A stoma is a surgically created opening on the abdomen used to divert waste. The stoma itself is a section of intestine or urinary tract brought through the abdominal wall and stitched to the skin. Because the digestive and urinary tracts handle different types of waste, the characteristics of the output vary significantly based on the stoma’s location. Understanding these differences is helpful for managing the three primary types: the ileostomy, the colostomy, and the urostomy.
Effluent Characteristics of an Ileostomy
An ileostomy is formed from the ileum (small intestine). Because the large intestine, which absorbs most of the water, is bypassed, the effluent is typically liquid or paste-like. This output contains a high concentration of water and can reach a substantial volume, often exceeding 1,000 milliliters per day. Individuals with an ileostomy face a constant risk of dehydration and electrolyte imbalance.
The effluent from an ileostomy is highly corrosive to the skin surrounding the stoma. This is due to the presence of potent digestive enzymes, such as proteases and lipases, which are designed to break down food. Direct contact with the skin can cause irritation and breakdown. The output color is often yellow-green due to bile salts that have not been processed by the large intestine.
The odor associated with ileostomy output is mild to moderate. The small intestine has less bacterial activity compared to the colon, which limits the production of foul-smelling gases. Properly fitted appliance systems and dietary choices help manage the odor.
Effluent Characteristics of a Colostomy
A colostomy diverts waste from the large intestine, and its output characteristics depend heavily on where the stoma is situated. The large intestine’s primary function is to absorb water and form solid stool. Therefore, the further along the colon the stoma is created, the more formed the stool will be.
Output by Location
Colostomies in the ascending or transverse colon produce a looser, semi-liquid, or oatmeal-like output. These stomas allow less time for water absorption, resulting in softer stool. Conversely, a stoma formed from the descending or sigmoid colon will produce output resembling normal, formed stool.
The volume of colostomy output is much lower and more predictable than that of an ileostomy, often ranging from 200 to 900 milliliters per day. The odor is more pronounced because the large intestine contains a dense population of bacteria responsible for the fermentation of undigested food matter. Modern pouching systems are designed with charcoal filters to neutralize gas and minimize detectable odor.
Effluent Characteristics of a Urostomy
A urostomy is designed to divert urine after the bladder has been removed or bypassed. The output is liquid, clear to yellow in color, consistent with normal urine. The volume of output should align with normal fluid intake and hydration status.
The presence of mucus is an expected characteristic of urostomy output. This occurs because the procedure most commonly uses a small segment of the ileum, known as an ileal conduit, to create the stoma. The inner lining of this bowel segment continues its natural function of producing a sticky, white mucus.
The mucus mixes with the urine, but this is a normal finding. An increase in mucus production can signal a urinary tract infection. Certain foods, such as asparagus, can also change the urine’s odor or color.
Factors That Alter Stoma Output and When to Seek Help
The normal characteristics of stoma output can be temporarily altered by several external and internal factors. Dietary choices have a direct impact on both the consistency and volume of effluent. Foods high in soluble fiber, such as bananas, rice, and oatmeal, can help thicken output, while high fluid intake or raw vegetables can loosen it.
Medications also influence output; antibiotics can change the balance of gut bacteria, affecting consistency and odor. Laxatives or diuretics will predictably increase the volume of liquid output. Monitoring these changes is an ongoing part of stoma management.
When to Seek Medical Help
A sudden, significant change in the output pattern can be a warning sign that requires professional assessment. If output stops completely for more than 12 hours, especially when accompanied by cramping, nausea, or vomiting, it may indicate a bowel obstruction. Conversely, an excessively high output, defined as more than 1.5 to 2 liters per day, can rapidly lead to severe dehydration and electrolyte depletion, which is a serious medical concern.
Any unusual color, such as dark green, or the presence of a large amount of fresh blood, warrants immediate contact with a healthcare provider. Skin irritation around the stoma is often caused by acidic or enzyme-rich output leaking onto the skin, which can indicate a poorly fitting appliance that needs adjustment. Recognizing these deviations from the personal norm is crucial for preventing complications.