An ostomy is a surgical procedure performed when normal bowel or bladder function is lost due to birth defects, disease, treatment for disease, or injury. Conditions that may require an ostomy include colorectal cancer, traumatic injury to the bowel or bladder, diverticulitis, inflammatory bowel disease, and removal of the bladder. Cancer necessitates nearly 80 percent of ostomy procedures. Ostomy procedures are performed in a hospital and patients are admitted for several days or longer, depending on the severity of the condition and complications that occur.
An ostomy may be temporary or permanent. Temporary ostomies are created when the digestive tract must be allowed to heal without irritation caused by the passage of waste. The surgery allows the body's wastes (e.g., stool, urine) to be expelled through an opening created in the abdomen. Types of ostomy procedures include colostomy, ileostomy, and urostomy. The type performed depends on the location and extent of the disease or injury. A person who has had ostomy surgery is an ostomate.
Types of Ostomy
A colostomy involves creating an opening in the abdomen (ostomy) and pulling through a portion of the large intestine (colon). This is called a stoma and allows stool to pass directly out of the body, bypassing the diseased or damaged section of the colon.
The consistency and frequency of the discharge from the stoma depends on the type of colostomy performed. There are four main types: ascending, transverse, descending, and sigmoid.
A colostomy is performed under general anesthesia, and the operating time varies according to the extent of the damage to the colon. Once the damaged section is located, the surgeon clamps both ends of the colon and brings one end out through the ostomy. This end becomes the stoma, and the other end of the colon remains clamped off. Sometimes the damaged section is removed.
Ascending colostomy—This procedure is performed in the ascending colon, on the right side of the abdomen. The stool that passes from this type is liquid to semiliquid and is rich in digestive enzymes. This discharge is often irritating to the skin around the stoma (peristomal skin).
Transverse colostomy—This procedure is performed in the transverse section of the colon, across the middle of the abdomen. Discharge from this type is usually liquid to semiformed in consistency and is less irritating to peristomal skin.
Descending colostomy—This type is performed in the descending portion of the colon, on the left side of the abdomen. Stool is semiformed to formed in consistency because most of the water has been absorbed as it moves through the ascending and transverse sections of the colon.
An ileostomy is performed under general anesthesia and involves surgically creating an opening in the abdomen (ostomy) and pulling through a portion of the small intestine (ileum) to create a stoma. In many cases, the colon is removed and its function (reabsorbing water and electrolytes) is partially carried out by the small intestine. Discharge after an ileostomy is liquid or pasty in consistency and occurs several times a day, usually after meals.
A procedure called ileoanal reservoir surgery requires two surgical procedures and may be an alternative to permanent ileostomy. In the first procedure, the colon is removed, and a temporary ileostomy is performed. In the second procedure, the ileostomy is closed, and a section of the small intestine is used to create an internal pouch to hold stool. This pouch is attached to the anus and rectal muscles hold it in place and prevent stool from leaking. Patients who have this surgery are able to control bowel movements.
A urostomy, also called urinary diversion, is performed to divert urine from a diseased or damaged section of the urinary tract. It is usually performed after the removal of the bladder. In this procedure, which is performed under general or spinal anesthesia, an opening in the abdomen (ostomy) is created for the discharge of urine. There are a number of surgical procedures available.
Ileal conduit—This type of urinary diversion is the most common. It involves attaching a piece of the small intestine (ileal conduit) to the two ureters (tubes that carry urine from the kidneys). The other end of the ileal conduit is brought out through the abdomen and becomes the stoma.
Other types of urostomy include nephrostomy (urine is diverted directly from the kidney to a stoma) and cystostomy (urine is diverted from the bladder to a stoma).