From North Central Oklahoma Ostomy Outlook Oct 2015:

On Stomas and their Nerves

Editor’s Note: In view of continued misunderstanding on this topic, we’re reprinting these three articles that we’ve published previously:

1. Does Your Stoma Hurt?

by Victor Alterescu, RN,ET; via Northwest Arkansas Mail Pouch; and North Central OK Ostomy Outlook, Jan 1999

Quite often people tell me that their stoma hurts. This surprises me a great deal since stomas do not have any sensation.

You could cut, burn, do anything to the stoma and you would not feel a thing. That’s hard to believe, but true. Stomas do not have receptors for pain.

Sometimes, the lack of stoma sensation can lead to problems. For example, an incorrectly fitting appliance may cut into the stoma, but no pain will be felt. A stoma can be badly damaged before the problem is noticed. For this reason, it is important not to wear your pouch for long periods of time (more than a week, in my opinion), since it is good to see if the stoma is OK.

Actually, when people talk about stoma pain, they are usually talking about pain from the skin around the stoma. That skin, the peristomal skin, is full of nerve receptors that are sensitive to such things as heat, cold, chemicals and adhesives that can cause pain. It is the skin that is sensing the pain, not the stoma.

If any unusual symptoms or irritations are noticed, do not hesitate to contact your doctor or ET [WOCN] for an evaluation and, if necessary, a prescription for a specific treatment.

2. Stomas and Pain Response

by Mike D’Orazio, ET(retired); written in response to #1 above; printed in North Central OK Ostomy Outlook, Feb 1999

While Victor’s statements regarding stoma pain are, at one level, essentially correct, there are legitimate situations when one’s stoma will feel pain.

In the normal condition of the intestine, of which a stoma is a part, typical pain touch receptors are not present. However when the bowel is stretched, as when obstructed and subsequently swollen, the bowel will “feel” painful. There are stretch receptors within the bowel wall that inform us of an obstructive event. While experiencing an obstructive event other physiological phenomena occur to further inform and distress us.

On rare occasions patients with stomas have strongly complained of stomal pain. Physical exams have often not been able to reveal any clear evidence of harm or obstruction to the stoma site. In these unusual situations the phenomenon of psychic pain has been put forth to explain the pain.

Just thought I would add my two cents worth to this oft noted question. My intent is not to discredit any point of view, rather to be more inclusive of explanations relating to this phenomenon.

3. The nerve(s) of those stomas!

by Mike D’Orazio (aka “Mike ET”); posted on UOAA Discussion Board, May 11, 2009; printed in North Central OK Ostomy Outlook, May 2009

The question or comment about stomas lacking sensory nerves, or the more broadly stated claim that stomas have no nerves, is a myth that dies very hard. Allow me to borrow from one of my presentations that partly addresses this issue:

“…most of the information carried by gastrointestinal primary afferent neurons is not consciously perceived. This is nicely demonstrated by tests on fistula patients who report no sensation when the healthy stomach is probed or in patients that have had the intestinal lining cut to take a biopsy.” Quoted from: Am J Physiol Gastrointest Liver Physiol 277:922-928, 1999. John B. Furness, Wolfgang A. A. Kunze and Nadine Clerc. page G924.

Additionally, we have: “There are more than 100 million nerve cells in the human small intestine, a number roughly equal to the number of nerve cells in the spinal cord. Add in the nerve cells of the esophagus, stomach, and large intestine and you find that we have more nerve cells in our bowel than in our spine. We have more nerve cells in our gut than in the entire remainder of our peripheral nervous system.” Quoted from: The Second Brain by Michael Gershon, M.D. page Xiii.

Alas, stomas do have nerves!
So, now let us put to rest the misstatement about the bowel and nerves, and bother to reeducate those who have misspoken early on. There are nerves; but the sensory nerves of the bowel between the esophagus and the rectum, for certain types of painful stimuli, such as cutting or cautery, are either very low in number and caliber or the brain is not readily able to perceive the pain.

Of course, one can still be a pain in the a**; however, this is a topic for other times and places.

Editor’s Note: Putting this all in perspective, the claim in article #1 that “stomas do not have any sensation” is false, as is the often-repeated claim that “stomas have no nerve endings.” Stomas definitely have nerves that are sensitive to stretching. However, it’s also true that stomas tend to be insensitive to certain other stimuli, notably cutting. This creates the real danger, as stated in article #1, that you can cut your stoma without being aware of it. And it’s also probably true that in most cases when people talk about stoma pain, it’s really from the peristomal skin.

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