What actually is a stoma, and what is the history behind it?

Andy Fletcher
Andy Fletcher
Although the creation of a stoma via an operation sounds a medical miracle, it has in fact been around for a lot longer than you will appreciate…..

Most people reading this have a stoma, but how many of us actually know what it is, or why we have it ……

Every day, the number of people who have a stoma increases – they are believed to number around one and a half million around the world.

What is a stoma

The dictionary definition of a stoma is from the Greek meaning “mouth, or opening” – it is usually created as a result of a Diverticular disease. A stoma is created from part of your intestine whereby an opening on your abdomen is created into which the stoma is then attached. The stoma is the exit point of all bodily solid waste, so therefore bypasses damaged tissue.

Sometimes if a part of your intestine is damaged, a surgeon can create a temporary “loop” ileostomy. This creates a stoma whereby all parts of your digestive tract remain in place. The reasoning behind this is that all remaining parts become inactive and thus given time to recover from whatever trauma it has encountered. The surgeon will at some stage in the future usually reverse the process and remove the stoma.

The other main type of ileostomy is called an “end” ileostomy, whereby a stoma is created which is usually permanent – the diseased parts are thus removed.

So, a stoma is actually a protruding part of your intestine, but “folded” out on itself, so the part you see is actually the inside, folded outwards (think banana skin…)

The digestive system is massive, with lots of different parts taking a different role in digestion – any of which can fail.

When you eat, food is initially mixed with saliva in the mouth and broken down into smaller pieces. Via the throat, food then passes to the oesophagus whereby contractions push it into the stomach.

The stomach secretes acid that continue breaking down any food present. The resultant end product now has a paste type consistency, which next passes to the smaller intestine where it is mixed with digestive juices from the pancreas, liver and intestine. Your small intestine absorbs moisture and digested nutrients into your bloodstream. The remaining “slush” is then pushed forward into the smaller intestine for further manipulation.

The average small intestine is around 20 foot long. Using enzymes released from the pancreas and bile from the liver, this paste continues to be broken down until it passes to the large intestine (colon).

The colon is around 6 foot long, and with the help of contractions, the remaining paste is stripped of most of its moisture and is pushed into the rectum.

The rectum is a “storage area” which holds the resultant stool until your brain says it can be expelled. When this happens, it is pushed via pelvic floor muscles into the anus from where it exits your body.

As you can see, there are a great many processes involved with the digestive system, and a failure of one part can affect other areas. As an example, if your large intestine is damaged, your body will expel a lot more moisture leaving you susceptible to dehydration. If your smaller intestine is damaged, your body may not receive all the nutrients required for healthy living, whilst if your rectum or anus is damaged, lack of bowel control could be a problem.

In my case, I only have a tiny part of my small intestine. I have no large intestine, no rectum and my anus was stitched up – so I was clearly in a bad way!

However, your body is very good at adapting – again, as an example, your large intestine also helps absorb salt from your waste into your body. When that is damaged, you will usually require additional salt in your diet to compensate. Over time though, the lower intestine will assume to take over some of the absorption.

Why do medical practitioners create a stoma for ostomates?

A stoma is usually created because medical drugs have failed to prevent disease. The creation of a stoma will in most cases result in the patient being pain free – maybe a little inconvenienced with having to carry stoma maintenance equipment around, but nether-the-less, it will give the individual a quality of life that most would have forgotten about. For me, this meant I could socialise again, go fishing, and do anything I want without having to rush to the toilet without previous notice!

Brief history about a stoma.

Although the creation of a stoma via an operation sounds a medical miracle, it has in fact been around for a lot longer than you will appreciate…..

It is believed that between 55BC and 7AD, “observations on damage to intestines” was first noted, whilst the first recorded stoma surgery was in 1707.

Over the years, stoma appliances have (thankfully) improved somewhat … in 1707, a stoma “bag” consisted only of tins, silver, pipes and cloths, but in 1795, this improved to using a leather drawstring bag. The early 20th century brought us innovations such as heavy surgical belts with plastic cups.

During the 1930’s more improvements lead to a thick heavy rubber bag being used (which was then washed out and reused), but it was not until the 1960’s that a thin “odour proof” disposable plastic bag” was used.

Modern day bags have filters, hydrocolloid tapes, soft covers and are, or course disposable.

The research and development into stoma products continues, and surgical techniques are improving every day. Who would have thought that I could undergo the total removal of my intestines and rectum by keyhole surgery, while at the same time sewing up my “no longer required” backside from the inside …

Let’s all be thankful we are not living in the 18th century!

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