In case if any individual has diseased or injured bowel or the bowel is needed to be roved due to any reason, then surgery is performed which allows the bowel content to pass out of the body through a hole in the abdominal wall, this hole or opening is known as stoma and the process is known as Ostomy. In Ostomy, a portion of the small or large bowel is brought to the abdominal surface so that the bowel contents can easily flow through it into the Ostomy pouch worn outside the body.
An ostomy can be permanent or temporary, depending on the condition of the patient. An expert surgeon performs the surgery.
Types of ostomies are:
- Continent ileostomy
- Ileoanal reservoir
What do you mean by a bowel?
The small and large intestines are alternatively known as bowel.. It is the largest part of GIT. GIT involves a long tube starting from the mouth and ends at the anus. The length of the small bowel is almost twenty inches for an adult. It has the following parts:
The food enters the stomach through peristalsis. It is a wavelike motion of the muscles of GIT. Several enzymes are released from different organs and help in the digestion of food. The small intestine helps in the absorption of nutrients from the fluids and the solid foods which enter the stomach. Then comes the large intestine. It is divided into three parts:
It is about five inches long and allows the reabsorption of water from the foods or liquids which come from the small intestine. The rectum is part where the feces are stored for some time before it passes out. The stool leaves the body through an opening at the bottom known as the anus.
Who needs an Ostomy?
- An individual may need an Ostomy due to the following reasons:
- Colon or rectal cancer
- Trauma or injury to the small or large bowel
- Bowel obstruction
What do you mean by a stoma?
During the Ostomy operation, a part of the large or small intestine is brought to the abdomen, resulting in an opening, this is known as a stoma. Stoma enables the bowel contents to leave the body. The waste is collected in a pouch or bag known as an ostomy appliance. It is worn outside the body over the stoma. The stoma is placed at the upper abdomen. Before the surgery, your surgeon will discuss it with you and mark the best possible location for the stoma. There is no muscle present in the stoma so you can’t control the passage of waste or stool. The stoma is created mainly for two types of Ostomy i.e. Colostomy and ileostomy.
What is meant by an ileostomy?
An Ostomy, in which part the last portion of the small intestine or ileum is involved in the creation of the stoma, is known as an ileostomy. An ileostomy can be momentary or everlasting. In case of complete removal of the colon, anus, and rectum, a permanent ileostomy is required. But in case of damage or injury to the rectum or colon, a temporary ileostomy is required till the healing of that part.
It is mostly performed for the treatment of IBD and rectal cancer.
What is meant by a colostomy?
When a part of the large intestine known as the colon is used for stoma formation, the Ostomy is known as colostomy. The colostomy may be temporary or permanent. It is done for treating:
- Rectal cancer
- Fecal incontinence
What is meant by ileoanal reservoir?
- An anal reservoir is an alternative for an ileostomy and it does not require a permanent stoma. It is also called J-pouch and pelvic pouch. The ileum is used for making an internal reservoir or pouch which is then connected with the anus and stool leaves the body through the anus. It is used in case of the removal of the entire large bowel, and when the anus remains safe and healthy. A patient with an ileoanal reservoir does not need to wear the Ostomy pouch.
- It is used for the treatment of ulcerative colitis and familial adenomatous polyposis.
- It is not applicable for patients with Crohn’s disease.
- What are the complications associated with Ostomy?
- Some common complications are:
- Discomfort in the skin around the stoma
- Irritation or discomfort in the skin mostly complains after the surgery. When a pouching system is not sealed properly it can cause leakage and if bowel contents come in contact with the skin, it can cause skin infection, itching soreness, or irritation, The patients can use skin powder to reduce itchiness and an Ostomy nurse can properly guide them about how to seal and fit the stoma pouch.
- Stoma issues such as prolapsed stoma, hernia, or narrowing of the stoma may occur.
- Obstruction: Sometimes it takes some time for the colostomy or ileostomy to start functioning after the surgery. If no bowel content has been passing out for four to six hours and the individual feels spasm in the abdomen and feels like vomiting it means that the intestines are blocked or obstructed.
- Diarrhea: Diarrhea is a condition in which very watery stool is passed out. This can cause a deficiency of water and salts in the body leading to severe dehydration.
- Blood loss: There can be internal bleeding; in case of too much bleeding blood transfusion is needed. The stoma may also bleed.
- Pouchitis: Inflammation or discomfort in the lining of the ileoanal reservoir is known as pouchitis. It can be treated with antibiotics. Symptoms of the pouchitis are:
- Repeated bowel movements along with diarrhea
- Urge need to pass out a bowel movement
- Abdominal cramps
Deficiency of B12 vitamin:
The deficiency of vitamin B12 can cause anemia, deficiency of red blood cells. It can be treated by using supplements.
Short bowel syndrome
It is a group of issues related to the improper absorption of nutrients after removing a portion of the small intestine. Diarrhea is the major symptom of short bowel syndrome.
People, who have undergone ileostomy or colostomy and have their colon, rectum, or anus intact, may observe the release of mucus from the rectum. It can keep leaking from the rectum and pass out as thin stool.
How to care for an Ostomy?
During the stay at the hospital, the patient learns a lot about how to care for the Ostomy. You need to make different changes in your lifestyle.
The most important thing is to select the best pouching system for you and learn to fil it properly around your stoma.
You can use a two-piece or one–piece pouching system depending on the type of your Ostomy. You can seek help from your Ostomy nurse while selecting the pouching system.
You should always wash your hands before and after changing the pouch.
You can wash your stoma with clean water and avoid using any soap or oil. It can irritate the stoma skin and makes it hard for the pouch to adhere properly.
The pouching system is available in different sizes, shapes, and colors, you just need to select the best one for you.
Getting back to normal life activities
Once you are recovered completely and you feel energetic you can restart your daily activities. You must wait for almost three weeks after the surgery and then you can start driving or any physical activities with the permission of your doctor. You can even swim like before and do light workouts. If you need to pull or lift heavy weights at your workplace you need to talk with your employer.
How to deal with social and emotional issues?
Even though the Ostomy is lifesaving surgery but some people feel awkward and embarrassed to visit public places with their stoma. They fear that people may find it weird, show sympathy, or make fun of them. But it is totally fine. You can conceal your stoma using Ostomy accessories. Online groups and therapists can help you to deal with this problem.
Diet and Nutrition
The patients need to live on soft foods and drinks for almost six to eight weeks after the surgery. Then he or she can gradually, add solid foods in small portions.
The diet must be:
- A lot of fluids
- Eat on time and in small portions
- Chew the food properly
- Add new foods slowly