What are the main types of stoma?

There are three main types:

Which nurses are likely to deliver stoma care?

All kinds of nurses might care for someone with a stoma, says Jennie Burch, head of gastrointestinal nurse education at St Mark’s National Bowel Hospital, London North West University Healthcare NHS Trust. The nursing care may or may not be related to the stoma. ‘People of any age can have a stoma,’ she says.

Nurses on gastrointestinal wards are likely to be supporting patients immediately following surgery, and community nurses may continue this when a patient gets home. Nurses in care homes, cancer services, emergency departments and general practice are also all likely to provide care for people with stomas. Stoma nurses provide specialist care.

Individuals may experience poor body image or difficulty adjusting after their stoma formation, or require extra support with bag changing

Picture credit: iStock

What does essential stoma care involve?

Ms Burch says all nurses in clinical practice should be able to change a bag. This means removing the used bag, then washing and thoroughly drying the skin around the stoma before applying a new bag. It may also mean emptying the bag, depending on what type of appliance the person is using.

Getting the correct aperture cut in the bag is important and is something patients may get wrong, so careful training from the nurse is required, Ms Burch says. A hole that is too small will rub on the delicate tissue of the stoma, but one even slightly too big can allow the bag’s contents to come into contact with skin, risking irritation and leakage.

Nurses should encourage patients to manage their stoma, if possible. ‘The focus should be on promoting independence and supervising the changing if the individual needs some advice on perfecting their technique,’ says Ms Burch.

What is the key area of risk in stoma care?

Be vigilant for skin damage in the area around the stoma, where the adhesive is applied, advises Ms Burch. If this skin is broken, then the bag may not stick properly, and leakage may occur.

‘Skin damage is the most common problem we come across,’ she says. ‘Normally this is because people have got a bit rushed about washing and drying the area properly, and the skin normally heals well when a good routine is restored.’

What kind of issues might patients experience following surgery?

Anxiety, depression, poor body image, sexual problems, impaired social relations, and adjustment problems are common psychosocial issues associated with stoma formation, according to a 2019 literature review. Support from close family and friends is important, and being able to signpost or refer to peer or mental health support is a key part of stoma care, says Ms Burch.

What are some common misconceptions?

‘People are worried about physical activity – but running, swimming and all the normal parts of life, like sex and having babies, can continue,’ says Ms Burch. ‘Women with inflammatory bowel disease have a better chance of having a baby after having a stoma, as their health improves.’ People with stomas can do everything those without a stoma can do, she emphasises, and nurses need to reinforce and normalise this positive message.