A stoma is a surgically created opening on the abdomen that serves as an alternate route for bodily waste or urine to leave the body. This opening is formed by bringing a section of the intestine or urinary tract to the surface of the skin. A stoma becomes necessary when the body’s natural elimination pathway is compromised due to disease, damage, or the need for temporary rest to heal. This procedure effectively reroutes waste into an external collection pouch, restoring a patient’s ability to safely manage bodily functions.
Managing Chronic Intestinal Disease
Chronic inflammatory conditions and malignant growths are frequent reasons for planned intestinal stoma creation, such as a colostomy or ileostomy. Inflammatory Bowel Disease (IBD), including Crohn’s disease and Ulcerative Colitis, often leads to extensive damage that cannot be managed by medication alone.
For patients with severe Ulcerative Colitis, the entire colon and rectum may need to be removed to resolve the disease, resulting in a permanent ileostomy. For Crohn’s disease, a stoma may be needed to divert waste away from severely inflamed segments or to manage complications like fistulas or strictures that cause bowel obstruction.
Colorectal cancer also necessitates stoma formation when the tumor is located very low in the rectum, requiring the removal of the rectum and the muscles that control the anus. This specific type of surgery typically results in a permanent end colostomy, as the natural exit cannot be preserved or reconnected. Other long-term conditions like severe, recurrent diverticulitis can also require a planned colostomy if the affected section of the colon is heavily scarred or perforated.
Addressing Acute Damage and Obstruction
A stoma may be created urgently to address sudden, life-threatening abdominal emergencies, contrasting with chronic disease management. Acute, severe bowel obstructions, which can be caused by tumors, scar tissue, or a twisted bowel, require immediate surgical intervention to relieve the blockage and prevent tissue death.
A bowel perforation, which is a hole in the intestinal wall, causes intestinal contents to spill into the abdominal cavity, leading to a dangerous infection called peritonitis.
In cases of severe abdominal trauma, such as penetrating injuries, a section of the bowel may be too damaged to safely repair and reconnect immediately. A temporary stoma is often created during these emergency procedures to divert the fecal stream and protect the damaged intestine from contamination. This diversion is a life-saving measure that allows the compromised bowel tissue time to heal before a subsequent surgery attempts to restore the natural flow.
Diversion for Urinary Function
A distinct type of stoma, known as a urostomy, is formed when the bladder or lower urinary tract is unable to function or must be removed entirely. The primary reason for a urostomy is the surgical removal of the bladder, or cystectomy, which is most often performed as a treatment for invasive bladder cancer. Other causes include severe, irreversible radiation damage to the bladder from prior cancer treatments, or congenital defects that prevent the bladder from working correctly.
To create a urostomy, a surgeon typically uses a small segment of the small intestine, called an ileal conduit, to form a passageway. The ureters, which carry urine from the kidneys, are connected to this isolated piece of bowel, which is then brought through the abdominal wall to create the stoma. Urine then drains continuously through this opening into a specialized collection pouch, bypassing the need for a non-functional or absent bladder.
Temporary Versus Permanent Necessity
The intended duration of the stoma is dictated by the underlying reason for the surgery and the condition of the remaining organs. A temporary stoma is intentionally created to allow a downstream surgical connection, or anastomosis, to rest and heal without the irritation of passing waste. This is frequently seen after acute trauma repair or in the initial stages of complex bowel surgeries for chronic disease.
Temporary stomas are often of the loop variety, where a loop of the bowel is brought out and partially opened, with the expectation that the stoma will be surgically reversed, or taken down, after a period of weeks or months.
A permanent stoma is necessary when the disease requires the complete removal of the rectum, anus, or bladder, meaning the original pathway for elimination is gone forever. For example, a permanent end colostomy is formed when the lower bowel is removed for low-lying rectal cancer, making reconnection impossible. The majority of urostomies are also permanent because they are typically performed following the complete removal of the bladder. In certain cases, a stoma initially planned as temporary may become permanent if the patient’s health or the condition of the remaining bowel tissue prevents a safe reversal.