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Ostomy Overview
This article discusses the general definition of an ostomy and explains (with diagrams) the various procedures involving colostomy, ileostomy and urostomy.
• Article added July 18, 2003
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What is an Ostomy?
An ostomy is a surgical procedure performed when normal bowel or bladder function is lost due to birth defects, disease, treatment for disease, or injury. Conditions that may require an ostomy include colorectal cancer, traumatic injury to the bowel or bladder, Crohn's Disease, diverticulitis, inflammatory bowel disease, and removal of the bladder. Cancer necessitates nearly 80% of ostomy procedures.
An ostomy may be temporary or permanent. Temporary ostomies are created when the digestive tract must be allowed to heal without irritation caused by the passage of stool. The surgery allows the body’s wastes to be expelled through an opening created in the abdomen called a stoma. Types of ostomy procedures include colostomy, ileostomy, and urostomy. The type performed depends on the location and extent of the disease or injury. A person who has had ostomy surgery is an ostomate. Most ostomates must wear special appliances over the stoma.
Normal Digestive Tract
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The digestive tract is a hollow tube which stretches from the mouth to the anus and is lined with mucous membrane. As food travels through the system, enzymes are added which break down the food into a form that can be absorbed and used by our bodies. It is important to remember that digestion and absorption of nutrients takes place in the small bowel. Therefore, if there is a need for the removal of the large bowel because of disease, the normal digestive process is minimally unchanged. The main function of the colon is to extract fluid and salt from the stool and act as a storage organ. [Top]
Colostomy
A colostomy involves creating an opening in the abdomen (ostomy) and pulling through a portion of the large intestine (colon). This is called a stoma and allows stool to pass directly out of the body, bypassing the diseased or damaged section of the colon. The consistency and frequency of the stool from the stoma depends on the type of colostomy performed (see below).
A colostomy is performed under general anesthesia, and the operating time varies according to the extent of the damage to the colon. Once the damaged section is located, the surgeon clamps both ends of the colon and brings one end out through the ostomy. This end becomes the stoma, and the other end of the colon remains clamped off. Sometimes the damaged section is removed altogether. [Top]
Descending or Sigmoid • This procedure is performed in the sigmoid colon, on the lower left side of the abdomen. Stool has a normal, formed consistency. Irrigation may be recommended by the physician to regulate bowel movement, in which case only a special pad or small security pouch is needed to be worn over the stoma.
Transverse Colostomy • This procedure is performed in the transverse section of the colon, across the middle of the abdomen. Stool from this type of colostomy is usually liquid to semi-formed in consistency. Irrigation may regulate bowel movement in some but not in the majority of cases. Special care must be taken to protect the peristomal skin. [Top]
Ileostomy
An ileostomy is performed under general anesthesia and involves surgically creating an opening in the abdomen (ostomy) and pulling through a portion of the small intestine (ileum) to create a stoma. In many cases, the colon (and often times the rectum) is removed and its function (re-absorbing water and electrolytes) is partially carried out by the small intestine. The stool will vary from being quite liquid at first to semi-solid as time goes on. It is necessary to wear an appliance at all times, and special care must be given to protecting the peristomal skin. It is important for the ileostomate to take meals at regular hours and to drink lots of fluid to keep electrolytes in balance. Diet will have a bearing on the quantity and consistency of output. [Top]
Continent Ileostomy • This type of ostomy involves utilizing the lower part of the small intestine to surgically create an internal reservoir (pouch) having a leak-free nipple valve and conduit to the outside forming a stoma in the abdomen. Stool, gas and intestinal secretions are collected in the pouch, which is emptied periodically by inserting a small catheter through the stoma into the pouch. To achieve maximum efficiency and comfort, the pouch should be emptied 3 to 5 times a day.
Ileoanal Reservoir • This type of surgery is usually performed for patients with ulcerative colitis and familial polyposis. The procedure called ileoanal reservoir surgery requires two surgical procedures and may be an alternative to a permanent ileostomy. In the first procedure, the colon is removed and a temporary ileostomy is performed. In the second procedure, the ileostomy is closed, and a section of the small intestine is used to create an internal pouch to hold stool. This pouch is attached to the anus and rectal muscles hold it in place and prevent stool from leaking. Patients who have this surgery are able to control bowel movements. [Top]
Urostomy
A urostomy, also called urinary diversion, is performed to divert urine from a diseased or damaged section of the urinary tract. The procedure is performed under general anesthesia and involves the surgical construction of a connection from the ureters to the abdomen, forming a stoma, which permits the discharge of urine after removal or dysfunction of the bladder.
Ileal Conduit • This type of urinary diversion is the most common. It involves attaching a piece of the small intestine (ileal conduit) to the two ureters. The other end of the ileal conduit is brought out through the abdomen and be- comes the stoma. The ureters carry the urine from the kidneys to the ileal conduit through which it flows to the outside of the body through the stoma. Wearing an appliance is needed at all times and great care must be taken to protect the peristomal skin. After the 15 cm piece of ileum is removed to create the conduit and stoma, the cut ends of the ileum are joined and the intestinal tract will soon function the same as before the surgery. [Top]
Continent Urostomy • This type of ostomy involves the surgical construction of an internal ileal pouch, into which urine is collected until it is emptied by insertion of a catheter into the pouch through the abdominal stoma. The pouch has two nipple valves, one to prevent urine from backing up into the kidneys and the other to maintain the urine in the pouch until it is removed. The pouch is drained periodically, perhaps four or five times a day. The daily schedule for pouch catheterization should be established by the physician or ET nurse.
Other types of urostomy include:
nephrostomy • urine is diverted from the kidney to a stoma
cystostomy • urine is diverted from the bladder to a stoma
ureterostomy • redirecting one (single uterostomy) or both (bilateral uterostomy) of the ureters from the kidney(s) to an ostomy(ies) created on the side(s) of the abdomen. [Top]
Sources and Credits
Excerpts in this article were obtained from:
United Ostomy Association of Canada web site
Types of Ostomies • Related TerminologyHealth Communities web site
Oncology Channel pertaining to ostomies
Endoscopic photos courtesy of:
Jackson Gastroenterology web site
Endoscopy Images Section
Disclaimer • This site and its contents are presented expressly for informational purposes only about London & District Ostomy Association (LDOA) and gastrointestinal and/or urinary diversions in general. In no way are any of the materials presented here meant to be a substitute for professional medical care or proper attention by a qualified physician, nor should they be construed as such. Always check with your doctor or ET if you have any questions or concerns about your condition or before starting a new program or treatment. The Webmaster and LDOA are not responsible or liable, directly or indirectly, for any form of damages whatsoever resulting from the use (or misuse) of information contained in or implied by this site.
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