| Colostomy |
The surgically created
opening of the colon (large intestine) which results in
a stoma. A colostomy is created when a portion of the colon
or the rectum is removed and the remaining colon is brought
to the abdominal wall. It may further be defined by the
portion of the colon involved and/or its permanence. |
Temporary Colostomy
|
Allows the lower portion
of the colon to rest or heal. It may have one or two openings
(if two, one will discharge only mucus). |
| Permanent Colostomy |
Usually involves
the loss of part of the colon, most commonly the rectum.
The end of the remaining portion of the colon is brought
out to the abdominal wall to form the stoma. |
Sigmoid or
Descending Colostomy
|
The most common
type of ostomy surgery, in which the end of the descending
or sigmoid colon is brought to the surface of the abdomen.
It is usually located on the lower left side of the abdomen.
|
| Transverse Colostomy |
The surgical
opening created in the transverse colon resulting in one
or two openings. It is located in the upper abdomen, middle
or right side. |
| Loop Colostomy |
Usually created
in the transverse colon. This is one stoma with two openings;
one discharges stool, the second mucus. |
| Ascending Colostomy |
A relatively
rare opening in the ascending portion of the colon. It is
located on the right side of the abdomen. |
|
| Ileostomy |
A surgically created opening
in the small intestine, usually at the end of the ileum.
The intestine is brought through the abdominal wall to form
a stoma. Ileostomies may be temporary or permanent, and
may involve removal of all or part of the entire colon.
|
| Ileoanal Anastomosis |
This is now the most common
alternative to the conventional ileostomy. Technically,
it is not an ostomy since there is no stoma. In this procedure,
the colon and most of the rectum are surgically removed
and an internal pouch is formed out of the terminal portion
of the ileum. An opening at the bottom of this pouch is
attached to the anus such that the existing anal sphincter
muscles can be used for continence. This procedure should
only be performed on patients with ulcerative colitis or
familial polyposis, and who have not previously lost their
rectum or anus. It is also called J-pouch, pull-thru, endorectal
pullthrough, pelvic pouch, or a combination of these terms.
|
| Continent Ileostomy |
This surgical variation
of the ileostomy is also called a Kock pouch .
A reservoir pouch is created inside the abdomen with a portion
of the terminal ileum. A valve is constructed in the pouch
and a stoma is brought through the abdominal wall. A catheter
or tube is inserted into the pouch several times a day to
drain feces from the reservoir. This procedure has generally
been replaced in popularity by the ileoanal pouch. A modified
version of this procedure called the Barnett Continent Ileal
Reservoir is performed at a limited number of facilities.
|
|
| Urostomy |
This is a general term
for a surgical procedure which diverts urine away from a
diseased or defective bladder. The ileal or cecal conduit
procedures are the most common urostomies. Either a section
at the end of the small bowel (ileum) or at the beginning
of the large intestine (cecum) is surgically removed and
relocated as a passageway (conduit) for urine to pass from
the kidneys to the outside of the body through a stoma.
It may include removal of the diseased bladder. |
| Continent Urostomy |
There are two main continent
procedure alternatives to the ileal or cecal conduit (others
exist). In both the Indiana and Kock Pouch versions,
a reservoir or pouch is created inside the abdomen with
a portion of either the small or large bowel. A valve is
constructed in the pouch and a stoma is brought through
the abdominal wall. A catheter or tube is inserted several
times daily to drain urine from the reservoir. |
| Indiana Pouch |
The ileocecal valve that
is normally between the large and small intestines is relocated
and used to provide continence for the pouch which is made
from the large bowel. With a Kock Pouch
version, which is similar to that used as an ileostomy alternative,
the pouch and a special "nipple" valve are both made from
the small bowel. In both procedures, the valve is located
at the pouch outlet to hold the urine until the catheter
is inserted. |
|
Types
of Pouching Systems
Pouching
systems may include a one-piece or two-piece system. Both
kinds include a faceplate/flange (barrier or wafer) and
a collection pouch. The pouch (one-piece or two-piece) attaches
to the abdomen by the faceplate/flange and is fitted over
and around the stoma to collect the diverted output, either
stool or urine. The barrier is designed to protect the skin
from the stoma output and to be as neutral to the skin as
possible.
|
Colostomy and
Ileostomy Pouches |
Can be either open-ended,
requiring a closing device usually called a clamp or tail
clip; or closed and sealed at the bottom. Open-ended pouches
are called drainable and are left attached to the body while
emptying. Most commonly, closed end pouches are used by
colostomates who can irrigate (see below), or by patients
who have regular elimination patterns. Closed end pouches
are usually discarded after one use. |
| Two-Piece Systems |
Consist of a separate
flange and pouch. The pouch contains a closing ring which
mechanically attaches to a mating piece on the flange. The
most common closure is a pressure fit snap ring, very similar
to that used in Tupperware™. |
| One-Piece Systems |
As the name implies, are
those in which the wafer and pouch are assembled together
in one piece and not separate. |
| Both two-piece and one-piece pouches
can be either drainable or closed.
|
|
| Irrigation Systems |
Some colostomates can
"irrigate," using a procedure analogous to an enema. This
is done to clean stool directly out of the colon through
the stoma. This requires a special irrigation system, consisting
of an irrigation bag with a connecting tube (or catheter),
a stoma cone and an irrigation sleeve. A special lubricant
is sometimes used on the stoma in preparation for irrigation.
Following irrigation, some colostomates can use a stoma
cap, a one- or two-piece system which simply covers and
protects the stoma. This procedure is usually done to avoid
the need to wear a pouch. |
|
Urinary Pouching
Systems |
Urostomates can use either
one or two piece systems. However, these systems also contain
a special valve or spout which adapts to either a leg bag
or to a night drain tube connecting to a special drainable
bag or bottle. |
|
These are
the major types of pouching systems. There are also a number
of styles. For instance there are flat faceplates and convex
shaped ones. There are fairly rigid and very flexible ones.
There are faceplates with and without adhesive backing and
with and without a perimeter of tape. The decision as to
what particular type of system to choose is a personal one
geared to each individual's needs. There is no right or
wrong choice, but each person must find the system that
performs best for him or her.
The
larger mail-order catalogues will illustrate the types and
styles from all or most of the
suppliers. If you have any trouble with your current
pouching system, discuss the problem with an ostomy nurse
or other caregiver and find a system that works better for
you. It is not uncommon to try several types until the best
solution is found. Free samples are readily available for
you to try. There is no reason to stay with a poorly
performing or uncomfortable pouching system. |
|
Types
of Accessories
You may need or want
to purchase certain pouching accessories. The most common
items are listed below. |
Convex Inserts |
Convex shaped plastic
discs that are inserted inside the flange of specific faceplates.
|
Ostomy Belts |
Belts that wrap around
the abdomen and attach to the loops found on certain pouches.
Belts can also be used to help support the pouch or as an
alternative to adhesives if skin problems develop. These
usually add a measure of security. |
Pouch Covers |
Made with a cotton or
cotton blend backing, easily fit over the pouch and protect
and comfort the skin. They are often used to cover the pouch
during intimate occasions. |
Skin Barrier
Liquid/Wipes/Powder |
Wipes and powder help
protect the skin under the wafer and around the stoma from
irritation caused by digestive products or adhesives. They
also aid in adhesion of the wafer. |
Skin Barrier Paste |
Paste that can be used
to fill in folds, crevices or other shape or surface irregularities
of the abdominal wall behind the wafer, thereby creating
a better seal. |
Tapes |
Tapes are sometimes used
to help support the flange or wafer (faceplate) and for
waterproofing. They are available in a wide range of materials
to meet the needs of different skin sensitivities. |
Tape Remover |
Tape remover is helpful
in cleaning the adhesive that might stick to the skin after
removing the tape or faceplate, or from other adhesives.
|
Psychosocial
Issues
A.
Patient's Concerns about Surgery
The reaction to intestinal or urinary diversion surgery
varies from one individual to the other. To some, it will
be a problem, to other, a challenge; where one person considers
its life-saving, another finds it a devastating experience.
Each person will adapt or adjust in their own way and in
their own time.
Body
Image/Self-Esteem Concerns
Permanent and significant changes in the body's appearance
and functional ability may change the way the person internalizes
their body image and self-concept.
Fear
of loss is normal and facing any loss is difficult. What
are patients giving up by having this operation? Is there
any gain? How changed will they be? Such thoughts may lead
to weeping or depression, or they may be denied.
It
is important to understand the impact of the ostomy surgery
on the patient's change in self-image and how they perceive
themselves. It may be accepted as the lesser of two evils,
or they may refuse to acknowledge its existence, or may
hold onto the belief that it is a temporary situation.
Within
the rehabilitation process there are times that patients
should have the opportunity to express or deny their feelings,
about their surgery, the changes in their body or their
self-image.
Self-Care
Concerns
Patients
have to be reassured that they will be taught self-care
and that they will be able to master the management process.
Basic anatomy and physiology should be explained to new
patients, so they can better understand the extent of their
surgery. Management options should be offered.
Patients
should begin to assist the ostomy nurse with caring for
the ostomy as soon as possible. Becoming involved in this
process will begin to build confidence and help the patient
to regain control of his situation.
Relationship
Concerns
Patients
may fear that their social role may be changed and that
others may not accept them as in the past. One of the first
concerns seems to be how to tell others about your surgery,
who to tell and when.
- Patients should be prepared to explain their surgery
with a few brief statements such as,
- An ostomy is a surgical procedure for the diversion
of bowel (or bladder).
- They should understand that they do not have
to tell everyone about the surgery. Be selective
about who and how much to tell. It may be only to
friends who will be supportive throughout the rehabilitation
process.
Returning
to the work place may present a concern about restroom facilities,
interaction with co-workers, and feelings of being watched.
- Maybe a few of their co-workers may need to know in
the event of an emergency.
- Employability and insurability are issues for some
individuals. If these issues develop, seek help from
healthcare professionals and/or talk with others who
have found solutions to any of these issues.
Sexuality
issues are common concerns for the new ostomate. Linked
closely to our feelings of sexuality is how we think about
ourselves and our body image.
- Any sexuality concerns that you have should be discussed
between the patient and his partner. It is likely that
the partner will have anxieties due to a lack of information.
An intimate relationship is one in which it matters
how well two people can communicate about the most personal
of human functions, that is, bodily elimination and
sex.
- Ostomy surgery may present more concerns for single
individuals. When to tell depends upon the relationships.
Brief casual dates may not need to know. If the relationship
grows and leads to intimacy, the partner needs to be
told about the ostomy prior to a sexual experience.
Phases
of Psychological Adaptation
Almost every patient goes through four phases of recovery
following an accident or illness that results in loss of
function of an important part of the body. The patient,
along with the family, goes through these phases, varying
only in the time required for each phase. People may experience
the various phases of adaptation in a different order and
at varying rates. Some people may skip certain phases entirely
and some may move up and down at different times.
These
phases are shock, denial, acknowledgment and resolution.
- Shock or Panic - Usually occurs immediately
after surgery. The patient is unable to process information
and may be tearful, anxious and forgetful. This phase
may last from days to weeks.
- Defense/Retreat/Denial - This phase
may last for weeks or months and delays the adaptation
process. During this phase, the individual denies or
minimizes the significance of the event and defends
himself against the implications of the crisis. You
may note the avoiding of reality and wishful thinking.
- Acknowledgment - As the patient
moves to the next step of acknowledgment, he begins
to face the reality of the situation. As you give up
the existing old structure, you may enter into a period,
at least temporarily, of depression, of apathy, of agitation,
of bitterness, and of high anxiety.
- Adaptation/Resolution - During this
phase, the acute grief begins to subside. The patient
copes with their situation in a constructive manner
and begins to establish new structures. They develop
a new sense of worth. This phase may take one to two
years.
With
the aid of an ostomy nurse and the ostomy visitor, you learn
about living with a stoma.
* Information
adapted from United Ostomy Association web site. |
