Ostomy

What is an ostomy?

An ostomy is a surgically created opening between an internal organ and the body surface. The opening is called a stoma. Ostomies are often created as a part of intestinal surgery when there must be a new way for wastes to leave the body. Cancer, trauma, inflammatory bowel disease (IBD), bowel obstruction, infection, fecal incontinence (inability to control bowel movements) and diverticulitis (inflammation of tiny pockets that commonly form in the colon wall) are all possible reasons for ostomy. The most common types of ostomies include: "ileostomy" (which connects the ileum, the last part of the small intestine, to the skin of the abdominal wall) and "colostomy" (which connects a part of the colon, or large intestine, to the skin of the abdominal wall).

An ostomy may be temporary or permanent. A temporary ostomy can usually be reversed. It is created to temporarily keep stool material away from a downstream area (closer to the anus), such as a healing surgery site, an area of inflammation, or a blockage associated with disease or scar. A permanent ostomy may be needed when disease, or its treatment, impairs normal intestinal function, or when the muscles that control elimination must be removed or no longer work properly.

Where will the ostomy be located?

An ostomy is best placed on a flat portion of the abdominal wall that can be easily seen and reached by you. Before surgery, it is best for your surgeon or WOC nurse to mark an appropriate place on your abdominal wall. A colostomy is usually placed to the left of your navel and an ileostomy to the right.

How will I control my bowel movements?

Once an ostomy is created, your bowel movements will naturally empty through the stoma. A pouch, called an ostomy appliance, is typically worn on the outside of your body around the opening. The appliance is designed to catch and hold the emptied stool. A wound ostomy continence nurse (WOC nurse or enterostomal therapist) who specializes in ostomy care and your colorectal surgeon will teach you how to attach and care for an ostomy appliance. The pouch (bag) is made of plastic and is held to the body with an adhesive, which, in turn, protects the skin from moisture. The pouch is disposable and is emptied or changed as needed. The system is quite secure; "accidents" are not common, and the pouches are odor-free.

The frequency and quantity of your bowel movements will vary, depending on the type of ostomy you have, your diet, and your bowel habits prior to surgery.

Will my diet be limited?

You may be instructed to modify your eating habits in order to control the frequency and consistency of your bowel movements, depending on the type of your ostomy. Chew your food well and drink plenty of fluids. You may be asked to avoid certain high roughage foods. Over time, most patients can introduce foods back into your diet a little at a time and monitor the effect of each food on the ostomy function. Most patients will eventually have no limitations. Your WOC nurse and colorectal surgeon will give you more details.

Will other people know that I have an ostomy?

Not unless you tell them. An ostomy is easily hidden by your usual clothing. You probably have met people with an ostomy and not realized it!

Will my physical activities be limited?

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

Will an ostomy affect my sex life?

Most patients with ostomies resume their usual sexual activity. Some patients worry about how their sexual partner will think of them because of their ostomy appliance. This perceived change in body image can be overcome by a strong relationship, time and patience. Many support groups are also available.

What are the complications of an ostomy?

Complications from an ostomy can occur. When you first start working with your ostomy, it may take some time for you to learn how the ostomy works and how the appliance fits and empties. During this time, there may be occasions when "accidents" happen. Once you have adjusted to the appliance, the most common complications related to the ostomy are minor, like local skin irritation, and can be easily remedied. Significant changes in body shape, such as weight loss or gain, can affect the function of an ostomy. Other problems that occur over time may include hernia (weakening of the abdominal wall around the ostomy) or prolapse (a protrusion of the bowel), that occasionally require surgery if they cause significant symptoms. Living with an ostomy will require some adjustments and learning, but an active and fulfilling life is expected. Your colorectal surgeon and WOC nurse will provide you with skills and support to help you live with your ostomy.