The first, easiest and best step in treating the problem stoma is to create a stoma correctly. The foundations of stoma construction are similar to the old real saying, "Location, Location, Location". Location is important so that the patient may properly care for the stoma. Skin folds and irregular surfaces are avoided, if possible, and the stoma should be visible to the patient, avoiding placement too low on the belly wall. Placement should also pay regard to wardrobe consideration, such as the belt line.
Therapy for stoma retraction can involve weight loss, if weight gain is the culprit. Often times this approach is not practical since many patients had weight loss from their disease - notably Crohn's Disease and ulcerative colitis - and go back to their normal weight after the disease is removed. Most commonly, the stoma will need to be revised operatively. An intra-abdominal procedure is needed. Therefore, surgery for correcting a stoma is major.
Stricture of the stoma (a narrowing of the intestine) will first show up as difficulty with evacuation at the stoma - like constipation - and possible cramping abdominal pain. The combination of a tight stricture and hard stool can result in impaction when the stool truly blocks the stoma and cannot come out.
Stoma stricture will occur in about two percent of ostomy patients. The stricture is made up of scar tissue and can be at the level of the skin or fascia - the tough muscle covering - or skin strictures. This repair is simpler and may be done as a local procedure. Fascia level strictures may require the relocation of the stoma.
Since the bowel is a contaminated organ, a relatively common problem after surgery is the development of an abscess or fistula. Patients with Crohn's Disease are most prone to this complication, since fistulas tend to develop commonly in Crohn's Disease anyway. Stoma abscess or fistula will occur in about five percent of ostomy patients. If such an infection occurs, it needs to be drained. Drainage of the infection should be done either right next to the stoma or well away from the stoma to allow proper care of the ostomy system. Making an incision to drain an abscess that will be covered by the skin barrier will either doom the attempt at drainage or the proper seal for the ostomy system. Complicated infections may require relocation and/or revision of the stoma.
Prolapse of the stoma is evident as the bowel telescopes out into the pouch, resembling an elephant's trunk. Prolapse will occur in about three percent of ostomy patients but is rare in those with a urostomy. If a prolapse is bothersome or causes symptoms, the stoma will need to be revised.
