdomen. Such a stoma is usually temporary and is easier to close than other types. The general surgery price list of Maja Hospital includes forming and closing a loop colostomy and closing a protective loop ileostomy.

A temporary stoma is usually made to protect a bowel join after surgery. While the join heals, the bowel contents pass through the stoma, and when the surgeon considers the join healed, the stoma is closed and the bowel works the usual way again.

A permanent stoma remains when the last part of the bowel or the anus has to be removed, or when closure is not possible or would not be safe. This can be the case, for example, after removal of the rectum and anal canal. Whenever possible, the surgeon discusses with the patient before surgery whether the stoma will be temporary or permanent.

Getting used to a stoma takes time and is different for everyone. In general:

• The bag is emptied and changed as instructed, and the skin around the stoma is washed with water and kept dry so the bag sticks well and the skin does not get irritated.
• With an ileostomy the output is looser, so drinking enough fluids during the day is important.
• The diet usually returns gradually to normal. Introduce foods that cause bloating or discomfort slowly and see how you tolerate them.
• Showering is possible with or without the bag, as instructed.
• Walking and light activities are recommended from the first days, while heavy effort and lifting are avoided until the surgeon allows them, because strain can contribute to a hernia next to the stoma.

Before discharge the patient receives instructions on stoma care. Ask the surgeon and medical staff about care and about getting bags and supplies, and also ask your family doctor about obtaining supplies.

The surgeon decides on closing the stoma after check-ups, when they consider the bowel join healed and the patient's general condition good. The timing differs from person to person and depends on why the stoma was made and how recovery goes, so it cannot be set in advance. Before closure the surgeon may request imaging or an endoscopic examination of the bowel join.

Stoma closure is an operation: the surgeon frees the bowel from the abdominal wall, joins it and returns it to the abdominal cavity, and the opening in the skin is closed. After surgery food is reintroduced gradually, as the surgeon advises. At first bowel movements can be more frequent and irregular until the bowel adjusts, and this usually settles gradually.

When complications occur at the stoma, such as narrowing, prolapse of the stoma or a hernia next to the stoma, a stoma revision is sometimes needed. The general surgery price list of Maja Hospital includes ileostomy revision and colostomy revision.

Contact the surgeon without delay or, if you cannot reach them, the nearest emergency department if:

• the stoma turns dark, purple or black,
• the stoma is not producing any output and there is pain, bloating or vomiting,
• there is more than a few drops of bleeding from or around the stoma,
• an ileostomy produces a lot of liquid output with strong thirst, dizziness or little urine,
• you develop a fever or severe abdominal pain.

With severe abdominal pain, vomiting and feeling very unwell, call the emergency service on 194.