A stoma is a surgically created opening on the abdomen that allows bodily waste to exit the body into a collection pouch (ostomy). This alteration means that waste products bypass the anus and exit through the stoma. A stoma blockage, also called a bowel obstruction, occurs when a partial or complete obstruction prevents the normal flow of output into the pouch. While some blockages can be managed at home, any obstruction is a serious medical situation that requires immediate attention and monitoring.
Recognizing a Stoma Blockage
The most common sign of a stoma blockage is a noticeable change in output, which may slow significantly or stop entirely. A partial obstruction may only allow a thin, watery liquid to pass around the blockage, sometimes accompanied by an offensive odor. This change in flow is often rapidly followed by waves of cramping and abdominal pain, which can be localized near the stoma or felt across the entire abdomen.
A person experiencing a blockage will often feel fullness or bloating as the intestine distends behind the obstruction. Nausea and vomiting are common symptoms, particularly if the blockage is high in the digestive tract; in severe cases, the vomit may have a foul, stool-like smell. Physical changes to the stoma itself are also telltale signs, including swelling of the stoma tissue and, in rare instances, a change in its normal healthy pink or red color. Reduced or dark urine can signal dehydration, which frequently accompanies a blockage due to fluid loss.
Initial Steps and Critical Time Limits
If a blockage is suspected, prompt action is necessary, as the duration a blockage can safely last is very limited. Initial self-management focuses on relaxing the abdominal muscles and encouraging the bowel to pass the obstruction. Immediately stop eating solid foods and focus on increasing fluid intake with oral rehydration solutions, water, or warm beverages like tea. Taking a warm bath or applying a heat pad to the abdomen can help relax the intestinal muscles, and gently massaging the area around the stoma may help dislodge a minor obstruction.
Movement and position changes can also be beneficial, such as taking a gentle walk or lying down with the knees drawn up toward the chest. It is recommended to seek professional medical advice if there is no output within two to four hours of symptoms beginning, or if symptoms are rapidly worsening. A complete lack of output, coupled with severe abdominal pain, persistent vomiting, or a noticeable change in the stoma’s color, constitutes a medical emergency requiring immediate transportation to an emergency department.
When Blockages Require Professional Care
Once a patient arrives at a healthcare facility with a suspected blockage, the first steps involve stabilizing the patient and determining the nature of the obstruction. Intravenous (IV) fluids are initiated to correct dehydration and electrolyte imbalances resulting from vomiting and reduced intake. Diagnostic imaging, typically abdominal X-rays or a Computed Tomography (CT) scan, is used to visualize the bowel and confirm the obstruction.
For blockages that do not resolve, a common non-surgical intervention is the placement of a nasogastric (NG) tube. This tube is inserted through the nose into the stomach to suction out accumulated fluid and air, a process called decompression. Decompression relieves pressure and distension within the bowel, which reduces pain and prevents complications like perforation. Surgery becomes necessary only if the blockage is caused by conditions like scar tissue (adhesions) or if there is evidence of bowel necrosis or perforation.
Preventing Future Stoma Blockages
Proactive dietary and lifestyle adjustments are the most effective way to minimize the risk of a recurrent stoma blockage. Thoroughly chewing food is the most important preventive measure, as poorly digested, large food particles are the primary cause of many obstructions. Patients should aim to chew each mouthful until it is almost liquid before swallowing.
Specific dietary modifications involve carefully managing the intake of high-fiber, stringy, or difficult-to-digest foods. Adequate hydration is also paramount, as sufficient fluid helps to break down food and move waste smoothly through the digestive system. Eating smaller, more frequent meals throughout the day, rather than large ones, can reduce the burden on the digestive tract and aid in consistent motility.
Foods to Limit
High-fiber foods known to cause issues include:
- Popcorn.
- Nuts.
- Seeds.
- Coconut.
- Mushrooms.
- Raw vegetables with skins or tough stalks.
- Celery and sweetcorn.