Understanding the purpose of a stoma
An ostomy is a surgically created opening, or stoma, that allows waste products (stool or urine) to exit the body when the normal pathway is disrupted by illness, injury, or a birth defect. It is not a disease in itself but rather a life-saving or life-enhancing procedure that can be either temporary or permanent.
A temporary stoma is created to give a section of the bowel or bladder time to heal, typically after surgery or due to conditions like diverticulitis. Once the area has recovered, the stoma can be reversed and the digestive or urinary system reconnected.
A permanent stoma becomes necessary when the lower portion of the bowel, rectum, or bladder must be removed or is no longer functional due to disease or treatment. This offers a long-term solution for waste evacuation.
Colorectal surgeries involving a stoma
Colostomy
A colostomy is a type of ostomy where a section of the colon (large intestine) is brought through an opening in the abdominal wall to create a stoma. A colostomy may be required for several reasons:
- Colorectal cancer: In cases where the cancer affects the lower part of the colon or rectum, a portion may need to be removed, and a colostomy created to divert stool. This can be permanent if the rectum or anus is removed.
- Diverticulitis: Severe complications from diverticulitis, such as a perforated bowel or infection, may necessitate a temporary colostomy to allow the bowel to rest and heal.
- Bowel obstruction: Blockages caused by tumors, scarring, or other issues can require a colostomy to relieve pressure.
- Trauma: Injuries to the colon, such as from an accident, may require a colostomy as part of the treatment.
Ileostomy
An ileostomy is a procedure that connects the ileum, the final section of the small intestine, to an opening on the abdomen to form a stoma. It is typically required when the entire large intestine is removed or needs to be bypassed.
- Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis can severely damage the large intestine, often requiring its removal and the creation of an ileostomy.
- Familial adenomatous polyposis (FAP): This genetic condition leads to numerous polyps in the colon that have a high risk of becoming cancerous, often leading to colon removal and a subsequent ileostomy.
- Restorative proctocolectomy (J-pouch surgery): This multi-stage surgery for ulcerative colitis involves removing the colon and creating an internal pouch. A temporary ileostomy is often created in the first stage to allow the internal pouch time to heal before the reconnection is made.
Urological and other surgeries requiring a stoma
Urostomy
When the bladder is removed or non-functional, a urostomy is created to divert urine from the kidneys and into a pouch outside the body.
- Bladder cancer: If bladder cancer requires the removal of the bladder, a urostomy is necessary.
- Birth defects: Congenital conditions affecting the bladder or urinary tract, such as spina bifida, can necessitate a urostomy.
- Severe bladder dysfunction: Chronic infections or other issues that prevent the bladder from functioning properly may lead to a urostomy.
Comparing Different Stoma Types
| Feature | Colostomy | Ileostomy | Urostomy |
|---|---|---|---|
| Surgical Origin | Large intestine (colon) | Small intestine (ileum) | Urinary tract (ureters) |
| Waste Type | Solid or semi-formed stool | Liquid or paste-like output | Urine |
| Output Frequency | Variable; often less frequent than ileostomy | Frequent; output is constant | Continuous urine output |
| Pouch Type | Pouching system for waste collection | Pouching system for waste collection | Pouching system for urine collection |
| Primary Purpose | Divert stool when the rectum or lower colon is damaged or removed | Divert stool when the large intestine is removed or bypassed | Divert urine when the bladder is removed or non-functional |
Living with a stoma post-surgery
Recovery from stoma surgery depends on the specific procedure, but patients can generally expect a hospital stay of a few days to a week. During this time, an ostomy nurse will provide education on how to care for the stoma and manage the pouching system.
Lifestyle adjustments
- Diet: Dietary changes are often necessary, especially with an ileostomy, to manage output consistency and prevent blockages. Patients are typically started on a low-fiber diet that is gradually expanded. Chewing food thoroughly and staying hydrated are crucial.
- Activity: Most individuals can return to their normal activities, including sports, after healing. However, heavy lifting and high-impact activities may need to be modified.
- Psychological impact: Adjusting to life with a stoma can be emotionally challenging, and support from ostomy nurses, support groups, and mental health professionals is vital for a smooth transition.
Conclusion
Stoma surgery is a significant medical procedure that can profoundly improve a patient's quality of life by addressing issues that impact the digestive or urinary systems. Whether temporary or permanent, an ostomy offers a necessary solution for complex conditions like cancer, IBD, and trauma. With proper care and support from medical professionals and communities, individuals with a stoma can continue to lead healthy, active, and fulfilling lives. For further reading on this topic, the United Ostomy Associations of America provides extensive resources and information(https://www.ostomy.org/).
