Ostomy

There are a number of reasons why you might need an ostomy. All of them are to save your life.

When you decide it's time to treat your colon or ileum condition or prevent your GI disease, we'll walk you through your options. Deciding to have this surgery is the first step in getting your life back.

A colostomy is a procedure to create a new way for bowel movements to leave your body. This is generally done after removal of part or all of the colon, or large intestine, and can be done for numerous reasons (colon cancer, diverticulitis, obstruction or twisting of the colon, etc.).

An ileostomy is a similar procedure, but involves your small intestine. Like a colostomy, your doctor connects the end of the small intestine, or ileum, to the hole.

Regardless of your ostomy, during surgery, your doctor will make a small hole on one side of your abdomen. Then he or she will pull the open end of your intestine through this hole. They will sew the end of the intestine to your skin, keeping it in place.

Removal of your bodily waste is through this hole after your procedure. You will no longer have bowel movements out of your anus. The waste collects in a bag adhered to your skin. This hole in your abdomen is a “stoma.”

This figure depicts a colostomy. Colostomies may be necessary for some people with severe GI disorders or colon cancer surgery. In some people, the colostomy is temporary, allowing the diseased area of the colon to heal. In other people, the colostomy may be permanent.

Reproduced with permission from: Patient Information: Colostomy Care (The Basics). In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA 2012. Copyright © 2012 UpToDate, Inc. For more information visit www.uptodate.com.

Management of an Ileostomy or Colostomy

Although management of your colostomy or ileostomy is similar, there are some differences. The difference is due to the role your small and large intestines play in your digestive tract.

An ileostomy tends to have higher volume of more liquid output than colostomy. This is due to your body not having a chance to reabsorb excess water in the large intestine. As a result, people with an ileostomy can loose a lot of body fluids and become dehydrated.

Your large intestine absorbs excess water from your stool. So a colostomy has less volume of thicker, more “pasty” output.

You will usually have about 4 to 8 bowel movements a day.

A special nurse, called an ostomy nurse, will teach you how to manage your colostomy. This will happen while you are in the hospital after surgery. He or she will tell you:

• When and how to empty the bag that collects your bowel movements
• When and how to put on a new bag to collect your bowel movements
• How to check your stoma for problems and how to manage any problems that may occur

There are different types of colostomy bags that you can use. Some bags are emptied, cleaned and reused. Other bags are thrown out each time you use them.

Before you discharge, your nurse, along with your care team, will make sure you have what you need to go home. This can incldue the proper supplies and care instructions.

Some people worry that their bag will leak, or that other people will be able to smell their bowel movements. But these things rarely happen. The bags are made so that they do not leak or smell.

Potential difficulties after an ostomy

Problems can happen after your ostomy surgery. They can be right away or years later. Let your doctor or nurse know if you have any of the following symptoms or problems. That way, you can get treatment if needed.

• Your stoma is swollen or larger than usual
• Your stoma is smaller than usual
• Your stoma turns purple, black, or white
• Your stoma leaks more than usual
• You have a rash or sores on the skin around your stoma
• You have diarrhea
• You have sudden abdominal pain, cramps, or nausea
• You get dehydrated with symptoms like dark yellow urine, feeling dizzy or confused
• You've not had any gas or bowel movements for four to six hours (during the day)

Dehydration is a major concern for those you have had ostomies. This is especially true if you have an ileostomy. Your body is loosing the liquid it would normally reabsorb in the colon.

You should drink twice as much as your normal daily fluid intake to compensate for this. The goal is drinking 4 liters of water and other liquids per day.

Other Concerns with a colostomy or ileostomy

• Medications - If you have a colostomy or an ileostomy, your body will not absorb certain medicines as well as it should. When possible, use liquid medicines instead of pills. Also, you should not use pills labeled “enteric coated” as your body will not absorb these types of pills.
• Diet - You will need to be on a low fiber diet, especially if you have an ileostomy. Fiber is not digested well and can cause blockages in the colostomy or ileostomy. The foods you eat can affect the odor of your bowel movements, and how solid or loose they are. Certain foods can also make you have more gas and may cause some abdominal discomfort.
• Avoid constipation - Many patients have liquid stools, but you can have problems with constipation. If your stool becomes too thick, your body is not able to expel is as should. This thickness can cause a blockage of the colostomy. Speak to your doctor if your stools are thick or if you have not had any gas or bowel movement out of the stoma for 4-6 hrs. Constipation is not generally an issue with an ileostomy.

Living with an ostomy

You should be able to live an active and normal life with your colostomy. But you might worry about the following:

• Clothes – You do not need to wear special clothes. Other people should not be able to see your bag under your clothes.
• Bathing and showering – You can bathe or shower with or without your bag on.
• Sports – You should be able to play most sports with your bag on. You might want to wear a special belt to protect your bag and keep it in place.
• Swimming – You can swim, but be sure to empty your bag beforehand.
• Sex – You should be able to have sex if you have a colostomy. But you might want to wear special clothes to protect your bag during sex.
• Traveling – Bring extra supplies for managing your colostomy when you travel. If you fly, keep your supplies with you in your carry-on luggage.

It is normal to feel sad, upset, or worried when you have a colostomy. If you have these feelings, talk to a family member, friend, your doctor, or a counselor. Some people also find it helpful to go to a support group for people with a colostomy.