Ostomy Information

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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.

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 counseling 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 post-surgery rehabilitation. This entails education on the 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.

Colostomy:

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.

Ileostomy:

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 the character of output.

Urostomy:

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.

Continent Ileostomy:

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.

Continent Urostomy:

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 daily). The daily schedule for pouch catheterization should be established by the physician or ET nurse.

Ileoanal Reservoir:

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.

Terminology

Adhesions:

The formation of new fibrous tissue as a result of inflammation or injury, which creates an abnormal union of surfaces or organs which are normally separate.
Anastamosis: The surgical union of two hollow tubular parts (e.g. the ureter and the ileum) to form a passage.
Anus: The final 4 cm (1.5 inches) of the large bowel, below the rectum, forming the excretory opening or anal canal.
Appliance: Pouch and accessories worn by a person with an ostomy over the stoma to collect bodily waste.
Bladder: The organ which acts as a collector for urine.
Bowel: The intestine(s); the part of the digestive tract between the stomach and the anus, composed of two parts: the colon, or large bowel, and the ileum, or small bowel.
Cecostomy Tube: Patients with fecal incontinence or chronic constipation can use a cecostomy tube to administer an enema to evacuate (flush) the large intestines through the anus. The tube is a catheter (usually a Chiat Cecostomy tube) placed through the abdomen into the cecum, the first part of the large bowel (in the lower right abdomen). The tube needs to be changed every 6-12 months.
Colitis: See ulcerative colitis.
Colon: Large bowel (large intestine). Its major functions are the absorption of fluid, and storage of fecal material (stool) prior to evacuation (bowel movement).
Colostomy: A surgical opening from the large bowel (colon) to the abdomen, forming a stoma for the discharge of stool (fecal material).
Continent ileostomy: Surgical technique of constructing an intra-abdominal pouch from part of the ileum. May be referred to as a Kock pouch or an ileoanal reservoir. External appliances are not required.
Continent urostomy: Surgical technique of an intra-abdominal pouch from a section of bowel for retention of urine, after dysfunction or removal of the bladder. May be referred to as Kock urostomy or Indiana pouch. External appliances are not required.
Crohn's disease: A chronic, progressive inflammatory bowel disease with an unknown cause that can affect any part of the digestive tract, from the mouth to the anus. Symptoms include abdominal pain, diarrhea, and fever.
Dehydration: Loss of fluids (water) or moisture. Maybe result of diarrhea, heat exposure, intestinal blockage or certain medications.
Diverticulitis: Inflammation of small sacs which have protruded from the wall of the bowel. May result in perforation or obstruction of the bowel.
Electrolytes: Compounds (sodium, potassium, magnesium) which maintain the body's chemical balance. Ostomates must ensure they have an adequate intake of these minerals through fluids and food.
ET Nurse: A nurse who has taken specific instruction for the care of persons with ostomies, wounds, or who are incontinent. An ET may assist with pre-and post-operative counseling and instruction.
Familial polyposis Also known as FAP: Familial Adenatomous Polyposis. An inherited disease, characterized by a proliferation of polyps in the colon and rectum. If untreated, polyps will become malignant. Symptoms may include rectal bleeding, mild to moderate diarrhea, and weight loss.
Feces: Bowel waste; also excrement or stool.
Fistula: An abnormal connection from one organ to another or from the bowel to the abdomen. A fistula may develop spontaneously but usually requires surgery to remove.
Gastroenteritis: Inflammation of stomach and bowel. Symptoms may include cramping, diarrhea, and fever.
Hernia: Abnormal bulging or extrusion of an organ through tissue or muscle which contains it; e.g. peristomal hernia, in which bowel bulges through the band of abdominal muscle around the stoma.
IBD: Inflammatory bowel disease; a term used to describe a group of bowel diseases which cause inflammation in the bowel, such as ulcerative colitis and Crohn's disease.
Ileitis: Inflammation of the small bowel (ileum).
Indiana Pouch: See Continent urostomy
Ileoanal reservoir: See Continent ileostomy
Ileostomy: A surgical opening from the small bowel (ileum) to the surface of the abdomen, forming a stoma for the discharge of stool (fecal material).
Ileum: The small bowel; joins the colon (large bowel). Major functions are digestion and absorption of nutrients and absorption of electrolytes.
Indiana pouch: See Continent urostomy.
Irrigation: The procedure which flushes bowel via insertion of water through the stoma into the colon. Only suitable for persons with a sigmoid or descending colostomy; should only be undertaken after consultation with physician or ET.
Kidneys: Organs which filter impurities and waste from the blood, and excrete them via the ureters to the bladder as urine.
Kock pouch: See Continent ileostomy
Malignant: Cancerous (in reference to tumors).
Mucosa: A moist mucous secreting lining of body cavities open to the exterior e.g. the bowel, mouth, nose, vagina.
Mucus: The slippery secretion that lines mucous membranes (mucosa). In the bowel, enables contents to 'slide'.
Ostomate: A person who has had surgery resulting in the creation of a stoma.
Ostomy: 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).
Perineum: The area of the body surrounding the genitals (sex organs) and the anus. Also referred to as the perineal area.
Peristomal: Around the stoma e.g. the peristomal skin is the skin around and closest to the stoma.
Polyps: Soft growths on the skin or mucous membranes. Maybe benign (harmless) or malignant (cancerous).
Rectum: The lower section of the large bowel (colon) about 15 cm (6 inches) long, terminating in the anus. Acts as a storage area for fecal waste.
Stoma: Opening. When used in reference to ostomy care, it is a segment of bowel or (less often) ureter brought to the surface of the abdomen. It is formed of mucosal tissue and is red and moist in appearance. Ideally, it will protrude about 1.5-2.5 cm.
Stenosis: Narrowing or constriction of a passageway.
Trauma: Injury caused by accident, violence e.g. car crash, stabbing. Maybe a cause of ostomy surgery.
Ulcerative colitis: An inflammatory bowel disease of unknown cause which affects the mucosal tissue of the colon and rectum. Symptoms include diarrhea, bleeding, abdominal discomfort, and weight loss.
Ureters: Tube-like structures which carry urine from the kidneys to the bladder.
Urethra: The tube-like structure which carries urine from the bladder to the urethral opening, situated at the tip of the penis (male) or in the vagina (female).
Urine: Liquid secreted by the kidneys which contain bodily wastes and excess fluids. It is stored in the bladder and discharged through the urethra.
Urostomy: A surgically constructed method of bypassing a dysfunctional or removed bladder in order to discharge urine. Most commonly a conduit is surgically created from a section of ileum, and the ureters are connected to it. The open end of the conduit (ileal conduit) is brought to the surface of the abdomen to create a stoma.
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