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When is a stoma not reversible?

UnXmas

Banned
I know some people go into surgery worried they'll wake up with a bag, but I'm worried I'll wake up without one. I don't ever want to go back to not having a stoma. I currently have an end ileostomy and a rectal stump. My stoma has prolapsed majorly. I showed my GP and she was quite shocked and told me to see my stoma nurses and to make an appointment with my surgeon. But I'm paranoid that they will think I just shouldn't keep the stoma and reconnect my digestive system. I'm prone to prolapses (including organs not part of the digestive system), and if surgically corrected my stoma would likely prolapse again. At the moment my stoma is working fine, and most of what I've read says a prolapsed stoma isn't usually a problem. But they're not talking about prolapses like mine, mine is an unknown.

If you've got an end ileostomy with a rectal stump, can they reverse the stoma? Do you have to have the rectum removed to make it irreversible?
 

UnXmas

Banned
I spoke to my stoma nurse and she confirmed what I've read online: stoma prolapse isn't dangerous, so I can just live with it. Some people have them fixed for cosmetic reasons or because of practical issues, e.g. getting a bag to fit. The only way to fix them (if you can't get them to go back by lying on your back or putting sugar on them) is surgery. Or you may have to have emergency surgery if the blood supply gets cut off or various other emergencies occur, but they're rare. She said my stoma could be reversed but that it would be diffficult because an end ileostomy is designed to be permanent. That doesn't reassure me all that much. But I'm happy living with the prolapse so as long as my stoma doesn't turn purple or black (which is apparently what happens when the blood gets cut off) I'm ok.
 

UnXmas

Banned
Btw has anyone tried the sugar thing? I'm guessing it absorbs water so the stoma shrinks and can be put back in more easily.
 
As you say, most patients are worried they'll "end up with a bag"!
I work in the health care area, but wouldn't presume to make more than general comments without properly knowing your history.
If you have an end ileostomy and a rectal stump, then yes, re-anastomosis would theoretically be possible, though possibly technically difficult. Most surgeons would be cautious about rejoining the two ends, depending on what previous surgery you've had(possible adhesions),how much small bowel you have, etc.
So I don't think you should worry too much about waking up without a bag, particularly if you are comfortable with it!
As for the prolapse situation, it's really mostly a problem if the circulation is comprised. Talk to your stomal nurse and/or surgeon. Refashioning your stoma may be an option - sometimes there can be a weakness in the muscles around the stoma which allows it to herniate.
Talk to your surgeon - they won't re-anastomose anything without extensive discussion and agreement!!
Can't really comment on the sugar discussion. It's going to be something to do with osmolarity I guess - inducing fluid to drain from the swollen area by contact with a solution that has a stronger concentration of sugar or salt. Again, your stomal therapist may know.
Hope all goes well...


HD
 

UnXmas

Banned
Thanks ellie - your explanation sounds just like my stoma nurse's about there being the possibility or reconnection but that it would be difficult. I have a connective tissue disease which makes me prone to prolapses - I've had rectoceles, cystoceles, uterine prolapses (all these had occurred before I was even out of my teens!) and, before my ileostomy, rectal prolapses, and had them surgically corrected but they just happen again, especially the rectal prolapses because of having diarrhoea 1 - 10 times a day. My surgeon told me before I got my stoma that it would prolapse.... I don't think he knew it would be this much though!

I had a loop ileostomy first and had that refashioned once, but then had emergency surgery for a perforated bowel and it was changed to an end ileostomy. I've had one small bowel resection, I don't know how much they removed.
 
a stoma is not reversible or recommended if the stump (rectum) has evidence of Crohn's. such is my case. I am bagged for life.
 

Bufford

Well-known member
Basically its the same for me. At first the surgeon was hopeful that it would heal and then be reversed. However active Crohn's along with scar tissue from complex fistulas made it not possible. I'm a bagger for life as a result.
 
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