An ostomy procedure involves changing the way bodily waste like urine or stool exits the body. It can protect the abdominal cavity to allow damaged or inflamed parts of the digestive system to heal. Bodily waste exits through a hole in the abdomen and collects in a pouch that fits outside of the body.
Ostomy bags can be a temporary or permanent addition to a person’s life.
An estimated 100,000 Americans undergo surgical operations to create a colostomy or ileostomy annually.
This article will cover ostomy creation procedures, aftercare, and more.
During an ostomy, a surgeon makes an incision in the abdomen and attaches a portion of the intestine to the abdominal wall so stool will exit the body via a hole in the abdomen instead of the rectum.
This hole is called a stoma, and it is dark pink in color. People wear a pouch over the stoma.
The pouch joins to a special sticker-like device that adheres to the skin. It serves as a collection bag for stool or urine. Doctors may call the bag and portion that attaches to the skin an ostomy “appliance.”
A stoma does not have muscle, which means a person cannot control when waste products exit their body.
A person may need an ostomy if they experience one or more of the following conditions:
- cancer, such as colorectal cancer
- Crohn’s disease
- perforated or complicated diverticulitis
- bowel obstructions
- ulcerative colitis
Doctors may also perform ostomy surgery after trauma to the abdomen, such as from a knife or gunshot wound.
Surgeons may create one of two ostomy types for waste elimination: a colostomy or an ileostomy.
Doctors name these based on what area of bowel they use to create the ostomy.
Because there are different ostomy types and potential areas for placement, ideally a patient will meet with their surgeon in advance of a procedure. This way, a surgeon can mark the site for the stoma creation and begin the educational process as to how to care for an ostomy.
When surgeons create an ostomy in a trauma surgical situation, this is not always possible.
A colostomy is a stoma created from a part of the colon.
There are two main types of colostomy.
In a loop colostomy, surgeons pull a loop of colon through a hole in the abdomen. They then open it up and stitch it to the skin.
In an end colostomy, surgeons pull one end of the colon through a hole in the abdomen and stitch it to the skin.
An ileostomy is a stoma created from a part of the small intestine known as the ileum.
The term urostomy refers to any procedure that diverts urine away from the bladder. Urine passes from the kidneys to the ureters, then to a portion of the small intestine called the ileal conduit. Doctors use one end of the ileal conduit to form a stoma outside the body.
The procedure can help protect a diseased or infected bladder. Sometimes, surgeons remove the bladder as well.
Examples of urostomies include cecal or ileal conduits.
In this procedure, surgeons create an internal reservoir in the shape of a J. It passes from a person’s small intestine to a stoma to collect stool.
Doctors most commonly recommend this procedure to people with ulcerative colitis or inherited conditions, such as familial adenomatous polyposis (FAP).
If J-pouch surgery is successful, surgeons can later remove the stoma so that the stool can exit the body through the anus again.
Surgeons can perform ostomy creation surgery laparoscopically or via a laparotomy.
Laparoscopic surgery is a minimally invasive surgery. It involves making small incisions into the abdomen and inserting special instruments that help the surgeon visualize the inside of the abdomen.
A laparotomy is a more open surgery than laparoscopic surgery. It involves making a large surgical incision to pull the abdominal skin back and allow the surgeon to visualize the inside of the belly. In up to 16% of cases, a surgeon performing a minimally invasive surgery has to convert to an open approach.
Some of the steps specific to ostomy creation include:
- decompressing, or removing air from the bowel, to reduce risks of injury
- making an incision at the selected loop of bowel
- stitching an area of the bowel to the selected ostomy site
Having an ostomy requires education and training. Ideally, this training can help prevent complications and allow a person to recognize when they are having a problem.
Both before and after the placement of an ostomy, a person will meet with an ostomy nurse. This is a specially trained nurse who has pursued additional education in ostomy care. An ostomy nurse may meet with a patient in the hospital after the patient has had their surgery. There, they will review ostomy care education, including how to change the bag.
Some recovery symptoms and steps include:
- Tiredness: A person may feel physically and emotionally tired after ostomy surgery. This is due to the big changes in their body and life. There are support groups available that can help.
- Driving: A person can begin driving after surgery once they feel they can make an emergency stop safely. This is usually around 6–8 weeks after the procedure.
- Lifting: A person cannot do any heavy lifting with a stoma. This is because they increase their risk of developing a hernia. During the first 8 weeks after surgery, a person should lift nothing heavier than a kettle full of water.
- Bathing: A person can bathe or shower with their stoma bag. However, doctors may recommend showering rather than bathing while the wound is still healing, as the water will be cleaner. Later, a person can apply a sticker over their stoma filter to stop it from clogging up with bathwater.
- Exercise: Once a person has recovered from surgery, they can begin exercising following the advice of their doctor.
- Diet: Immediately after surgery, a person should only drink fluids. Over time, a person can begin to incorporate soft foods that the body digests easily.
Complications rates for post-ostomy surgery are higher for those where a surgeon created the ostomy as a result of a trauma or emergency, at 55%. The complication rate for planned surgical procedures is 37%.
One complication may be infection. Other potential complications include:
- electrolyte imbalances
- ostomy obstruction, where stool cannot exit via the stoma
- parastomal hernia, which causes the intestine to protrude out through the skin
- skin breakdown
There are also social implications to undergoing ostomy surgery. Patients with an ostomy wear a bag that collects stool. This may require them to make specific clothing choices to accommodate the medical device. People may feel self-conscious that others will know they have an ostomy bag. They also can no longer control when they go to the restroom. Their stool is able to exit via the stoma at a rate that can vary based on the time of day, what they ate, and their activity level.
Many people find the adjustment to life with a stoma very difficult. However, the United Ostomy Association of America has created a support group finder that people can use to interact with others in the same situation. This can help people voice their emotional or physical frustrations.
It can take a person around 8 weeks to fully recover from ostomy surgery.
Sometimes, a surgeon performs an ostomy procedure with the idea the ostomy may be temporary. This may be the case for patients with some forms of cancer or who have experienced abdominal trauma.
A temporary ostomy can allow a person’s body to heal while reducing the risk that bowel contents will leak into the abdominal cavity.
Ostomy reversal procedures are usually shorter in duration than the procedures to create them. However, an
Ostomy creation procedures are life-saving, but they do bring some risks.
Education from an ostomy care nurse and other professionals related to ostomy care can help a person improve their abilities to manage an ostomy in the post-surgical period.
A close system of family, friends, and support groups can help a person receive the psychosocial support they may need after ostomy creation surgery.