There are two main types of stomas, and they both have certain “ideal” characteristics in common. Do you know what they are?
You say potato, I say potahto. You say ostomy, I say … stoma. Huh? Those of us in wound care know that it’s not uncommon to hear the terms ostomy and stoma used interchangeably, even though they have different meanings.
In the WCEI blog, “Let’s Talk Ostomy Types,” we described the types and sub-types of bowel and bladder ostomy surgeries. Now, we’re focusing on an aspect of ostomies that wound care professionals experience directly in practice: the stoma.
What Is a Stoma?
Let’s start with the basics:
- The stoma is the mouth-like, visible part of an ostomy.
- A fecal or urinary stoma is composed of mucous membrane or the lining of the intestine that’s exposed to the surface.
- Following ostomy surgery, effluent (output) – such as fecal matter, urine, or mucous – will pass through the opening of the stoma, called the lumen.
- The patient will not have voluntary control of the effluent expelled by the stoma.
Types of Stomas
There two major categories of stomas: the end and the loop.
An end stoma is created when the surgeon brings one end of the GI tract through the abdominal wall, then folds it over. The other end is either removed or sewn shut.
In some cases, the surgeon will create end stomas from both ends of the GI tract, called a double-barrel stoma. In this case, you’ll see two distinct stomas: the proximal stoma (which discharges stool), and the distal stoma (which discharges mucous). Sometimes the two stomas will be separated by an expanse of skin, and sometimes they will share the same opening. This construction is most common for infants or very small children.
To create this type of colostomy, a loop of the transverse colon is lifted through the abdomen. The colon is given a small split on the side facing out, and a rod is placed underneath for support (the rod may be removed after a few days, when support is no longer needed). The proximal opening of the stoma drains stool from the intestine, while the distal opening of the stoma drains mucus. Loop stomas are usually created for temporary ostomies.
Ideal Stoma Characteristics
Each stoma is unique, just as each patient’s physiology is unique. And as discussed earlier, different surgical techniques will result in stomas of different appearance. At the same time, the “ideal” stoma has some identifiable characteristics:
Moist: The inner surface of the stoma continually produces mucus to cleanse the stoma. Mucus production is a normal function of the intestines that serves as natural lubrication for food passing through the body. The mucus gives the healthy stoma a wet appearance.
Beefy red: Blood flow is essential to the health of the stoma. Normal stoma tissue is highly vascular and will appear deep pink to red (pale pink is also normal in a urinary stoma). Stoma tissue may even bleed slightly when rubbed or irritated, which is normal. When a stoma turns pale, or dark, the blood supply has been compromised and needs investigation.
Round. A round stoma facilitates measurement with circular rulers, and also works best with pre-cut skin barriers (the part of the ostomy appliance that affixes to the skin and attaches to pouch). An elongated or irregularly shaped stoma may require cut-to-fit skin barriers.
The shape is affected by the type of ostomy and the individual’s body composition. The shape can also vary with the wave-like muscular contractions of the intestines, the peristaltic movement.
Budded/Protruding. When a stoma has a rosebud shape (rather than flat or retracted), it protrudes into the pouching system. This allows the effluent to fall out into the pouch away from the body. The ideal protrusion is 2-3 cm with a lumen in the very center.
Strategically Located. To easily accommodate the skin barrier, it’s ideal to have 2-3 inches of flat skin surrounding the stoma, and avoid beltlines, bony prominences, skin folds, suture lines, or the umbilicus (belly button). Also, the patient will have more success managing the stoma if it’s located in an area that he or she can see and reach.
Stoma Assessment & Education
The stoma itself has no sensory nerve endings, which means there is no sensation for the patient. In other words, the patient may not feel pain or discomfort if the stoma becomes lacerated or injured. Therefore, your thorough clinical assessment of the stoma and the surrounding skin is essential to catching problems early.
Want to learn more?
WCEI instructor Joy Hooper RN, BSN, CWOCN, OMS, WCC offers a one-hour webinar to help you conduct a stomal and peristomal skin assessment. To view the webinar for free, click here and use the code BLOG. Educational credit is available.
For advanced training and board certification in ostomy care, take the week-long WCEI Ostomy Management Specialist® (OMS) course and NAWCO certification exam, held at locations throughout the US. It will get you current with standards of care to help this underserved patient population.
Do You Know Your Stomas?
When you are asked to care for ostomy patients, do you feel comfortable assessing stomas? If not, what do you think is the most challenging aspect of this? If you have any comments (or examples to share), we’d love to hear about them. Please leave your feedback below.
Wound Care Education Institute® provides online and onsite courses in the fields of Skin, Wound, Diabetic and Ostomy Management. Health care professionals who meet the eligibility requirements may sit for the prestigious WCC®, DWC® and OMS national board certification examinations through the National Alliance of Wound Care and Ostomy® (NAWCO®). For more information see wcei.net.