A stoma is a surgically created opening on the body’s surface, typically on the abdomen, designed to divert waste products like stool or urine. This procedure becomes necessary when the body’s natural waste elimination pathways are compromised due to various medical conditions. For many individuals facing this surgery, a primary concern revolves around the potential for pain associated with the stoma itself.
Understanding a Stoma
A stoma is an opening that connects an internal organ, such as the bowel or urinary tract, to the outside of the abdomen. It appears as a moist, pink or red, round or oval-shaped tissue, often resembling the inside lining of the mouth. This surgical creation allows waste to exit the body into a collection pouch worn externally, bypassing the usual route through the rectum or urethra.
People may require a stoma for various reasons, including certain diseases of the bowel or bladder, injuries, or cancer. Common reasons include inflammatory bowel disease (Crohn’s disease or ulcerative colitis), diverticulitis, and colorectal or bladder cancer. There are three main types: a colostomy, which diverts waste from the large intestine; an ileostomy, which diverts from the small intestine; and a urostomy, which reroutes urine from the urinary tract. Stomas can be temporary, allowing a diseased or injured part of the bowel to heal, or permanent, depending on the underlying medical condition.
Does the Stoma Tissue Feel Pain?
The stoma itself, the visible tissue on the abdomen, does not contain pain-sensing nerve endings. This is because the tissue used to form the stoma comes from the inside of the intestine or urinary tract, which is not designed to feel external pain. Therefore, touching or cleaning the stoma typically causes no direct sensation of pain.
While the stoma tissue lacks pain receptors, the surrounding abdominal skin does possess nerve endings. Pressure or stimulation applied near the stoma can still be felt by the individual. Any perceived sensation directly from the stoma might actually be originating from these adjacent nerve endings or deeper tissues.
Common Causes of Stoma-Related Discomfort
While the stoma tissue itself does not feel pain, individuals with a stoma may experience discomfort or pain from various related issues. One of the most frequent causes is skin irritation around the stoma, known as peristomal skin complications. This irritation often results from leakage of output (stool or urine) underneath the adhesive of the pouching system, which can cause redness, itching, soreness, or even skin breakdown. Improper pouch fitting, incorrect size, or frequent appliance removal can also lead to skin stripping and irritation.
Stoma complications can also contribute to discomfort. A peristomal hernia, where intestines bulge around the stoma, can cause pain and may affect pouch adherence. Other issues like stoma prolapse (where the stoma extends out further than usual), retraction (where it pulls inward), or stenosis (narrowing of the stoma opening) can lead to blockages or skin problems, resulting in pain. Such complications often require medical assessment.
Internal issues can also manifest as pain in the stoma area. Bowel blockages, caused by undigested food or adhesions, can lead to severe cramping, abdominal pain, and changes in stoma output. Underlying disease progression, such as inflammation from Crohn’s disease or ulcerative colitis, or even post-surgical pain, might be perceived as originating from the stoma region. These internal pains are related to the digestive or urinary system’s function rather than the stoma tissue.
Gas and bloating are common experiences that can cause significant discomfort for individuals with a stoma. Swallowing air, consuming gas-producing foods, or digestive issues can lead to trapped gas, resulting in cramping and abdominal distension around the stoma. This type of discomfort is often relieved by passing gas or making dietary adjustments.
Strategies for Managing Stoma Discomfort
Managing stoma discomfort often begins with proper pouching and meticulous skin care. Ensuring the pouching system fits correctly, with the opening cut to the appropriate size to protect the skin from output, is fundamental. Regular, gentle cleaning of the peristomal skin with warm water, avoiding harsh soaps or alcohol-based products, helps maintain skin integrity and prevents irritation. Using skin barrier products can also provide an additional layer of protection.
Dietary adjustments play a significant role in managing gas, bloating, and preventing blockages. Eating slowly, chewing food thoroughly, and consuming smaller, more frequent meals can aid digestion. Identifying and temporarily limiting foods known to cause excessive gas (e.g., beans, cabbage, fizzy drinks) or potential blockages (e.g., certain high-fiber foods if not chewed well) can reduce discomfort.
Adequate hydration is important, particularly for those with an ileostomy, as they are at a higher risk of dehydration due to reduced fluid absorption in the large intestine. Drinking sufficient fluids, especially oral rehydration solutions, helps maintain fluid balance and can influence stoma output consistency, potentially preventing issues like very thick output that could lead to blockages.
Seek medical advice from a healthcare professional or an ostomy nurse if discomfort persists or if new symptoms arise. Persistent pain, significant changes in stoma appearance (e.g., color changes, swelling, retraction), signs of infection around the stoma, or symptoms of a blockage (like severe cramping, nausea, or no output) warrant immediate attention. They can assess the cause of discomfort and recommend appropriate interventions, which may include adjustments to the pouching system, dietary modifications, or medical treatment. For mild discomfort, over-the-counter pain relievers might be suggested, but always under professional guidance.