What Is An Ostomy?

Types of ostomies

Ostomies come with different names, depending on what part of the body they are coming from. There are three MAJOR types of ostomies, but each type can have variations, depending on how the stoma functions and what part of the bowel the stoma is formed from.

• Ileostomy (Brooke ileostomy): This type of ostomy is usually formed at the end of the small intestine (the ileum).  Output bypasses the colon and rectum.  
• Colostomy: This type of ostomy is formed along the colon (large intestine).  Stool bypasses the rectum through the stoma.  Depending on the location of the large intestine where the stoma is made, a colostomate may have an ascending colostomy, transverse colostomy or a sigmoid/descending colostomy. The closer to the small intestine the less formed the stools will be. A sigmoid/descending colostomy often produces formed stool.
• Urostomy: A urostomy is often formed by first having a portion of small or large intestine removed, and then having the ends of each ureter attach to it.  The section of intestine is then brought out through the abdominal wall and made into a stoma. The ureters come from our kidneys and would normally bring urine into our bladder.  Urostomates usually have their bladder removed and their urine is diverted out through the stoma instead.

There are also continent ostomies, which may be an option for both ileostomates and urostomates (colostomates can simply irrigate their ostomy if they choose).  Continent ostomies involve creating an internal pouch or reservoir which would need to be emptied several times a day using a catheter. This means that the ostomate would not require an external pouching system. A “Kock Pouch” and “BCIR” are two types of continent ostomies.

About the stoma

Stomas can vary in size and shape, but they are usually a bright red colour and moist (similar to the inside of your mouth).  A stoma will usually protrude a bit from the skin, although some stomas can be recessed below the skin; a stoma that sticks out too much could be prolapsed.  You should, at some point after your surgery, have a stoma nurse or your surgeon look at your stoma to make sure everything is fine.

Stomas aren’t sensitive to touch, as there are no nerve endings in your bowel.  While a stoma can bleed, there’s usually no reason to panic as the delicate tissue is easy to break and will heal quickly; if you notice excessive bleeding or bleeding coming out of your stoma (with stool or urine), then you should contact a medical professional.

If your stoma isn’t covered, you may noticed it contract with peristalsis.  It’s pretty interesting to see and should cause no concern; that’s how stool or urine gets pushed along and out of your body. Some ostomates will feel this contraction and others won’t notice a thing.  A transparent pouch can be an endless source of entertainment for an ostomate!

Reasons for having an ostomy

I had my ileostomy done because of Crohn’s Disease, but that’s not the only reason why someone might get an ostomy.  Here are some common reasons why ostomy surgery would be considered:

• Cancer (intestines, bladder or rectum)
• Bowel perforation (due to illness or injury)
• To give the bowel a rest (and allow it to heal)
• Inflammatory Bowel Disease (Crohn’s or Ulcerative Colitis)
• Accidents
• Birth defects
• Neurological disorders

While there can be many reasons for having an ostomy, it’s not usually the first line of treatment for something like IBD.  In the case of accidents or bowel perforation, there may be an emergency need to have an ostomy, but most of the time, other forms of treatment are used to see if an ostomy (or any other surgery) can be delayed or avoided.

Also, some ostomies can be temporary, while others are permanent.  In IBD, a temporary ileostomy may be used in order to give the colon and rectum some time to heal.  It can also be used temporarily in preparation of a “j-pouch” before the intestine is reattached. When a temporary ostomy is formed, it’s often a “loop ostomy”, which means that a loop of bowel is brought out through the skin with two openings made from a single incision: one actively producing output and the other “inactive” (although it may still output mucus).  An “end ostomy” is created when only one part of the intestine comes through the skin.  A loop ostomy is often used when the stoma is temporary, and it can easily be reattached and put back inside the body.