Ostomy Information From the UOAA website @ www.ostomy.org
Types of Ostomies and Continent Procedures
The terms ostomy and stoma are general descriptive terms that are often used interchangeably though they have different meanings. An ostomy refers to the surgically created opening in the body for the discharge of body wastes. A stoma is the actual end of the ureter or small or large bowel that can be seen protruding through the abdominal wall. The most common specific types of ostomies are described below.
The surgically created opening of the colon (large intestine) which results in a stoma. A colostomy is created when a portion of the colon or the rectum is removed and the remaining colon is brought to the abdominal wall. It may further be defined by the portion of the colon involved and/or its permanence.
Allows the lower portion of the colon to rest or heal. It may have one or two openings (if two, one will discharge only mucus).
Usually involves the loss of part of the colon, most commonly the rectum. The end of the remaining portion of the colon is brought out to the abdominal wall to form the stoma.
Sigmoid or Descending Colostomy
The most common type of ostomy surgery, in which the end of the descending or sigmoid colon is brought to the surface of the abdomen. It is usually located on the lower left side of the abdomen.
The surgical opening created in the transverse colon resulting in one or two openings. It is located in the upper abdomen, middle or right side.
Usually created in the transverse colon. This is one stoma with two openings; one discharges stool, the second mucus.
A relatively rare opening in the ascending portion of the colon. It is located on the right side of the abdomen.
A surgically created opening in the small intestine, usually at the end of the ileum. The intestine is brought through the abdominal wall to form a stoma. Ileostomies may be temporary or permanent, and may involve removal of all or part of the entire colon.
Ileoanal Reservoir (J-Pouch)
This is now the most common alternative to the conventional ileostomy. Technically, it is not an ostomy since there is no stoma. In this procedure, the colon and most of the rectum are surgically removed and an internal pouch is formed out of the terminal portion of the ileum. An opening at the bottom of this pouch is attached to the anus such that the existing anal sphincter muscles can be used for continence. This procedure should only be performed on patients with ulcerative colitis or familial polyposis who have not previously lost their anal sphincters. In addition to the "J" pouch, there are "S" and "W" pouch geometric variants. It is also called ileoanal anastomosis, pull-thru, endorectal pullthrough, pelvic pouch and, perhaps the most impresssive name, ileal pouch anal anastomosis (IPAA).
Continent Ileostomy (Kock Pouch)
In this surgical variation of the ileostomy, a reservoir pouch is created inside the abdomen with a portion of the terminal ileum. A valve is constructed in the pouch and a stoma is brought through the abdominal wall. A catheter or tube is inserted into the pouch several times a day to drain feces from the reservoir. This procedure has generally been replaced in popularity by the ileoanal reservoir (above). A modified version of this procedure called the Barnett Continent Intestinal Reservoir (BCIR) is performed at a limited number of facilities.
This is a general term for a surgical procedure which diverts urine away from a diseased or defective bladder. The ileal or cecal conduit procedures are the most common urostomies. Either a section at the end of the small bowel (ileum) or at the beginning of the large intestine (cecum) is surgically removed and relocated as a passageway (conduit) for urine to pass from the kidneys to the outside of the body through a stoma. It may include removal of the diseased bladder.
There are two main continent procedure alternatives to the ileal or cecal conduit (others exist). In both the Indiana and Kock pouch versions, a reservoir or pouch is created inside the abdomen using a portion of either the small or large bowel. A valve is constructed in the pouch and a stoma is brought through the abdominal wall. A catheter or tube is inserted several times daily to drain urine from the reservoir.
The ileocecal valve that is normally between the large and small intestines is relocated and used to provide continence for the pouch which is made from the large bowel. With a Kock pouch version, which is similar to that used as an ileostomy alternative, the pouch and a special “nipple” valve are both made from the small bowel. In both procedures, the valve is located at the pouch outlet to hold the urine until the catheter is inserted.
A replacement bladder, made from a section of intestine, that substitutes for the bladder in its normal position and is connected to the urethra to allow voiding through the normal channel. Like the ileoanal reservoir, this is technically not an ostomy because there is no stoma. Candidates for neobladder surgery are individuals who need to have the bladder removed but do not need to have the urinary sphincter muscle removed.
Types of Pouching Systems
Pouching systems may include a one-piece or two-piece system. Both kinds include a skin barrier/wafer ("faceplate" in older terminology) and a collection pouch. The pouch (one-piece or two-piece) attaches to the abdomen by the skin barrier and is fitted over and around the stoma to collect the diverted output, either stool or urine. The barrier/wafer is designed to protect the skin from the stoma output and to be as neutral to the skin as possible.
Colostomy and Ileostomy Pouches
Can be either open-ended, requiring a closing device (traditionally a clamp or tail clip); or closed and sealed at the bottom. Open-ended pouches are called drainable and are left attached to the body while emptying. Closed end pouches are most commonly used by colostomates who can irrigate (see below) or by patients who have regular elimination patterns. Closed end pouches are usually discarded after one use.
Allow changing pouches while leaving the barrier/wafer attached to the skin. The wafer/barrier is part of a "flange" unit. The pouches include a closing ring that attaches mechanically to a mating piece on the flange. A common connection mechanism consists of a pressure fit snap ring, similar to that used in Tupperware™.
Consist of a skin barrier/wafer and pouch joined together as a single unit. Provide greater simplicity than two-piece systems but require changing the entire unit, including skin barrier, when the pouch is changed.
Both two-piece and one-piece pouches can be either drainable or closed.
Some colostomates can “irrigate,” using a procedure analogous to an enema. This is done to clean stool directly out of the colon through the stoma. This requires a special irrigation system, consisting of an irrigation bag with a connecting tube (or catheter), a stoma cone and an irrigation sleeve. A special lubricant is sometimes used on the stoma in preparation for irrigation. Following irrigation, some colostomates can use a stoma cap, a one- or two-piece system which simply covers and protects the stoma. This procedure is usually done to avoid the need to wear a pouch.
Urinary Pouching Systems
Urostomates can use either one or two piece systems. However, these systems also contain a special valve or spout which adapts to either a leg bag or to a night drain tube connecting to a special drainable bag or bottle.
These are the major types of pouching systems. There are also a number of styles. For instance there are flat wafers and convex shaped ones. There are fairly rigid and very flexible ones. There are barriers with and without adhesive backing and with and without a perimeter of tape. Some manufacturers have introduced drainable pouches with a built-in tail closure that doesn't require a separate clip. The decision as to what particular type of system to choose is a personal one geared to each individual's needs. There is no right or wrong choice, but each person must find the system that performs best for him or her.
The larger mail-order catalogues will illustrate the types and styles from all or most of the suppliers. If you have any trouble with your current pouching system, discuss the problem with an ostomy nurse or other caregiver and find a system that works better for you. It is not uncommon to try several types until the best solution is found. Free samples are readily available for you to try. There is no reason to stay with a poorly performing or uncomfortable pouching system.
Types of Accessories
You may need or want to purchase certain pouching accessories. The most common items are listed below.
Convex shaped plastic discs that are inserted inside the flange of specific two-piece products.
Belts that wrap around the abdomen and attach to the loops found on certain pouches. Belts can also be used to help support the pouch or as an alternative to adhesives if skin problems develop. A belt may be helpful in maintaining an adequate seal when using a convex skin barrier.
Made with a cotton or cotton blend backing, easily fit over the pouch and protect and comfort the skin. They are often used to cover the pouch during intimate occasions. Many pouches now include built-in cloth covers on one or both sides, reducing the need for separate pouch covers.
Liquid/Wipes/PowderWipes and powder help protect the skin under the wafer and around the stoma from irritation caused by digestive products or adhesives. They also aid in adhesion of the wafer.
Skin Barrier Paste
Paste that can be used to fill in folds, crevices or other shape or surface irregularities of the abdominal wall behind the wafer, thereby creating a better seal. Paste is used as a "caulking" material; it is not an adhesive.
Tapes are sometimes used to help support the wafer or flange (faceplate) and for waterproofing. They are available in a wide range of materials to meet the needs of different skin sensitivities.
Adhesive remover may be helpful in cleaning the adhesive that might stick to the skin after removing the wafer or tape, or from other adhesives.
A. Patient’s Concerns about Surgery
The reaction to intestinal or urinary diversion surgery varies from one individual to the other. To some, it will be a problem, to other, a challenge; where one person considers its life-saving, another finds it a devastating experience. Each person will adapt or adjust in their own way and in their own time.
Body Image/Self-Esteem Concerns
Permanent and significant changes in the body’s appearance and functional ability may change the way the person internalizes their body image and self-concept.
Fear of loss is normal and facing any loss is difficult. What are patients giving up by having this operation? Is there any gain? How changed will they be? Such thoughts may lead to weeping or depression, or they may be denied.
It is important to understand the impact of the ostomy surgery on the patient’s change in self-image and how they perceive themselves. It may be accepted as the lesser of two evils, or they may refuse to acknowledge its existence, or may hold onto the belief that it is a temporary situation.
Within the rehabilitation process there are times that patients should have the opportunity to express or deny their feelings, about their surgery, the changes in their body or their self-image.
Patients have to be reassured that they will be taught self-care and that they will be able to master the management process. Basic anatomy and physiology should be explained to new patients, so they can better understand the extent of their surgery. Management options should be offered.
Patients should begin to assist the ostomy nurse with caring for the ostomy as soon as possible. Becoming involved in this process will begin to build confidence and help the patient to regain control of his situation.
Patients may fear that their social role may be changed and that others may not accept them as in the past. One of the first concerns seems to be how to tell others about your surgery, who to tell and when.
Patients should be prepared to explain their surgery with a few brief statements such as, “An ostomy is a surgical procedure for the diversion of bowel (or bladder).”
They should understand that they do not have to tell everyone about the surgery. Be selective about who and how much to tell. It may be only to friends who will be supportive throughout the rehabilitation process.
Returning to the work place may present a concern about restroom facilities, interaction with co-workers, and feelings of being “watched.”
Maybe a few of their co-workers may need to know in the event of an emergency.
Employability and insurability are issues for some individuals. If these issues develop, seek help from healthcare professionals and/or talk with others who have found solutions to any of these issues.
Sexuality issues are common concerns for the new ostomate. Linked closely to our feelings of sexuality is how we think about ourselves and our body image.
Any sexuality concerns should be discussed between the patient and his partner. It is likely that the partner will have anxieties due to a lack of information. An intimate relationship is one in which it matters how well two people can communicate about the most personal of human functions, that is, bodily elimination and sex.
Ostomy surgery may present more concerns for single individuals. When to tell depends upon the relationships. Brief casual dates may not need to know. If the relationship grows and leads to intimacy, the partner needs to be told about the ostomy prior to a sexual experience.
B. Phases of Psychological Adaptation
Almost every patient goes through four phases of recovery following an accident or illness that results in loss of function of an important part of the body. The patient, along with the family, goes through these phases, varying only in the time required for each phase. People may experience the various phases of adaptation in a different order and at varying rates. Some people may skip certain phases entirely and some may move up and down at different times.
These phases are shock, denial, acknowledgment and resolution.
1. Shock or Panic
Usually occurs immediately after surgery. The patient is unable to process information and may be tearful, anxious and forgetful. This phase may last from days to weeks.
This phase may last for weeks or months and delays the adaptation process. During this phase, the individual denies or minimizes the significance of the event and defends himself against the implications of the crisis. You may note the avoiding of reality and “wishful” thinking.
As the patient moves to the next step of acknowledgment, he begins to face the reality of the situation. As you give up the existing old structure, you may enter into a period, at least temporarily, of depression, of apathy, of agitation, of bitterness, and of high anxiety.
During this phase, the acute grief begins to subside. The patient copes with their situation in a constructive manner and begins to establish new structures. They develop a new sense of worth. This phase may take one to two years.
With the aid of an ostomy nurse and the ostomy visitor, you learn about living with a stoma.
A One-Piece Ostomy System is where the bag and the adhesive base plate are one system. The base plate is called several different things, it is known as a flange, wafer, skin barrier, and/or a base plate. Basically, it is the piece of the ostomy bag that attaches to the skin around your stoma. In a One-Piece Ostomy bag, the bag and wafer is one item, you can not separate them.
A Two-Piece Ostomy System is where the ostomy bag and the wafer (flange) are two separate items.
A collection of pus caused by an infection in a closed space.
The formation of new fibrous tissue as a result of inflammation or injury, which created an abnormal union of surfaces or organs which are normally separate.
The surgical union of two hollow tubular parts (e.g. the ureter and the ileum) to form a passage
The opening at the lower end of the large intestine
Pouch and accessories worn by a person with an ostomy over the stoma to collect bodily waste.
The organ which acts as collector for urine
The intestines – the part of the digestive tract between the stomach and the anus, composed of two parts: the color or large bowel, and the ileum or small bowel.
The first part of the large intestine located just after the junction of the small intestine with the large intestine.
An inflammatory condition of the large intestine. Also see Ulcerative Colitis
Colon & Rectal Surgery
The medical and surgical treatment of diseases of the small and large intestines including the rectum and anus.
The large intestine; the final 3-4 feet of the gastrointestinal tract
An inflammatory auto immune disease of the intestinal tract that causes thickening of the
intestinal wall and inflammation of the intestinal lining (mucous membrane). Crohn's Disease can cause problems from the mouth to the anus. Symptoms include abdominal pain, diarrhea, fever, and weight loss. Complications include bleeding, obstruction, perforation and development of fistulas.
Loss of fluids (water) or moisture. May be result of diarrhea, heat exposure, intestinal
blockage or certain medications.
Inflammation of the colon that occurs in the region of existing diverticulosis. This results in
intense pain associated with fever, constipation or diarrhea. Complications of diverticulitis include intestinal obstruction, perforation, bleeding, and the development of abnormal connections (Fistulas) between the skin, intestine, bladder or vagina.
A condition of the large intestines characterized by the development of weakness in the
intestinal wall that permits herniation or outpouching of the intestinal lining. Diverticulosis usually develops as a result of inadequate dietary fiber.
A cleansing solution used for preparation for examination of the large intestine.
Compounds (Sodium, Potassium, Magnesium) which maintain the body's chemical balance.
Ostomates must ensure they have adequate intake of these minerals through fluids and food.
Enterostomal Therapy The treatment of patients with surgically constructed connections between the intestine or the urinary tract and the skin.
ET (Enterostomal Nurse, WOCN)
A nurse who has taken specific instruction for the care of persons with ostomies, wounds or
who are incontinent. An ET may assist with pre-and post-operative counseling and instruction.
An abnormal connection from one organ to another or from the bowel to the abdomen. A fistula may develop spontaneously, but usually requires surgery to remove.
Inflammation of stomach and bowel. Symptoms may include cramping, diarrhea and
Dilated veins that are located at the anal opening. May be either internal or external.
IBD Inflammatory Bowel Disease
Term used to describe a group of bowel diseases which cause an inflammation in the bowel such as ulcerative colitis and Crohn's disease
Inflammation of the small bowel (Ileum)
Where the small bowel joins the colon (large bowel)
Inflammatory Bowel Disease
Ulcerative Colitis or Crohn's Disease
Blockage of the small or large intestine by tumor, inflammation or adhesions. Symptoms usually include crampy abdominal pain, nausea, vomiting, abdominal distention and constipation.
Procedure which flushes bowel via insertion of water through stoma into colon. Only suitable
for persons with sigmoid or descending colostomy. Should only be undertaken after consultation with Physician or ET (ostomy nurse.)
A surgically constructed reservoir made from the small intestine and connected to the anal
sphincter muscles in order to restore intestinal continuity and maintain continence in patients undergoing surgery for ulcerative colitis or Familial Polyposis.
Also called Continent Ileostomy. A surgically constructed intestinal reservoir with a leak-
free valve that is emptied by insertion of a catheter 3-4 times daily.
A moist mucous secreting lining of body cavities open to the exterior e.g. the bowel, mouth, nose, vagina. In bowel, enables contents to "slide".
Person who has had surgery resulting in the creation of a stoma.
Surgical procedure creating an opening from the bowel or ureters to the abdomen, resulting in a stoma for the purpose of eliminating waste (Stool/urine).
A non-invasive skin cancer that involves the skin in and about the anus.
A hole in the intestine that permits the flow of intestinal contents into the abdominal cavity.
The area of the body surrounding the genitals (sex organs) and the anus. Also referred to as
the perineal area.
Around the stoma e.g. the peristomal skin is the skin around and closest to the stoma.
A flat or grape-like growth of benign (harmless) or malignant (cancerous) tissue in the intestine or on the skin.
The surgical removal of the colon and rectum.
Also called Procidentia. The protrusion of the rectum through the anus. Usually caused by
relaxation of the normal supporting structures of the rectum.
The last 15cm (6 inches) of the intestinal tract.
Surgical Removal of a diseased colon and rectum with the reestablishment of intestinal continuity utilizing an intestinal reservoir. Also called J-Pouch, Parks Pouch, Ileoanal Pull Through and Ileal Pouch Anal Anastomosis.
The internal and external muscle that surrounds the anus. The sphincter permits continence or control over intestinal function.
Narrowing or constriction of a passageway.
When used in reference to ostomy care, it is a segment of bowel or ureter brought to the surface of the abdomen. It is formed of mucosal tissue, is red and moist in appearance.
An Inflammatory Bowel Disease that causes inflammation of the lining of the colon and typically causes bloody diarrhea.
A surgically constructed method of bypassing a dysfunctional or removed bladder in order to discharge urine. Most commonly a conduit is surgically created from a section of the ileum and the ureters are connected to it. The open end of the conduit (ileal conduit) is brought to the surface of the abdomen to form a stoma. An appliance is required to collect waste.