Abdominoperineal excision of rectum (APER/APR)
A surgical procedure involving excision of the rectum and anus with closure of the perineum resulting in a permanent colostomy. Is usually performed for very low rectal/anal cancers.
A localised collection of pus in a cavity. For example, a diverticulum or an anastomotic abscess. Symptoms include pain and pyrexia due to infection.
Digested nutrients and fluids are absorbed via the gastrointestinal system into the blood. Disease or surgery may reduce the body's capacity to absorb nutrients and fluids.
Accessory products assist in stoma management and include items such as belts, convex inserts, pouch covers, bag closures/clips, sprays, creams, hydrocolloid wafers/seals, powders, pastes, odour removers/deodorants, solvents, and tapes. They do not include the stoma bag/pouch or base plate/flange/wafer.
See Antegrade colonic enema.
A malignancy of glandular epithelium. 95% of cancers arising in the large bowel are adenocarcinomas.
Benign tumour with the cells arising from glandular epithelium in the bowel.
Internal growth of scar tissue following surgery or sepsis. Bands of this fibrous scar tissue cause the joining together of two surfaces, for example, loops of bowel, which normally should be separate.
A type of therapy that assists another therapy. Adjuvant therapy can be given pre- or post-surgery for the treatment of bowel cancer, for example, chemotherapy. See Neo-adjuvant therapy, Chemotherapy, and Radiotherapy.
See Gastrointestinal system.
Allergic contact dermatitis
The pathogenesis of allergic reactions is conventionally divided into four types, I to IV. Allergic contact dermatitis is a type IV reaction, which is a delayed type hypersensitivity. In this condition, the allergen is a chemical that is small enough to cross the skin's outer barrier (Lyon and Smith, 2001).
An altered bodily reaction (as hypersensitivity) to an antigen in response to a first exposure. Once established, this hypersensitivity will result in an inflammatory reaction if the agent responsible is ever encountered again, e.g., latex.
A condition in which the blood is deficient in red blood cells, in haemoglobin, or in total volume. Symptoms include lethargy, tiredness, and breathlessness.
Between the rectum and the anus lies the anal canal, which is 2 to 3 cm long and made up of the upper borders of the internal and external sphincters and the puborectalis muscle.
A split in the mucosa and skin of the anal canal. Usually caused by the passage of hard constipated stool and resulting in pain and bleeding.
Comprises the internal sphincters (involuntary muscles) and external sphincters (voluntary constrictive muscles) to control discharge of faeces.
The surgical join of two cut ends of bowel. An anastomosis may be hand sewn or joined by the use of surgical staples.
Involuntary contraction of the anal sphincter.
Antegrade colonic enema (ACE)
ACE refers to a continent washout stoma.
The procedure is most commonly performed in children with continence disorders. These disorders include congenital malformations, such as spina bifida, imperforate anus, long-term soiling, and constipation. The procedure is now also used in adults for the management of bowel dysfunction.
It is a surgical technique where one end of the appendix is re-implanted in a non-refluxing manner into the caecum, and the other end is brought out onto the abdominal wall as a continent stoma. This provides a catheterisable channel, which facilitates the administration of an antegrade washout to empty the colon.
Surgical removal of part of/or all of the rectum and sigmoid colon. Anterior resections are often categorised as high or low depending on the site of the cancer.
The natural exit at the end of the gastrointestinal system, where faecal waste leaves the body.
See Abdominaloperineal excision of rectum.
Surgical removal of the appendix.
Inflammation of the appendix.
Surgical opening into the appendix. See Antegrade colonic enema.
"Blind" part of the caecum.
See Stoma appliances.
This is a condition where the spout of the ileostomy is torn off due to trauma.
Microscopic single-celled organisms. Some bacteria are harmless or even beneficial; others can cause infection.
Ballooning (of stoma appliance)
Occurs when a stoma pouch/bag that is being worn by the patient fills up with flatus. This is most likely to be seen when a filter is blocked or ineffective or where there is no filter on the pouch/bag.
A radiological examination, where a constrast medium (barium) is introduced into the bowel, allowing imaging of the ileum, colon, and rectum for diagnosis.
The part of a two-piece appliance that adheres to the peristomal skin and to which the pouch/bag is attached.
A non-cancerous tissue growth that does not spread from its location site to other areas of the body.
Fluid produced by the liver, stored in the gallbladder, and used in the small intestine to break down fats. Bile salts are re-absorbed in the terminal ileum. The daily volume of bile production averages 600 to 1000 ml.
A non-surgical process that focuses on re-training the pelvic floor muscles. It involves assessment and education of the patient for the management of constipation and faecal/urinary incontinence.
Diagnostic procedure in which a tissue sample is surgically removed from a portion of the body and subjected to microscopic analysis. Most biopsies are performed to determine whether an observed growth of tissue is malignant or benign.
A membranous sack located inside the pelvic cavity for temporary storage of urine. The bladder is normally a compliant structure that allows for storage of up to an average of 400 ml of urine.
A malignant growth within the bladder. Bladder cancers usually arise from the transitional cells of the bladder (the cells lining the bladder).
These tumours may be classified based on their growth pattern as either papillary tumours (meaning they have a wart-like lesion attached to a stalk) or nonpapillary tumours. Nonpapillary tumours are much less common, but they are more aggressive and have a poorer prognosis.
As with most other cancers, the exact cause is uncertain.
Bladder cancer is divided into five stages:
Stage 0: In-situ or non-invasive lesions limited to the bladder lining.
Stage I: Tumour extends through the mucosa, but does not extend into the muscle layer.
Stage II: Tumour invades into the muscle layer.
Stage III: Tumour invades past the muscle layer into tissue surrounding the bladder.
Stage IV: Cancer has spread to regional lymph nodes or to distant sites (metastatic).
Bladder cancer spreads by extending into the nearby organs, including the prostate, uterus, ureters, and rectum.
Excessive gurgling noises heard in the intestine, for example, in bowel obstruction and irritable bowel syndrome.
The bowel is made up of two parts:
Small intestine: See Duodenum, Jejunum, and Ileum.
Large intestine: See Colon and Rectum.
Bricker bladder/Bricker loop
An opening into the caecum generally used to decompress the large bowel in cases of obstruction. Very rarely used as a formal stoma.
This is the first section of colon/large bowel, which is 10 to 15 cm (2.5–3 inches) in length and is situated on the lower right side of the abdomen. The caecum contains the ileocaecal valve and the appendix.
This term refers to the abnormal and uncontrolled growth of cells, which may destroy and invade adjacent body tissues or spread elsewhere in the body (secondary spread metastases). Normally cell divisions and replications divide to match normal cell loss. On rare occasions, there is a defect in this division, and a rogue, potentially malignant cell arises. This is not recognised by the immune system and will continue to divide to produce millions of unwanted cells, thus destroying the function of normal body cells.
A term used to describe a bluish-purple discoloration of the skin caused by dilation of the cutaneous veins around the stoma. This is usually as a result of portal hypertension (sometimes seen in the terminal patient when liver metastasis is present).
A polysaccharide extracted from plant fibres that absorbs moisture and forms a gel. It is a constituent of the stoma skin barrier and can also be found in food and drugs.
A plastic/silicone/rubber tube, which allows fluids to pass into or out of the body.
Chemical (irritant) dermatitis
Inflammation of the peristomal skin area due to direct toxic reaction from faecal/urinary leakage, ostomy deodorants, or solvents.
Cytotoxic drug therapy used to control or destroy existing disease and reduce the risk of re-occurrence of cancer. It can be administered by various routes, including orally or intravenously.
Chronic papillomatous dermatitis
Greyish nodules/warty papules occurring on the skin around urostomies as a reaction to urine irritation of the skin. Also known as pseudoverrucous lesions and pseudoephitheliomatous hyperplasia. If contact with urine is stopped, the condition resolves within a few weeks.
Surgical removal of all or part of the colon/large bowel. This procedure may require stoma formation depending on extent of disease, physical status, and patient/surgeon preference.
Subtotal colectomy: Surgical removal of part of the colon with either an anastomosis or a temporary/ permanent ileostomy.
Total colectomy: Surgical removal of the whole colon with either an ileorectal anastomosis or an ileostomy.
Proctocolectomy: Surgical removal of the colon and rectum with a permanent ileostomy. Or if performed in conjunction with an ileo/anal pouch, a temporary loop ileostomy may be required. See Ileo anal pouch.
Pan proctocolectomy: Surgical removal of the colon, rectum, and anus resulting in a permanent ileostomy.
Other colonic resections include:
Sigmoid colectomy: Surgical removal of the sigmoid colon.
Right hemicolectomy: Surgical removal of the ascending colon.
Extended right hemicolectomy: Surgical removal of the ascending and part/all of the transverse colon.
Left hemicolectomy: Surgical removal of the descending colon.
Extended left hemicolectomy: Surgical removal of the descending and part/all of the transverse/sigmoid colon.
Hartmann's procedure: See Hartmann's procedure.
High anterior resection: See Anterior resection.
Low anterior resection: See Anterior resection.
A colostomy is a surgically created opening in the large bowel/colon. The bowel is brought through the abdominal wall and sutured to the skin. A colostomy can be formed in the ascending, transverse, descending, or sigmoid colon, although the most common colostomy sites are sigmoid (left iliac fossa) and transverse (right upper quadrant) colon. The colostomy diverts the faecal flow through the stoma, and a pouch/bag is worn to collect the faeces.
The stoma does not possess any nerve endings; therefore, any trauma to the stoma will be painless but harmful, e.g., injury from an ill-fitting stoma appliance.
A colostomy generally starts to function 2 to 5 days postoperatively. The output, volume, and consistency vary in each individual case and on the location of the stoma within the colon. This means that a colostomy in the distal colon will produce stool of thicker consistency and lower volume than a colostomy in the proximal colon. There is frequently an 'adaptation phase', which may last for several weeks. The average person with a colostomy would change/empty the pouch two times a day.
A method of bowel management suitable for sigmoid/descending colostomies to regulate bowel movements and provide continence between procedures.
The irrigation is self-administrated through the colostomy (every 24–48 hours) and makes it unnecessary to use a normal size stoma appliance. A stoma cap is often sufficient. Medical advice should be obtained prior to education and training of procedure.
A channel or pipe for conveying fluids.
Conditions/defects that arise during foetal development or at birth, for example, Imperforate anus or Hirschprungs disease.
Irregular and infrequent defecation, accompanied by hard, dry stools, which are difficult to pass.
Continent urinary diversion
See Mitrofanoff principle, Kock pouch.
Convexity (convex stoma appliances)
Convexity is defined as the outward curving of a base plate or skin barrier. The convexity allows for continuous contact between the skin and the pouching system.
When in contact with the skin, the convexity creates pressure on the peristomal area to partly evert a retracted or flush stoma. This helps to provide security and prevents leakages.
Convexity products are made as one- and two-piece appliances, manufactured in both hard and soft materials. A range of depths is available between 2 and 7 mm.
Patients should be carefully assessed for the appropriate use of hard convex products, which should be used only under the guidance of a trained competent stoma care nurse. Deep, hard convex products have been known to trigger peristomal skin problems like pressure ulcers or the onset of pyoderma gangrenosum.
See Chronic papillomatous dermatitis.
An inflammatory disease affecting any part of the gastrointestinal system from mouth to anus.
The ureters are brought directly onto the skin surface to drain the urine. This type of diversion is mainly performed in babies or children as a temporary intervention until extensive surgery can be performed. It can also be used as a palliative measure in terminally ill patients with obstructed ureters, e.g., tumours and when the insertion of nephrostomy tubes are not feasible.
A urinary diversion directly from the bladder to the skin. More common in infants and young children as the bladder is located more abdominally than in adults. The bladder is mobilised midway between the umbilicus and symphysis pubis. The bladder mucosa is sutured to the skin and a pouch/bag is worn.
Total or partial removal of the urinary bladder, resulting in a urinary stoma or a continent urinary diversion.
A multi-organ, genetically determined disease, thought to be due to a primary disorder of the exocrine and mucous-secreting glands. In the newborn, this condition results in the meconium being very thick and tenacious. This can result in intestinal obstruction, which may necessitate surgery.
The action of emptying the rectum of faeces. The reflex for this is initiated by distension of the rectal wall, which stimulates the stretch receptors and causes contraction of the rectal muscles.
An ileostomy or colostomy constructed to divert the faecal flow away from a diseased, traumatized segment of the bowel or a newly formed anastomosis.
See Allergic contact, Chemical irritant dermatitis, and Chronic papillomatous dermatitis.
The skin layer below the epidermis.
Fibrous tissue tumours, which may grow on the anterior abdominal wall in the abdomen.The cause is unknown, but they occur in about 9% of familial adenomatous polyposis patients.They do not metastasise but can grow to varying sizes. Due to their sheer bulk and location, they may require surgery, only if symptomatic, e.g., there is a bowel obstruction (Phillips 2001).
Classified as increased amounts of loose, watery effluent or the number of loose or unformed bowel movements in a 24-hour period.
The conversion of food into absorbable substances in the gastrointestinal system. Digestion is accomplished through the mechanical and chemical breakdown of food into small molecules, which can then be absorbed into the bloodstream.
Stretch/widen a stenosed area of bowel lumen, e.g., a stoma or an anastomosis.
Below the point of reference. The anus is distal to the rectum.
Over-expansion of the bowel with gas/fluid/stool. Reasons for distension include intestinal obstruction, constipation, irritable bowel syndrome, and acute abdomen.
Diverticular disease (diverticulosis/diverticulum/diverticulitis)
A condition where small sacks or pouches form in the wall of the large bowel. Contributory factors include raised intraluminal pressure related to low fibre diet and lifestyle. Commonly found in the descending/sigmoid colon from late middle age and onwards. The term diverticulitis is used when the pouches or sacks become inflamed or infected. Complications arising from diverticular disease include fistula formation, abscess, stricture, haemorrhage, and perforation leading to peritonitis. These complications can result in surgery and sometimes stoma formation.
See Mucous fistula.
Double-barrel stoma (Paul Mickulitz)
This type of stoma can be formed from the ileum or the colon. The bowel is divided and the proximal and distal ends are brought out through one opening in the abdominal wall and sutured to the skin to form two stomas, which lay side by side and are managed as one stoma.
Dukes classification is one of the most widely used classifications designed to define the extent of colorectal cancer.
Dukes classification uses stages from A to D.
A: The cancer is confined within the bowel wall.
B: The cancer has spread through the wall of the bowel.
C: The cancer has spread into the lymph nodes.
D: The cancer has spread to other sites, often the liver.
First 25 cm of the small intestine extending from the pylorus to the jejunum. It plays a vital part in digestion due to the digestive enzymes being delivered from the liver/gallbladder and pancreas. The main function of the duodenum is to neutralise acidic gastric contents, emulsify fats, and absorb carbohydrates.
Alternative term for indigestion or heartburn.
Abnormal changes of mature cells that indicate possible development of cancer. These may be graded as mild, moderate, or severe dysplasia.
The process of excretion of metabolic waste from the blood via the kidneys.
When just one end of the bowel is exteriorised and formed into a stoma. This may be from either small or large intestine.
A collective name for visual inspections of the gastrointestinal tract using a flexible fiberoptic endoscope. The procedure can be performed for either diagnostic or therapeutic purposes. The procedure is performed to find the cause of bleeding, diarrhea, abdominal pain, and/or constipation and also to detect signs of cancer, bleeding, inflammation, abnormal growths, and ulcers.
Enteral tube feeding
When oral feeding fails to meet nutritional requirements, patients may need enteral tube feeding. This involves the introduction of nutrients (via a tube) into the gastrointestinal tract by four main routes:
Nasogastric: Via the nose and into the stomach.
Nasoduodenal: Via the nose and into the duodenum.
Gastrostomy: Through the abdominal wall and into the stomach.
Jejunostomy: Via the abdominal wall and into the jejunum.
An enzyme is a biological catalyst, which alters the rate of a chemical reaction without itself being changed.
External non-vascular layer of the skin.
Surface layer of cells covering internal and external surfaces of the body, including cutaneous, mucous, and serous layers.
A term applied to a gradual breakdown of the epidermis. The skin will be excoriated; moist and bleeding. The erosion does not extend into the dermis and heals without scarring.
A term applied to redness of the skin produced by congestion of the capillaries.
The process of emptying the bowel or bladder (elimination).
To surgically cut out/ remove a part, e.g., bowel or bladder.
A term used in stoma care to describe a superficial loss of skin around the stoma. This results in the skin integrity being broken, leading to a moist, bleeding area.
Radical surgical removal of some/all of the pelvic cavity.
The extent of the disease will determine how radical the procedure will be. For example, total pelvic extenteration could include the removal of the bladder, lower ureters, urethra, vagina, ovaries, uterine tubes, colon, rectum, anus, pelvic lymph nodes, and all of the pelvic peritoneum.
Faecal impaction is the result of chronic constipation causing a grossly dilated colon. Treatments include conservative management and/or surgery.
Faecal occult blood
Solid/semi-solid waste products excreted by the body through the anus. Faecal material consists primarily of bile pigments, mucus, unabsorbed minerals, undigested fats, cellulose, desquamated epithelial cells, potassium, sodium, bicarbonate, and water. Faecal composition is three parts water and one part solid material. Amount of faeces evacuated is approximately 150 to 250 g daily.
Familial adenomatous polyposis (FAP)
A hereditary condition where large numbers (100–1000) of pre-malignant polyps develop in the large bowel from puberty and onwards. Malignant changes occur if left untreated. Treatment includes surgical removal of the colon and rectum.
The roughage constituent from indigestible foods. Daily recommended intake of fibre is 18 to 30 g. Dietary fibres contribute to a healthy diet for people with or without a stoma, but should be used with caution for a person with an ileostomy.
There are two forms of fibre:
An abnormal passage or communication from an internal epithelialised organ to the skin surface or between two internal epithelialised organs.
Common causes of fistulae include diverticular disease, Crohn's disease, and radiotherapy. A large proportion of fistulae occurs as a complication of surgery and is more common in malnourished patients.
See Wafer and Baseplate.
Gas/wind formed in the large intestine as a result of the action of bacteria on undigested food. We produce between 400 ml and 2 l of wind/gas in 24 hours.
Where the stoma mucosa is at a level with the skin, either circumferentially or partially. A stoma may be flush because of surgical technique/difficulties (e.g., poor mobilisation of the bowel and/or excessive tension of the suture line at the fascial layer), recurrent malignancy, or weight gain.
This may cause problems in obtaining and maintaining a secure and leak-proof seal, particularly in the management of an ileostomy or urostomy, due to the liquid nature of the output. A variety of stoma products is available to manage this problem.
FOB (faecal occult blood)
Presence of microscopic blood in the stool.
Pustular lesions and inflammation seen at the hair follicles surrounding the stoma.
A pear-shaped sack 7 to 10 cm long, which acts as a reservoir for bile.
Related to the stomach.
A reflex precipitated by the entry of food into the stomach causing the terminal ileum to contract and faeces to enter the caecum. In response to this, there is a mass movement within the bowel, which can propel the bowel contents up to 30 cm towards the rectum. This reflex usually occurs after meals, but is particularly evident in the morning.
Gastrointestinal system (GI tract/alimentary canal/digestive system/gut)
The gastrointestinal system starts at the mouth, finishes at the anus, and is approximately 6 to 7 meters (15–20 feet) long. Its main function is to digest, absorb, store, and evacuate.
Inspection of the upper gastrointestinal tract, including the oesophagus, stomach, and duodenum.
A protein extracted from animal skin, hoofs, and bones. It is a fine, white powder that absorbs moisture and forms a gel. It is used in food and drugs, as well as in stoma skin barriers.
A term used to describe small, reddish, raised areas/nodules on the stoma or on the peristomal skin. Commonly caused by local irritation from stoma appliances, suture sites, and/or leakage of effluent.
See Gastrointestinal system.
Commonly known as piles. Haemorrhoids are engorged and displaced vascular anal cushions. These anal cushions normally help seal the upper and lower canal and contribute to continence. Caused by constipation, straining, and pregnancy. Symptoms include bleeding and discomfort.
In this procedure, the diseased part of the distal colon is surgically removed. The proximal end of the descending or sigmoid colon is brought up to the surface of the abdomen to form an end colostomy. The rectal stump is over-sewn/stapled and left inside. The colostomy may be permanent or temporary. The most common reasons for performing this procedure are complicated diverticular disease or colorectal cancer.
Hernia (parastomal hernia)
A weakness in the muscle layer where internal organs may protrude. A parastomal hernia appears as a bulge around the stoma. The bulge contains loops of intestine that protrude through the fascia defect around the stoma and into the subcutaneous tissue. Causes include surgical technique, muscle weakness, and coughing/straining.
Parastomal herniation is a common complication, which may occur weeks, months, or years after stoma surgery.
The patient often experiences discomfort, has problems with stoma appliances/clothing, and can find the appearance of the hernia very distressing.
Management can include fitting an abdominal support, appliance advice, and occasionally, surgical repair.
A rare complication is if the bowel segment becomes strangulated. The patient will have symptoms of an acute abdomen (bowel obstruction, ischaemic bowel, abdominal pain, distension, vomiting) and would require urgent surgery.
This disease is due to an absence of autonomic ganglion (nerve) cells of the large intestine. This prevents peristalsis occurring in that part of the bowel (spastic). Approximately 75% of the cases are confined to the recto-sigmoid region (short-segment Hirschsprung's disease), 10% have total colonic involvement (long-segment Hirschsprung's disease). The condition usually becomes apparent in the neonatal period (80%) due to the delayed/failed passage of meconium. In babies, it usually appears with increasing abdominal distension and vomiting, requiring surgery to relieve the obstruction. Infants with this condition will need to have a temporary stoma, but a second operation will be carried out a few months later to remove the spastic (aganglionic) section of bowel and 'pull through' the healthy bowel down to the anus.
Children with short-segment disease have a good outlook. Those with long-segment disease (no nerve cells in the colon) are more likely to require their ileostomy for longer, depending on the child's progress.
Hirschsprung's disease affects 1:5000 live births and is more prevalent in males than females 4:1.
Microscopic study of the structure of cells and tissues to assist diagnosis.
HNPCC (hereditary non-polyposis colon cancer)
A dominantly inherited genetic abnormality that predisposes to colorectal cancer. 80% of people with HNPCC are at risk of developing cancer.
Hydro means water; colloid means stable solution of particles in water. It is a synthetic carboxymethylcellulose substance bound with copolymers, gelatine, pectin, and/or cotton. The particles absorb water and form a gel. Hydrocolloids are used in the pharmaceutical, cosmetic, and chemical industry. Hydrocolloids are an important ingredient in the manufacturing of stoma skin barriers.
(Urostomy/Bricker loop or Bricker bladder)
(Ileo-anal reservoir, Ileal pouch anal anastomosis (IPAA), Restorative proctocolectomy)
This is an optional surgical procedure primarily for patients with ulcerative colitis and familial adenomatous polyposis. During this procedure, the colon and rectum are removed and a reservoir/pouch is constructed, using the distal ileum. The configurations of the pouch can vary depending on surgeon preferences. The most common ones are the J-pouch and W-pouch. The pouch is then joined/anastomosed to the anus to restore continuity of bowel function. To facilitate healing in the postoperative period, the patient may require a temporary loop ileostomy.
Ileo-anal pouch function
Following pouch construction, and when continuity of the bowel function is restored, the number of pouch evacuations varies with each individual. The expected average defecations/emptying of the pouch is between 4 and 8 in a 24-hour period. This will be more frequent in the initial months until the ileal pouch has adapted to its new function. Patients commonly require anti-diarrhoea medication to help control output.
With the faecal evacuation coming directly from the small bowel, skin irritation and soreness in the perianal area are common. Cleansing of the anal area is therefore recommended after each pouch evacuation. Skin barrier creams can also be applied to prevent skin irritation in this area.
The ileo-caecal valve is a one-way valve located at the junction between the ileum and colon. It regulates the emptying into the colon and prevents reflux of contents back into the small intestine.
An ileostomy is a surgically created opening in the small bowel, the ileum. In most cases the surgeon uses part of the terminal ileum (last section of small intestine) to form the stoma. The ileum is brought through the abdominal wall, everted to form a spout, and sutured to the skin. The output/consistency will vary depending on the location of the stoma within the small bowel. A stoma pouch/bag is applied to allow for the collection of faeces. The stoma does not possess any nerve endings; therefore, any trauma to the stoma will be painless but harmful, e.g., injury from an ill-fitting stoma appliance.
An ileostomy may stop functioning due to a blockage caused by adhesions or undigested food. The patient may experience abdominal pain, distension, nausea, and vomiting. There will be minimal or no output from the stoma. Management will include fluids only, relaxation, and abdominal massage. A food blockage will in most cases resolve spontaneously, but if symptoms persist, the patient may require admission to hospital for conservative or surgical treatment.
An ileostomy generally begins to function within the first 48 to 72 hours after surgery. The initial effluent is usually viscous, green, and shiny. This output does not necessarily signal return of peristalsis; it can be fluid that has been collected in the distal small bowel. Once peristalsis returns, the patient may experience a period of high-volume output from the stoma.
This is often referred to as the 'adaptation phase'. Output during this period can exceed 1000 ml per day. The physiological basis of this high-output phase is loss of the colon's absorptive surface coupled with the delay factor normally provided by the ileocaecal valve. It is very important to monitor the patient in this period (fluid and electrolyte balance).
Over a period of days or weeks following surgery, the proximal small bowel increases fluid absorption. There is a gradual reduction in the volume of output, and a thickening of stool to a 'toothpaste' consistency will occur. This may vary according to the amounts/type of food and drink consumed. After this 'adaptation' period, the average amount produced by an ileostomy decreases to between 500 and 800 ml per 24 hours. An ileostomy will function intermittently throughout the day. The effluent from an ileostomy contains enzymes, and if in contact with the peristomal skin, excoriation and soreness will occur.
The final and longest segment of the small intestine. It extends about 4 m (13 ft) from the jejunum (middle section of the small intestine) to the ileocaecal valve, where it joins the large intestine.
It is the site of absorption of fluids, nutrients, vitamin B12 and re-absorption of about 90% of conjugated bile salts. Disorders of the ileum produce problems of absorption and vitamin B12 deficiency. Fluid imbalance caused by diarrhoea will occur as a result of malabsorption and the presence of bile salts in the large intestine interfering with water absorption.
See Paralytic ileus.
This is when a newborn baby has a displaced or unformed anal opening. Imperforate anus affects 1 in 4000 new babies, but the cause is unknown. These infants may also have other congenital anomalies, such as fistulae (recto-urethral fistulae in boys, recto-vestibular fistulae in girls). Other malformations, such as vertebral defects, cardiac anomalies, and oesophageal atresia are often associated with the condition. The incidence of kidney and bladder problems increases with the severity of the imperforate anus, ranging from 5 to 20% with low lesions and up to 60 to 90% in high lesions.
Babies born with this condition will need surgery to create an opening (anus) to allow for the passage of stool. This initially requires the formation of a stoma and then further reconstructive surgery at a later date depending on the severity of their condition.
Discomfort/pain in the digestive system, differs from person to person, and is related to diet and physical and psychological circumstances. Also called heartburn.
Invasion of the body by various agents (bacteria, fungus, protozoa, viruses, worms) and the body's reaction to them or their toxins. Infections are sub-clinical until they affect health, when they then become infectious diseases/conditions. Infections can be local (e.g., an abscess), confined to one body system (e.g., pneumonia in the lungs), or generalised (e.g., septicaemia). Infectious agents can enter the body by inhalation, ingestion, and transmission or wound contamination. The body responds with a rise in leukocytes, production of antibodies or antitoxins, and often a rise in temperature.
The body's reaction to infection, irritation, or other injury. The symptoms include redness, warmth, swelling, pain, and impaired function.
Inflammatory bowel disease (IBD)
Inflammatory bowel disease is a broad term used to describe the two conditions: Crohn's disease (CD) and ulcerative colitis (UC). There is no definitive cause, aetiology is uncertain, and the usual presentation is in young people. Common symptoms are abdominal pain, weight loss, diarrhoea, mucous, and anorexia. Inflammatory bowel disease is characterised by remissions and relapses. The majority of cases are managed conservatively, but some will eventually require surgery.
Crohn's disease affects any part of the gastrointestinal tract from mouth to anus and may involve all layers of the intestinal wall with acute and chronic inflammation, resulting in fissures, fistulae, abscesses, and strictures. Non-continuous parts (skip lesions) of the intestine (both large and small) may be affected, the most common parts being the terminal ileum and ascending colon. Smoking has been proven to be a risk factor for recurrent episodes of Crohn's disease. Medical management and surgery may alleviate symptoms, but at present, there is no cure for this disease.
Ulcerative colitis is confined to the colon and rectum. Ulcerative colitis often starts in the rectum and spreads proximally in a continuous manner. The inflammation causes bloody diarrhoea, urgency, and frequency of stools. Where surgery is required, a restorative procedure can be an option, for example, Ileo-anal pouch.
Can be identified as any form of surgically reconstructed internal pouch/reservoir for the purpose of evacuation/elimination.
The intestine, especially the colon, contains millions (over 400 species) of helpful bacteria that assist the digestive process and maintain intestinal function. Anaerobic bacteria present in the colon serve to putrefy remaining proteins and indigestible residue. This bacterial action also creates intestinal gas.
(Common bacteria include Escherichia coli, Aerobacter aerogenes, Clostridium perfigens, and Lactobacillus bifidus.)
These secretions are necessary for the process of digestion. The major characteristic is the high content of digestive enzymes. Secretions enter the duodenum from the pancreas, the liver, and the glands in the bowel (intestinal) wall.
Pancreatic secretion has a high bicarbonate concentration and therefore an alkaline pH (neutralises the acid entering from the stomach); the digestive enzymes secreted from the pancreas are trypsin (protein digestion), amylase (starch digestion), and lipase (fat digestion).
Bile (secreted by the liver and stored in the gallbladder) contains the bile salts cholesterol and lecithin (emulsifying of fat). Secretions from the intestinal glands consist of mucous, which protects the duodenum from attack by hydrochloride acid, hormones, electrolytes, and enzymes.
A part of the alimentary canal extending from the stomach to the anus.
Refers to the invagination of one part of the intestine into itself. Clinical symptoms (colic pain and the "red currant jelly" stool), together with physical and radiographic examination, help in diagnosing this condition. It can occur at any age, but more than 60% of the cases are encountered from birth to 4 years.
A method of cleaning the bowel by instilling water via the stoma/rectum. There are two types of irrigation: antegrade colonic irrigation and colonic irrigation.
Irritable bowel syndrome (IBS)
A common condition characterised by symptoms of cramping, abdominal pain, bloating, and erratic bowel habit. The cause is unknown, but it is often associated with stress, with anxiety, or following severe intestinal infection. On investigation, there is no detectable structural disease.
Poor blood flow to an area caused by constriction or blockage of the blood vessels supplying the area, e.g., an ischaemic/necrotic stoma.
A jejunostomy is a surgically created opening from the jejunum that is brought through the abdominal wall and sutured to the skin. This type of stoma is relatively uncommon, but may be necessary in extensive Crohn's disease or ischaemia. A high-output stoma pouch/bag will be required to manage this stoma.
A jejunostomy will generally function immediately. The very watery output and high volume (4–12 l per 24 hours) necessitates the need for additional parenteral nutrition. This is due to the inability for normal digestive absorption to take place in the ileum.
The middle part of the small intestine that extends from the duodenum to the ileum. It measures about 3 meters (9 feet) in length. The jejunum is the major organ for nutrient absorption.
Most of the fats, proteins, and vitamins are absorbed in the jejunum, as well as any remaining carbohydrates not already absorbed in the stomach or duodenum. Approximately 3 to 3.5 l of intestinal fluid are secreted into the jejunum per 24 hours.
Is produced in India and is a polysaccharide taken from the Sterculia urens tree. Karaya gum has a special buffering action, which keeps the skin pH slightly acidic (4.5–4.7). Due to its excellent water holding capacity it is used in ice creams, sausages, and breads to improve consistency, as well as being the active ingredient of the Karaya paste and the Karaya skin barrier for stoma management.
See Urinary tract.
Kock pouch (continent ileostomy)
The surgical construction of an internal pouch/reservoir. The internal pouch provides storage capacity of faeces and eliminates the need to wear a permanent stoma pouch/bag. Following panproctocolectomy, approximately 45 cm of distal ileum is used in the construction of the pouch. Once this has been achieved, an outlet channel with a nipple valve using the terminal ileum is constructed. The function of this valve is to maintain continence. The outlet channel is passed through the abdominal wall, out onto the body surface, leaving a small flush stoma. Emptying the pouch takes place by inserting a catheter into the stoma and down into the pouch. The catheter opens the nipple valve and evacuation takes place.
Whilst the need for a stoma appliance has been eliminated, a stoma cap or dressing may be required to absorb any mucus from the stoma. The Kock pouch is not considered to be the first surgical choice when internal pouch surgery is an option (see Ileo-anal pouch), but may be offered to patients who have had their anal sphincters removed.
Kock pouch (continent urostomy)
Kock urinary reservoir:
This was developed as a variation of the Kock continent ileostomy. The reservoir is located in the abdominal cavity, and to construct the reservoir, 60 to 80 cm of the ileum is used. An intussuscepted valve achieves the continence mechanism at the stoma site. A second nipple valve is constructed at the other end of the ileum and the ureters implanted; this second valve is intended to prevent reflux into the ureters.
Laceration (of the stoma)
This term refers to a cut/tear to the stoma, usually due to friction from the stoma appliance, or it may develop in conjunction with trauma to the stoma. It usually appears as a yellow-to-white linear discoloration of the stoma mucosa.
It can be severe enough to penetrate/fistulate the bowel wall, but is commonly superficial. Due to the fact that the stoma does not contain nerve endings, the patient may not experience any pain.
An examination or surgical procedure using a type of endoscope (laparoscope) inserted through the abdominal wall via small incisions. The procedure is carried out under video control and minimises trauma, postoperative pain, and length of hospital stay. A variety of surgical procedures (colectomy, stoma formation, ACE procedure) can now be performed in some specialised centres.
A surgical incision of the abdominal wall used in exploratory emergency surgery and elective colorectal procedures.
Large bowel (Intestine)
The large bowel (intestine) begins at the ileocaecal valve, terminates at the anus, and is about 1.5 m (4–5 feet) long. Its main functions are the absorption of fluid and electrolytes, mixing and propelling contents from the terminal ileum towards the anus, storage, and defecation. It also produces mucus to facilitate the passage of faeces and harbouring of colonic bacteria for the breakdown of complex carbohydrates and synthesis of vitamins B and K.
The liver is the largest organ of the body, weighs up to 2 kg, and plays a vital role in digestion. It is dark red in colour and occupies the upper right portion of the abdominal cavity immediately below the diaphragm. It receives blood both from the hepatic artery and the portal vein and returns it to the systemic circulation by the hepatic veins.
It is a complex organ that performs many metabolic and digestive functions. The functions of the liver include bile formation; metabolism of carbohydrate, protein, fat, steroid, and minerals; vitamin storage; coagulation; and detoxification. The liver also converts sugars into glycogen, which it stores until required.
Bile production and secretion are continuous processes within the liver. Bile salts, the most abundant substance secreted into bile, are formed by the liver cells. Bile salts function primarily to emulsify fat globules into minute sizes to facilitate digestion and to promote the absorption of lipids (cholesterol and fatty acids) across the intestinal mucosa. Re-absorption of approximately 94% of the bile salts occurs in the terminal ileum; the re-absorbed salts are returned to the liver through the portal blood. The daily volume of bile production averages 600 to 1000 ml.
A loop colostomy is formed in the large bowel, and common sites are in the transverse colon (right upper quadrant) or sigmoid colon (left iliac fossa).
A loop ileostomy is formed in the small intestine, commonly in the terminal ileum (right iliac fossa).
A loop of intestine is brought out through a surgical opening made in the abdominal wall. This diverts the faecal flow from diseased, traumatized, obstructed intestine or from the site of an anastomosis.
When the stoma is constructed, the bowel is not completely divided but is opened along the anterior surface. The opened edges are then everted and sutured to the skin. This stoma has two distinct openings, the proximal functional opening and the distal non-functional opening, that remain connected by the undivided posterior section of the bowel wall.
Loop stomas are sometimes supported in position by a bridge/rod of plastic, rubber, or glass. The bridge/rod prevents the stoma from retracting and remains in position 5 to 10 days following surgery.
The construction of a loop stoma means that faeces may sometimes overflow from the functional proximal opening into the non-functional distal opening. This is generally not a cause for concern but requires careful explanation to the patient.
A loop stoma can either be temporary or permanent. A loop stoma can be constructed as part of a major surgical procedure (laporotomy) or a minimal surgical procedure (laparoscopy).
Peristomal skin being excoriated and moist.
Another term for cancer.
The first stools of a newborn baby.
The inability to pass meconium (stool) by normal defecation in the newborn. The condition may result in intestinal obstruction, perforation, and peritonitis, which will ultimately require surgery.
A term used to describe a number of conditions in which the colon is excessively dilated, e.g., Hirschsprung's disease and/or Inflammatory bowel disease. If left untreated, it may predispose to perforation.
A double layer of peritoneum that encircles most of the small intestine and anchors it to the posterior abdominal wall. The mesentery contains the blood vessels and nerve fibres that supply and nourish the small intestine.
Spread of cancer cells from their original site. Cells from a primary malignant tumour may invade and get into the bloodstream or lymphatic system enabling them to reach a new site and form a secondary tumour.
The most common site for colorectal cancer to metastasise is the liver. The most common site for bladder cancer to metastasise is the prostate, uterus, ureters, and rectum.
See Stoma cap.
The procedure is named after Dr. Paul Mitrofanoff, who in 1980, was the first to attach the appendix to the bladder by means of an anti-reflux valve.
The Mitrofanoff principle contains five elements:
MRI (magnetic resonance imaging)
A sophisticated imaging technique used to produce detailed cross-sectional images of the body. Frequently used to stage and assist in treatment planning of rectal cancers.
Sutured junction of a stoma between the bowel (mucosa) and the skin (cutaneous).
See Mucous membrane.
It occurs naturally on the surface of a stoma or in the urine following formation of an Ileal conduit. Varying amounts may be passed rectally following surgical de-functioning of the colon (e.g., anterior resection/Hartmann's procedure) or as a discharge from a mucous fistula. Increasing amounts may be seen as a response to active bowel disease (e.g., cancer and inflammatory bowel disease). The consistency of the discharge can vary from an offensive, thick, yellow matter to a crystal clear fluid.
During bowel surgery if primary anastomosis is contraindicated, or surgically impossible, both ends of the bowel will be exteriorised. The proximal end will form the functioning stoma and will pass faeces. The distal end of the bowel is brought out through the abdominal wall to form a non-functioning stoma called a mucous fistula. This procedure can be performed in either the large or small intestine.
The mucous fistula may be located close to the proximal stoma, in the abdominal suture line, or elsewhere on the abdomen. It discharges mucous, serous fluid, and retained stool. A mucous fistula can be permanent or temporary and will require the use of a stoma cap or small dressing.
A mucous-secreting membrane that lines the gastrointestinal tract.
Mucus is naturally produced and secreted by glands lining the bowel wall. Its function is to act as a barrier and to lubricate the passage of stool. It is usually a clear viscous fluid, which may contain enzymes and has a protective function. The quantity that is produced will increase if inflammation and/or infection is present.
The need or desire to vomit. It is often manifested by wavelike sensations at the back of the throat, epigastria, and abdominal area. The management of nausea is based primarily on rectifying or minimising the cause.
See Stoma necrosis.
Necrotising entererocolitis (NEC)
This condition affects premature babies which leads to necrosis, gangrene and in extreme cases death. Babies with obstructive symptoms require an emergency laparotomy to identify and remove the necrotic bowel resulting in a temporary ileostomy.
The administration of therapeutic agents before a main treatment.
Also known as the gullet. This canal extends from the pharynx to the stomach and is approximately 23 cm long.
Part of the mesentery that is referred to as lesser omentum or greater omentum.
Lesser omentum is the name given to the mesentery that attaches the lesser curve of the stomach to the liver and the diaphragm.
Greater omentum is the name given to the mesentery that attaches the greater curvature of the stomach to the transverse colon and the posterior abdominal wall.
This is also known as the "fatty apron" because it hangs down in front of the stomach where large amounts of fat accumulate in and between its double folds.
A person who has a stoma.
A surgically created opening for the excretion of faecal waste (colostomy, ileostomy) or urine (urostomy) that can be temporary or permanent.
Pancaking (of stoma appliance)
Refers to the presence of faeces staying on top of the stoma and not dropping/moving down into the bottom of the pouch/bag. Most commonly seen in colostomy management. Occurs when the filter on the stoma pouch/bag eliminates all air in the appliance, creating a 'vacuum'/'sucking in' of the appliance onto the mucosa of the stoma.
It is not an easy problem to solve, but primarily the use of an adhesive cover over the filter can help to minimise the problem.
A tongue-shaped glandular organ lying below and behind the stomach. It is about 18 cm long and weighs about 100 g. The pancreas has both an exocrine and an endocrine function. Average daily volume for pancreatic secretions is 700 to 1000 ml.
It has a key role in digestion by releasing pancreatic juice, which passes into the duodenum via the pancreatic duct. These exocrine secretions are odourless, colourless, watery, and alkaline (pH of 8.3). The primary components of pancreatic juice include water (97%) and bicarbonate. Electrolytes as sodium and potassium in high concentrations and calcium and chloride in smaller concentrations are also present. Pancreatic juice also contains enzymes, which are involved in the digestion of fats, proteins, and carbohydrates in the small intestine.
The Islets of Langerhans in the pancreas produce the endocrine products of insulin, glucagon, somatostatin, and polypeptide hormones, which play a major part in the regulation of carbohydrate metabolism. These substances are released into surrounding capillaries, empty into the portal vein, and are distributed to target cells in the liver where they enter the general circulation.
A term that refers to loss of intestinal motility (peristalsis). It manifests itself by absence of bowel sounds and absence of stool. The patient can experience varying degrees of colic/spasmodic type pain, distension, nausea, and projectile vomiting.
Following surgery, peristalsis usually resumes in the small bowel within about 48 hours and the large bowel within 72 hours. However, the "ileus" may be prolonged following lengthy surgical procedures or extensive bowel manipulation.
Beside the stoma.
A polysaccharide extracted from lemons, apples, oranges, or grapes. Pectin absorbs moisture and forms a gel and is used in food, cosmetics, drugs, and stoma skin barriers and pastes.
Successive, wavelike, involuntary muscular contractions along the wall of the intestine. These propel the digested products along the length of the gastrointestinal tract.
The area immediately surrounding the stoma.
See Stomal complications.
A serous membrane that lines much of the abdominal cavity and covers most of the abdominal organs. It is a flexible sheet of tissue that holds the organs of the digestive tract in position and conveys nerves, blood vessels, and lymphatic ducts to the organs.
The peritoneum that covers the abdominal organs is known as the visceral peritoneum; the peritoneum that lines the abdominal cavity is known as the parietal peritoneum.
Inflammation of the peritoneal cavity, which includes the serosa, mesentery, and omentum. It is categorised as either localised or generalised.
Localised perotinitis involves the transmural inflammation of the bowel (e.g., appendicitis, diverticulitis). This may progress into generalised peritonitis due to perforation of the bowel (e.g., perforated appendix/diverticulum). This is a life-threatening situation.
Common symptoms include pain, nausea, fever, abdominal distension, and difficulty passing faeces or gas. Treatment involves antibiotics and/or surgery.
A painful sensation experienced in the perineum. This can occur following abdominoperineal excision of the rectum.
A hydrophobic polymer that is a clear/yellowish soft rubber-like substance. It is very sticky and has high viscosity. It does not absorb water and will not dissolve in it. PIB binds/gives inner strength to the skin barrier and helps the skin barrier to adhere on dry skin. It is also used in chewing gum.
Polyps (in the bowel)
Small growths in the bowel that vary in shape and size. They can be flat, sessile, or project out from the mucous membrane. These polyps are usually benign but can undergo malignant changes over a long period of time (5-10 yrs). Polyps in the bowel are more common after middle age.
It is suggested that patients undergo routine colonoscopy after the age of 50 years to have any polyps removed and microscopically examined for malignant changes. Symptoms, if any, can include bleeding, pain, and altered bowel habit, depending on location in the bowel and size of the polyp.
A term used to describe a stoma appliance or stoma pouch/bag. It is worn over a stoma to collect faeces or urine.
A term describing inflammation of the ileo-anal pouch reservoir. Its cause is unknown, but it has been suggested that it is due to bacterial overgrowth. It is more common for those who have had a pouch constructed for ulcerative colitis and may affect as many as 20 to 35% of patients.
Symptoms include diarrhoea, bleeding, pyrexia, and general malaise. The condition responds well to oral antibiotics and steroids. However, very rarely, surgery may be indicated to remove the ileo-anal pouch and form a permanent ileostomy.
These are non-digestable food ingredients that have a beneficial effect on the gut. They stimulate the growth of some colonic bacteria, e.g., fructose favours the fermentation of bifidobacteria.
Refers to a condition that is not malignant but is known to become so if left untreated.
Probiotics are live microorganisms that can beneficially alter the micro-flora of our gut, e.g., lactobacilli. To enable this to happen, they have to be alive when eaten, survive the acid produced by our stomachs, and be alive on leaving.
A severe shooting pain in the rectum/anus. More common in men than women.
Proctitis is an inflammation of the rectal mucosa most commonly seen in relation to ulcerative colitis. Proctitis can also be associated with infection from campylobacter, shigella, and salmonella organisms, as well as with venereal infections. Radiation proctitis is the most common complication of pelvic radiation, often occurring years after treatment. Symptoms of severe proctitis will include profuse watery diarrhoea, bleeding, and tenesmus.
Refers to the medical specialty that deals with the diagnosis and treatment of disorders of the rectum and anus.
In this condition, the rectum protrudes through the anus usually as a result of weakening of the supporting tissues. Depending on severity, surgical treatment may be indicated.
Above the point of reference (the colon is proximal to the rectum), e.g., loop stomas; distal end goes down to anus, proximal end goes up to mouth.
A condition that affects mainly the colon and rectum. It is characterised by the formation of a thick blanket of yellowish-white mucosal plaques on the surface of the colon.
It is believed to result from the toxins produced by the bacteria Clostridium difficile, related to severe forms of antibiotic-associated conditions. Pseudomembranous colitis may become chronic or relapsing and may necessitate surgical intervention (total or subtotal colectomy).
Psoriasis is a chronic, recurring skin disorder that is characterised by whitish scaly patches of various sizes. The cause is unknown. It is most common on the elbows, knees, scalp, and nails, but it has also been reported to occur in the peristomal area. Psoriasis may become active (Koebner's phenomenon) following surgery or as a result of localised chemical or mechanical irritation. Active psoriasis may impair bag adhesion, but can be treated effectively with topical corticosteroids.
A thick yellow/green liquid formed at a site of an established infection.
A small pus-containing "blister" on the skin.
Pyoderma gangrenosum (PG) is a rare ulcerative, inflammatory skin disorder. Lesions may appear as single or multiple painful papules, pustules, or nodules that rapidly become indurated and ulcerated.
These often extensive lesions appear raised with a dark red to purple irregular margin.
Peristomal pyoderma gangrenosum (PPG) constitutes 4% of stoma skin problems (Lyon 2001). The
established ulcer is very painful and almost always interferes with the normal use of a stoma
PG is associated with systemic disease, e.g., inflammatory bowel disease or rheumatoid arthritis, but the cause is unknown. Treatments include topical and/or systemic anti-inflammatory preparations.
Quality of life
The individual's ability to pursue and enjoy life in relation to personal goals, standards, and concerns.
Treatment of disease with penetrating radiation. In rectal cancers, radiotherapy may be used depending on the staging and fixity. Preoperative short-course radiotherapy is given to reduce local recurrence rate. Long-course chemo radiotherapy is given preoperatively to help shrink rectal tumours prior to resection. Radiotherapy can also be given postoperatively as an adjuvant/definitive/palliative measure and where surgery is not an option.
See Retracted stoma.
When the stoma mucosa is below skin level, either circumferential or partial. Retraction may be caused by surgical technique/difficulties, recurrent malignancy, or weight gain. Retraction may cause problems in obtaining and maintaining a secure and leak-proof seal around the stoma, necessitating an in-depth assessment by a trained, competent stoma care nurse.
The rectum is positioned between the sigmoid colon and the anal canal. The rectum measures 12 to 15 cm in length, and its main function is for the storage of faecal waste. The rectum is usually empty and collapsed until just before defecation; when fully distended, it can hold up to 400 ml.
Where the stoma mucosa is below skin level, either circumferential or partial. Retraction may be caused by surgical technique/difficulties (e.g., poor mobilisation of the bowel and/or excessive tension of the suture line at the fascial layer), recurrent malignancy, or weight gain.
Retraction may cause problems in obtaining and maintaining a secure and leak-proof seal around the stoma, necessitating an in-depth assessment by a trained, competent stoma care nurse. A variety of products is available to manage this problem.
The serosa is the outermost layer of the GI tract. It is also found as the connective tissue layer (beneath the visceral peritoneum), which covers the structures within the peritoneal cavity.
Short bowel syndrome
Short bowel syndrome refers to malabsorption and malnutrition following extensive resections of the small bowel.
It occurs when disease or surgery destroys the capacity and absorption of the small bowel. If some, or all of the colon has been resected, the problems may become more complicated. Patients require assessment for additional nutritional supplements either orally, via a gastrostomy, or total parenteral nutrition.
This type of stoma is formed from the sigmoid part of the colon. It is situated on the left-hand side of the abdomen and can either be an end or a loop stoma (see Colostomy).
The sigmoid colostomy can take the longest to regain its normal peristalsis, although some flatus and faecal liquid may be seen by the third or fourth day. A normal output is expected to be a soft-formed stool, which may take between five days to a few weeks to establish after surgery.
Sigmoid colostomy function
Colostomy function varies, but normally occurs twice a day to every other day depending on diet, general condition, medical treatment, and/or underlying disease.
An investigation performed to examine the lower part of the large intestine. This investigation can be carried out using a rigid or flexible endoscope. The rigid scope visualises up to the recto-sigmoid junction. The flexible scope visualises up to the splenic flexure.
These are available in a variety of applications such as liquids, wipes, sprays, and foams. They are all water-based preparations and may contain varying amounts of lanolin, urea, propylene glycol, fragrance, and artificial colours. After use, rinsing with clean water may be required prior to pouch application.
There are two types of skin protectors.
These are available in a variety of applications such as wipes, spays, gels, liquids, and roll-on. They are made up of plasticising agents, such as copolymers with variable amounts of isopropyl alcohol.
These are also available in a variety of applications, such as wafers, rings/washers, paste, strips, and powders. They can be made from Karaya gum, pectin, gelatine, carboxymethylcellulose, polysobutolin, cotton, and copolymers. Some applications may contain alcohol.
It is important to note that any preparations containing alcohol will cause a stinging or burning sensation in patients with sore/broken skin.
Slow transit constipation
Thought to be due to a muscular disorder of the colon (colonic inertia). Treatment options include laxatives, biofeedback, and surgery.
The small intestine is 4 to 5 meters (12–15 feet) in length and consists of the duodenum, jejunum, and ileum.
It is the major organ for digestion and absorption of nutrients and is crucial for life and health.
Solitary rectal ulcer
An uncommon condition characterised by an ulcer on the anterior wall of the rectum, thought to arise as a result of repeated mucosal trauma. The condition is often associated with other rectal conditions, such as prolapse and pelvic floor disorders. Straining on hard, constipated stool may cause it or it can be externally induced by an enema tip or by using fingers or objects to aid defecation. If not treatable conservatively, surgery may be rarely indicated.
Group of muscles surrounding an opening in the body that expand or contract to control the flow of fluid/faeces through the opening.
See Mucous fistula.
Stenosis is a narrowing of the lumen of the intestine or the stoma.
Occurs at either the fascial or cutaneous level. It may be caused by ischaemia, trauma, peristomal sepsis, retraction, excessive scar formation (following mucocutaneous separation), or narrowing after repair of a peristomal hernia. Manual dilation may be considered depending on the cause; if this is not successful, re-fashioning of the stoma may be required to avoid obstruction.
Occurs in both the small and the large intestine. Sepsis, adhesions, anastomotic scarring, radiotherapy, and diseases such as Crohn's disease, diverticulitis, and malignancy may cause intestinal stenosis. Extensive narrowing will require surgical assessment to avoid complete obstruction.
A tube (usually metal or plastic) inserted into a vessel or passage (e.g., gut, urethra, bile duct) to relieve or prevent obstruction.
This term refers to perforation of the colon as a result of severe faecal impaction, which will require emergency surgery.
From the Latin word for mouth. Denotes a new opening into or out of the body.
See Ileostomy, Colostomy, or Urostomy.
A collective term referring to pouches/bags worn over a stoma. They are generally divided into three categories:
Closed appliances, which are generally worn over a colostomy.
Drainable appliances worn for a more liquid output and in ileostomy management.
Drainable with a tap for ease of emptying in urostomy management.
All categories of appliances are available in both 1-piece and 2-piece versions. The 1-piece is where the pouch/bag and baseplate/wafer are integral. The 2-piece product has a detachable pouch/bag from the baseplate/wafer. This enables the person with a stoma to change the pouch/bag without removing the baseplate/wafer.
See Wafer, Pouch.
The smallest closed pouch. Can be worn following colostomy irrigation, during intimacy and sex, or when bathing. Very useful in the appliance management of a mucous fistula.
These include stoma necrosis, mucocutaneous separation, prolapse, granuloma, retraction, stenosis, laceration (trauma), and parastomal hernia.
For peristomal complications, see Caput medusa, Allergic contact dermatitis, Chemical (irritant) dermatitis, Erythema, Maceration, Erosion, Ulcer, Granulomas, Folliculitis, Pyoderma gangrenosum, and Chronic papillomatous dermatitis.
Necrosis occurs due to inadequate blood supply to the stoma. This may be due to excessive dissection of the mesentery, traction of the mesentery (due to abdominal distension or obesity), or severe oedema of the bowel (after manipulation of the bowel or exposure of the bowel to air).
The necrosis manifests with a dark brown or black discolouration of the stoma, which appears dry and firm.
This will usually be noticeable during the first 24 hours postoperatively, but requires careful monitoring over the next 3 to 5 days after surgery. If the necrotic area extends below the fascial level, immediate revision will be required.
The stomach is a distendable J-shaped organ located in the left upper quadrant of the abdomen. Its size depends on its state of fullness. With an approximate capacity of 1 l, it is 25 cm long and 10 cm in width.
The stomach acts as a reservoir for swallowed food, which remains there for 3 to 5 hours.
The ingested nutrients mix with gastric secretions to form a semi-fluid chyme in preparation for the main digestive process that takes place in the small intestine. Another important function of the stomach is secretion of the intrinsic factor necessary for the effective absorption of vitamin B12 in the terminal ileum.
Inadequate haemostasis post-op, portal hypertension, trauma to the stoma, or recurrent disease (IBD, Pyoderma gangrenosum, polyps, diverticula, or cancer) can all cause bleeding from small vessels of the stoma mucosa, the mesentery, or at the stoma exit site on the abdomen.
Trauma to the stoma either accidental or intentional. May be evident on the stoma as a white/yellow band or red indentation. Laceration may be caused by an improperly sized aperture of baseplate/wafer, which may cut/rub on the stoma mucosa.
Refers to inflammation of the stoma, but may involve the whole gastrointestinal tract. Most commonly seen as a temporary side effect of radiotherapy or chemotherapy.
Strangulation of the bowel
Refers to a segment of bowel having a disrupted blood supply, which may result in infarction and perforation. The process of strangulation starts with partial obstruction of the bowel as a result of external pressure (tumour, hernia, adhesions) or twisting (volvulus), which leads to oedema of the bowel wall, which in turn prevents venous return.
TAR (trans-anal resection)
A palliative surgical procedure used for controlling rectal tumours that are inoperable or for patients who cannot withstand major surgery. The procedure requires the use of an endocopic instrument to 'apple-core' out the center of a rectal tumour.
TEM (trans-anal endoscopic microsurgery)
Surgical treatment of early tumours of the rectum. The use of a large endoscope per-rectum enables the entire tumour to be excised directly from the rectal wall.
A persistent urge to empty the bowel or feeling of not being able to completely empty one's bowels. This symptom may be experienced by people with a low rectal cancer.
TME (total mesorectal excision)
A surgical procedure performed during rectal cancer surgery. The mesorectum is a layer of fatty tissue surrounding the rectum. A specialist colorectal surgeon is required to perform the procedure, but it has reduced local recurrence rates and improved survival outcomes. Surgery involving the procedure will often require a de-functioning stoma.
TNM (tumor node and metastatis)
A classification/staging tool to describe bladder or colorectal tumours' stage and grade.
The transverse colon is approximately 45 cm in length. It extends from its two fixed points: the hepatic flexure to the splenic flexure linking the ascending and descending colon.
This type of stoma is formed in the transverse part of the colon. It is usually positioned on the right upper quadrant of the abdomen and can be formed as either a loop or split stoma. Loop transverse colostomies are often raised for symptomatic/palliative reasons. Due to the position of these stomas, being outside the rectus muscle, herniation and prolapse are common complications.
Transverse colostomy function
A transverse colostomy usually starts to function by the third or fourth day after surgery. Faecal output may be variable due to its location within the colon and will be dependent on diet, underlying disease, and general condition. Therefore, stoma management may require the use of either closed or drainable pouches. In addition, large/oval-shaped flanges may be necessary to accommodate the large/irregular-sized stoma.
Usually refers to a parastomal skin defect reaching into the subcutaneous layer of the skin. Ulcers may occasionally be seen on the mucosa of the stoma. In this case, they are usually in response to active Crohn's disease.
Inflammatory bowel disease that affects the colon but not the small intestine.
A non-invasive scan of the abdomen, using sound waves to build up a picture of the internal organs/abnormalities of the abdomen.
The muscular mechanism that controls the retention and release of urine from the bladder. There are two urethral sphincters:
The internal sphincter: Part of the muscular bladder wall acts as the internal urethral sphincter and prevents urine from leaving the bladder to enter the urethra. This sphincter cannot be willfully controlled but is under automatic (involuntary) control by the brain.
The external sphincter: A layer of muscle, called the urogenital diaphragm, supplies support for the contents of the pelvis and acts as the external urethral sphincter. It provides a second means of stopping the escape of urine from the body. This sphincter is under voluntary control.
The urinary tract consists of the kidneys, ureter, bladder, and urethra. The kidneys are reddish-brown, bean-shaped organs and are approximately 12 cm in length. They are located at either side of the vertebral column. The kidneys excrete waste products as urine and regulate fluid and electrolyte balance. The ureters carry urine from the kidneys to the bladder.
The tube-shaped ureters are 24 to 30 cm in length, are approximately 3 cm in diameter, and pass from the renal pelvis to the ureter orifices of the bladder.
The urinary bladder is a hollow, muscular-lined organ located in the pelvis. It acts as a reservoir for urine. Its shape varies with the amount of urine it contains.
The urethra extends from the bladder neck to the external meatus. It has a sphincter mechanism that serves the dual purpose of preventing urinary leakage between episodes of micturation and acting as a conduit during urination.
The waste material that is secreted by the kidneys. It contains urea, uric acid, and creatinine, salts, and pigments. Alkalinity/acidity of urine is expressed as pH values with 7 as the neutral point. The kidneys play an important role in balancing the acidity of the body. Urine should be a clear, amber-coloured fluid and is usually slightly acid.
Urostomy (ileal conduit/Bricker loop)
This type of urinary diversion involves disconnecting the ureters from the bladder and attaching them to an isolated segment of the ileum (or colon for a colonic conduit). The distal end of the ileum is brought out at a pre-determined site, usually on the right side of the abdomen, as a urinary stoma. A urostomy pouch/bag is then applied to allow for the collection of urine.
At the time of surgery, urethral stents/catheter (through the ureters and out into the stoma pouch/bag) are placed to stabilise the anastomosis and to prevent stenosis and obstruction during the initial postoperative period. After 7 to 14 days, these urethral stents are removed or may fall out themselves. The kidneys will be constantly producing urine; therefore, function from the ileal conduit will be immediate.
Discharge from a urostomy is normal urine, and output depends on the intake. The urostomate is recommended to drink about 1800 to 2500 ml of liquid every day. Enough and adequate fluid intake is the single most important factor in prevention of complications, such as urinary tract infections and stone formation.
This term refers to a rotation and twisting of the intestine, usually seen in the sigmoid colon. A volvulus can occur in people who have long-standing constipation or chronic laxative abuse, when the colon becomes larger, elongated, and relatively atonic. It is often possible to decompress and untwist the bowel by passing a rectal (flatus) tube, but a recurrent volvulus may require surgery (Sigmoid resection or Hartmann's).
The baseplate of a 2-piece stoma appliance. The wafer, which consists of an adhesive skin barrier with a pre-cut hole, is placed over the stoma and adheres to the skin. The wafer will also have an attachment system where the pouch/bag can be secured onto the wafer. This allows for frequent pouch changing without having to remove the wafer. The wafer can remain in place for an average of 3 to 7 days.
The term "wafer" also refers to a protective sheet (usually hydrocolloid) used as a skin barrier in stoma management.
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