Ostomy

Definition

A surgical procedure creating an opening in the body for the discharge of body wastes.

Purpose

Certain diseases of the bowel or urinary tract involve removing all or part of the intestine or bladder. This creates a need for an alternate way for feces or urine to leave the body. An opening is surgically created in the abdomen for body wastes to pass through. The surgical procedure is called an ostomy. The opening that is created at the end of the bowel or ureter is called a stoma, which is pulled through the abdominal wall.

Description

Different types of ostomy are performed depending on how much and what part of the intestines or bladder is removed.

The three most common types of ostomies are:

• colostomy
• ileostomy
• urostomy

Colostomy

A colostomy is a when a small portion of the colon (large intestine) is brought to the surface of the abdominal wall to allow stool to be eliminated. A colostomy may be temporary or permanent. A permanent colostomy usually involves the loss of the rectum.

A colostomy might be performed due to cancer, diverticulitis, imperforate anus, Hirschsprung's disease, or trauma to the affected area.

Ileostomy

An ileostomy is an opening created in the small intestine to bypass the colon for stool elimination. The end of the ileum, which is the lowest part of the small intestine, is brought through the abdominal wall to form a stoma.

Ileoanal reservoir surgery is an alternative to a permanent ileostomy. It requires two surgical procedures. The first removes the colon and rectum and a temporary ileostomy is created. The second procedure creates an internal pouch from a portion of the small intestine to hold stool. This is then attached to the anus. Since the muscle of the rectum is left in place, there is control over bowel movements.

An ileostomy might be performed due to ulcerative colitis, Crohn's disease, or familial polyposis.

Urostomy

A urostomy is a surgical procedure that diverts urine away from a diseased or defective bladder. Among several methods to create the urostomy, the most common method is called an ileal or cecal conduit. Either a section at the end of the small intestine (ileum) or at the beginning of the large intestine (cecum) is relocated surgically to form a stoma for urine to pass out of the body. Other common names for this procedure are ileal loop or colon conduit.

A urostomy may be performed due to bladder cancer, spinal cord injuries, malfunction of the bladder, and birth defects such as spina bifida.

Since colostomy, ileostomy, and usotomy bypass the sphincter muscle there is no voluntary control over bowel movements and an external pouch must be worn to catch the discharge.

Preparation

Aftercare

The skin around the stoma, called the peristomal skin, must be protected from direct contact with discharge. The discharge can be irritating to the stoma since it is very high in digestive enzymes. The peristomal skin should be cleansed with plain soap and rinsed with water at each change of the pouch.

The stoma can change in size due to weight gain/loss or several other situations. To ensure proper fit of discharge pouch the stoma should be measured each time supplies are purchased.

Risks

People with ostomies can be prone to certain types of skin infections. Skin irritations or rashes around the stoma may be caused by leakage from around the pouch due to an improperly fitted pouch. Correctly fitting the pouch and carefully cleaning the skin around the stoma after each change are the best ways of preventing skin irritation.

Urinary tract infections are common among people who have urostomies. Preventative measures include drinking plenty of fluids, emptying the pouch regularly and using a pouch with an anti-reflux valve to prohibit the discharge from moving back into the stoma.

Normal results

Most ostomy pouches are inconspicuous and can be worn under almost any kind of clothing. There are typically no restrictions of activity, sport, or travel with an ostomy. Certain contact sports would warrant special protection for the stoma.

After recovery from surgery, most people with ostomies can resume a balanced diet.

Ostomy surgery does not generally interfere with a person's sexual or reproductive capacities.

Abnormal results

After an ileostomy, water and electrolyte loss may occur. It may be necessary to drink a significant amount of fluid or fruit juice each day to prevent dehydration.

After any type of ostomy surgery digestion and absorbtion of medications may also be affected.

High-fiber foods can cause blockages in the ileum, especially after surgery. Chewing food well helps break fiber into smaller pieces and makes it less likely to accumulate at a narrow point in the bowel. Drinking plenty of fluids can also help.

Resources

ORGANIZATIONS

Crohn's & Colitis Foundation of America, Inc. 386 Park Avenue South 17th Floor, New York, NY 10016-8804. (800) 932-2423 or (212) 685-3440.

International Foundation for Functional Gastrointestinal Disorders. P.O. Box 17864, Milwaukee, WI 53217. (414) 964-1799.

National Digestive Diseases Clearinghouse. 2 Information Way, Bethesda, MD 20892-3570. 〈http://www.niddk.nih.gov/〉.

United Ostomy Association. 19772 MacArthur Boulevard, Suite 200 Irvine, CA 92612-2405. (800) 826-0826 or (949) 660-8624.

KEY TERMS

Crohn's disease— A chronic inflammatory disease, primarily involving the small and large intestine, but which can affect other parts of the digestive system as well.

Diverticulitis— Inflammation of the diverticula (small outpouchings) along the wall of the colon, the large intestine.

Familial polyposis— An inherited condition in which several hundred polyps develop in the colon and rectum.

Hirschsprung disease— Hirschsprung disease is a congenital abnormality (birth defect) of the bowel in which there is absence of the ganglia (nerves) in the wall of the bowel. Nerves are missing starting at the anus and extending a variable distance up the bowel. This results in megacolon (massive enlargement of the bowel) above the point where the nerves are missing. (The nerves are needed to assist in the natural movement of the muscles in the lining of the bowels that move bowel contents through.)

Ileum— The lowest part of the small intestine, located beyond the duodenum and jejunum, just before the large intestine (the colon).

Imperforate anus— A congenital malformation (a birth defect) in which the rectum is a blind alley (a cul-de-sac) and there is no anus.

Spina bifida— A birth defect (a congenital malformation) in which there is a bony defect in the vertebral column so that part of the spinal cord, which is normally protected within the vertebral column, is exposed. People with spina bifida can suffer from bladder and bowel incontinence, cognitive (learning) problems and limited mobility.