What is an ostomy?
An ostomy is a surgically-created opening connecting an internal organ to the surface of the body. The most common types of ostomies in intestinal surgery are an "ileostomy" (connecting the ileal part of the small intestine to the abdominal wall) and a "colostomy" (connecting the colon, or, large intestine to the abdominal wall).
Ostomies may be temporary or permanent. A temporary ostomy may be required if the intestinal tract can't be properly prepared for surgery because of blockage by disease or scar tissue. A temporary ostomy may also be created to allow inflammation or an operative site to heal without contamination by stool. Temporary ostomies can usually be reversed with minimal or no loss of intestinal function. A permanent ostomy may be required when disease, or its treatment, impairs normal intestinal function, or when the muscles that control elimination do not work properly or require removal.
How are bowel movements controlled with ostomy?
Once an ostomy has been created, the surgeon or wound ostomy continence nurse teaches patients to attach and care for a pouch called an ostomy appliance. An ostomy appliance, or pouch, is designed to catch eliminated fecal material. The pouch is made of plastic and is held to the body with an adhesive. The adhesive, in turn, protects the skin from moisture. The pouch is disposable and is emptied or changed as needed.
Bowel movements naturally empty into the pouch. The frequency and quantity of bowel movements varies, depending on the type of ostomy, diet, and bowel habits prior to surgery. Patients may be instructed to modify eating habits in order to control the frequency and consistency of bowel movements. If the ostomy is a colostomy, irrigation techniques may be learned which allow for increased control over the timing of bowel movements.
Does a patient's diet have to change drastically after ostomy surgery?
Some changes in diet might be needed after ostomy surgery, but most patients should be able to go back to a somewhat normal diet. In time patients will find the diet that works for them, identifying food that does and does not digest well. With an ostomy in place, it?s very important to chew food well and follow meals with as much liquid as possible. Adequate liquid helps to avoid blockage or obstruction and to maintain adequate hydration.
Some foods are harder to digest then others. Before patients leave the hospital after ostomy surgery, the wound ostomy continence nurse will educate them on proper diet and send them home with helpful, easy-to-understand dietary plans.
Do ostomies limit normal daily activities?
Patients are able to resume normal active lifestyles after ostomy surgery. Many ostomates even have better quality of live after ostomy surgery because they feel better than they did prior to surgery. Activities such as exercising, swimming, skiing, hiking, travelling and more, are all possible with a little bit of preparation. Planning ahead for possible situations, such as leaks or appliance changes, helps with peace of mind.
Most patients are able to wear the same clothes that they wore prior to surgery, as well. It might take some getting used to, as patients worry that their pouch will be noticed by others, but the pouch is easily hidden under clothing. While tight clothing will not injure the stoma, it can make it harder for fecal matter to fill the ostomy bag without causing a leak. Patients figure out what works for them and learn to adapt their clothing choices accordingly.
How many bathroom trips can ostomy patients expect daily?
The frequency of bowel movements depends on several things including diet, fluid intake and how the patient?s body adjusts to the surgery. Colostomy patients might be able to empty their ostomy as few as two times per day; the average is around four to six times a day. Ileostomy patients have to empty the pouch more often, since their output is much softer.
How often do ostomy appliances need to be changed?
Most ostomy appliances will last from three to seven days before needing to be changed; however, this varies greatly on lifestyle and activity level. Patients learn, in time, how long their appliance will usually last and when to change it to avoid leakage.
What is the correct way to change an appliance?
All patients are educated on how to properly care for and change their appliance before leaving the hospital, having several visits from the wound ostomy continence nursing team. These nurses make sure that patients go home confident that they can care for and change their appliance. They often educate any family members that will be helping at home as well.
There are several different types of appliances and adhesives, allowing for patients to find what works best for them. It is not uncommon for patients to try different types of products before finding the right fit.
Can normal showers be taken with an ostomy?
People with ostomies are able to shower like people without ostomies. Some patients like to shower when changing their ostomy appliance, giving the skin a break from the adhesive and cleaning the area around the stoma as much as possible. Appliances, however, are able to get wet without being affected. Showering frequently with the appliance on may mean more frequent appliance changes, but for patients uncomfortable with showering without the stoma covered, this is an option.
Exposure to air or contact with soap and water will not harm the stoma. With an ileostomy, it?s beneficial to choose a time to shower when the bowel is less active. Less output during the shower makes it easier to clean the area and attach the new appliance.
It's best to stay away from scented soaps and lotions, as they make it hard for the adhesive to stick and will result in an appliance lasting a short time period.
Is there an odor associated with the ostomy?
Modern technology has allowed for ostomy appliances to be virtually odorless. When the appliance is properly attached and sealed, no odor should be present. There is no need for patients to worry that those around them can smell their pouch.
When emptying the ostomy bag, an odor may be noticed, depending on what types of foods have been eaten; however, there are many products available to help alleviate that.
What is a blockage? How is it noticed? What can be done?
There will be times when an ileostomy does not have output for short periods of time. This is normal. But, if a stoma is inactive for four to six hours, and cramps/or nausea are noticed, the intestine could be blocked (obstructed). A doctor or ostomy nurse should be called right away if this happens.
There are some things can be done to help move things through an ileostomy:
- Watch for swelling of the stoma and adjust the opening of the pouch as needed until the swelling goes down.
- Take a warm bath to relax abdominal muscles.
- Sometimes changing positions, such as drawing knees to the chest, may help move the food along
High-residue foods (foods high in fiber) such as Chinese vegetables, pineapple, nuts, coconut, and corn can cause obstruction. Obstruction can also be caused by internal changes such as adhesions (scar tissue that forms inside the abdomen after surgery).
What are common complications of an ostomy?
Complications from an ostomy can occur. Most, like local skin irritation, are typically minor and can be easily remedied. Problems such as a hernia associated with the ostomy or prolapse of the ostomy (a protrusion of the bowel) occasionally require surgery if they cause significant symptoms. Weight loss or gain may affect the function of an ostomy.
Living with an ostomy will require some adjustments and learning, but an active and fulfilling life is still possible and likely. Colon and rectal surgeons and WOC nurses will provide the skills and support to help maintain great quality of life after ostomy.