Caring for a Stoma and the Potential Complications

Stomas are surgically created openings made into a hollow organ, like the bladder, to connect to the outside of the body. A variety of factors can lead to the need for a stoma, such as bladder and bowel obstructions or cancer, Crohn's Disease, and Ulcerative Colitis. Surgically created stomas can be temporary or permanent, depending on the medical reasons they were necessary. For example, if a person has a radical cystectomy to treat their bladder cancer and opts for an ileal conduit or Indiana pouch as their urinary diversion, the stoma would be permanent.^1,2

Living with a stoma

Stoma complications can occur for numerous reasons. It is good to know in advance what to look for, and strategies to manage any complications you may experience. 150,000+ stomas are surgically created in the US each year.¹ A stoma can improve a patient's quality of life, allowing them to live with few restrictions.¹ When complications develop, they can take a physical and psychological toll, affecting your job, relationships, intimacy, ability to exercise, and other forms of recreation.

Complications

Complications can develop at any time, but they are classified as early (within the first 30 days) or late (which can be years later.) ¹ They tend to be more common with colostomies, but can occur with urostomies as well. The most common complications include:

• Hernias
• Retraction
• Necrosis infection
• Prolapse
• Stenosis
• Fistula obstruction

Maintaining a relationship with a stoma nurse can help you manage any issues as they arise, and the curse can advise on when it is important to consult a physician.^2,3

Taking steps to prevent complications

Taking care of your skin and stoma bags and appliances are important steps in controlling some of the simpler complications. Diligence in basic care can help to reduce infection risk and irritations that can cause skin damage around the stoma site.

Retrospective findings from several studies identified that increased risks associated with complications were not disease-specific but more closely related to a short stoma length, obesity, and insufficient preoperative marking, especially in emergency surgery (less common for bladder cancer patients).¹ Preoperative marking is the technique of drawing on the patients’ skin to mark the exact position for the creation of the stoma. Placement is a very personal choice based on body type, how you wear your clothing, and your need for flexibility of movement based on work or leisure activities.

Risk factors for complications

Risk factors for stoma complications include the underlying disease, the patient and their comorbidities, and stoma creation surgical procedure.¹ Stoma necrosis (a complication resulting from insufficient blood supply resulting in a change in the stoma viability or resulting in tissue death) tends to occur soon after a procedure and is most closely associated with complications associated with emergency surgery. Complications can cause pain and discomfort and create difficulty holding a skin seal with the stoma bag (which prevents leakage).¹

Stoma repair and relocation

Stoma relocation can be necessary if there is leakage from a stoma bag that hasn’t been fitted correctly, fills too quickly, or the output becomes too loose.³ A stoma normally protrudes slightly above the skin. The length of a protrusion depends on the kind of stoma. Stoma retraction is when the stoma lays flat to the skin or below the skin surface level. This placement can affect the fit of a stoma bag, resulting in leaks, painful and irritated skin. ¹

A prolapsed stoma happens when the stoma extends to an abnormal length making the skin more susceptible to abrasion or infection. In most cases, intervention is unnecessary unless other complications present that require a surgical plan.¹

Knowing what to look for

Stomas rarely have life-threatening complications. Complication rates vary depending on the circumstances for stoma creation. Attention to detail at the time of creation, especially for permanent stomas, can help reduce chances of developing associated conditions, and other medical problems. ¹ Knowing the possible complications and what to look for can help you to quickly identify and bring any issues to your doctor.