What is an ostomy?
An Ostomy is a surgical procedure creating an opening from the bowel or ureters to the abdomen, resulting in a stoma, for the purpose of eliminating waste (stool/urine).
The digestive tract is a hollow tube which stretches from the mouth to the anus and is lined with mucous membrane. As food travels through the system, enzymes are added which break down the food into a form that can be absorbed and used by our bodies. It is important to remember that digestion and absorption of nutrients takes place in the small bowel. Therefore, if there is a need for the removal of the large bowel because of disease, the normal digestive process is minimally unchanged. The main function of the colon is to extract fluid and salt from the stool and act as a storage organ.
Ostomies are created to overcome problems with the bowel or bladder which are caused by injury, disease or congenital defect. All ostomies allow for the discharge of normal waste through a surgically-created opening (stoma) in the abdomen. Most ostomates wear a pouch to cover the stoma and to collect body waste, but a few have some control over discharge of waste and do not need an appliance.
This type of ostomy involves the surgical construction of a connection from the colon to the abdomen, forming a stoma, which allows the waste to be discharged from the body without passing through the diseased part of the colon and the rectum.
Descending or Sigmoid - This type of colostomy may often produce formed stools. Irrigation (enema) may be recommended by the physician to regulate bowel movement, in which case only a special pad or small security pouch is needed to be worn over the stoma.
Transverse - This type of colostomy generally does not result in formed stools, it being more likely that stools will be loose. Irrigation may regulate bowel movement in some but not in the majority of cases. Special care must be taken to protect the skin from discharge. It is probably necessary to wear an appliance at all times.
This type of ostomy involves the surgical construction of a connection from the small bowel to the abdomen, forming a stoma which allows for the discharge of body wastes. Surgery often involves removal of the colon and rectum.
The discharge will vary from being quite liquid at first to semisolid as time goes on. It is necessary to wear an appliance at all times, and special care must be given to protecting the skin. It is important for the ileostomate to take meals at regular hours and to drink lots of fluid to keep electrolytes in balance. Diet will have a bearing on the quantity and character of output.
This type of ostomy involves the surgical construction of a connection from the ureters to the abdomen, forming a stoma, which permits the discharge of urine after removal or dysfunction of the bladder.
The ureters carry the urine from the kidneys to the Ileal Conduit (pipeline created from a small section of the ileum) through which it flows to the outside of the body. Wearing an appliance is needed at all times and great care must be taken to protect the skin around the stoma. After the 15 cm piece of ileum is removed to create the conduit and stoma, the cut ends of the ileum are joined and the intestinal tract will soon function the same as before the surgery.
This type of ostomy involves utilizing the lower part of the small intestine to surgically create an internal reservoir (pouch) having a leak-free nipple valve and conduit to the outside forming a stoma in the abdomen. Fluid intestinal secretions (gas and feces) are collected in the pouch, which is emptied periodically by inserting a small catheter through the stoma into the reservoir. To achieve maximum efficiency and comfort, the pouch should be emptied 3 to 5 times daily.
This type of ostomy involves the surgical construction of an internal ileal pouch, into which urine is maintained until it is emptied by insertion of a catheter into the pouch through the abdominal stoma. The pouch has two nipple valves, one to prevent urine from backing up into the kidneys and the other to maintain the urine in the pouch until it is removed. The pouch is drained periodically perhaps four or five times day). The daily schedule for pouch catheterization should be established by the physician or ET nurse.
This type of surgery is usually done only for ulcerative colitis and familial polyposis patients. The colon (large bowel) is removed. A reservoir is made from the ileum (small bowel) and connected directly to the anus. The sphincter muscle is in place. A temporary ileostomy is performed to allow the reservoir to heal. Later, the ileostomy is closed and feces exits normally through the anus.
Note that the type of surgery depends upon the disease and its severity and also upon the physical condition and age. There may or may not be a choice. The surgeon is the person to advise upon this.
What Is Enterostomal Therapy?
Enterostomal therapy is a comparatively new specialty in the field of professional nursing. The first Enterostomal Therapy (ET), Norma Gill-Thompson (deceased 1998) came on the scene in the very early sixties under the tutelage of Dr. Rupert Turnbull from the Cleveland Clinic. Canada's first ET is Bertha Okun of Montreal who has just recently retired. Both Norma and Bertha were ostomates before being trained as ETs.
ET Nurses give preoperative and postoperative counselling to patients who must have ostomy surgery. The duties include marking the stoma site on the abdomen prior to surgery and assisting the patient with postsurgery rehabilitation. This entails education on daily management of the ostomy, and adjustments to diet, exercise and as well as to social and marital relations. ET nurses are responsible for helping patients to cope with fear and frustration and for the involvement of the family in the rehabilitation program.
ET nurses contribute special nursing skills and understanding in the promotion of better patient care by education health-care personnel, both in the hospital and the community. Also, they are involved in the special care of draining wounds, fistulas and decubitus ulcers. ET nurses are obliged to attend and participate in seminars and workshops, to keep themselves up-to-date on new techniques and information, and to carry out research which will result in optimal care for the ostomate.
Approximately 70,000 patients undergo some form of ostomy surgery each year in the United States and Canada. Most, if not all, are aided by an ET.