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Ostomy

Ostomy | ASCRS

OSTOMY

An ostomy, or stoma, is a surgically created opening between the intestines and the abdominal wall. The most common types of ostomy connect either the small intestines (ileostomy or jejunostomy) or the large intestine (colostomy) to the abdominal wall. Ostomies can be temporary or permanent. 

REASONS FOR AN OSTOMY

  • Cancer
  • Trauma
  • Inflammatory bowel disease (IBD) such as Crohn’s disease or ulcerative colitis.
  • Bowel obstruction
  • Infection
  • Fecal incontinence (inability to control bowel movements)
  • Diverticular disease (small bulges or sacs that form in the wall of the large intestine)

OSTOMY TYPES

Ask your surgeon if you do not know what type of ostomy you have.

  • Ileostomy: Connects the last part of the small intestines (ileum) to the abdominal wall.
  • Colostomy: Connects a part of the colon (large intestine) to the abdominal wall.
  • Temporary ostomy: This is an ostomy that can be removed surgically at a later time.  It is generally made from the small intestines (ileostomy).  It prevents the passage of stool through the intestines below the stoma. A temporary ostomy is created to allow the intestines to heal after surgery or from a disease such as diverticular disease or Crohn’s disease. 
  • Permanent ostomy: This is an ostomy that is used when parts of the rectum, anus and colon have been removed due to disease or treatment of a disease.  It is generally made from the large intestines (colostomy). It may also be done when the muscles that control elimination are removed or no longer function properly. A permanent ostomy may be removed under some circumstances.  

Figure 1: An ostomy connects either the small or the large intestine to the abdominal wall.

THE OSTOMY BAG

After an ostomy is created, bowel movements occur through the opening in the abdominal wall or stoma. The ostomy appliance consists of a wafer and bag. The wafer sticks to the abdominal wall with adhesive and is made of plastic.  The bag catches and holds the stool. The bag is disposable and emptied or replaced as needed. This system is secure, odor-free and accidents are uncommon.

OSTOMY PLACEMENT

Prior to surgery, your surgeon or Wound, Ostomy and Continence (WOC) nurse will examine your abdomen to find a suitable place on your abdominal wall for the opening or stoma. An ostomy is best placed on a flat portion of the front of your abdomen that is easy to see. A colostomy is usually placed to the left of the navel and an ileostomy to the right.  

 

Figure 2: An ostomy appliance is a plastic pouch. It is held to the body with an adhesive skin barrier that provides secure and odor-free control of bowel movements.

POSTSURGICAL CARE

  • You will be taught how to use the ostomy bag by a WOC nurse or enterostomal therapist and your colon and rectal surgeon. The doctors and nurses will work with you on any necessary changes to your diet.
  • The frequency and volume of bowel movements vary from person to person. Your bowel movements will depend on how often you went to the bathroom prior to surgery, the type of ostomy that was placed, the type of surgery that was done and your dietary habits.

An ostomy appliance is a plastic pouch. It is held to the body with an adhesive skin barrier. It provides secure and odor-free control of bowel movements.

DIETARY RESTRICTIONS

Depending on the type of ostomy, you may need to change what you eat to control the number of and consistency of bowel movements. You will learn to monitor the effect of food on ostomy function. After a period of time, many patients are able to slowly introduce foods back into their diets. It helps to chew food well, drink plenty of fluids and avoid certain high roughage foods, such as green leafy vegetables. After recovering from surgery, most patients do not have dietary limitations.

PHYSICAL RESTRICTIONS

All activities including recreational sports and activities may be resumed once healing from surgery is complete. Public figures, famous entertainers and even professional athletes have ostomies that do not limit their activities.

Most patients with ostomies are able to resume their usual sexual activity. Some patients worry that their sexual partner will not find them attractive due to the ostomy bag. This change in body image can be overcome. A strong relationship, time, patience and support groups all help address these problems.

WILL PEOPLE KNOW I HAVE AN OSTOMY?

Unless you tell someone, they won’t know that you have an ostomy. An ostomy is easily hidden by most clothing. You have probably met people with an ostomy and did not realize it.

POST-OSTOMY PROGNOSIS

An ostomy can have complications. In the beginning, it may take some time to adjust to the way the appliance fits and empties. During this time, accidents, or leakage from the bag, may happen. Once you are used to the stoma wafer and bag, most common problems, such as local skin irritation, are easily treated. Major changes in weight loss or gain can how the ostomy sits on your abdomen. Some people develop a hernia (weakening of the abdominal wall around the ostomy) or prolapse (a protrusion of the bowel). These problems require surgery only if they cause major symptoms.

Living with an ostomy requires a period of learning and adjustment. Your colon and rectal surgeon and WOC nurse will provide necessary assistance and support. With a little time, you will discover ways to live an active and full life with an ostomy.

WHAT IS A COLON AND RECTAL SURGEON?

Colon and rectal surgeons are experts in the surgical and non-surgical treatment of diseases of the colon, rectum, and anus. They have completed advanced surgical training in the treatment of these diseases, as well as full general surgical training. Board-certified colon and rectal surgeons complete residencies in general surgery and colon and rectal surgery, and pass intensive examinations conducted by the American Board of Surgery and the American Board of Colon and Rectal Surgery. They are well versed in the treatment of both benign and malignant diseases of the colon, rectum and anus and are able to perform routine screening examinations and surgically treat conditions, if indicated to do so.

DISCLAIMER

The American Society of Colon and Rectal Surgeons is dedicated to ensuring high-quality patient care by advancing the science, prevention and management of disorders and diseases of the colon, rectum and anus. These brochures are inclusive but not prescriptive. Their purpose is to provide information on diseases and processes, rather than dictate a specific form of treatment. They are intended for the use of all practitioners, health care workers and patients who desire information about the management of the conditions addressed. It should be recognized that these brochures should not be deemed inclusive of all proper methods of care or exclusive of methods of care reasonably directed to obtain the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all the circumstances
presented by the individual patient. 

Would you like additional information?  More information about ostomies can be found at:  www.ostomy.org – The United Ostomy Associations of America.

 

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