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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

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.

ostomy

 [os´tah-me]
an operation in which an artificial opening is formed, such as a colostomy or ureterostomy; see also stoma.

os·to·my

(os'tŏ-mē),
1. An artificial stoma or opening into the urinary or gastrointestinal canal, or the trachea.
2. Any operation by which a permanent opening is created between two hollow organs or between a hollow viscus and the skin externally, as in tracheostomy.
[L. ostium, mouth]

ostomy

/os·to·my/ (os´tah-me) general term for an operation in which an artificial opening is formed.

ostomy

(ŏs′tə-mē)
n. pl. osto·mies
Surgical construction of an artificial excretory opening, as a colostomy or ileostomy.

ostomy

[os′təmē]
Etymology: L, ostium, mouth,
Usage notes: (informal)
a surgical procedure in which an incision or stoma is surgically created in the wall of the abdomen to allow the passage of urine from the bladder or of intestinal contents from the bowel. An ostomy procedure may be performed to correct an anatomic defect, relieve an obstruction, or permit treatment of a severe infection or injury of the urinary or intestinal tract. Each procedure is named for the anatomic location of the ostomy, such as a colostomy, ureterostomy, cecostomy, or cystostomy.
enlarge picture
Ostomy sites

ostomy

 GI disease A surgical opening through which waste material is discharged due to functional rectum or bladder. See Appliance, Colostomy, Ileostomy, Stomach-partitioning gastrojejunostomy, Urostomy.

os·to·my

(os'tŏ-mē)
1. An artificial stoma or opening into the urinary or gastrointestinal canal, or the trachea.
2. Any operation by which a permanent opening is created between two hollow organs or between a hollow viscus and the skin externally, as in tracheostomy.
[G. stoma, mouth]

ostomy

(os'to-me)
Enlarge picture
OSTOMY APPLIANCE
A surgically formed fistula connecting a portion of the intestine or urinary tract to the exterior (usually through the abdominal wall). See: colostomy; ileostomy See: illustration

Ostomy Care

Whether the ostomy is temporary or permanent, the patient should be assured that it will be possible to carry on normal activities with a minimum of inconvenience. Prior to being discharged from the hospital, the patient and/or family should be provided full explanation and demonstration of ostomy care. Consultation with another patient who has become competent in ostomy care will be esp. helpful. Those individuals may be contacted through ostomy clubs that have been organized in various cities. The patient should be provided with precise directions concerning places that sell ostomy care equipment. Detailed instructions for care and use of ostomy devices are included in the package.

Specific care involves the stoma (enterostomal care) and irrigation of the bowel, when appropriate, leading to the stoma. In caring for a double-barrel colostomy, it is important to irrigate only the proximal stoma.

Stoma Care

The character of the material excreted through the stoma will depend on the portion of the bowel to which it is attached. Excretions from the ileum will be fluid and quite irritating to skin; those from the upper right colon will be semifluid; those from the upper left colon are partly solid; and those from the sigmoid colon will tend to be solid. Care of the stoma, whether for ileostomy or colostomy, is directed toward maintaining the peristomal skin and mucosa of the stoma in a healthy condition. This is more difficult to achieve with an ileostomy than with a lower colon colostomy. The skin surrounding the stoma can be protected by use of commercially available disks (washers) made of karaya gum or hypoallergenic skin shields. The collecting bag or pouch can be attached to the karaya gum washer or skin shield so that a watertight seal is made. The karaya gum washers can be used on weeping skin, but the skin shields cannot. New skin will grow beneath the karaya gum. The stoma may require only a gauze pad covering in the case of a sigmoid colostomy that is being irrigated daily or every other day. If a plastic bag is used for collecting drainage, it will need to be emptied periodically and changed as directed. At each change of the bag, meticulous but gentle skin care will be given. The stoma should not be digitally dilated except by those experienced in enterostomal care.

Irrigation of Colostomy

Many individuals will be able to regulate the character of their diet so that the feces may be removed from the colonic stoma at planned intervals. The stoma is attached to a plastic bag held in place with a self-adhering collar or a belt. Tap water at 40°C (104°F), is introduced slowly through a soft rubber catheter or cone. The catheter is inserted no further than 10 to 15 cm, and the irrigating fluid container is hung at a height that will allow fluid to flow slowly. The return from the irrigation may be collected in a closed or open-ended bag. The latter will allow the return to empty into a basin or toilet. The return of fluid and feces should be completed in less than one-half hour after irrigating fluid has entered the bowel.

At the completion of the irrigating process, the skin and stoma should be carefully cleaned and the dressing or pouch replaced. The equipment should be cleaned thoroughly and stored in a dry, well-ventilated space. When irrigation of an ostomy is provided for a hospitalized patient, charting is done on the amount and kind of fluid instilled, the amount and character of return, the care provided for the stoma, the condition of the stoma, and if a pouch or bag is replaced.

Miscellaneous Considerations

Odor may be controlled by avoiding foods that the individual finds to cause undesirable odors. Chlorophyll or bismuth subgallate tablets may control odor as well. Gas may be controlled by avoiding foods known to produce gas, which will vary from patient to patient, and with the use of simethicone products. The diet should be planned to provide a stool consistency that will be neither hard and constipating nor loose and watery. The patient may learn this by trial and error and by consulting with nutritionists and ostomy club members. Daily physical activity, sexual relations, and swimming are all possible.

illustration

ostomy

general term for an operation in which an artificial opening is formed, as in colostomy, ureterostomy, tracheostomy, etc. See also stoma (2).
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