what is it,
types of ostomies,
kinds of ostomy systems,
Ostomy, stoma or fistula, is a surgically created connection between the large intestine, the small intestine or the ureter and the skin. An ostomy is created when an injury or illness resulted in damage to the large intestine, small intestine, ureters or bladder, making it mpossible for faeces or urine to be excreted naturally
Types of ostomies
An opening (stoma) formed by drawing the healthy end of the large intestine or small intestine through an incicion in the anterior abdominal wall is called coloctomy or ileostomy respectively. A small bag attached to the stoma provides an alternative channel for undigested remains of food to be discharged.
Similarly, urostomy is an artificial opening for the urinary system where a catheter or a fragment of the small intestine is inserted into the bladder, ureters or directly into the renal pelvis enabling the drainage of urine into a special bag.
What does the ostomy look like?
The ostomy is a hole in the lower abdomen through which the surgeon has drown a part of the intestine. It is pink-red, similar to the oral mucosa, it is 2-5 mm in diameter and protrudes above the skin for several up to several dozen millimeters. It is not innervated so touching it does not cause any pain. Other names used for the stoma include: artificial anus, abdominal aorta, intestinal fistula, and urinary fistula.
A colostomy, created after a removal of part of the large intestine and/or rectum, is usually located on the left side of the abdomen. If during a surgery the anus has been saved, it is possible to reestablish the flow of waste and a temporary stoma is then created. After some time, the surgeon can reattach the remaining part of the intestine to the anus and restore the continuity of the gastrointestinal tract.
Ileostomy is necessary when the entire colon has been removed. It is constructed by bringing the end or a loop of small intestine out onto the skin surface, usually on the right side of the abdomen. Temporary ileostomy is performed to promote the healing of the intestine below the stoma, part of which has been removed due to inflammation or obstruction.
Absence of the anal sphincter closing the anus makes it impossible for the patient to control defecations and gas disposition, therefore patients with a colostomy must use a special ostomy pouch to provide the exit for the intestinal contents.
In urostomy the opening is usually on the right side of the abdomen. One of the methods of performing a urostomy involves the implantation of ureter to an isolated section of the intestine, one end of which is sutured and the other comes out on the surface of the abdomen. A replacement intestinal reservoir for urine enables bladder control, then urine can be drained periodically through the catheter. In other methods, uncontrolled urine exit makes the use of pouches necessary. Temporary urostomy is possible when the bladder has not been removed.
When is the ostomy performed?
The condition when it is no longer possible for undigested waste to exit naturally via the anus can be caused by e.g. colon cancer or injuries e.g.sustained in accidents. Other indications for the procedure include: inflammatory bowel disease (ulcerative colitis, Crohn’s Disease), intestinal polyposis, intestinal obstruction and abdominal post-op complications. Then a large section of colon often has to be removed or needs to be ‘rested’.
In addition, the operation which involves an incision of the intestinal walls increases the risk of tissue dehiscence at the incision site which is triggered by shifting food residue. This may result in the outflow of digestive tract content into the peritoneal cavity and life-threatening infection. In such cases an artificial anus or stoma is necessary.
Permanent or temporary ostomy can be performed depending on the cause and severity of the disease. However, when it is impossible to restore the former functions of the excretory system the stoma has to remain for a lifetime.
Children commonly are given a temporary colostomy. The clostomy is often required due to congenital defects (e.g. anal atresia), necrotizing enterocolitis in newborns and infants and due to non-specific inflammatory bowel disease in adolescents.
GOOD TO KNOW:
Each intestinal surgery involves a risk of stoma, which is why patients must sign an informed consent prior to such surgical interventions.
Urostomy in the urinary tract is performed when urination naturally through the urinary tract is impossible as a result of e.g. nephrolithiasis, ureterolithiasis or cancer, or when urethra, bladder or ureters have been damaged due to injury or inflammation.
Ostomy systems and ostomy care
Many patients treat their stoma as a sentence, defying their current professional and social life. Meanwhile, with a properly performed and nurtured ostomy, patients can function normally. What is very important in all types of stoma is proper fitting and care of ostomy appliances.
The ostomy patient must use special bags to collect faeces or urine. The bags are made of a multi-layer laser-welded film made of a skin-friendly and safe material. The risk of a bag rupture is minimal. The stoma bags are equipped with carbon filters that absorb odours.
There are two types of ostomy bags: one- and two-piece system. One-piece bags are stuck directly to the abdomen and the plate is permanently attached to the bag in which faeces or urine are collected. Two-piece system allows patients to change the bag without removing the baseplate. Both types of bags can be worn under clothing. The urostomy bags are equipped with a tap which allows you to drain the contents of the pouch into the toilet. They also have a unique system to prevent backflow of urine, which reduces the risk of urinary tract infections. The bags are waterproof and can be worn while bathing or showering. Colostomy and ileostomy bags are equipped with filtered vents which allow the gas to escape and prevent the bag from “ballooning.” In the early postoperative period drainable pouches are applied and they allow for their contents to be removed without having to be replaced.
- For patients insured in National Health Fund (NFZ) ostomy appliances are 100% reimbursed. You must submit a written recommendation by a GP, a surgeon or an ostomy nurse, and a Monthly Supply Card.
- See: stoma care packages with a refund
In colostomy the frequency of pouch replacement depends on the stoma placement – the closer it is to the anus, the less frequently the bags have to be replaced. Proper care of the skin around the stoma is crucial.
Ordinary soaps or gels can irritate the skin while creams and balms reduce the adhesion of the bags. Tight adhesion of the bags is particularly important in ileostomy, as the semi-liquid pouch content contains enzymes that can irritate the skin. There are special ostomy care products which protect the skin against irritations and prevent leakage of the contents under the plate.
Ostomy care and management is taught by specially-trained ostomy nurses. Ostomy patients can live normally, socialize, do sports, swim, and have sex. The limitations that patients feel frequently result from psychological reasons: difficulty in accepting their body image, fear of being rejected by the environment. It is worth talking about your problems with an ostomy nurse, social workers or finding support groups, for example, in Polish Ostomy Association Pol-ilko or a counselling psychologist.