What is a Colostomy?question01

A colostomy is a surgically created opening of the large intestine (colon) which results in a stoma. A colostomy is created when a portion of the large intestine (colon) or rectum is removed by a surgeon and the remaining large intestine is brought to the abdominal wall to create an opening called a stoma.

The part of the colostomy that you see is called the stoma. A stoma is typically positioned around the abdomen depending on the type of the colostomy. The stoma is where the stool will now leave the body. Since a colostomy has no type of sphincter (controlling) muscles, there is no control of when the stool comes out.

Types of Colostomiesquestion02

Sigmoid (Descending) Colostomy is the most common type of ostomy surgery. This type of colostomy is created by the sigmoid (descending) colon is brought to the surface of the abdomen. The bowel is usually that of a typical bowel movement. The surgeon usually puts the stoma on the lower left side of the abdomen.

Transverse Colostomy is a surgical opening that is created in the transverse colon which results in either one or two openings. The bowel is typically is more of a paste consistency. The surgeon can put the stoma on the upper, middle, or right side of the abdomen.

Loop Colostomy is usually created in the transverse colon as well. This is actually one stoma, but with two openings. One of the stomas releases bowel, the other releases mucus.

An Ascending Colostomy is a much more rare type of colostomy. It is usually created in the ascending portion of the colon and the stoma is typically located on the right side of the abdomen.

Depending on the reason for the colostomy, a surgeon can make the colostomy permanent or temporary. The temporary colostomy is created to let the lower part of the colon to rest or heal. The temporary colostomy can have one or two openings. One of the stomas release bowels, the other releases the mucus. The doctor can connect the large intestine back together and normal bowel function can continue.

A permanent colostomy usually involves the complete loss of a portion of the large intestine (colon), most commonly the rectum. The very end of the remaining portion of the large intestine (colon) is brought to the abdominal wall to form the stoma.

 

Reasons for a Colostomyquestion03

There are several reasons a doctor will recommend a colostomy. This is done to alleviate or cure symptoms of a disease or condition. Some of the reasons for this surgery are:

• Some Types of Cancer
• Diverticulitis
• Imperforate Anus
• Hirschsprung's Disease
• Gastrointestinal Trauma
• Colostomy Stomas

 

Most stomas are typically round, although not perfectly round in shape. Stomas vary in shades of red and pink, are fleshy and moist. They also greatly vary in size (circumference). If you or your healthcare provider happen to note a stomal color like brown, purple or black (especially black), the surgeon must be notified at once. A change in color may mean that the pouching appliance may be on too tight, or an internal problem is present. Any color other than a beefy red or pink may indicate that the stoma may not be perfused and that stoma death may follow if interventions are not done. Whatever the reason for the change in stoma color, call the surgeon.

The frequency of the output of the stoma is affected by food and liquid intake. Medications and treatment prescribed by your doctor also have an affect on the stoma output. The stoma can also bleed slightly while releasing its output. However, if there is blood in the stool, or the bleeding is constant you should contact your doctor.

Colostomy Stomasquestion04

There are many different types of stomas as well, some of which include:

Normal Stomas

• Protruding stomas are stomas that protrude from the skin's surface of the abdomen. It does not make a difference if the abdomen is fleshy or flat. The protrusion varies in length and can slightly retract or extend throughout the life of the colostomy.
• A flush stoma is a stoma that, as its name implies, is flush with the skin's surface. The best way to deal with this is to use a wafer system that has convexity. This will help the stoma stand out more against the skin so that a better seal will form.
• Retracting Stomas are stomas that are pulled inward from the skin's surface. These types of stomas will require a wafer system that has a high convexity. This will help the stoma stand out more against the skin so that a better seal will form and irritation occurs much less.
• An End Stoma is made by dividing the intestine and bringing the closest end through the abdominal wall. An End Stoma can be in the large or small intestine.
• Another type of stoma is called the Loop Stoma which can also be created in either the large or small intestines. A loop of intestine is brought to the abdominal wall. The portion above the skin's surface is opened and made into two stomas. One (functioning) releases the stool, the other (non-functioning) releases mucus. Occasionally a rod is put underneath the loop of the intestine to support the stoma on the skin's surface. The rod should only be removed under the physician's guidance.
• A Double-Barrel Stoma can be made in the large or small intestine. The intestine is separated and the two ends are brought through the abdominal wall and made into two stomas. One (functioning) releases the stool, the other, (non-functioning) also called the mucous fistula, releases mucus.

 

Challenging Stomas

• Prolapsed stomas are often seen in overweight patients or patients with weak abdominal muscles. These types of stomas often continually protrude 1 to 4in as time goes on. The treatment for a prolapsed stoma is to use a flat and flexible pouching system; this will prevent trauma to the stoma when pouching. Using a support belt can prevent trauma, as well as preventing the stoma from protruding further.
• Parastomal stomas occur due to weak muscle in the abdominal wall, which allows the intestine to come through the muscle. Especially if the stoma is place just outside of the rectus abdominus muscle. This can be prevented by wearing some type of abdominal support belt when lifting or exercising. Using a one piece pouching system or a two piece adhesive system adapts to any irregular contours of the skin and/or stoma.
• Mucocutaneous Separation occurs when the sewn intersection between the stoma and the skin separates. This can occur when an infection occurs or there is too much tension on the sewn stitch. If this occurs, call your physician. Typically a wound care product will be used to absorb drainage and prevent excess soiling of separation from stool or urine.
• Stomal Necrosis occurs when there is impaired or restricted blood flow to the stoma. Talk to your doctor if this happens. The stoma will slough off and a colostomy deodorizer will be used while the necrotic stoma is sloughing off.

 

Colostomy System Products question05
Pouching systems
These types of systems may include a one-piece or two-piece system. Both kinds include a skin barrier/wafer ("faceplate" in older terminology) and a collection pouch. The pouch (one-piece or two-piece) attaches to the abdomen by the skin barrier and is fitted over and around the stoma to collect the diverted output, either stool, urine, or mucus. The barrier/wafer is designed to protect the skin from the stoma output and to be as comfortable to the skin as possible. Both two-piece and one-piece pouches can be either drainable or closed.

• Two-Pouch Systems allow changing pouches while leaving the barrier/wafer attached to the skin. The wafer/barrier is part of a "flange" unit. The pouches include a closing ring that attaches mechanically to a mating piece on the flange. A common connection mechanism consists of a pressure fit snap ring, similar to that used in Tupperware™.
• One Pouch Systems consist of a skin barrier/wafer and pouch joined together as a single unit. Provide greater simplicity than two-piece systems but require changing the entire unit which includes the skin barrier, every time the pouch is changed.

 

Irrigation System
This is also a special system that consists of an irrigation bag with a connecting tube (or catheter), a stoma cone and an irrigation sleeve. Some colostomates can "irrigate," using a procedure similar to an enema. This is done to clean stool directly out of the colon through the stoma. A special lubricant is sometimes used on the stoma to make it easier to insert the catheter. 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 for those who do not wish to wear a pouch.
These are the major types of colostomy systems. There are also a number of styles. Keep in mind, there is no right or wrong choice, but each person must find the system that performs best for him or her. For instance there are flat wafers and convex shaped ones. There are fairly rigid and very flexible ones. There are barriers with and without adhesive backing and with and without a perimeter of tape. Some manufacturers have introduced drainable pouches with a built-in tail closure that doesn't require a separate clip.
The decision as to what particular type of system to choose is a personal one geared to each individual's needs. It is not uncommon to try several types until the best solution is found. There is no reason to stay with a poorly performing or uncomfortable pouching system.

Life after a Colostomy

 question06

• Work: With the possible exception of the types of jobs that require very heavy lifting, a colostomy should not interfere with work. People with colostomies are successful business people, teachers, doctors, writers, etc.
• Sex and social life: Physically, the creation of a colostomy usually does not affect sexual function. If there is a problem, it is almost always related to the removal of the rectum. In females, the position, structure of the vagina may feel slightly different. It is best to be open with your partner of how you are feeling. The colostomy itself should not interfere with the normal sexual activity or pregnancy. It does not prevent one from dating, marriage or even having children.
• Clothing: Usually one is able to wear the same clothing as before surgery, including swimwear.
• Sports and activities: With a securely attached and properly fitted pouch one can swim, camp out, play baseball and participate in practically all types of sports. Caution should be taken in activities with heavy body contact. Special small pouches can be used if swimming or playing sports if desired. If you spend time in a sauna or hot tub, the heat may loosen the barrier. Always check for a proper seal.
• Travel is not restricted in any way. Just remember to pack all of your supplies for the trip. Always keep your supplies where you can easily reach them.
• Bathing and showering may be done with or without the pouch in place. If you shower/bathe with your pouch off, make sure that you choose a soap that is oil and residue free. These types of soaps will not affect any adhesive the colostomy system may require.
• Diet: Unless your doctor has prescribed you a specific diet, usually there are no diet restrictions and foods can be enjoyed as before.

 

Learning How to Care for Your Colostomyquestion07

There are very important things to remember when caring for your colostomy.

• Empty your pouch frequently, never allowing the output to reach a certain point in the collection bag such as 1/3 or ½ full. A full pouch can become heavy and break loose from the skin. A full pouch is also more difficult to drain.
• Replace your entire pouching system 3 times per week. For children and infants, the pouching system needs to be changed more frequently.
• Plan on changing your pouch in the morning before your colostomy becomes active.
• Always care for your skin by using a clean washcloth or wipe, and soap with no oils, no fragrance, and no dyes.
• Make sure skin is completely dry and check for any color changes or irritations.
• Be sure that you have a Colostomy System in place that fits securely and comfortably.
• For additional information contact your physician.