An ostomy is a surgically created intestinal or urinary tract diversion that modifies the normal pathway for waste elimination. A portion of the intestine is brought through the abdominal wall and sewn on to the skin. This piece of intestine is then called a stoma. The word stoma is Greek for opening, and the person usually wears a pouch system over the stoma to collect the waste. One should know what type of stoma they have and what changes have been made to their intestinal system or urinary tract. An ostomy may be temporary or permanent.
There are three standard stomas: Colostomy, Ileostomy, and Urostomy or Ileal Conduit. These stomas are named for the part of the intestine used, i.e., Colostomy from the colon, or for the stoma, i.e., Ileal Conduit - passageway (conduit) for urine made out of Ileum.
An opening into any part of the large intestine (colon), made because part of the colon has been removed or must be bypassed. The most common type is a sigmoid colostomy, where only the rectum has been removed or must be bypassed, and the stoma is usually placed in the lower-left abdomen. The output from a sigmoid colostomy has nearly the same consistency as normal stool because it has passed through most of the large intestine.
One of the main functions of the large intestine is to reabsorb fluid; thus, that is how digestive waste material becomes formed stool. Colostomies made in the ascending or transverse colon have a less solid output. There are no specific dietary restrictions with a colostomy, but drinking extra fluid is recommended.
Some persons with a sigmoid colostomy use an irrigation method, which suits their lifestyle and stoma functioning. Many persons wear a closed-end pouch as they empty their pouch only once or twice a day. However, some have frequent and loose stools that wear an open-end pouch to facilitate emptying more frequently. During Chemotherapy and Radiation treatment, it's recommended using an open-end pouch as there is often diarrhea with these treatments.
An opening into the last portion of the small intestine (ileum), made because the entire colon has been removed or is being bypassed. An ileostomy is typically placed in the lower-right abdomen. Its output has passed through most of the small intestine, but none of the large intestine. The consistency of this output can vary from very liquid to a semi-solid paste. The skin around the stoma should be protected at all times, as the output contains enzymes that break down food and can just as quickly break down the skin around the stoma if the pouch is not fitted correctly. Check with your ET nurse if the skin around the stoma becomes red, raw, or painful.
There are some dietary concerns with an Ileostomy. Some of the best dietary rules are to chew your food well, drink extra fluid, water is best, and be wary of high fiber goods such as coconut, celery, nuts, etc. Ileostomies should never have stoma irrigation.
A stoma for a urostomy is usually built from a short length of ileum and is called an Ileal Conduit. The ureters (drainage tubes from the kidney to the bladder) are sewn into this piece of the intestine (conduit). One end of the conduit stitched closed, and the other end is brought to the abdomen and sewn to the skin. This type of stoma will always drain urine because of the attached ureters and mucus because it is indeed still a functioning piece of intestines. Interesting fact, people sometimes mistakenly use the word "ileostomy" when referring to a urostomy. But the difference is simple: If it drains urine, it's a urostomy.
In addition to the stomas described above, some patients who previously would have required an ileostomy or urostomy can now opt for an alternative "continent" procedure. These people then avoid wearing a pouch. In these procedures, an internal pouch is fashioned from the patient's intestine to replace the missing rectum or bladder. In some continent ileostomies and urostomies, the patient still has an opening on the abdomen, but wears only a light dressing (similar to a band-aid), and inserts a catheter when necessary to empty the pouch. In other variants, the internal pouch is attached directly to the patient's retained anus or urethra, so the patient continues to void in a more or less "normal" manner.
Continent procedures are not available to all patients. For example, the ileoanal reservoir (pelvic pouch) is now an option for many patients with Ulcerative Colitis but is generally not done for patients with Crohn's disease. Also, while these procedures enable patients to avoid wearing a pouch, they are not free of problems. For example, people with continent ileostomies and pelvic pouches may get "pouchitis" - inflammation of the internal pouch. The United Ostomy Association of America is here to help all people with both standard ostomies, and the newer alternative procedures live fully productive lives.
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