What Is An Ostomy?
Stoma is a Greek word meaning ‘mouth’ or ‘opening’. Ostomy surgery normally results in an opening on the surface of the abdomen in order to divert the colon or ileum through the abdominal wall; this allows the flow of fasces or urine, to be collected in an ostomy pouch. It is estimated that over 900,000 people in the United States have some form of Ostomy. The most common conditions resulting in ostomy surgery are colorectal cancer, bladder cancer, ulcerative colitis, Cohn’s disease and accidental Injury. A stoma normally looks like a small button, deep pink in color and although it appears to look sore it has no nerve endings hence no feeling and pain-free. Waste matter comes out of the stoma and is collected in an ostomy pouch; the type of pouch used depends on the type of ostomy.
- Colostomy – coming from the colon uses either a closed or drainable pouch.
- Ileostomy – coming from the ileum uses a drainable pouch.
- Urostomy – coming from the kidneys uses a Urostomy pouch.
Some colostomy or ileostomy patients have an ostomy on a temporary basis allowing the bowel to heal and settle before having a reversal surgery.
The length of time before reversal varies but most are not reversed before six months.
Types of Ostomies
The term Colostomy is a surgery to remove all or part of the colon. In many cases, it can dramatically improve a person’s quality-of-life, especially in cases of a serious disease. It is used to treat many conditions including colon cancer, Crohn’s Disease, intestinal obstruction and diverticulitis. The removal of the colon is also used as a treatment for ulcerative colitis.
A colostomy is a surgical procedure where the large intestine/colon is cut and brought through the abdominal wall. The colostomy can be created from any part of the colon depending on the condition and reason for colostomy surgery, but most commonly is created from the descending colon and will be on the left side of the abdomen, this type of colostomy produces a stool that is semi to well-formed because it has passed through the ascending and transverse colon.
The other types of Colostomy are Ascending and Transverse but are less common, both of which produce a stool that is more liquid and contains digestive enzymes that can irritate the skin.
Colostomies can be both Temporary or Permanent depending upon the reason behind the surgery.
A temporary colostomy may be used when the part of the colon (normally the lower section) needs time to heal after trauma or surgery. After the colon is healed, the colostomy can be reversed, returning the bowel function to normal. In the reversal surgery, the two ends of the colon are reconnected and the stoma area in the abdomen is closed.
A permanent colostomy is necessary for some conditions, including about 15% of rectal cancer cases, this surgery is commonly used when the rectum needs to be removed because of disease or cancer, most of the colon would normally be removed, and the remaining portion used to create a stoma.
The term Ileostomy is a surgical procedure which usually involves removing the whole of the large intestine or colon and in some cases the rectum, In many cases it can dramatically improve a person’s quality-of-life, especially in cases of serious illness.
It is used to treat many conditions including Ulcerative Colitis, Familial Adenomatous Polyposis (FAP), inflammatory bowel disease and bowel cancer.
The Ileostomy may be temporary or permanent depending on the reason behind the operation. The end of the small intestine or ileum is cut and brought to the surface of the abdomen creating a stoma; this would normally be on the right-hand side of the abdomen.
- “Panproctocolectomy” – is the removal of the entire colon, rectum, and anal canal. This type of stoma is permanent.
- “Total Colectomy” – is the removal of the entire colon, the rectum is left in place. This type of stoma is reversible.
- “Anterior resection” – is the removal of the upper part of the rectum, the remaining colon is then sewn onto the remaining rectum.
A loop Ileostomy is usually formed to allow the bowel to heal then reversed at a later date.
A temporary Ileostomy may be used when the part of the colon needs time to heal after trauma or surgery. After a period of time, it would then be reversed, and the stoma area in the abdomen is closed.
A Urostomy is a stoma (artificial opening) for the urinary system and is made in cases where long-term drainage of urine through the bladder and urethra is not possible.
It is a surgical procedure which diverts the normal flow of urine from the kidneys and ureters into a surgically created stoma.
The surgeon will isolate a short piece of your small intestine from which he will make a tube “known as an “ileal conduit” the two ureters will be connected into this which will then be brought to the surface of the abdomen as a stoma.
Urine will continue to pass through the stoma; completely bypassing the bladder. In some cases depending on the reason for the surgery, the bladder may be completely removed.
A Urostomy is permanent and not reversible whereas some ileostomies and colostomies are reversible.
There are a number of reasons for a Urostomy all of which are connected to a defect or problem with the urinary system which needs to be removed or by- passed. Neurological disorders leading to severe incontinence or bladder cancer may also result in Urostomy surgery.
The flow of urine from a Urostomy is continuous and a Urostomy bag with a tap must be worn and will need emptying several times per day.
The Urostomy bag can be attached to a small pipe at night to a night drainage bag on a stand at the bedside and in some cases, a larger leg bag can be used during the day to increase the time between emptying if going out.
Living with an Ostomy
How you feel after ostomy surgery will depend on the reason behind your surgery. You may feel relieved that a problem has been addressed, or shocked/confused if your stoma was given through an emergency. Post-Surgery you may feel strange and resent having a pouch on your stomach, having to care for it and make adjustments to your lifestyle. You may also feel frightened or angry because you think the ostomy looks unsightly, smells or makes you feel less complete than before. Your ostomy nurse understands that you may have these feelings, so don’t be afraid to discuss these with her. When leaving hospital you should have a good idea of how to cope with your ostomy but don’t worry if you still fumble or take a long time as practice makes perfect. As your health improves and you become stronger you will find it easier to adjust to the physical changes in your body. During the early weeks after your operation, there will be support from your ostomy nurse. On leaving hospital your ostomy nurse will give you details on how to contact them and obtain further ostomy care products. The process of adjustment both physically and physiologically is not instant; some people can take up to a year as we are all different everyone adapts at their own pace so don’t worry if it takes you longer.The feelings and emotions can be similar to that of a bereavement, grief, and anger. This is normal and can go on for different periods of time depending on your attitude and outlook, even after the surgical wounds have healed. With support and a positive outlook, you will soon pick up the pieces of your life. Be realistic and allow yourself time to adjust to having an ostomy. Traveling, days out and the normality of life are still all possible. Having an ostomy can also affect other members of your family and friends as they may have concerns/questions and not like to ask you. Talking can help diffuse these fears. Sometimes talking to another person with an ostomy will also help. Go out for short trips to the supermarket ( etc ) before you embark on a longer journey. This can be helpful in overcoming any problems or concerns you may have. Always ensure on longer journeys you carry a kit to be able to change your bag in the case of an emergency.
Diet & Blockages
Listed below are some general guidelines of the effects of foods after Ostomy surgery. Use trial and error to determine your individual tolerance. Do not be afraid to try foods that you like, just try small amounts.
- Apple peels
- Cabbage, raw
- Chinese vegetables
- Corn, whole kernel
- Dried fruit
- Baked Beans
- Cod liver oil
- Peanut butter
- Some vitamins
- Brussel Sprouts
- Coffee warm or cold
- Cooked fruits
- Cooked vegetables
- Fresh fruits
- Fruit juices
- Any warm or hot beverage
- Alcoholic beverages
- Whole grains
- Bran cereals
- Cooked cabbage
- Fresh fruits
- Greens, leafy
- Raw vegetables
Ostomy Blockages from Food
An Ostomate with an Ileostomy or Colostomy should learn some important tips and emergency signs to manage their ostomy in a case of a blockage.Foods high in fiber may cause a problem. All foods should be chewed slowly and thoroughly. In the case of a new ostomy, foods should be slowly added back into the diet and watch for reactions as different foods affect people in different ways. You also need to stay well hydrated with 8 – 12 cups of water daily.Eating large amounts of foods at one time may not be digested properly and cause a blockage, this could become an emergency if not managed correctly.Signs of blockage are constant spurting of liquid or a watery stool, feeling full or bloated, cramping, a swollen stoma, nausea and vomiting, the problem with blockages are that the intestine could rupture, and you could become severely dehydrated.
It is important to remember the following points if a blockage is suspected:
- Don’t eat solid food.
- Consume liquids such as Water, Hot tea.
- Avoid use of laxatives.
- Cut the opening of your wafer/barrier a little larger than normal as the stoma may swell.
- Massage the abdomen and the area around the stoma as this might increase the pressure behind the blockage and help it to “pop out.” Most food blockages occur just below the stoma.
- Lie on back, pull knees to chest and roll side to side.
- Take a hot bath for 15 – 20 minutes.
If those steps don’t work and the conditions persist for more than 2 hours or if you start vomiting, SEEK MEDICAL ATTENTION EITHER FROM YOUR OSTOMY NURSE or a HOSPITAL EMERGENCY FACILITY
To prevent blockage in the first place you should chew food slowly and thoroughly, eat small amounts of new foods and limit high fiber foods.
Beware of foods that are known to cause blockage problems such as corn, celery, popcorn, nuts, coleslaw, coconut macaroons, grapefruit, Chinese vegetables such as bamboo shoots and water chestnuts, raisins, dried fruit, potato skins, apple skins, and orange rinds.
Traveling with an Ostomy
There are so many decisions to be made when planning to travel away from home – but even more to think about when you’re an ostomate hoping to get away.
Listed below, we have compiled a list of tips to help you cover all eventualities and enjoy your trip, and arrive feeling relaxed and refreshed.
Ostomy Travel Checklist
Check your baggage limit with your airline as carrying a lot of supplies can make a big difference to the weight of luggage.
Carry your supplies in your carry-on luggage to guard against lost baggage. (A small suitcase with wheels is a good idea).
Do not over pack cases as the luggage may become too heavy to lift and add to the risk of muscle damage or a parastomal hernia.
Take extra supplies with you as different foods and drinks could cause your stoma to behave differently, work out what you would normally use and times it by 2 also allow for airport delays etc.
If you cut your own wafer/barrier it’s worthwhile pre-cutting several for the journey as scissors will have to be carried in your main luggage.
Carry a small emergency kit with you that you could discreetly take to the toilet in the airport or onboard the plane without having to open up all your hand baggage in case an emergency bag change is required.
If you are traveling to a warm climate store all your supplies in a cool area in your room as high temperatures can affect the adhesives on supplies.
If your destination country recommends that you drink bottled water it is also a good idea to use bottled water to clean/irrigate your colostomy.
Whether you are staying in a hotel at home or abroad, it’s a good idea to try to make sure to get an en-suite bathroom. This will enable you to change your pouches easily, in private and at leisure, at a convenient time.
It’s a good idea to check if spare supplies are available in the country you are visiting.
A useful guide for dealing with the TSA
TSA has a toll-free helpline to provide information and assistance to passengers with disabilities and medical conditions and their families before they fly. TSA Cares and is now accepting calls. Travelers may call TSA Cares toll free at 1-855-787-2227 prior to traveling with questions about screening policies, procedures and what to expect at the security checkpoint.
When a passenger with a disability or medical condition calls TSA Cares, a representative will provide assistance, either with information about screening that is relevant to the passenger’s specific disability or medical condition, or the passenger may be referred to disability experts at TSA. TSA recommends that passengers call approximately 72 hours ahead of travel so that TSA Cares has the opportunity to coordinate checkpoint support with a TSA Customer Service Manager located at the airport, when necessary.
The hours of operation are:
Monday through Friday
9 a.m. – 9 p.m. EST, excluding federal holidays.
After hours, travelers can find information about traveling with disabilities and medical needs on TSA’s Website.
Travelers who are deaf or hard of hearing can use a relay service to contact TSA Cares or via e-mail