Understanding Ostomy Surgeries and Stomas
A stoma is a surgically created opening on the abdomen that allows waste, such as stool or urine, to exit the body and be collected in an external pouch. The specific type of ostomy surgery performed depends on which part of the digestive or urinary system needs to be rerouted due to injury, disease, or birth defects. The most common types are colostomy, ileostomy, and urostomy, each named for the organ involved.
Colostomy: From the Large Intestine
A colostomy is a surgical procedure that connects a part of the colon (large intestine) to the abdominal wall to create a stoma. It is often needed when the colon or rectum is diseased or damaged and waste can no longer exit through the anus. A colostomy can be temporary, allowing a portion of the bowel to heal, or permanent, if the lower part of the colon or rectum must be removed entirely.
Different types of colostomy
- End colostomy: The end of the large intestine is brought through the abdominal wall to form one stoma. This is often permanent.
- Loop colostomy: A loop of the colon is brought to the surface, where it is cut to create two openings within a single stoma. It is typically temporary.
- Double-barrel colostomy: Two separate stomas are created, one for stool and the other for mucus. This is usually temporary and used in emergency situations.
Ileostomy: From the Small Intestine
An ileostomy is a procedure that brings the ileum, the final part of the small intestine, through the abdominal wall to form a stoma. An ileostomy is necessary when the entire large intestine is removed or needs to rest and heal. The output from an ileostomy is generally more liquid or semi-liquid and occurs continuously, as it bypasses the colon's water absorption function.
Types of ileostomy
- End ileostomy: The end of the ileum is brought through the abdominal wall to form the stoma.
- Loop ileostomy: A loop of the ileum is pulled through the abdomen, creating a temporary stoma with two openings.
- Continent ileostomy (Kock pouch): This is a less common procedure where an internal pouch is created, and the waste is drained by a catheter through a valve, eliminating the need for an external bag.
Urostomy: For the Urinary System
A urostomy is a surgical procedure that diverts urine from the kidneys when the bladder is not functioning correctly or has been removed. A small segment of the intestine is used to create a conduit, or passageway, for the urine to exit the body through a stoma. Unlike colostomies and ileostomies, urostomies are not reversible. The most common type is the ileal conduit, which uses a section of the ileum.
Reasons for Ostomy Surgery
Many medical conditions and injuries can necessitate an ostomy and the creation of a stoma. The decision to perform this surgery is based on the specific health issue and the patient's overall condition.
- Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis can cause severe damage to the intestines, requiring parts of the bowel to be removed or bypassed.
- Colorectal or Bladder Cancer: When cancer affects the colon, rectum, or bladder, a surgeon may need to remove the organ, requiring a new pathway for waste.
- Diverticulitis: Serious infections or tears in the colon caused by diverticulitis may require a temporary colostomy to allow the bowel to heal.
- Trauma: Severe injury to the bowel from an accident or wound can necessitate an emergency ostomy.
- Birth Defects: Congenital conditions like Hirschsprung's disease or anal atresia may require a stoma in infants or children.
- Intestinal Obstruction: Blockages in the intestines due to scar tissue or other conditions may require an ostomy to relieve the issue.
Comparison of Major Ostomy Types
| Feature | Colostomy | Ileostomy | Urostomy |
|---|---|---|---|
| Organ Involved | Large Intestine (Colon) | Small Intestine (Ileum) | Urinary Tract (Kidneys, Ureters) |
| Waste Type | Feces | Feces | Urine |
| Output Consistency | Varies, can be solid or soft depending on stoma location | Liquid or semi-liquid | Continuous urine flow |
| Stoma Location | Usually on the left side of the abdomen | Typically on the right side of the abdomen | Usually on the right side of the abdomen |
| Reversibility | Can be temporary or permanent | Can be temporary or permanent | Generally permanent |
Living with a Stoma
For many, life with an ostomy requires significant adjustments, but it does not prevent them from living a full and active life. Care involves learning to manage a pouching system, which collects the waste and protects the skin around the stoma. An ostomy nurse or other healthcare professional provides comprehensive education on how to change and empty the pouch, care for the skin, and manage diet. Resources such as support groups can also help individuals adapt to these lifestyle changes, offering a sense of community and shared experience. For reliable and extensive information on living with an ostomy, you can visit the United Ostomy Associations of America at www.ostomy.org.
Conclusion
In summary, a stoma is a medical opening created during an ostomy procedure, most commonly a colostomy, ileostomy, or urostomy. These life-changing and often life-saving surgeries are performed for a variety of conditions, including cancer, inflammatory bowel disease, and trauma. While adapting to life with a stoma takes time, patients can receive comprehensive support and care to continue living active and fulfilling lives.
