An Explanation of Three Frightening Words : Ostomy, Colostomy, Ileostomy

These three words bring up frightening images and dread in many people who know very little about them. I hope I can give you a little new information on this subject that will help you understand what an ostomy is and why it may be needed.

An ostomy is a surgical opening that is created on the abdominal wall for waste products to move out of the body. An ostomy is performed when a medical condition makes it necessary to bypass the small intestine, large intestine, rectum or anus. This procedure can be permanent, to offer a better quality of life to patients after cancer surgery, or it may just be temporary, until the intestines, rectum or anus heals, and the connection to the intestines can be reconnected.

The word ostomy means the artificial opening on the abdominal wall where waste material passes out of the body from the bowel or urinary tract.

To understand an ostomy, it will help to understand a bit about the body's anatomy. The gastrointestinal tract begins with the esophagus (the tube connecting the mouth and the stomach in which food goes down). From the stomach, the gastrointestinal tract (G.I. tract) continues through the stomach, small intestine, large intestine (colon) rectum and anus.

When food is swallowed in the esophagus it is mixed and churned in the stomach, then digested and absorbed in the small intestine. The waste leaves the small intestine as liquid. The large intestine (colon) absorbs water from the liquid material and stores what is left as formed stool until it passes out of the body through the rectum.

An ILEOSTOMY is when the ileum (the last part of the small intestine) is brought through the abdominal wall. When waste reaches the ileum it is in liquid form. A collection device (bag) is placed over the stoma (hole) in the abdomen to collect this liquid stool. In some cases, the doctor can make an internal pouch with skin from inside the abdomen and a bag on the outside is not required. In this case the type of ileostomy is called a Koch's pouch or continent ileostomy.

A COLOSTOMY means the opening is from the colon. The waste from the colon is formed so it will not be in liquid form. The opening can be on the left side of the colon or on the right side. (This depends on what part of the colon is diseased.) If the stoma is made on the left side, only a pad may be needed to cover the opening. When it is on the right side of the colon, a bag is required.

There are many causes for a colostomy or ileostomy to be necessary. In a baby or child, it may be due to an imperforate anus which is the absence of an anal opening. It also may be due to Hirschsprung's Disease, a condition in which the nerves controlling bowel function are abnormal, or it may be due to other malformations that are present at birth.

For adults, the conditions can include cancer of the colon, or rectum, trauma, malformations present from birth, obstruction of the bowel, or complications of diverticulosis and Crohn's disease. In certain conditions the ostomy may be temporary and can be reversed at a later time.

When the physician first mentions an ostomy, every patient has negative feelings. There is probably no surgical procedure that has more misunderstanding and fear than an ostomy.

There are also several kinds of ostomies that divert only urine from the bladder, kidneys or ureters to the outside of the body:

UROSTOMY

A urostomy is a urinary diversion. Unlike the type of ostomies above , the following are for the collection of urine (only) from a diseased or damaged section of the urinary tract. This type of ostomy is usually performed after the bladder has been removed due to cancer or other disease or due to a birth defect.

In this procedure, an opening in the abdomen is created for the urine to pass though. A bag is attached to the stoma to collect the urine.

ILEAL CONDUIT

This is the most common type of urinary diversion. A piece of the small intesting (ileal conduit) is attached to the two ureters which are the tubes that carry the urine from the kidneys. The other end of the ileal conduit is brought out throught the abdominal wall and becomes the stoma. A bag is attached to collect the urine.

URETEROSTOMY

In this procedure one or both of the ureters is redirected from the kidney to an ostomy or ostomies created on the side (or one on each side) of the abdomen.

There are two other types of urostomies. The first is the NEPHROSTOMY where the urine is diverted directly from the kidney through the abdominal wall to a stoma and bag, and the CYSTOSTOMY where the urine is diverted from the bladder through the abdominal wall to a stoma and bag.

After surgery for any ostomy, the patient needs to learn how to manage the ostomy and mentally adapt to these changes. Most hospitals have enterostomal therapists or nurse specialists to provide support and teaching.

Contrary to what you may believe, an ostomy almost always improves the quality of life for the patient by correcting the previous serious or debilitating condition.