Understanding the Ostomy Pouch and Stoma
An ostomy is a surgical procedure that creates an opening (a stoma) in the abdomen to reroute the body’s waste disposal system when the usual route is non-functional due to disease, injury, or other medical issues. The bag, known as an ostomy pouch, is an external pouching system worn over the stoma to collect waste. This system can be either temporary, to allow a part of the bowel to rest and heal, or permanent, in cases of severe or irreversible damage.
Types of Ostomy Procedures
The specific name and location of the ostomy and its stoma depend on which part of the intestine or urinary tract is diverted. The three main types are:
- Colostomy: This involves a portion of the large intestine (colon) being brought through the abdominal wall to form a stoma. Waste from a colostomy is typically more formed, and the stoma is often located on the left side of the abdomen.
- Ileostomy: This is created when the small intestine (ileum) is diverted through the abdominal wall. Waste from an ileostomy is more watery and continuous since it has not passed through the entire colon where water is absorbed.
- Urostomy: For patients whose bladder must be removed or is non-functional, a urostomy diverts urine to a stoma. In this procedure, a small piece of the intestine is often used to create a passageway, called an ileal conduit, for the urine to flow into a collection pouch.
Life with an Ostomy Pouch
Living with an ostomy involves a learning curve, but most individuals can lead a full and active life. The pouching systems are designed to be discreet, secure, and odor-proof, allowing people to work, exercise, and socialize without worry. Advances in ostomy products, including different sizes, types, and accessories like skin barriers and deodorizers, have significantly improved the quality of life for those with stomas.
It is crucial for an individual with an ostomy to work closely with their healthcare team, including a wound, ostomy, and continence (WOC) nurse, to learn proper care techniques. Proper stoma and peristomal skin care is essential for preventing common complications like skin irritation.
Comparing Ostomy Types
| Feature | Colostomy | Ileostomy |
|---|---|---|
| Surgical Site | Large intestine | Small intestine (ileum) |
| Waste Consistency | More solid or formed | Liquid and more frequent |
| Pouch Emptying | Less frequent | More frequent |
| Risk of Dehydration | Lower risk | Higher risk (due to fluid loss) |
| Stoma Location | Typically left side of abdomen | Typically right side of abdomen |
Caring for Your Ostomy
Proper care is key to managing an ostomy effectively and preventing complications. The pouching system, which consists of a skin barrier and the collection pouch, must be properly fitted and changed regularly. A WOC nurse can assist in finding the right system and teach techniques for proper application and removal.
- Empty the pouch regularly: A drainable pouch should be emptied when it is about one-third to one-half full to prevent it from getting too heavy and potentially loosening the seal.
- Change the pouching system: The system should be changed every 3 to 7 days, depending on individual needs and product type. During the change, the stoma and surrounding skin should be cleaned with warm water and patted dry.
- Monitor skin health: The skin around the stoma (peristomal skin) should be monitored for redness, irritation, or breakdown. Proper-fitting and skin-protectant products can help prevent this.
- Stay hydrated: This is especially important for those with an ileostomy due to the more frequent, watery output. Replenishing fluids and electrolytes is crucial to prevent dehydration.
- Manage diet: Certain foods can affect output and gas production. Working with a dietitian can help identify trigger foods and manage a diet that promotes good ostomy function.
For more detailed guidance on ostomy care and support, the United Ostomy Associations of America offers a wealth of resources and a community for those with ostomies.
Potential Complications and How to Address Them
While ostomies are generally safe, complications can occur. Knowing how to identify and manage them is important for maintaining good health and preventing more serious issues.
Common Complications:
- Skin Irritation: This is one of the most common issues, often caused by leakage from an ill-fitting pouch. It can be prevented by ensuring a proper fit and using protective skin barriers.
- Hernia: A parastomal hernia occurs when abdominal tissue bulges around the stoma. Support belts or garments can help, and severe cases may require surgery.
- Bowel Obstruction: This can be caused by scar tissue or poorly digested food. Symptoms include cramping and a decrease in output. Dietary management can help prevent obstructions.
- Stoma Prolapse or Retraction: The stoma can either protrude too far out (prolapse) or retract inwards. A WOC nurse can help find better-fitting products, though surgical revision might be necessary for severe cases.
Conclusion
The bag attached to the stomach after surgery is an essential part of an ostomy procedure, which is often a life-saving and life-enhancing intervention. With the support of healthcare professionals and a community of peers, individuals can successfully navigate life with an ostomy. By understanding the different types of ostomies, how to properly care for the pouching system and stoma, and how to address potential complications, many people can regain their health and live active, fulfilling lives.
