List of Terms
Abdominoperineal excision of rectum (APER/APR)
A surgical procedure involving excision of the rectum and anus with closure of the perineum
resulting in a permanent colostomy. Is usually performed for very low rectal/anal cancers.
A localised collection of pus in a cavity. For example, a diverticulum or an anastomotic abscess.
Symptoms include pain and pyrexia due to infection.
Digested nutrients and fluids are absorbed via the gastrointestinal system into the blood. Disease
or surgery may reduce the body's capacity to absorb nutrients and fluids.
Accessory products assist in stoma management and include items such as belts, convex inserts, pouch
covers, bag closures/clips, sprays, creams, hydrocolloid wafers/seals, powders, pastes, odour
removers/deodorants, solvents, and tapes. They do not include the stoma bag/pouch or base
See Antegrade colonic enema.
A malignancy of glandular epithelium. 95% of cancers arising in the large bowel are
Benign tumour with the cells arising from glandular epithelium in the bowel.
Internal growth of scar tissue following surgery or sepsis. Bands of this fibrous scar tissue cause
the joining together of two surfaces, for example, loops of bowel, which normally should be separate.
A type of therapy that assists another therapy. Adjuvant therapy can be given pre- or post-surgery
for the treatment of bowel cancer, for example, chemotherapy. See Neo-adjuvant therapy, Chemotherapy,
See Gastrointestinal system.
Allergic contact dermatitis
The pathogenesis of allergic reactions is conventionally divided into four types, I to IV. Allergic
contact dermatitis is a type IV reaction, which is a delayed type hypersensitivity. In this
condition, the allergen is a chemical that is small enough to cross the skin's outer barrier (Lyon
and Smith, 2001).
An altered bodily reaction (as hypersensitivity) to an antigen in response to a first exposure. Once
established, this hypersensitivity will result in an inflammatory reaction if the agent responsible
is ever encountered again, e.g., latex.
A condition in which the blood is deficient in red blood cells, in haemoglobin, or in total volume.
Symptoms include lethargy, tiredness, and breathlessness.
Between the rectum and the anus lies the anal canal, which is 2 to 3 cm long and made up of the upper
borders of the internal and external sphincters and the puborectalis muscle.
A split in the mucosa and skin of the anal canal. Usually caused by the passage of hard constipated
stool and resulting in pain and bleeding.
Comprises the internal sphincters (involuntary muscles) and external sphincters (voluntary
constrictive muscles) to control discharge of faeces.
The surgical join of two cut ends of bowel. An anastomosis may be hand sewn or joined by the use of
Involuntary contraction of the anal sphincter.
Antegrade colonic enema (ACE)
ACE refers to a continent washout stoma.
The procedure is most commonly performed in children with continence disorders. These disorders
include congenital malformations, such as spina bifida, imperforate anus, long-term soiling, and constipation. The procedure is now also used in adults for the management of bowel dysfunction.
It is a surgical technique where one end of the appendix is re-implanted in a non-refluxing
manner into the caecum, and the other end is brought out onto the abdominal wall as a continent
stoma. This provides a catheterisable channel, which facilitates the administration of an antegrade
washout to empty the colon.
Surgical removal of part of/or all of the rectum and sigmoid colon. Anterior resections are often
categorised as high or low depending on the site of the cancer.
- High anterior resection is the removal of the upper/mid third of the rectum and the lower sigmoid colon.
- Low anterior resection is the removal of the lower and mid third of the rectum. A colonpouch may be
constructed with this procedure depending on the surgeon's preference.
- Following anterior resections, varying degrees of bowel dysfunction may be experienced, e.g.,
incontinence, diarrhoea, and constipation.
- A temporary loop ileostomy may also be necessary to protect the anastomosis, but is more
commonly seen with the low anterior resection.
The natural exit at the end of the gastrointestinal system, where faecal waste leaves the body.
See Abdominaloperineal excision of rectum.
Surgical removal of the appendix.
Inflammation of the appendix.
Surgical opening into the appendix. See Antegrade colonic enema.
"Blind" part of the caecum.
See Stoma appliances.
This is a condition where the spout of the ileostomy is torn off due to trauma.
Microscopic single-celled organisms. Some bacteria are harmless or even beneficial; others can cause
Ballooning (of stoma appliance)
Occurs when a stoma pouch/bag that is being worn by the patient fills up with flatus. This is most
likely to be seen when a filter is blocked or ineffective or where there is no filter on the
A radiological examination, where a constrast medium (barium) is introduced into the bowel, allowing
imaging of the ileum, colon, and rectum for diagnosis.
The part of a two-piece appliance that adheres to the peristomal skin and to which the pouch/bag is
A non-cancerous tissue growth that does not spread from its location site to other areas of the
Fluid produced by the liver, stored in the gallbladder, and used in the small intestine to break
down fats. Bile salts are re-absorbed in the terminal ileum. The daily volume of bile production
averages 600 to 1000 ml.
A non-surgical process that focuses on re-training the pelvic floor muscles. It involves
assessment and education of the patient for the management of constipation and faecal/urinary
Diagnostic procedure in which a tissue sample is surgically removed from a portion of the body and
subjected to microscopic analysis. Most biopsies are performed to determine whether an observed
growth of tissue is malignant or benign.
A membranous sack located inside the pelvic cavity for temporary storage of urine. The bladder is
normally a compliant structure that allows for storage of up to an average of 400 ml of urine.
A malignant growth within the bladder. Bladder cancers usually arise from the transitional cells
of the bladder (the cells lining the bladder).
These tumours may be classified based on their growth pattern as either papillary tumours (meaning
they have a wart-like lesion attached to a stalk) or nonpapillary tumours. Nonpapillary tumours are
much less common, but they are more aggressive and have a poorer prognosis.
As with most other cancers, the exact cause is uncertain.
Bladder cancer is divided into five stages:
Stage 0: In-situ or non-invasive lesions limited to the bladder lining.
Stage I: Tumour extends through the mucosa, but does not extend into the muscle layer.
Stage II: Tumour invades into the muscle layer.
Stage III: Tumour invades past the muscle layer into tissue surrounding the bladder.
Stage IV: Cancer has spread to regional lymph nodes or to distant sites (metastatic).
Bladder cancer spreads by extending into the nearby organs, including the prostate, uterus, ureters,
Excessive gurgling noises heard in the intestine, for example, in bowel obstruction and irritable
The bowel is made up of two parts:
Small intestine: See Duodenum, Jejunum, and Ileum.
Large intestine: See Colon and Rectum.
Bricker bladder/Bricker loop
An opening into the caecum generally used to decompress the large bowel in cases of obstruction.
Very rarely used as a formal stoma.
This is the first section of colon/large bowel, which is 10 to 15 cm (2.5–3 inches) in length and is
situated on the lower right side of the abdomen. The caecum contains the ileocaecal valve and the
This term refers to the abnormal and uncontrolled growth of cells, which may destroy and invade
adjacent body tissues or spread elsewhere in the body (secondary spread metastases). Normally cell
divisions and replications divide to match normal cell loss. On rare occasions, there is a defect in
this division, and a rogue, potentially malignant cell arises. This is not recognised by the immune
system and will continue to divide to produce millions of unwanted cells, thus destroying the
function of normal body cells.
A term used to describe a bluish-purple discoloration of the skin caused by dilation of the
cutaneous veins around the stoma. This is usually as a result of portal hypertension (sometimes seen
in the terminal patient when liver metastasis is present).
A polysaccharide extracted from plant fibres that absorbs moisture and forms a gel. It is a
constituent of the stoma skin barrier and can also be found in food and drugs.
A plastic/silicone/rubber tube, which allows fluids to pass into or out of the body.
Chemical (irritant) dermatitis
Inflammation of the peristomal skin area due to direct toxic reaction from faecal/urinary leakage,
ostomy deodorants, or solvents.
Cytotoxic drug therapy used to control or destroy existing disease and reduce the risk of re-occurrence of cancer. It can be administered by various routes, including orally or
Chronic papillomatous dermatitis
Greyish nodules/warty papules occurring on the skin around urostomies as a reaction to urine
irritation of the skin. Also known as pseudoverrucous lesions and pseudoephitheliomatous
hyperplasia. If contact with urine is stopped, the condition resolves within a few weeks.
Surgical removal of all or part of the colon/large bowel. This procedure may require stoma
formation depending on extent of disease, physical status, and patient/surgeon preference.
Subtotal colectomy: Surgical removal of part of the colon with either an anastomosis or a temporary/
Total colectomy: Surgical removal of the whole colon with either an ileorectal anastomosis or an
Proctocolectomy: Surgical removal of the colon and rectum with a permanent ileostomy. Or if performed in
conjunction with an ileo/anal pouch, a temporary loop ileostomy may be required. See Ileo anal
Pan proctocolectomy: Surgical removal of the colon, rectum, and anus resulting in a permanent
Other colonic resections include:
Sigmoid colectomy: Surgical removal of the sigmoid colon.
Right hemicolectomy: Surgical removal of the ascending colon.
Extended right hemicolectomy: Surgical removal of the ascending and part/all of the transverse colon.
Left hemicolectomy: Surgical removal of the descending colon.
Extended left hemicolectomy: Surgical removal of the descending and part/all of the transverse/sigmoid
Hartmann's procedure: See Hartmann's procedure.
High anterior resection: See Anterior resection.
Low anterior resection: See Anterior resection.
A colostomy is a surgically created opening in the large bowel/colon. The bowel is brought through
the abdominal wall and sutured to the skin. A colostomy can be formed in the ascending, transverse,
descending, or sigmoid colon, although the most common colostomy sites are sigmoid (left iliac fossa)
and transverse (right upper quadrant) colon. The colostomy diverts the faecal flow through the
stoma, and a pouch/bag is worn to collect the faeces.
The stoma does not possess any nerve endings; therefore, any trauma to the stoma will be painless but
harmful, e.g., injury from an ill-fitting stoma appliance.
A colostomy generally starts to function 2 to 5 days postoperatively. The output, volume, and
consistency vary in each individual case and on the location of the stoma within the colon. This
means that a colostomy in the distal colon will produce stool of thicker consistency and lower
volume than a colostomy in the proximal colon. There is frequently an 'adaptation phase', which may
last for several weeks. The average person with a colostomy would change/empty the pouch two times a
A method of bowel management suitable for sigmoid/descending colostomies to regulate bowel
movements and provide continence between procedures.
The irrigation is self-administrated through the colostomy (every 24–48 hours) and makes it
unnecessary to use a normal size stoma appliance. A stoma cap is often sufficient. Medical advice
should be obtained prior to education and training of procedure.
A channel or pipe for conveying fluids.
Conditions/defects that arise during foetal development or at birth, for example, Imperforate anus
or Hirschprungs disease.
Irregular and infrequent defecation, accompanied by hard, dry stools, which are difficult to
Continent urinary diversion
See Mitrofanoff principle, Kock pouch.
Convexity (convex stoma appliances)
Convexity is defined as the outward curving of a base plate or skin barrier. The convexity allows
for continuous contact between the skin and the pouching system.
When in contact with the skin, the convexity creates pressure on the peristomal area to partly evert
a retracted or flush stoma. This helps to provide security and prevents leakages.
Convexity products are made as one- and two-piece appliances, manufactured in both hard and soft
materials. A range of depths is available between 2 and 7 mm.
Patients should be carefully assessed for the appropriate use of hard convex products, which should be used only under the guidance of a trained competent stoma care nurse. Deep, hard convex products
have been known to trigger peristomal skin problems like pressure ulcers or the onset of pyoderma
See Chronic papillomatous dermatitis.
An inflammatory disease affecting any part of the gastrointestinal system from mouth to anus.
The ureters are brought directly onto the skin surface to drain the urine. This type of diversion is
mainly performed in babies or children as a temporary intervention until extensive surgery can be
performed. It can also be used as a palliative measure in terminally ill patients with obstructed
ureters, e.g., tumours and when the insertion of nephrostomy tubes are not feasible.
A urinary diversion directly from the bladder to the skin. More common in infants and young children as the bladder is located more abdominally than in adults.
The bladder is mobilised midway between the umbilicus and symphysis pubis. The bladder mucosa is
sutured to the skin and a pouch/bag is worn.
Total or partial removal of the urinary bladder, resulting in a urinary stoma or a continent urinary
A multi-organ, genetically determined disease, thought to be due to a primary disorder of the
exocrine and mucous-secreting glands. In the newborn, this condition results in the meconium being
very thick and tenacious. This can result in intestinal obstruction, which may necessitate
The action of emptying the rectum of faeces. The reflex for this is initiated by distension of the
rectal wall, which stimulates the stretch receptors and causes contraction of the rectal muscles.
An ileostomy or colostomy constructed to divert the faecal flow away from a diseased, traumatized
segment of the bowel or a newly formed anastomosis.
See Allergic contact, Chemical irritant dermatitis, and Chronic papillomatous dermatitis.
The skin layer below the epidermis.
Fibrous tissue tumours, which may grow on the anterior abdominal wall in the abdomen.The cause is
unknown, but they occur in about 9% of familial adenomatous polyposis patients.They do not
metastasise but can grow to varying sizes. Due to their sheer bulk and location, they may require
surgery, only if symptomatic, e.g., there is a bowel obstruction (Phillips 2001).
Classified as increased amounts of loose, watery effluent or the number of loose or unformed bowel
movements in a 24-hour period.
The conversion of food into absorbable substances in the gastrointestinal system. Digestion is
accomplished through the mechanical and chemical breakdown of food into small molecules, which can
then be absorbed into the bloodstream.
Stretch/widen a stenosed area of bowel lumen, e.g., a stoma or an anastomosis.
Below the point of reference. The anus is distal to the rectum.
Over-expansion of the bowel with gas/fluid/stool. Reasons for distension include intestinal
obstruction, constipation, irritable bowel syndrome, and acute abdomen.
Diverticular disease (diverticulosis/diverticulum/diverticulitis)
A condition where small sacks or pouches form in the wall of the large bowel. Contributory
factors include raised intraluminal pressure related to low fibre diet and lifestyle. Commonly found
in the descending/sigmoid colon from late middle age and onwards. The term diverticulitis is used
when the pouches or sacks become inflamed or infected. Complications arising from diverticular
disease include fistula formation, abscess, stricture, haemorrhage, and perforation leading to
peritonitis. These complications can result in surgery and sometimes stoma formation.
See Mucous fistula.
Double-barrel stoma (Paul Mickulitz)
This type of stoma can be formed from the ileum or the colon. The bowel is divided and the proximal
and distal ends are brought out through one opening in the abdominal wall and sutured to the skin to
form two stomas, which lay side by side and are managed as one stoma.
Dukes classification is one of the most widely used classifications designed to define the extent of
Dukes classification uses stages from A to D.
A: The cancer is confined within the bowel wall.
B: The cancer has spread through the wall of the bowel.
C: The cancer has spread into the lymph nodes.
D: The cancer has spread to other sites, often the liver.
First 25 cm of the small intestine extending from the pylorus to the jejunum. It plays a vital part
in digestion due to the digestive enzymes being delivered from the liver/gallbladder and pancreas.
The main function of the duodenum is to neutralise acidic gastric contents, emulsify fats, and absorb
Alternative term for indigestion or heartburn.
Abnormal changes of mature cells that indicate possible development of cancer. These may be graded
as mild, moderate, or severe dysplasia.
The process of excretion of metabolic waste from the blood via the kidneys.
When just one end of the bowel is exteriorised and formed into a stoma. This may be from either
small or large intestine.
A collective name for visual inspections of the gastrointestinal tract using a flexible fiberoptic
endoscope. The procedure can be performed for either diagnostic or therapeutic purposes. The
procedure is performed to find the cause of bleeding, diarrhea, abdominal pain, and/or constipation
and also to detect signs of cancer, bleeding, inflammation, abnormal growths, and ulcers.
Enteral tube feeding
When oral feeding fails to meet nutritional requirements, patients may need enteral tube feeding. This
involves the introduction of nutrients (via a tube) into the gastrointestinal tract by four main
Nasogastric: Via the nose and into the stomach.
Nasoduodenal: Via the nose and into the duodenum.
Gastrostomy: Through the abdominal wall and into the stomach.
Jejunostomy: Via the abdominal wall and into the jejunum.
An enzyme is a biological catalyst, which alters the rate of a chemical reaction without itself
External non-vascular layer of the skin.
Surface layer of cells covering internal and external surfaces of the body, including cutaneous,
mucous, and serous layers.
A term applied to a gradual breakdown of the epidermis. The skin will be excoriated; moist and
bleeding. The erosion does not extend into the dermis and heals without scarring.
A term applied to redness of the skin produced by congestion of the capillaries.
The process of emptying the bowel or bladder (elimination).
To surgically cut out/ remove a part, e.g., bowel or bladder.
A term used in stoma care to describe a superficial loss of skin around the stoma. This results in
the skin integrity being broken, leading to a moist, bleeding area.
Radical surgical removal of some/all of the pelvic cavity.
The extent of the disease will determine how radical the procedure will be. For example, total
pelvic extenteration could include the removal of the bladder, lower ureters, urethra, vagina,
ovaries, uterine tubes, colon, rectum, anus, pelvic lymph nodes, and all of the pelvic
Faecal impaction is the result of chronic constipation causing a grossly dilated colon. Treatments
include conservative management and/or surgery.
Faecal occult blood
Solid/semi-solid waste products excreted by the body through the anus. Faecal material consists
primarily of bile pigments, mucus, unabsorbed minerals, undigested fats, cellulose, desquamated
epithelial cells, potassium, sodium, bicarbonate, and water. Faecal composition is three parts water
and one part solid material. Amount of faeces evacuated is approximately 150 to 250 g daily.
Familial adenomatous polyposis (FAP)
A hereditary condition where large numbers (100–1000) of pre-malignant polyps develop in the large
bowel from puberty and onwards. Malignant changes occur if left untreated. Treatment includes surgical removal of the colon and rectum.
The roughage constituent from indigestible foods. Daily recommended intake of fibre is 18 to 30
g. Dietary fibres contribute to a healthy diet for people with or without a stoma, but should be
used with caution for a person with an ileostomy.
There are two forms of fibre:
- Soluble fibre attracts water and turns to gel during digestion. This slows digestion and the
rate of nutrient absorption from the stomach and intestine is increased. It is found in oat bran,
barley, nuts, seeds, beans, lentils, peas, and some fruits and vegetables.
- Insoluble fiber is found in foods such as wheat bran, vegetables, and whole grains. It appears to
speed the passage of foods through the stomach and intestines and adds bulk to the stool.
An abnormal passage or communication from an internal epithelialised organ to the skin surface or
between two internal epithelialised organs.
- Colo - Colon
- Entero - Small bowel
- Vesico - Bladder
- Vaginal - Vagina
- Cutaneous - Skin
- Recto - Rectum
e.g., a colovaginal fistula will be from the large bowel to the vagina.
Common causes of fistulae include diverticular disease, Crohn's disease, and radiotherapy. A large
proportion of fistulae occurs as a complication of surgery and is more common in malnourished
See Wafer and Baseplate.
Gas/wind formed in the large intestine as a result of the action of bacteria on undigested food. We
produce between 400 ml and 2 l of wind/gas in 24 hours.
Where the stoma mucosa is at a level with the skin, either circumferentially or partially. A stoma may
be flush because of surgical technique/difficulties (e.g., poor mobilisation of the bowel and/or
excessive tension of the suture line at the fascial layer), recurrent malignancy, or weight gain.
This may cause problems in obtaining and maintaining a secure and leak-proof seal, particularly in
the management of an ileostomy or urostomy, due to the liquid nature of the output. A variety of
stoma products is available to manage this problem.
FOB (faecal occult blood)
Presence of microscopic blood in the stool.
Pustular lesions and inflammation seen at the hair follicles surrounding the stoma.
A pear-shaped sack 7 to 10 cm long, which acts as a reservoir for bile.
Related to the stomach.
A reflex precipitated by the entry of food into the stomach causing the terminal ileum to
contract and faeces to enter the caecum. In response to this, there is a mass movement within the
bowel, which can propel the bowel contents up to 30 cm towards the rectum. This reflex usually
occurs after meals, but is particularly evident in the morning.
Gastrointestinal system (GI tract/alimentary canal/digestive system/gut)
The gastrointestinal system starts at the mouth, finishes at the anus, and is approximately 6 to 7
meters (15–20 feet) long. Its main function is to digest, absorb, store, and evacuate.
Inspection of the upper gastrointestinal tract, including the oesophagus, stomach, and duodenum.
A protein extracted from animal skin, hoofs, and bones. It is a fine, white powder that absorbs
moisture and forms a gel. It is used in food and drugs, as well as in stoma skin barriers.
A term used to describe small, reddish, raised areas/nodules on the stoma or on the peristomal skin.
Commonly caused by local irritation from stoma appliances, suture sites, and/or leakage of
See Gastrointestinal system.
Commonly known as piles. Haemorrhoids are engorged and displaced vascular anal cushions. These anal
cushions normally help seal the upper and lower canal and contribute to continence. Caused by
constipation, straining, and pregnancy. Symptoms include bleeding and discomfort.
In this procedure, the diseased part of the distal colon is surgically removed. The proximal end of
the descending or sigmoid colon is brought up to the surface of the abdomen to form an end
colostomy. The rectal stump is over-sewn/stapled and left inside. The colostomy may be permanent or
temporary. The most common reasons for performing this procedure are complicated diverticular disease or
Hernia (parastomal hernia)
A weakness in the muscle layer where internal organs may protrude. A parastomal hernia appears as
a bulge around the stoma. The bulge contains loops of intestine that protrude through the fascia
defect around the stoma and into the subcutaneous tissue. Causes include surgical technique, muscle
weakness, and coughing/straining.
Parastomal herniation is a common complication, which may occur weeks, months, or years after stoma
The patient often experiences discomfort, has problems with stoma appliances/clothing, and can find the
appearance of the hernia very distressing.
Management can include fitting an abdominal support, appliance advice, and occasionally, surgical
A rare complication is if the bowel segment becomes strangulated. The patient will have symptoms of
an acute abdomen (bowel obstruction, ischaemic bowel, abdominal pain, distension, vomiting) and
would require urgent surgery.
This disease is due to an absence of autonomic ganglion (nerve) cells of the large intestine. This
prevents peristalsis occurring in that part of the bowel (spastic). Approximately 75% of the cases
are confined to the recto-sigmoid region (short-segment Hirschsprung's disease), 10% have total
colonic involvement (long-segment Hirschsprung's disease). The condition usually becomes apparent in
the neonatal period (80%) due to the delayed/failed passage of meconium. In babies, it usually
appears with increasing abdominal distension and vomiting, requiring surgery to relieve the
obstruction. Infants with this condition will need to have a temporary stoma, but a second operation
will be carried out a few months later to remove the spastic (aganglionic) section of bowel and
'pull through' the healthy bowel down to the anus.
Children with short-segment disease have a good outlook. Those with long-segment disease (no nerve
cells in the colon) are more likely to require their ileostomy for longer, depending on the child's
Hirschsprung's disease affects 1:5000 live births and is more prevalent in males than females
Microscopic study of the structure of cells and tissues to assist diagnosis.
HNPCC (hereditary non-polyposis colon cancer)
A dominantly inherited genetic abnormality that predisposes to colorectal cancer. 80% of people
with HNPCC are at risk of developing cancer.
Hydro means water; colloid means stable solution of particles in water. It is a synthetic carboxymethylcellulose substance bound with copolymers, gelatine, pectin, and/or cotton. The particles
absorb water and form a gel. Hydrocolloids are used in the pharmaceutical, cosmetic, and chemical
industry. Hydrocolloids are an important ingredient in the manufacturing of stoma skin barriers.
(Urostomy/Bricker loop or Bricker bladder)
(Ileo-anal reservoir, Ileal pouch anal anastomosis (IPAA), Restorative proctocolectomy)
This is an optional surgical procedure primarily for patients with ulcerative colitis and familial
adenomatous polyposis. During this procedure, the colon and rectum are removed and a reservoir/pouch
is constructed, using the distal ileum. The configurations of the pouch can vary depending on
surgeon preferences. The most common ones are the J-pouch and W-pouch. The pouch is then
joined/anastomosed to the anus to restore continuity of bowel function. To facilitate healing in the
postoperative period, the patient may require a temporary loop ileostomy.
Ileo-anal pouch function
Following pouch construction, and when continuity of the bowel function is restored, the number of
pouch evacuations varies with each individual. The expected average defecations/emptying of the
pouch is between 4 and 8 in a 24-hour period. This will be more frequent in the initial months until the
ileal pouch has adapted to its new function. Patients commonly require anti-diarrhoea medication to
help control output.
With the faecal evacuation coming directly from the small bowel, skin irritation and soreness in the
perianal area are common. Cleansing of the anal area is therefore recommended after each pouch
evacuation. Skin barrier creams can also be applied to prevent skin irritation in this area.
The ileo-caecal valve is a one-way valve located at the junction between the ileum and colon. It
regulates the emptying into the colon and prevents reflux of contents back into the small
An ileostomy is a surgically created opening in the small bowel, the ileum. In most cases the
surgeon uses part of the terminal ileum (last section of small intestine) to form the stoma. The
ileum is brought through the abdominal wall, everted to form a spout, and sutured to the skin. The
output/consistency will vary depending on the location of the stoma within the small bowel. A stoma
pouch/bag is applied to allow for the collection of faeces. The stoma does not possess any nerve
endings; therefore, any trauma to the stoma will be painless but harmful, e.g., injury from an ill-fitting stoma appliance.
An ileostomy may stop functioning due to a blockage caused by adhesions or undigested food. The
patient may experience abdominal pain, distension, nausea, and vomiting. There will be minimal or no
output from the stoma. Management will include fluids only, relaxation, and abdominal massage. A food
blockage will in most cases resolve spontaneously, but if symptoms persist, the patient may require
admission to hospital for conservative or surgical treatment.
An ileostomy generally begins to function within the first 48 to 72 hours after surgery. The initial
effluent is usually viscous, green, and shiny. This output does not necessarily signal return of
peristalsis; it can be fluid that has been collected in the distal small bowel. Once peristalsis
returns, the patient may experience a period of high-volume output from the stoma.
This is often referred to as the 'adaptation phase'. Output during this period can exceed 1000 ml
per day. The physiological basis of this high-output phase is loss of the colon's absorptive surface
coupled with the delay factor normally provided by the ileocaecal valve. It is very important to
monitor the patient in this period (fluid and electrolyte balance).
Over a period of days or weeks following surgery, the proximal small bowel increases fluid
absorption. There is a gradual reduction in the volume of output, and a thickening of stool to a 'toothpaste' consistency will occur. This may vary according to the amounts/type of food and drink
consumed. After this 'adaptation' period, the average amount produced by an ileostomy decreases to
between 500 and 800 ml per 24 hours. An ileostomy will function intermittently throughout the day. The
effluent from an ileostomy contains enzymes, and if in contact with the peristomal skin, excoriation
and soreness will occur.
The final and longest segment of the small intestine. It extends about 4 m (13 ft) from the jejunum
(middle section of the small intestine) to the ileocaecal valve, where it joins the large
It is the site of absorption of fluids, nutrients, vitamin B12 and re-absorption of about 90% of
conjugated bile salts. Disorders of the ileum produce problems of absorption and vitamin B12
deficiency. Fluid imbalance caused by diarrhoea will occur as a result of malabsorption and the
presence of bile salts in the large intestine interfering with water absorption.
See Paralytic ileus.
This is when a newborn baby has a displaced or unformed anal opening. Imperforate anus affects 1 in
4000 new babies, but the cause is unknown. These infants may also have other congenital anomalies,
such as fistulae (recto-urethral fistulae in boys, recto-vestibular fistulae in girls). Other malformations, such as vertebral defects, cardiac anomalies, and oesophageal atresia are often associated with the
condition. The incidence of kidney and bladder problems increases with the severity of the
imperforate anus, ranging from 5 to 20% with low lesions and up to 60 to 90% in high lesions.
Babies born with this condition will need surgery to create an opening (anus) to allow for the
passage of stool. This initially requires the formation of a stoma and then further reconstructive
surgery at a later date depending on the severity of their condition.
Discomfort/pain in the digestive system, differs from person to person, and is related to diet and physical and psychological circumstances. Also called heartburn.
Invasion of the body by various agents (bacteria, fungus, protozoa, viruses, worms) and the body's
reaction to them or their toxins. Infections are sub-clinical until they affect health, when they
then become infectious diseases/conditions. Infections can be local (e.g., an abscess), confined to
one body system (e.g., pneumonia in the lungs), or generalised (e.g., septicaemia). Infectious agents
can enter the body by inhalation, ingestion, and transmission or wound contamination. The body
responds with a rise in leukocytes, production of antibodies or antitoxins, and often a rise in
The body's reaction to infection, irritation, or other injury. The symptoms include redness, warmth,
swelling, pain, and impaired function.
Inflammatory bowel disease (IBD)
Inflammatory bowel disease is a broad term used to describe the two conditions: Crohn's disease (CD)
and ulcerative colitis (UC). There is no definitive cause, aetiology is uncertain, and the usual
presentation is in young people. Common symptoms are abdominal pain, weight loss, diarrhoea, mucous,
and anorexia. Inflammatory bowel disease is characterised by remissions and relapses. The majority
of cases are managed conservatively, but some will eventually require surgery.
Crohn's disease affects any part of the gastrointestinal tract from mouth to anus and may involve
all layers of the intestinal wall with acute and chronic inflammation, resulting in fissures,
fistulae, abscesses, and strictures. Non-continuous parts (skip lesions) of the intestine (both large
and small) may be affected, the most common parts being the terminal ileum and ascending colon. Smoking
has been proven to be a risk factor for recurrent episodes of Crohn's disease. Medical management
and surgery may alleviate symptoms, but at present, there is no cure for this disease.
Ulcerative colitis is confined to the colon and rectum. Ulcerative colitis often starts in the
rectum and spreads proximally in a continuous manner. The inflammation causes bloody diarrhoea,
urgency, and frequency of stools. Where surgery is required, a restorative procedure can be an option,
for example, Ileo-anal pouch.
Can be identified as any form of surgically reconstructed internal pouch/reservoir for the purpose
The intestine, especially the colon, contains millions (over 400 species) of helpful bacteria that
assist the digestive process and maintain intestinal function. Anaerobic bacteria present in the
colon serve to putrefy remaining proteins and indigestible residue. This bacterial action also
creates intestinal gas.
(Common bacteria include Escherichia coli, Aerobacter aerogenes, Clostridium perfigens, and
These secretions are necessary for the process of digestion. The major characteristic is the high
content of digestive enzymes. Secretions enter the duodenum from the pancreas, the liver, and the
glands in the bowel (intestinal) wall.
Pancreatic secretion has a high bicarbonate concentration and therefore an alkaline pH
(neutralises the acid entering from the stomach); the digestive enzymes secreted from the pancreas
are trypsin (protein digestion), amylase (starch digestion), and lipase (fat digestion).
Bile (secreted by the liver and stored in the gallbladder) contains the bile salts cholesterol and
lecithin (emulsifying of fat). Secretions from the intestinal glands consist of mucous, which
protects the duodenum from attack by hydrochloride acid, hormones, electrolytes, and enzymes.
A part of the alimentary canal extending from the stomach to the anus.
Refers to the invagination of one part of the intestine into itself. Clinical symptoms (colic pain
and the "red currant jelly" stool), together with physical and radiographic examination, help
in diagnosing this condition. It can occur at any age, but more than 60% of the cases are encountered
from birth to 4 years.
A method of cleaning the bowel by instilling water via the stoma/rectum. There are two types of
irrigation: antegrade colonic irrigation and colonic irrigation.
Irritable bowel syndrome (IBS)
A common condition characterised by symptoms of cramping, abdominal pain, bloating, and erratic
bowel habit. The cause is unknown, but it is often associated with stress, with anxiety, or following
severe intestinal infection. On investigation, there is no detectable structural disease.
Poor blood flow to an area caused by constriction or blockage of the blood vessels supplying the
area, e.g., an ischaemic/necrotic stoma.
A jejunostomy is a surgically created opening from the jejunum that is brought through the abdominal
wall and sutured to the skin. This type of stoma is relatively uncommon, but may be necessary in
extensive Crohn's disease or ischaemia. A high-output stoma pouch/bag will be required to manage
A jejunostomy will generally function immediately. The very watery output and high volume (4–12
l per 24 hours) necessitates the need for additional parenteral nutrition. This is due to the
inability for normal digestive absorption to take place in the ileum.
The middle part of the small intestine that extends from the duodenum to the ileum. It measures about 3
meters (9 feet) in length. The jejunum is the major organ for nutrient absorption.
Most of the fats, proteins, and vitamins are absorbed in the jejunum, as well as any remaining
carbohydrates not already absorbed in the stomach or duodenum. Approximately 3 to 3.5 l of
intestinal fluid are secreted into the jejunum per 24 hours.
Is produced in India and is a polysaccharide taken from the Sterculia urens tree. Karaya gum has a
special buffering action, which keeps the skin pH slightly acidic (4.5–4.7). Due to its excellent
water holding capacity it is used in ice creams, sausages, and breads to improve consistency, as well
as being the active ingredient of the Karaya paste and the Karaya skin barrier for stoma
See Urinary tract.
Kock pouch (continent ileostomy)
The surgical construction of an internal pouch/reservoir. The internal pouch provides storage
capacity of faeces and eliminates the need to wear a permanent stoma pouch/bag. Following
panproctocolectomy, approximately 45 cm of distal ileum is used in the construction of the pouch.
Once this has been achieved, an outlet channel with a nipple valve using the terminal ileum is
constructed. The function of this valve is to maintain continence. The outlet channel is passed
through the abdominal wall, out onto the body surface, leaving a small flush stoma. Emptying the
pouch takes place by inserting a catheter into the stoma and down into the pouch. The catheter opens
the nipple valve and evacuation takes place.
Whilst the need for a stoma appliance has been eliminated, a stoma cap or dressing may be required
to absorb any mucus from the stoma. The Kock pouch is not considered to be the first surgical choice
when internal pouch surgery is an option (see Ileo-anal pouch), but may be offered to patients who
have had their anal sphincters removed.
Kock pouch (continent urostomy)
Kock urinary reservoir:
This was developed as a variation of the Kock continent ileostomy. The reservoir is located in the
abdominal cavity, and to construct the reservoir, 60 to 80 cm of the ileum is used. An intussuscepted valve
achieves the continence mechanism at the stoma site. A second nipple valve is constructed at the
other end of the ileum and the ureters implanted; this second valve is intended to prevent reflux into
Laceration (of the stoma)
This term refers to a cut/tear to the stoma, usually due to friction from the stoma appliance, or it
may develop in conjunction with trauma to the stoma. It usually appears as a yellow-to-white linear
discoloration of the stoma mucosa.
It can be severe enough to penetrate/fistulate the bowel wall, but is commonly superficial. Due to
the fact that the stoma does not contain nerve endings, the patient may not experience any pain.
An examination or surgical procedure using a type of endoscope (laparoscope) inserted through the
abdominal wall via small incisions. The procedure is carried out under video control and minimises
trauma, postoperative pain, and length of hospital stay. A variety of surgical procedures
(colectomy, stoma formation, ACE procedure) can now be performed in some specialised centres.
A surgical incision of the abdominal wall used in exploratory emergency surgery and elective
Large bowel (Intestine)
The large bowel (intestine) begins at the ileocaecal valve, terminates at the anus, and is about
1.5 m (4–5 feet) long. Its main functions are the absorption of fluid and electrolytes, mixing and
propelling contents from the terminal ileum towards the anus, storage, and defecation. It also
produces mucus to facilitate the passage of faeces and harbouring of colonic bacteria for the
breakdown of complex carbohydrates and synthesis of vitamins B and K.
The liver is the largest organ of the body, weighs up to 2 kg, and plays a vital role in digestion.
It is dark red in colour and occupies the upper right portion of the abdominal cavity immediately
below the diaphragm. It receives blood both from the hepatic artery and the portal vein and returns
it to the systemic circulation by the hepatic veins.
It is a complex organ that performs many metabolic and digestive functions. The functions of the
liver include bile formation; metabolism of carbohydrate, protein, fat, steroid, and minerals;
vitamin storage; coagulation; and detoxification. The liver also converts sugars into glycogen, which
it stores until required.
Bile production and secretion are continuous processes within the liver. Bile salts, the most
abundant substance secreted into bile, are formed by the liver cells. Bile salts function primarily
to emulsify fat globules into minute sizes to facilitate digestion and to promote the absorption of
lipids (cholesterol and fatty acids) across the intestinal mucosa. Re-absorption of approximately
94% of the bile salts occurs in the terminal ileum; the re-absorbed salts are returned to the liver
through the portal blood. The daily volume of bile production averages 600 to 1000 ml.
A loop colostomy is formed in the large bowel, and common sites are in the transverse colon (right
upper quadrant) or sigmoid colon (left iliac fossa).
A loop ileostomy is formed in the small intestine, commonly in the terminal ileum (right iliac
A loop of intestine is brought out through a surgical opening made in the abdominal wall. This diverts the faecal flow from diseased, traumatized, obstructed intestine or from the site of an anastomosis.
When the stoma is constructed, the bowel is not completely divided but is opened along the anterior surface. The opened edges are then everted and sutured to the skin. This stoma has two distinct openings, the proximal functional opening and the distal non-functional opening, that remain connected by the undivided posterior section of the bowel wall.
Loop stomas are sometimes supported in position by a bridge/rod of plastic, rubber, or glass. The bridge/rod prevents the stoma from retracting and remains in position 5 to 10 days following surgery.
The construction of a loop stoma means that faeces may sometimes overflow from the functional proximal opening into the non-functional distal opening. This is generally not a cause for concern but requires careful explanation to the patient.
A loop stoma can either be temporary or permanent. A loop stoma can be constructed as part of a major surgical procedure (laporotomy) or a minimal surgical procedure (laparoscopy).
Peristomal skin being excoriated and moist.
Another term for cancer.
The first stools of a newborn baby.
The inability to pass meconium (stool) by normal defecation in the newborn. The condition may result
in intestinal obstruction, perforation, and peritonitis, which will ultimately require surgery.
A term used to describe a number of conditions in which the colon is excessively dilated, e.g.,
Hirschsprung's disease and/or Inflammatory bowel disease. If left untreated, it may predispose to
A double layer of peritoneum that encircles most of the small intestine and anchors it to the
posterior abdominal wall. The mesentery contains the blood vessels and nerve fibres that supply and
nourish the small intestine.
Spread of cancer cells from their original site. Cells from a primary malignant tumour may invade
and get into the bloodstream or lymphatic system enabling them to reach a new site and form a
The most common site for colorectal cancer to metastasise is the liver. The most common site for bladder cancer to metastasise is the prostate, uterus, ureters, and rectum.
See Stoma cap.
The procedure is named after Dr. Paul Mitrofanoff, who in 1980, was the first to attach the appendix
to the bladder by means of an anti-reflux valve.
The Mitrofanoff principle contains five elements:
- A small conduit (usually the appendix) is brought to the skin to produce a stoma through
which patients can catheterise themselves.
- A connection called a flap valve is surgically constructed between the bladder and the implanted
tube that prevents urine from leaking out.
- This results in a low-pressure reservoir with enough storage room to grant patients a socially
acceptable time between catheterisations.
- To protect the kidneys from high-pressured urine reflux, the ureters are reattached to the
bladder using an anti-reflux valve technique.
- The reservoir is emptied by regular intermittent catheterisation by the patient or
MRI (magnetic resonance imaging)
A sophisticated imaging technique used to produce detailed cross-sectional images of the body.
Frequently used to stage and assist in treatment planning of rectal cancers.
Sutured junction of a stoma between the bowel (mucosa) and the skin (cutaneous).
See Mucous membrane.
It occurs naturally on the surface of a stoma or in the urine following formation of an Ileal
conduit. Varying amounts may be passed rectally following surgical de-functioning of the colon (e.g., anterior resection/Hartmann's procedure) or as a discharge from a mucous fistula. Increasing
amounts may be seen as a response to active bowel disease (e.g., cancer and inflammatory bowel
disease). The consistency of the discharge can vary from an offensive, thick, yellow matter to a
crystal clear fluid.
During bowel surgery if primary anastomosis is contraindicated, or surgically impossible, both ends
of the bowel will be exteriorised. The proximal end will form the functioning stoma and will pass
faeces. The distal end of the bowel is brought out through the abdominal wall to form a non-functioning
stoma called a mucous fistula. This procedure can be performed in either the large or small
The mucous fistula may be located close to the proximal stoma, in the abdominal suture line, or
elsewhere on the abdomen. It discharges mucous, serous fluid, and retained stool. A mucous fistula
can be permanent or temporary and will require the use of a stoma cap or small dressing.
A mucous-secreting membrane that lines the gastrointestinal tract.
Mucus is naturally produced and secreted by glands lining the bowel wall. Its function is to act as
a barrier and to lubricate the passage of stool. It is usually a clear viscous fluid, which may
contain enzymes and has a protective function. The quantity that is produced will increase if
inflammation and/or infection is present.
The need or desire to vomit. It is often manifested by wavelike sensations at the back of the
throat, epigastria, and abdominal area. The management of nausea is based primarily on rectifying or
minimising the cause.
See Stoma necrosis.
Necrotising entererocolitis (NEC)
This condition affects premature babies which leads to necrosis, gangrene and in extreme cases
death. Babies with obstructive symptoms require an emergency laparotomy to identify and remove the
necrotic bowel resulting in a temporary ileostomy.
The administration of therapeutic agents before a main treatment.
Also known as the gullet. This canal extends from the pharynx to the stomach and is approximately 23
Part of the mesentery that is referred to as lesser omentum or greater omentum.
Lesser omentum is the name given to the mesentery that attaches the lesser curve of the stomach to
the liver and the diaphragm.
Greater omentum is the name given to the mesentery that attaches the greater curvature of the
stomach to the transverse colon and the posterior abdominal wall.
This is also known as the "fatty apron" because it hangs down in front of the stomach where large
amounts of fat accumulate in and between its double folds.
A person who has a stoma.
A surgically created opening for the excretion of faecal waste (colostomy, ileostomy) or urine
(urostomy) that can be temporary or permanent.
Pancaking (of stoma appliance)
Refers to the presence of faeces staying on top of the stoma and not dropping/moving down into the
bottom of the pouch/bag. Most commonly seen in colostomy management. Occurs when the filter on the
stoma pouch/bag eliminates all air in the appliance, creating a 'vacuum'/'sucking in' of the
appliance onto the mucosa of the stoma.
It is not an easy problem to solve, but primarily the use of an adhesive cover over the filter can
help to minimise the problem.
A tongue-shaped glandular organ lying below and behind the stomach. It is about 18 cm long and
weighs about 100 g. The pancreas has both an exocrine and an endocrine function. Average daily
volume for pancreatic secretions is 700 to 1000 ml.
It has a key role in digestion by releasing pancreatic juice, which passes into the duodenum via the
pancreatic duct. These exocrine secretions are odourless, colourless, watery, and alkaline (pH of
8.3). The primary components of pancreatic juice include water (97%) and bicarbonate. Electrolytes
as sodium and potassium in high concentrations and calcium and chloride in smaller concentrations
are also present. Pancreatic juice also contains enzymes, which are involved in the digestion of
fats, proteins, and carbohydrates in the small intestine.
The Islets of Langerhans in the pancreas produce the endocrine products of insulin, glucagon,
somatostatin, and polypeptide hormones, which play a major part in the regulation of carbohydrate
metabolism. These substances are released into surrounding capillaries, empty into the portal vein,
and are distributed to target cells in the liver where they enter the general circulation.
A term that refers to loss of intestinal motility (peristalsis). It manifests itself by absence of
bowel sounds and absence of stool. The patient can experience varying degrees of colic/spasmodic
type pain, distension, nausea, and projectile vomiting.
Following surgery, peristalsis usually resumes in the small bowel within about 48 hours and the large
bowel within 72 hours. However, the "ileus" may be prolonged following lengthy surgical
procedures or extensive bowel manipulation.
Beside the stoma.
A polysaccharide extracted from lemons, apples, oranges, or grapes. Pectin absorbs moisture and
forms a gel and is used in food, cosmetics, drugs, and stoma skin barriers and pastes.
Successive, wavelike, involuntary muscular contractions along the wall of the intestine. These propel
the digested products along the length of the gastrointestinal tract.
The area immediately surrounding the stoma.
See Stomal complications.
A serous membrane that lines much of the abdominal cavity and covers most of the abdominal organs.
It is a flexible sheet of tissue that holds the organs of the digestive tract in position and
conveys nerves, blood vessels, and lymphatic ducts to the organs.
The peritoneum that covers the abdominal organs is known as the visceral peritoneum; the peritoneum
that lines the abdominal cavity is known as the parietal peritoneum.
Inflammation of the peritoneal cavity, which includes the serosa, mesentery, and omentum. It is
categorised as either localised or generalised.
Localised perotinitis involves the transmural inflammation of the bowel (e.g., appendicitis,
diverticulitis). This may progress into generalised peritonitis due to perforation of the bowel
(e.g., perforated appendix/diverticulum). This is a life-threatening situation.
Common symptoms include pain, nausea, fever, abdominal distension, and difficulty passing faeces
or gas. Treatment involves antibiotics and/or surgery.
A painful sensation experienced in the perineum. This can occur following abdominoperineal excision
of the rectum.
A hydrophobic polymer that is a clear/yellowish soft rubber-like substance. It is very sticky and
has high viscosity. It does not absorb water and will not dissolve in it. PIB binds/gives inner
strength to the skin barrier and helps the skin barrier to adhere on dry skin. It is also used in
Polyps (in the bowel)
Small growths in the bowel that vary in shape and size. They can be flat, sessile, or project out
from the mucous membrane. These polyps are usually benign but can undergo malignant changes over a
long period of time (5-10 yrs). Polyps in the bowel are more common after middle age.
It is suggested that patients undergo routine colonoscopy after the age of 50 years to have any
polyps removed and microscopically examined for malignant changes. Symptoms, if any, can include
bleeding, pain, and altered bowel habit, depending on location in the bowel and size of the polyp.
A term used to describe a stoma appliance or stoma pouch/bag. It is worn over a stoma to collect
faeces or urine.
A term describing inflammation of the ileo-anal pouch reservoir. Its cause is unknown, but it has been suggested that it is due to bacterial overgrowth. It is more common for those who have had a pouch
constructed for ulcerative colitis and may affect as many as 20 to 35% of patients.
Symptoms include diarrhoea, bleeding, pyrexia, and general malaise. The condition responds well to
oral antibiotics and steroids. However, very rarely, surgery may be indicated to remove the ileo-anal pouch and form a permanent ileostomy.
These are non-digestable food ingredients that have a beneficial effect on the gut. They stimulate
the growth of some colonic bacteria, e.g., fructose favours the fermentation of bifidobacteria.
Refers to a condition that is not malignant but is known to become so if left untreated.
Probiotics are live microorganisms that can beneficially alter the micro-flora of our gut, e.g.,
lactobacilli. To enable this to happen, they have to be alive when eaten, survive the acid produced
by our stomachs, and be alive on leaving.
A severe shooting pain in the rectum/anus. More common in men than women.
Proctitis is an inflammation of the rectal mucosa most commonly seen in relation to ulcerative
colitis. Proctitis can also be associated with infection from campylobacter, shigella, and salmonella
organisms, as well as with venereal infections. Radiation proctitis is the most common complication
of pelvic radiation, often occurring years after treatment. Symptoms of severe proctitis will include
profuse watery diarrhoea, bleeding, and tenesmus.
Refers to the medical specialty that deals with the diagnosis and treatment of disorders of the
rectum and anus.
In this condition, the rectum protrudes through the anus usually as a result of weakening of the
supporting tissues. Depending on severity, surgical treatment may be indicated.
Above the point of reference (the colon is proximal to the rectum), e.g., loop stomas; distal end
goes down to anus, proximal end goes up to mouth.
A condition that affects mainly the colon and rectum. It is characterised by the formation of a
thick blanket of yellowish-white mucosal plaques on the surface of the colon.
It is believed to result from the toxins produced by the bacteria Clostridium difficile, related to
severe forms of antibiotic-associated conditions. Pseudomembranous colitis may become chronic or
relapsing and may necessitate surgical intervention (total or subtotal colectomy).
Psoriasis is a chronic, recurring skin disorder that is characterised by whitish scaly patches of
various sizes. The cause is unknown. It is most common on the elbows, knees, scalp, and nails, but it
has also been reported to occur in the peristomal area. Psoriasis may become active (Koebner's phenomenon)
following surgery or as a result of localised chemical or mechanical irritation. Active psoriasis
may impair bag adhesion, but can be treated effectively with topical corticosteroids.
A thick yellow/green liquid formed at a site of an established infection.
A small pus-containing "blister" on the skin.
Pyoderma gangrenosum (PG) is a rare ulcerative, inflammatory skin disorder. Lesions may appear as
single or multiple painful papules, pustules, or nodules that rapidly become indurated and
These often extensive lesions appear raised with a dark red to purple irregular margin.
Peristomal pyoderma gangrenosum (PPG) constitutes 4% of stoma skin problems (Lyon 2001). The
established ulcer is very painful and almost always interferes with the normal use of a stoma
PG is associated with systemic disease, e.g., inflammatory bowel disease or rheumatoid arthritis,
but the cause is unknown. Treatments include topical and/or systemic anti-inflammatory
Quality of life
The individual's ability to pursue and enjoy life in relation to personal goals, standards, and
Treatment of disease with penetrating radiation. In rectal cancers, radiotherapy may be used
depending on the staging and fixity. Preoperative short-course radiotherapy is given to reduce
local recurrence rate. Long-course chemo radiotherapy is given preoperatively to help shrink rectal
tumours prior to resection. Radiotherapy can also be given postoperatively as an
adjuvant/definitive/palliative measure and where surgery is not an option.
See Retracted stoma.
When the stoma mucosa is below skin level, either circumferential or partial. Retraction may be
caused by surgical technique/difficulties, recurrent malignancy, or weight gain. Retraction may cause
problems in obtaining and maintaining a secure and leak-proof seal around the stoma, necessitating
an in-depth assessment by a trained, competent stoma care nurse.
The rectum is positioned between the sigmoid colon and the anal canal. The rectum measures 12 to 15 cm
in length, and its main function is for the storage of faecal waste. The rectum is usually empty and
collapsed until just before defecation; when fully distended, it can hold up to 400 ml.
Where the stoma mucosa is below skin level, either circumferential or partial. Retraction may be
caused by surgical technique/difficulties (e.g., poor mobilisation of the bowel and/or excessive
tension of the suture line at the fascial layer), recurrent malignancy, or weight gain.
Retraction may cause problems in obtaining and maintaining a secure and leak-proof seal around the
stoma, necessitating an in-depth assessment by a trained, competent stoma care nurse. A variety of
products is available to manage this problem.
The serosa is the outermost layer of the GI tract. It is also found as the connective tissue layer
(beneath the visceral peritoneum), which covers the structures within the peritoneal cavity.
Short bowel syndrome
Short bowel syndrome refers to malabsorption and malnutrition following extensive resections of the
It occurs when disease or surgery destroys the capacity and absorption of the small bowel. If some,
or all of the colon has been resected, the problems may become more complicated. Patients
require assessment for additional nutritional supplements either orally, via a gastrostomy, or total
This type of stoma is formed from the sigmoid part of the colon. It is situated on the left-hand
side of the abdomen and can either be an end or a loop stoma (see Colostomy).
The sigmoid colostomy can take the longest to regain its normal peristalsis, although some flatus
and faecal liquid may be seen by the third or fourth day. A normal output is expected to be a soft-formed stool, which may take between five days to a few weeks to establish after surgery.
Sigmoid colostomy function
Colostomy function varies, but normally occurs twice a day to every other day depending on diet,
general condition, medical treatment, and/or underlying disease.
An investigation performed to examine the lower part of the large intestine. This investigation can
be carried out using a rigid or flexible endoscope. The rigid scope visualises up to the recto-sigmoid junction. The flexible scope visualises up to the splenic flexure.
These are available in a variety of applications such as liquids, wipes, sprays, and foams. They are
all water-based preparations and may contain varying amounts of lanolin, urea, propylene glycol,
fragrance, and artificial colours. After use, rinsing with clean water may be required prior to pouch
There are two types of skin protectors.
These are available in a variety of applications such as wipes, spays, gels, liquids, and roll-on.
They are made up of plasticising agents, such as copolymers with variable amounts of isopropyl
These are also available in a variety of applications, such as wafers, rings/washers, paste, strips,
and powders. They can be made from Karaya gum, pectin, gelatine, carboxymethylcellulose,
polysobutolin, cotton, and copolymers. Some applications may contain alcohol.
It is important to note that any preparations containing alcohol will cause a stinging or burning
sensation in patients with sore/broken skin.
Slow transit constipation
Thought to be due to a muscular disorder of the colon (colonic inertia). Treatment options include
laxatives, biofeedback, and surgery.
The small intestine is 4 to 5 meters (12–15 feet) in length and consists of the duodenum, jejunum, and
It is the major organ for digestion and absorption of nutrients and is crucial for life and
Solitary rectal ulcer
An uncommon condition characterised by an ulcer on the anterior wall of the rectum, thought
to arise as a result of repeated mucosal trauma. The condition is often associated with other rectal
conditions, such as prolapse and pelvic floor disorders. Straining on hard, constipated stool may
cause it or it can be externally induced by an enema tip or by using fingers or objects to aid
defecation. If not treatable conservatively, surgery may be rarely indicated.
Group of muscles surrounding an opening in the body that expand or contract to control the flow of
fluid/faeces through the opening.
See Mucous fistula.
Stenosis is a narrowing of the lumen of the intestine or the stoma.
Occurs at either the fascial or cutaneous level. It may be caused by ischaemia, trauma, peristomal
sepsis, retraction, excessive scar formation (following mucocutaneous separation), or narrowing after
repair of a peristomal hernia. Manual dilation may be considered depending on the cause; if this is
not successful, re-fashioning of the stoma may be required to avoid obstruction.
Occurs in both the small and the large intestine. Sepsis, adhesions, anastomotic scarring,
radiotherapy, and diseases such as Crohn's disease, diverticulitis, and malignancy may cause
intestinal stenosis. Extensive narrowing will require surgical assessment to avoid complete
A tube (usually metal or plastic) inserted into a vessel or passage (e.g., gut, urethra, bile duct)
to relieve or prevent obstruction.
This term refers to perforation of the colon as a result of severe faecal impaction, which will
require emergency surgery.
From the Latin word for mouth. Denotes a new opening into or out of the body.
See Ileostomy, Colostomy, or Urostomy.
A collective term referring to pouches/bags worn over a stoma. They are generally divided into three
Closed appliances, which are generally worn over a colostomy.
Drainable appliances worn for a more liquid output and in ileostomy management.
Drainable with a tap for ease of emptying in urostomy management.
All categories of appliances are available in both 1-piece and 2-piece versions. The 1-piece is where the
pouch/bag and baseplate/wafer are integral. The 2-piece product has a detachable pouch/bag from the
baseplate/wafer. This enables the person with a stoma to change the pouch/bag without removing the
See Wafer, Pouch.
The smallest closed pouch. Can be worn following colostomy irrigation, during intimacy and sex, or
when bathing. Very useful in the appliance management of a mucous fistula.
These include stoma necrosis, mucocutaneous separation, prolapse, granuloma, retraction, stenosis,
laceration (trauma), and parastomal hernia.
For peristomal complications, see Caput medusa, Allergic contact dermatitis, Chemical (irritant) dermatitis,
Erythema, Maceration, Erosion, Ulcer, Granulomas, Folliculitis, Pyoderma gangrenosum,
and Chronic papillomatous dermatitis.
Necrosis occurs due to inadequate blood supply to the stoma. This may be due to excessive dissection
of the mesentery, traction of the mesentery (due to abdominal distension or obesity), or severe
oedema of the bowel (after manipulation of the bowel or exposure of the bowel to air).
The necrosis manifests with a dark brown or black discolouration of the stoma, which appears dry and
This will usually be noticeable during the first 24 hours postoperatively, but requires careful
monitoring over the next 3 to 5 days after surgery. If the necrotic area extends below the fascial
level, immediate revision will be required.
The stomach is a distendable J-shaped organ located in the left upper quadrant of the abdomen. Its
size depends on its state of fullness. With an approximate capacity of 1 l, it is 25 cm long and
10 cm in width.
The stomach acts as a reservoir for swallowed food, which remains there for 3 to 5 hours.
The ingested nutrients mix with gastric secretions to form a semi-fluid chyme in preparation for the
main digestive process that takes place in the small intestine. Another important function of the
stomach is secretion of the intrinsic factor necessary for the effective absorption of vitamin B12
in the terminal ileum.
Inadequate haemostasis post-op, portal hypertension, trauma to the stoma, or recurrent disease (IBD,
Pyoderma gangrenosum, polyps, diverticula, or cancer) can all cause bleeding from small vessels of
the stoma mucosa, the mesentery, or at the stoma exit site on the abdomen.
Trauma to the stoma either accidental or intentional. May be evident on the stoma as a
white/yellow band or red indentation. Laceration may be caused by an improperly sized aperture of
baseplate/wafer, which may cut/rub on the stoma mucosa.
Refers to inflammation of the stoma, but may involve the whole gastrointestinal tract. Most commonly
seen as a temporary side effect of radiotherapy or chemotherapy.
Strangulation of the bowel
Refers to a segment of bowel having a disrupted blood supply, which may result in infarction and
perforation. The process of strangulation starts with partial obstruction of the bowel as a result
of external pressure (tumour, hernia, adhesions) or twisting (volvulus), which leads to oedema of
the bowel wall, which in turn prevents venous return.
TAR (trans-anal resection)
A palliative surgical procedure used for controlling rectal tumours that are inoperable or for
patients who cannot withstand major surgery. The procedure requires the use of an endocopic
instrument to 'apple-core' out the center of a rectal tumour.
TEM (trans-anal endoscopic microsurgery)
Surgical treatment of early tumours of the rectum. The use of a large endoscope per-rectum enables
the entire tumour to be excised directly from the rectal wall.
A persistent urge to empty the bowel or feeling of not being able to completely empty one's bowels.
This symptom may be experienced by people with a low rectal cancer.
TME (total mesorectal excision)
A surgical procedure performed during rectal cancer surgery. The mesorectum is a layer of fatty
tissue surrounding the rectum. A specialist colorectal surgeon is required to perform the procedure,
but it has reduced local recurrence rates and improved survival outcomes. Surgery involving the
procedure will often require a de-functioning stoma.
TNM (tumor node and metastatis)
A classification/staging tool to describe bladder or colorectal tumours' stage and grade.
The transverse colon is approximately 45 cm in length. It extends from its two fixed points: the
hepatic flexure to the splenic flexure linking the ascending and descending colon.
This type of stoma is formed in the transverse part of the colon. It is usually positioned on the
right upper quadrant of the abdomen and can be formed as either a loop or split stoma. Loop
transverse colostomies are often raised for symptomatic/palliative reasons. Due to the position of
these stomas, being outside the rectus muscle, herniation and prolapse are common complications.
Transverse colostomy function
A transverse colostomy usually starts to function by the third or fourth day after surgery. Faecal output
may be variable due to its location within the colon and will be dependent on diet, underlying
disease, and general condition. Therefore, stoma management may require the use of either closed or
drainable pouches. In addition, large/oval-shaped flanges may be necessary to accommodate the
Usually refers to a parastomal skin defect reaching into the subcutaneous layer of the skin. Ulcers
may occasionally be seen on the mucosa of the stoma. In this case, they are usually in response to
active Crohn's disease.
Inflammatory bowel disease that affects the colon but not the small intestine.
A non-invasive scan of the abdomen, using sound waves to build up a picture of the internal
organs/abnormalities of the abdomen.
The muscular mechanism that controls the retention and release of urine from the bladder. There are
two urethral sphincters:
The internal sphincter: Part of the muscular bladder wall acts as the internal urethral sphincter
and prevents urine from leaving the bladder to enter the urethra. This sphincter cannot be willfully
controlled but is under automatic (involuntary) control by the brain.
The external sphincter: A layer of muscle, called the urogenital diaphragm, supplies support for the
contents of the pelvis and acts as the external urethral sphincter. It provides a second means of
stopping the escape of urine from the body. This sphincter is under voluntary control.
The urinary tract consists of the kidneys, ureter, bladder, and urethra. The kidneys are reddish-brown, bean-shaped organs and are approximately 12 cm in length. They are located at either side of
the vertebral column. The kidneys excrete waste products as urine and regulate fluid and electrolyte
balance. The ureters carry urine from the kidneys to the bladder.
The tube-shaped ureters are 24 to 30 cm in length, are approximately 3 cm in diameter, and pass from the renal
pelvis to the ureter orifices of the bladder.
The urinary bladder is a hollow, muscular-lined organ located in the pelvis. It acts as a reservoir
for urine. Its shape varies with the amount of urine it contains.
The urethra extends from the bladder neck to the external meatus. It has a sphincter mechanism that
serves the dual purpose of preventing urinary leakage between episodes of micturation and acting as a
conduit during urination.
The waste material that is secreted by the kidneys. It contains urea, uric acid, and creatinine,
salts, and pigments. Alkalinity/acidity of urine is expressed as pH values with 7 as the neutral point.
The kidneys play an important role in balancing the acidity of the body. Urine should be a clear,
amber-coloured fluid and is usually slightly acid.
Urostomy (ileal conduit/Bricker loop)
This type of urinary diversion involves disconnecting the ureters from the bladder and attaching
them to an isolated segment of the ileum (or colon for a colonic conduit). The distal end of the ileum
is brought out at a pre-determined site, usually on the right side of the abdomen, as a urinary
stoma. A urostomy pouch/bag is then applied to allow for the collection of urine.
At the time of surgery, urethral stents/catheter (through the ureters and out into the stoma
pouch/bag) are placed to stabilise the anastomosis and to prevent stenosis and obstruction during the
initial postoperative period. After 7 to 14 days, these urethral stents are removed or may fall out
themselves. The kidneys will be constantly producing urine; therefore, function from the ileal
conduit will be immediate.
Discharge from a urostomy is normal urine, and output depends on the intake. The urostomate is
recommended to drink about 1800 to 2500 ml of liquid every day. Enough and adequate fluid intake is the
single most important factor in prevention of complications, such as urinary tract infections and
This term refers to a rotation and twisting of the intestine, usually seen in the sigmoid colon. A
volvulus can occur in people who have long-standing constipation or chronic laxative abuse, when the
colon becomes larger, elongated, and relatively atonic. It is often possible to decompress and
untwist the bowel by passing a rectal (flatus) tube, but a recurrent volvulus may require surgery
(Sigmoid resection or Hartmann's).
The baseplate of a 2-piece stoma appliance. The wafer, which consists of an adhesive skin barrier
with a pre-cut hole, is placed over the stoma and adheres to the skin. The wafer will also have an
attachment system where the pouch/bag can be secured onto the wafer. This allows for frequent pouch
changing without having to remove the wafer. The wafer can remain in place for an average of 3 to 7
The term "wafer" also refers to a protective sheet (usually hydrocolloid) used as a skin barrier in