A stoma is a surgically created opening on the abdomen, allowing waste to exit the body into an external pouch when the normal digestive or urinary tract cannot function as intended. While a stoma significantly improves quality of life for many individuals, it also introduces potential complications. One such concern is a stoma blockage, an obstruction of stool passage. This condition requires prompt attention as it can lead to serious health issues if not addressed.
Understanding Stoma Blockage
A stoma blockage typically occurs just below the stoma, often due to undigested food particles getting lodged in the intestinal pathway. While poorly digested food is a common cause, other factors can contribute to blockages. Adhesions, which are bands of scar tissue that form after abdominal surgery, can narrow the bowel and impede passage. Inflammatory bowel diseases or diverticulitis can also lead to blockages by causing narrowing or strictures in the intestines. Additionally, a parastomal hernia, where a part of the intestine bulges near the stoma, or a twisted bowel, can also cause an obstruction.
When a blockage occurs, waste accumulates behind the obstruction, leading to a buildup of pressure within the intestines. This increased pressure can cause the bowel to swell and distend. If the blockage is not relieved, the continuous pressure can potentially compromise the blood supply to the affected bowel segment. In severe and prolonged cases, this can result in tissue damage or even perforation, meaning a rupture of the bowel, which is a life-threatening emergency. Furthermore, ongoing vomiting and reduced fluid absorption due to the blockage can quickly lead to dehydration and electrolyte imbalances.
Identifying the Signs of Blockage
Recognizing the signs of a stoma blockage early is important. The most noticeable symptom is a significant reduction or complete cessation of output from the stoma. For individuals with an ileostomy, this change can occur rapidly, sometimes within 24 hours, as ileostomies are typically very active. Those with a colostomy might experience a more gradual slowdown, initially resembling constipation.
Accompanying the change in output, individuals often experience abdominal pain and cramping, which may be localized near the stoma or spread across the entire abdomen. The abdomen may become swollen or distended, and the stoma itself might appear swollen or change color, potentially looking darker than usual. Nausea and vomiting are also common symptoms. Additionally, signs of dehydration, such as decreased urine output or dark-colored urine, can develop due to fluid loss from vomiting and reduced absorption.
Immediate Steps and Medical Care
If a stoma blockage is suspected, several initial steps can be taken at home to help alleviate the issue:
- Increase fluid intake with water, clear liquids, or warm drinks like tea or broth.
- Gently massage the abdomen around the stoma in a clockwise direction.
- Take a warm bath or apply a heating pad to the abdomen.
- If the stoma appears swollen, replace the current ostomy pouch with one that has a slightly larger opening.
- Temporarily stop solid food intake and consume only liquids.
Despite these home measures, it is important to know when to seek professional medical attention. Individuals should contact their healthcare provider or go to an emergency room immediately if they experience severe or worsening abdominal pain, persistent vomiting, a fever, or if there has been no stoma output for 12 hours or more. Signs of significant dehydration, such as extreme thirst, dry mouth, or reduced urination, also warrant urgent medical evaluation. Medical professionals may perform imaging tests, such as X-rays or CT scans, to locate the blockage. In some cases, manual dislodgement of the blockage by a healthcare provider, or even surgical intervention, may be necessary to resolve the obstruction and prevent serious complications.
Preventing Stoma Blockages
Preventing stoma blockages involves careful dietary management and adequate hydration. Chewing food thoroughly into very small pieces is a fundamental step, as poorly chewed food is a leading cause of obstructions. Eating slowly and allowing ample time for digestion can also reduce the risk. It is also advisable to introduce new foods one at a time and in small amounts, which helps identify how different foods are tolerated by the digestive system.
Maintaining adequate hydration is also important, as sufficient fluid intake helps keep stool soft and facilitates its passage. While water is the primary hydrating fluid, some individuals may benefit from oral rehydration solutions to replace electrolytes, especially if they have a high stoma output. Certain foods are known to increase the risk of blockages, particularly high-fiber items that are difficult to digest. These foods should be consumed with caution, especially in the initial weeks following stoma surgery when the bowel is still healing and potentially narrower. Regular follow-ups with healthcare providers and stoma care nurses can provide personalized dietary advice and ongoing support to minimize the risk of blockages.
- Raw fruits and vegetables with skins or seeds
- Corn
- Nuts
- Popcorn
- Dried fruits
- Celery
- Tough meats